Awareness, uptake of recommended maternal and childhood vaccines among Malaysian women not optimal

Several gaps in knowledge and practice exist in mothers and pregnant women with regard to childhood and maternal immunisation, a survey reveals.

The survey was conducted by Immunise4Life (IFL), an “expert-driven community education initiative to promote immunisation for people of all ages against vaccine-preventable diseases and to address issues surrounding vaccination hesitancy and refusal.” To address these gaps, IFL, under the auspices of the Ministry of Health (MOH) Malaysia, the Malaysian Paediatric Association (MPA), and the Malaysian Society of Infectious Diseases and Chemotherapy Malaysia (MSIDC), organized a forum titled “Doses of Love for Mom & Child” in conjunction with World Immunisation Week. The event was presided by Health Minister Khairy Jamaluddin and attended by various key opinion leaders.

According to Datuk Dr Zulkifli Ismail, chairman of the IFL Technical Committee, very few respondents were aware that Tdap/tetanus, diphtheria, and pertussis (21.8 percent of respondents) and influenza (26.9 percent of respondents) vaccinations are advised during pregnancy. However, awareness of the necessity for COVID-19 (72.8 percent) and ATT/tetanus (63.7 percent) immunisations was higher. This could be the result of the latter two vaccines being provided free while Tdap and influenza vaccines are paid out of pocket. He also noted that the majority of respondents were aware that maternal immunisation protects mothers (78.7 percent), but only 64.2 percent were aware that it can also protect infants, and 11.9 percent were uncertain about its benefits.

Additionally, while the majority of respondents (92.9 percent) agreed or strongly agreed that vaccinating children on time is essential, some were unable to put their beliefs into effect. A total of 15.5 percent of survey respondents missed or delayed their child’s immunisation, and 0.5 percent did not vaccinate their child at all. “Forgot” or “too busy” were the most often given reasons for preventable delayed or missed childhood immunisation visits, followed by logistical/transportation and safety issues.

With regard to safety, the concern is less of an issue among respondents when it came to childhood immunisation compared with maternal immunisation. Among respondents, 81.5 percent agreed or strongly agreed that vaccines given to children are safe while only 62.8 percent agreed or strongly agreed that vaccinations given to pregnant women are safe.

Dato’ Dr Musa Mohd Nordin, consultant paediatrician and neonatologist, strongly recommended parents adhere to their child’s immunisation schedule. He emphasised that the longer parents delay immunising their child, the greater the likelihood that their child may be exposed to life-threatening vaccine-preventable infections. “Some parents have asked what they should do if their child is 2 years late for a particular immunisation appointment. In most cases, for example pneumococcal, diphtheria, pertussis and polio, the vaccinations can and should be given even if the child has reached the ages of three or four.  Do talk to your child’s doctor or paediatrician to determine what is best for your child.”

Vaccination key to nation’s low infant mortality

Khairy noted that the maternal death rate in Malaysia in 2018 was 23.8 per 100,000 live births, compared to 280 per 100,000 live births in 1957. This reduction is the result of prioritising mother-and-child health over the decades. He added: “Under-five mortality was also markedly reduced, by 90.2 percent, in 2020 (6.9 per 1,000 live births) from 70.2 per 1,000 live births in 1965, putting Malaysia on par with advanced nations.”

In recent decades, childhood and maternal immunisation programmes have been among the most important drivers in lowering mortality rates. Khairy said that the MOH’s National Immunisation Programme (NIP) for children began in the 1950s, when just a few vaccines were offered for free at MOH clinics. Now, the NIP protects children against 13 vaccine-preventable diseases.

For mothers, the MOH began its maternal immunisation programme by delivering free anti-tetanus (ATT) vaccinations to all pregnant women in 1976. The initiative continues to safeguard mothers and newborns from tetanus infection and its resulting complications. Nonetheless, the MOH intends to enhance it with the introduction of (?free) Tdap immunisation, which will protect mothers and children against tetanus, diphtheria, and pertussis, said Khairy.

Dr Mohd Hanif Zailani, public health medicine specialist and head of Vaccine Preventable Diseases & Food/Waterborne Diseases Sector, MOH, said that some maternal and childhood vaccines may not be among the 11 vaccines specified in the NIP, but are just as vital. He urged parents to get all the recommended maternal and childhood vaccinations, especially if they can afford it.

Professor Dr Jamiyah Hassan, consultant obstetrician and gynaecologist and maternal-foetal medicine specialist, University Technology Mara (UiTM), noted that many nations have introduced Tdap vaccination to replace ATT to combat the increase in pertussis (whooping cough) incidence among young children. She noted that Malaysia is experiencing a spike in pertussis cases, 70 percent of which include infants under 6 months who are either too young to be vaccinated or have not finished their vaccine schedule. These infants frequently contract pertussis from infected mothers and close relatives. She said: “Newborns and infants are more likely to suffer from serious pertussis complications that can lead to death.”

Furthermore, Jamiyah noted that vaccinating pregnant mothers against pertussis is crucial for two reasons: it transfers antibodies from the mother to the foetus through the placenta, protecting the child from birth until the child is old enough to be vaccinated; and it reduces the likelihood of the mother transmitting pertussis to the child.

As such, Jamiyah reiterated the need of adhering to the prescribed maternal immunisation schedule. She emphasised that at the proper stage of pregnancy, maternal immunisation seeks to give optimal protection to both mother and child via optimal placental transfer of vaccine-specific antibodies.

Furthermore, since pregnant women are more likely to develop serious disease due to influenza and COVID-19, Jamiyah advised that they be vaccinated against these diseases, too. “Most of us might have forgotten that during the influenza A (H1N1) pandemic, many of the mortalities were pregnant mothers. We cannot afford to be complacent—vaccinating pregnant mothers against this preventable infectious diseases is the right thing to do.”