THE MALAYSIAN PAEDIATRIC ASSOCIATION JULY 2006 FOR MEMBERS ONLY Editorial Board Thalassaemia Clinical Dr Zulkifli Ismail Dr Noor Khatijah Nurani Management Course MPA 2005/2006 EXECUTIVE COMMITTEE President A state-level Thalassaemia Clinical Dr Zulkifli Ismail Management Course was conducted in Kota Kinabalu on June 10, 2006. It was Vice-President Dr Soo Thian Lian held at the new Hospital Likas, located strategically on a hill overlooking the Hon Secretary scenic Likas Bay. A total of 114 Assoc Prof Tang Swee Fong participants attended the course, coming Asst Hon Secretary from all 20 hospitals in the state. Of note Dr Noor Khatijah Nurani was also active participation of the public Treasurer health sector. About 40% were medical Dr Musa Mohd Nordin officers, 50% were nurses and another 10% were medical lab technologists. Committee Members Dr Koh Chong Tuan The guest lecturers, Prof Chan Lee Lee from Dr Thiyagar Nadarajan UMMC and Prof. A. Rahman Jamal from Dato’ Dr Jimmy Lee HUKM, conducted a lively course, covering a Dr Hung Liang Choo A token of appreciation to guest lecturer, Assoc Prof Dr Koh Mia Tuang comprehensive range of topics ranging from Prof Chan Lee Lee(R) from Dr. Soo(L) Dr Zilfalil Alwi molecular diagnosis to practical day to day management of thalassaemia patients. Both patients. The carrier rate is estimated to be Co-opted Committee Members experts in the field, they addressed the various Prof Datuk Mohd Sham Kasim in the range of 5-10% among the local Dr Hussain Imam Haji topics in a manner that is well understood and indigenous population, with the highest Mohd Ismail appreciated by the target audience. incidence among the Kadazan-dusuns and Dato’ Dr Zakaria Zahari The audience consisted mainly of medical Bajaus. Affiliated to: officers and nurses who are involved in the A big hurdle in the optimal management of • Malaysian Council For Child care of thalassaemic patients at the district thalassaemics was the cost of iron-chelation Welfare hospital level. With 1246 transfusion- therapy. This load has been lifted with the • ASEAN Pediatric Federation dependent thalassaemia patients, Sabah government policy of making universal • Asian Pacific Paediatric has the dubious honour of being the state Association – APPA (Previously with the highest number of thalassaemia Continued on page 4 Association of Paediatric Societies of the South East Asian Region – APSSEAR) • International Paediatric Association (IPA) The Berita MPA is published for members to keep them informed of the activities of the Association. The views & opinions in all the articles are entirely those of the authors unless otherwise specified. Medical officers, nurses and medical lab Special performance by a group of thalassaemic technologists attending the Thalassaemia Clinical We invite articles and feedback from patients during the course readers – Editor Management Course in Kota Kinabalu, Sabah 3rd Floor (Annexe Block), National Cancer Society Building, 66, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur. Tel: 2691 5379/2698 9966 Fax: 2691 3446 E-mail: [email protected] Web page: www.mpaeds.org.my BERITA MPA – JULY 2006 1 From The President Pneumococcal Awareness and More about Vaccines There is no argument that vaccines have led to the emphasis on pneumococcus at this particular time is reduction of previously fatal infectious diseases. With because there is a vaccine to prevent the disease. It every new vaccine that is introduced, there are both would have been of no use talking about it without proponents and opponents. In fact, if one were to anything to offer other than the run–of–the–mill usual 'Google' or web-search 'vaccine', the sites that appear antibiotics. The campaign is aimed at educating about first are anti-vaccine sites. Perhaps the opponents have a the disease and letting people know that a vaccine is louder voice and have more control over cyberspace. available. As a spin–off, we hope that these parents will With this in mind, as doctors and paediatricians, our ask and discuss the issues with us. It is then up to us to main concern and focus should be to promote whatever be appropriately and adequately informed about the is good for children, vaccines being foremost in active disease and the vaccines available. disease prevention. Worthy Pathogen? The involvement of MPA in the introduction of the pneumococcal vaccines is also with the same main There are some paediatricians who are not convinced intention. The 23-valent polysaccharide vaccine has been that the pneumococcus is a worthy pathogen to educate given by all of us to high-risk patients like the the public on. In enlightening parents on the bacteria, thalassaemics post-splenectomy for a long time. Being we are also introducing other organisms and touching derived from the carbohydrate cell wall, the vaccine on related diseases like otitis media and sinusitis. The immunogenicity is compromised. Hence, it is not cumulative result of all this is