Four is better than nine. a combined diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine for routine immunization in Malaysia.

Malaysian infants would have to receive nine injections during the first few months of life in order to be protected against disease caused by hepatitis B (HBV), diphtheria, tetanus, pertussis and Haemophilus influenzae type b (Hib) if single HBV and Hib vaccines were used. We evaluated a combined DTPw-HBV/Hib vaccine administered at 1.5, 3 and 5 months after a birth dose of hepatitis B vaccine (HBV). One month after completion of the primary vaccination, 99% of subjects had seroprotective anti-HBV antibody levels, and at least 98% had seroprotective antibodies against diphtheria, tetanus, and Hib, and were seropositive for pertussis antibodies. The immune response to the combined vaccine was comparable to that induced by separate injections with DTPw, HBV and Hib vaccines. Overall, the DTPw-HBV/Hib vaccine was as well tolerated as separate administration of DTPw, HBV and Hib vaccines. The combined DTPw-HBV/Hib vaccine induces protection against five diseases as recommended in the Malaysian routine vaccination schedule. Use of the combined DTPw-HBV/Hib vaccine can reduce the required number of injections from nine to four in the first few months of life.

Estimates of the burden of rotavirus disease in Malaysia.

BACKGROUND: Accurate national estimates of the disease burden associated with rotavirus diarrhea are essential when considering implementation of a rotavirus vaccination program. We sought to estimate rotavirus disease-associated morbidity and mortality in Malaysia, using available sources of information. METHODS: We analyzed national data from the Ministry of Health (Kuala Lumpur, Malaysia) to derive rates of hospitalization, clinic visits, and deaths related to acute gastroenteritis (AG) among children <5 years of age. The number of events attributable to rotavirus infection was estimated by multiplying age-stratified rates of detection of rotavirus from 2 hospital surveillance sites by national data. RESULTS: In 1999 and 2000, an average of 13,936 children (1 in 187 children) were hospitalized annually for AG. Surveillance of visits to outpatient clinics for AG identified an average of 60,342 such visits/year between 1998 and 2000. The AG-associated mortality rate was 2.5 deaths/100,000 children. On the basis of the finding that 50% of children were hospitalized for rotavirus diarrhea, we estimated that 1 in 61 children will be hospitalized for rotavirus disease and that 1 in 37 children will seek treatment as an outpatient. CONCLUSIONS: Among Malaysian children, there is a significant burden associated with AG- and rotavirus disease-related hospitalizations and outpatient visits, and this burden potentially could be prevented by the use of rotavirus vaccines.

Cost-effectiveness analysis of Malaysian neonatal intensive care units.

OBJECTIVE: To perform a cost-effective analysis on the care of infants between 1000 and 1500 g birthweight (the study group), where outcomes are measured as survival to 1 year of age. METHODOLOGY: This was a multicenter observational study to determine the outcome, cost and cost-effectiveness of neonatal intensive care provided by Ministry of Health (MOH) Pediatric services. A total of 333 patients enrolled were eligible for analysis according to the inclusion and exclusion criteria of this study. RESULTS: Overall survival probability of the study group infants at 1 year of age was 78%. Survival at 1-year of age was 77% for infants with birth weight 1000 to 1249 g, 79% for 1250 to 1499 g. Survival at 1 year of age for the sample group was 53% for 22 to 27 weeks gestation, 80% for 28 to 36 weeks. The average cost-effectiveness ratio (CER) of neonatal intensive care for the study group infants was US$3979 [corrected] per survivor at 1 year of age (95% confidence interval US$3411, 5160). CONCLUSION: There was variability in the outcome and cost-effectiveness between the neonatal units, which need to be further assessed. However, neonatal intensive care services provided for the study group infants were cost-effective compared to that in developed countries.