Chickenpox vaccine -- does it necessary?

A mother planned to bring his child to the children's clinic for chickenpox vaccine, as advised by the paediatrician. However, the grandmother told the mother it is better for the child to have natural chickenpox infection. The mother was confused with two different opinions and asked," what is a better option?"
I agreed with the grandmother partly as a natural chickenpox infection can confer 100% protection againt further infection. In comparison, the current chickenpox vaccine has only 95% efficacy against natural chickenpox infection. Then why the doctor still advised for chickenpox vaccine?

Firstly, the unfornated 5% vaccinated children will have very mild chickenpox infection, less than 50 spots. This is in case they are exposed and infected.

Secondly, we can reduce the risk of chickenpox ionfection that has very untimely occurence e.g. school examination, family trip or during her pregnancy.

Thirdly, the child need to miss school and the mother need to miss work if the child has chickenpox. If there is small infant, pregnant lady or elderly people at home, the isolation issue need to be addressed.

So, I opted chickenpox vaccine.

Malaysian Dietary Guidelines 2010

Malaysians like to eat. This is best illustrated by our daily greeting of "have you eaten?". At the same time, we are suffering from various diseases as a result of inappropraite eating habits. Therefore, this guideline is timely and should serve as our dietary guide.

Key message 1: Eat a variety of foods within your recommended intake
Recommendations
1. Choose your daily food intake from a combination of foods based on the Malaysian Food Pyramid.

2. Choose your daily food intake according to the serving size recommended.
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Key message 2: Maintain body weight in a healthy range
Recommendations
1. Maintain body weight in a healthy range by balancing calorie intake with physical activity.
2. Weigh yourself regularly, at least once a week.
3. If you are an adult, prevent gradual weight gain over time.
4. If overweight, aim for a slow and steady weight loss.
5. If underweight, increase energy intake as recommended.

Key message 3: Be physically active everyday
Recommendations
1. Be active every day in as many ways as you can.
2. Accumulate at least 30 minutes of moderate intensity physical activity on at least five to six days a week, preferably daily.
3. Participate in activities that increase flexibility, strength, and endurance of the muscles, as frequent as two to three times a week.
4. Limit physical inactivity and sedentary habits.
Overweight/obese
To lose weight, a total of more than 30 minutes a day of moderate intensity physical activity is recommended, whilst approximately 45 to 60 minutes per day of moderate intensity physical activity is required to prevent the transition from overweight to obesity.
For weight control and for preventing weight gain or regain among formerly obese individuals, a total of 60 to 90 minutes a day of moderate intensity activity or lesser amount of vigorous activity is recommended.

Key message 4: Eat adequate amount of rice, other cereal products (preferably whole grain), and tubers
Recommendations
1. Consume at least four servings of cereal foods daily.
2. Choose at least half of your grain products from whole grains.
3. Choose cereal products that are high in fibre, low in fat, sugar and salt.

Key message 5: Eat plenty of fruits and vegetables everyday
Recommendations
1. Eat a variety of fruits everyday.
2. Eat a variety of vegetables everyday.
3. Eat at least five servings of fruits and vegetables everyday.

Key message 6: Consume moderate amounts of fish, meat, poultry, egg, legumes, and nuts
Recommendations
I. Consume fish more frequently, if possible daily.
2. Consume meat, poultry, and egg moderately.
3. Practise healthier cooking methods for fish, meat poultry, and egg dishes.
4. Choose meat and poultry that are low in fat and cholesterol.
5. Consume legumes daily.
6. Include nuts and seeds in weekly diet.

Key message 7: Consume adequate amounts of milk and milk products
Recommendations
1. Consume milk and milk products everyday.
2. Replace sweetened condensed milk and sweetened condensed-filled milk with unsweetened liquid or powdered milk.