that the public will be effective in infants aged less than 2 years and the better informed of diseases in general. The middle- immunity is not long lasting. With the introduction of income 21st century Malaysian parent will listen to us and the 7-valent conjugate vaccine in 2000 in the US, it is then ask and discuss with another paediatrician before possible to provide protection against the usual deciding on whether their child needs the vaccine or not. pathogenic strains of Streptococcus pneumoniae that An interesting survey commissioned by one of the cause invasive pneumococcal disease. vaccine companies worldwide showed that 36% of Malaysian mothers discussed with another doctor (other We do not have accurate disease burden data except for than the child's regular doctor) regarding their children's the often-quoted meningitis study in Ministry of Health vaccination needs compared with 14% in the rest of the (MOH) hospitals in which the main aetiologic agent was world. Sixty-six percent of Malaysian mothers would Haemophilus influenzae type b followed by discuss their baby's immunisation with others, mainly pneumococcus. By inference, though not yet evidence- non-healthcare providers. It is therefore better for these based, pneumococcus will take position uno numero mothers to get correct information from us (number 1) with Hib vaccine in our immunisation paediatricians than from third party sources. schedule. Data from our northern and southern neighbours indicate that pneumococcus has a significant Disease Awareness vs Vaccine Promotion role to play in disease morbidity and mortality. Since the start of the PnD Awareness Campaign, MPA With the arrival of the pneumococcal conjugate vaccine has received a number of feedback. Although most were on our shores in the last quarter of 2005, we had the supportive, we cannot ignore those who oppose, choice of letting things fall into place slowly by natural whether directly or indirectly. To the latter, we urge you design or to promote it actively. The Pneumococcal to look at the advertisements again and note that MPA is Awareness Campaign(see News on pg. 10) is an telling the public about the bacteria and the diseases educational campaign to let the public know about this and resultant morbidity from it. The source references bacterium and the diseases that it can cause. The BERITA MPA – JULY 2006 2 From The President are included so that readers can confirm the factual data thing is to drive demand. Thus, MPA's involvement. offered in the ads. The public is urged to ask their It has also been argued that MPA is being used by the doctors about vaccines that prevent bacterial diseases, industry. This is only possible if one sees an industry logo not specifically pneumococcus, at the end. There is no next to MPA's logo in the ads and if MPA actually direct reference to the vaccine concerned. promotes the vaccine by name, generic or brand. We We know this is a powerful message and looking at the have been very careful in projecting every word and possible catastrophic outcome, there is no easier way to appearance of the ads, so if members find details that convey the message. MPA is not trying to create fear we have missed, please write in, call or e-mail us. We amongst parents so that they will rush to force doctors shall amend it. to vaccinate their children; we are trying to open up a discussion point for parents the next time they visit their Successful Vaccine Update child's doctor. It is up to us to offer the facts and allay MPA's Vaccines 2006 Update in Bangi (see report on pg their guilt if they cannot afford to set aside the amount 6) was well attended and allowed formal and informal required to get the vaccine. discussions on everything related to vaccines. There were no industry talks and everything was factual and 'Boutique Vaccine' evidence-based. It was a highly successful update that All of us know that the pneumococcal conjugate vaccine allowed free-flow of bi–directional exchange between is pricey (a 'boutique vaccine' as I described it in the April the invited speakers and the audience.2 issue of Berita MPA). In order for the price to drop, there must either be higher sales volume, triggered by demand, or competition. As the latter is currently non- Zulkifli Ismail existent due to the difficulty in the multi-valent President 2005-6 conjugation process that is proprietary, the next best <[email protected]> 3 BERITA MPA – JULY 2006 Report Continued from page 1 chelation available. However, it has only been fairly recently PALS Revival provided and the uptake of iron- chelation in the state has been slow. Many factors contribute to this; patient/parental understanding, acceptance and Paediatric Advan ced Life Support (PALS) compliance are very significant issues in a state where the majority of the patients come from the rural poor and less Resuscitation Teaching Programme Co nducted on June 2-4, 2006 at the Paediatric Institute educated community.