Key message 8: Limit intake of foods high in fats and minimise fats and oils in food preparation
Recommendations
1. Limit the intake of unsaturated fats to less than 10% of total daily calorie intake.
2. Increase the intake of unsaturated fats monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA).
3. Limit the intake of foods with high cholesterol.
4. Limit foods containing trans fatty acids (TFAs).
5. Minimise the use of fat in food preparation in order to keep total daily fat intake between 20% to 30% energy.
6. When eating out, choose low-fat foods.

Key message 9: Choose and prepare foods with less salt and sauces
Recommendations
1. Limit salt intake to one teaspoon a day.
2. Reduce consumption of highly salted foods and condiments.

Key message 10: Consume foods and beverages low in sugar
Recommendations
1. Eat foods low in sugar.
2. Drink beverages low in sugar.

Key message 11: Drink plenty of water daily
Recommendations
1. Drink six to eight glasses of plain water daily.
2. Maintain fluid intake from other food sources.
3. Avoid alcoholic beverages.

Key message 12: Practise exclusive breastfeeding from birth until six months and continue to breastfeed until two years of age
Recommendations
1. Prepare for breastfeeding during pregnancy.
2. Initiate breastfeeding within one hour of birth.
3. Breastfeed frequently and on demand.
4. Give only breast milk to baby below six months with no additional fluid or food.
5. Continue to give babies breast milk even if the baby is not with the mother.
6. Introduce complementary foods to baby beginning at six months of age.
7. Lactating mothers should get plenty of rest, adequate food and drink to maintain health.
8. Husbands and family members should provide full support to lactating mothers.

Key message 13: Consume safe and clean foods and beverages
Recommendations
1. Choose safe and clean foods and beverages.
2. Store foods appropriately.
3. Prepare foods hygienically.
4. Cook foods thoroughly.
5. Hold foods appropriately.
6. When eating out, choose safe and clean premises.

Key message 14: Make effective use of nutrition information on food labels
Recommendations
1. Use Nutrition Information Panel (NIP) as a guide in making food choices.
2. Make use of nutrition claims wisely.
3. Educate children on the use of NIP.

States take on Pertussis as Disease Cases Resurge Around the Nation

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In US, it was reported that pertussis disease has increased recently:

States take on Pertussis as Disease Cases Resurge Around the Nation

Reports of pertussis have reached startling numbers in communities around the nation in recent months, leading to renewed attention to the common infectious disease.
Despite the resurgence, public health workers caution that such outbreaks are not unexpected and should serve as important immunization reminders.

Vaccination is the most effective way of disease prevention, second only to hand washing. Yet, we occasionally take the vaccination lightly as some diseases are rarely reported nowadays. In fact, the vaccination is the tool that help us to fight against smallpox, polio and many others. So, we should adhere to the recommended vaccination schedule to safeguard the best interest of children.

Oral Diosmectite is effective in Children with Acute Watery Diarrhoea

We are in the era of evidence-based medicine. The treatmen to diseases should be based on the best available scientific evidence. I would like to share this clinical study with you for the following reasons:

• This is a study done in Malaysia (and Peru) -- suit to our local context
• This adresses the common childhood problem -- diarrhoea

Oral Diosmectite Reduces Stool Output and Diarrhea Duration in Children With Acute Watery Diarrhea

"These results show that diosmectite significantly decreased stool output in children with acute watery diarrhea, especially those who were rotavirus-positive."

I read the prescription literature and it states "not recommended in childeren below 6 in accordance to Malaysia's Drug Control Authority".
However, the above study involved children from 0 to 36 months old. No adverse side effects were noted. In the past, there are many off-label prescription done for the children among the doctors in Malaysia. With this study results, we can safely administer this drug to the suffering children.
The only problem with this medicine is it has no pleasant taste. You can help your babies by mixing it with a semi-liquid food, broth, stewed, fruit, puree, etc.

Flu Shots OK for People With Egg Allergy

Currently, we recommend Flu shot (influenza vaccine) to all children above 6 months old. This article should be able to reassure the parents whose children has egg allergy:

For years, people with egg allergy were told to avoid the flu vaccine because it contains egg protein and could trigger a reaction, but this advice no longer stands. People with egg allergies can -- and should -- get the flu shot this year, according to a new report by the American Academy of Allergy, Asthma & Immunology.

Why the change?
"We now know with confidence that most people with egg allergy can receive the flu shot without reaction," says the report’s author, James T. Li, MD, PhD, an allergist at the Mayo Clinic in Rochester, Minn.
There is a "detectable, but very low" amount of egg protein in the H1N1 and seasonal flu vaccines, and studies have shown that the majority of people with egg allergy do not have an allergic reaction to the flu shot, he says.
"The number of reactions wasn't zero, but it was low, and most reactions were not serious," Li tells WebMD.
Caution is still advised in certain scenarios. For example, there is still some question on whether people with severe egg allergy can receive the flu shot, he says.

We hope those children with allergy also get to enjoy the benefits of flu shots. 

Constipation

picture

What is constipation? It is difficult to define the normal frequency of bowel opening. However,
the American Academy of Pediatrics (AAP) had outlined normal frequency of bowel movements for children.
In general, the bowel frequency is less than 3 times per week, the stools are usually hard, dry and difficult to eliminate. It can be hard large stool or hard pellet like stools.
How to solve this problem, the AAP has recommended the following "10 commandments" (adapted):

1. Drinking plenty of water can help regulate constipation.
2. Encourage high-fiber fo such as whole-grains, fruits, vegetables and Pedia-Lax Fiber Gummies.
3. Avoid giving your child large amounts of foods which could lead to constipation. Every child is different. Discuss dietary changes with your pediatrician.
4. Help your child set up a regular toilet routine.
5. For the younger child, reward them for attempting to have a bowel movement and for successfully having a bowel movement. (Sticker charts, etc.)
6. Be attuned to your child's body and behavior. For instance, if a younger child exhibits symptoms like clenching buttocks or crossing legs, help them to the bathroom. If your child is soiling his underpants and hiding them in embarrassment, address the issue with your child in a sensitive manner.
7. Discuss your child's feelings with them in an empathetic manner. Children, at every age level, are embarrassed, scared, and maybe even angry about their situation. Make them feel like they are being heard, understood, and helped. Help them feel like they are in control by allowing them to be part of the development of a constipation management plan.
8. Parents should never show anger and frustration about the child's constipation to the child. Nor should the parent be overly obsessed with the child's bowel habits. These could be detrimental to the management of constipation and the well-being of the child.
9. If you notice any of the symptoms listed in "How do I know if my child is constipated?" contact your pediatrician as soon as possible. Do not wait for days to see if it will resolve on its own. The key to good management is recognizing the symptoms and addressing them before the situation worsens.
10. Encourage your child to be physically active. Exercise along with a balanced diet provides the foundation for a healthy, active life.

You may explain the body digestive system to your children with this chart, as a picture is better than a thousand words:
You may keep a fibre diary for your children as well.

Ambulatory Paediatrics

I attended the 32nd Malaysian Paediatric Association congress in Kuala Lumpur from 15 to 17 October 2010. This year theme is Ambulatory Paediatrics. I totally agree with what the President, Professor Zabidi Hussin (please click to view his blog), said:

"... provide expertise within a larger community-based setting... Children are certainly best looked after in their own homes at all times and more so when they are sick."

Some interesting topics include:

• Identifying and Managing Sleep Problems in Infants
• Snoring in Chidren
• Assessment of Nutrition in Children
• Practice and Malpractice in complementary feeding in early childhood
• Nocturnal enuresis
• Food allergy in children

As a children doctor, I strive to give the best possible medical care and as far as possible, to allow children to stay at their home en route to recovery.

A 28 day-old baby with jaundice

A mother exclusively breastfeeds her baby. Her baby has persistent jaundice but otherwise well. The parents are very concerned.The doctor writes the following letter to the baby. The baby name is BB, and the parents are Mr & Mrs AA, for the sake of their privacy.

Dear Ms BB,

Hi, good day!

First and foremost, I would like to tell you that Mr & Mrs AA are very loving and caring parents. You must be the luckiest girl on earth to be their little girl. I believe your 2 year-old elder sister must be totally agree with me.

Just to recapitulate, your highest serum bilirubin level was only 238 umol/L when you are 10 days old. This was normal physiological jaundice. When I saw you this morning, you have grown into a 28 day-old cute little girl. You looked slightly jaundice but otherwise active, well and healthy. For your information, your father had just arrived home from his US business trip that morning. He must be tired after the long travel but for your sake, he brought you to my clinic immediately.

Please be reassured that you are a very healthy baby girl. Your problem of prolonged jaundice is just part of a normal body process. I can confidently say this because you are well, pass normal colour stool and the blood investigation is normal. Your liver function test shows you have unconjugated hyperbilirubinemia. Total bilirubin 197 umol/L, direct 7, indirect 190.

Your mother, Ms A gives you the b(r)e(a)st feed, the most nutritious food on earth. Although this may contribute to your prolonged jaundice but her decision to continue breastfeeding is the best decision.

I can see your parents are very concerned with your prolonged jaundice. Mr A had googled online for information on neonatal jaundice. Nevertheless, not all the online information is reliable. I have attached an articles for your parents to read so as to alleviate their anxiety. I hope this helps.

BREASTFEEDING A NEWBORN WITH JAUNDICE

I am privileged to be your paediatrician.

Thank you.

Yours truly,

Allergy - Where does it start & Where does it end?

I chaired an allergy workshop in G Hotel, Penang on 26 September 2010.

Assoc Prof Dr Amir Hamzah Abdul Latiff from Monash University Malaysia gave a very interesting lecture on "Allergy - Where Does It Start & Where Does It End?".

I found this is a very interesting topic, a question I have never give a deep thought.

Does allergy start before pregnancy, during pregnancy or after delivery?
Does allergy end as a result of prevention, treatment or sadly, death?
Is it true the answer is "from womb to tomb", as shown below?

I will spend more time on this topic -- Allergy.

MMR vaccine and Fever

All babies need to receive MMR vaccine at 12 months old. This is a combination vaccine for Measles, Mumps and Rubella. Normally, the post vaccination fever occurs on the first 2 days after vaccination. However, this particulat vaccine cause fever from day 7 to day 12 after vaccination. Although this only occurs in 5-15% of cases, the parents need to know this statistic so as not to get worry should the fever does occur.

Dengue Outbreak Areas in Penang -- update on 20 September 2010

I attended a dengue seminar organised by Penang State Health Department on last Sunday. There are lectures from public health (vector unit) and infectious disease consultants (adult and children medicine). The participants are doctors from private practice.

I benefited from the lectures and impressed on the heated discussion during the Q & A session. The doctors are really concerned with the dengue outbreak in Penang.

• There are already 4 dengue deaths this year, compared to only 1 last year.
• The dengue vaccine is coming soon (I have heard it from the medical student days!!!)
• The WHO has made the classification easier and more practical to doctors.

Below is the list of dengue outbreak areas in Penang, copy and paste from an email from Penang Sate Health Department:
Dear All
Enclosed is the current dengue outbreak areas

update on dengue outbreak areas, 15 localities

Flat Hamna, Sungai Dua, Timur Laut
Taman Pelangi, Bukit Mertajam, SPT
Kampung Pisang, Air Itam, Timur Laut
Flat Seri Delima, Sungai Ara, Barat Daya
Taman Bukit Jambul, Timur Laut
Taman Utara, Batu Uban, Timur Laut
Tingkat Teluk Kumbar, Bayan Lepas, Barat Daya
Lorong Nipah, Sungai Dua, Timur Laut
Jalan Molek, Taman Brown, Timur Laut
Lengkok Sungai Gelugor, Gelugor, Timur Laut
Desa Airmas, Sungai Dua, Timur Laut
Desa Permai Indah, Sungai Dua, Timur Laut
Lorong Semarak Api, Air Itam, Timur Laut
Sunny Ville, Batu Uban, Timur Laut
Lorong Mahsuri, Bayan Lepas, Barat Daya

Protruded belly button -- Umbilical hernia

You may notice some babies with the following condition, especially in a premature baby or young infant:

picture source

This is called umbilical hernia. It occurs because the two sides of the abdomimal wall muscles are still not adhered completely, thus leaving a space for part of the tummy contents to protrude out (image).

Generally, it does not cause problems and resolved by one year old. Should the condition persisted until school going age, then we hae to do something to avoid teasing in school. This involves a very minor surgey as illustrated below.

There are some myths about this condition, among them are described below:

• This create an entry point for the "wind" to enter -- this is not true as the covered skin is intact, thus leaving no door/ window to enter =)
• This can be resolved by occluding the bellybutton with a 50 cents coin -- this is not necessary as the condition resolved when the underlying muscle layers adhered completely. As the condition usually resolves spontaneously, making this grandmother's ritual appears to work.

Influenza Vaccine -- does my baby need it?

The Influenza A (H1N1) pandemic in 2009 caused great concerns among the caring parents. As the saying goes "prevention is better than cure", we are fortunate to have influenza vaccine to combat this common, and potentially dreadful infection.

The American Academy of Pediatrics (AAP), in response to this development, has updated its recommendation for influenza vaccine.
Recommendations for Prevention and Control of Influenza in Children, 2010-2011

• Children younger than 6 months are too young to receive influenza vaccine.
• Only 1 dose is needed for children at least 9 years old.
• Children younger than 9 years require at least 2 doses of 2009 pandemic H1N1 vaccine. They will need 2 doses of seasonal influenza vaccine this year if they did not receive the H1N1 vaccine during last year's influenza season.
• Children younger than 9 years who have never before received the seasonal influenza vaccine will require 2 doses.
• Children younger than 9 years who received seasonal influenza vaccine before the 2009-2010 influenza season need only 1 dose this year if they received at least 1 dose of the H1N1 vaccine last year, but they need 2 doses this year if they did not receive at least 1 dose of the H1N1 vaccine last year.  
• Children younger than 9 years who received seasonal influenza vaccine for the first time last year, but who only received 1 dose, require 2 doses this year.
• For children younger than 9 years who received influenza vaccine last year, but for whom it cannot be determined whether it was a seasonal influenza vaccine or the H1N1 influenza vaccine, 2 doses are recommended this year.
• For all children who require 2 doses, the second dose should be administered at least 4 weeks after the first dose.

Sounds confusing ? Never mind, bring your baby to the paediatrician and ask further.

 

A 2 year old girl had blood in the stool

A close friend sent me this picture (no consent given by the owner as she is only 2 years old!):

A 2 year-old girl had blood in the stool for the past one day. She passed motion five times already. She had low grade fever of 37.8 degree Celsius. She was otherwise well, active and not in pain.

I told the father if she was less than one year old, I would definitely start antibiotic. This is because there is higher risk of severe disease in this group of small infants. As she is two years old and appeared well, I offered 2 choices:

• Wait and see -- as there is possibility of spontaneous resolution of symptoms
• Antibiotic therapy -- as this can kill the causative bacteria, reduce duration of illness and reduce transmission risks. The following article may be helpful:

"The antibiotics recommended by the WHO—ciprofloxacin, ceftriaxone and pivmecillinam—are effective in reducing the clinical and bacteriological signs and symptoms of dysentery and thus can be expected to decrease diarrhoea mortality attributable to dysentery." (Beatrix S Traa et al. Antibiotics for the treatment of dysentery in children. Int. J. Epidemiol. 39 (1) Pp. i70-i74)

The father preferred to wait and see. I agreed.
P/S I enjoy discussion with the care-takers regarding treatment to the baby. They understand the baby condition, agree on the treatment plan and thus unload their unnecessary anxiety. 

Rotavirus

Rotavirus Vaccine Effective in Preventing Hospitalizations

TUESDAY, Aug. 24 (HealthDay News) -- High three-dose coverage with a universal infant pentavalent rotavirus vaccine (RV5) is effective in preventing rotavirus and non-rotavirus acute gastroenteritis (AGE) hospitalizations in vaccinated children and older individuals who are unvaccinated, according to a study published online Aug. 23 in Pediatrics.
(read here for full text).

Rotavirus image

Some parents ask me whether they should give their baby rotavirus vaccines. Before making a decision, the following facts may be interesting to know:

• Rotavirus is a virus that infects the gastrointestinal tract.
• Nearly every child worldwide will suffer from at least one rotavirus infection before their fifth birthday (Parashar UD et al. Emerg Infect Dis 2003;9565-72). In Malaysia, the leading cause of diarrhoeal hospitalizations among children is due to rotavirus (Bresee JS et al. Emerg Infect Dis 2004;10:988-95). 38% of hospitalizations for diarrhoea in children younger than 5 years old are caused by rotavirus (Hung LC et al. Int J Infect Dis 2006;10:470-4). So, this is a common disease.
• Rotavirus infection can cause acute gastroenteritis. The baby will suffer from diarrhoea, vomiting, fever and abdominal pain. The most dreadful complication is dehydration (loss of fluid and electrolytes), which may lead to organ failure and death if left untreated. So, this can be a serious diease.
• There are currently 2 types of Rotavirus vaccines, Rotarix and Rotateq. To take Rotarix as an example, it can prevent up to 96% of severe rotavirus gastroenteritis and 100% of hospitalization due to rotavirus gastroenteritis (Vesikari T et al. Human Rotavirus vaccine Rotarix is highly eficacious in Europe. Presented at 24th ESPID, Basel, Switzerland, 3-5 May 2006). So, this is effective.
• One of the concerns with rotavirus vaccines is their association with the risk of intussuception. Rotarix has been extensively studied in worldwide clinical trials with more than 60,000 infants. Results showed that with Rotarix, there is no increased risk of intussuception (Ruiz-Palacios GM et al. N Engl J Med 2006;354:11-22). So, it is safe.
• The total dose of rotavirus vaccines are 2 doses (Rotarix) or 3 doses (Rotateq). There is no much difference in the cost, about RM 300 in total. A study conducted in Malaysia reported the cost of treating a baby with gastroenteritis in Malaysia is RM 650. So, the cost is acceptable.

In summary, the rotavirus vaccines fulfill the following criteria:

• Preventing a common disease in Malaysia.
• Preventing a potentially serious disease in Malaysia.
• A safe vaccine.
• An effective vaccine.
• A cost-effective vaccine.

Therefore, I strongly recommend rotavirus vaccine to all Malaysian children.

"Wind", "Angin", "风" or Colic ?

When we have a question that has no definite answer, we tend to label it very weirdly. The following condition is a good example:

• An apparently well baby who is easy to be taken care of since birth -- feeding, sleeping, feeding, sleeping....
• He/ she started to appear uneasy after about 3 weeks of life (or anytime within 3 months)
• He/ she tend to cry a lot, difficult to console
• An observant parent may notice this baby seemed to know the timing of crying, classically in the evening but stopped by midnight (when he/ she + parents are already exhausted!)
• The doctor checked the baby thoroughly and reassured the parents that everything is okay (but the parents strongly disagree. THEY are not okay -- they are tired of trying all means to console the baby at home)

Most of the time, the parents and the doctor will find a common ground between them -- the baby passes a lot of flatus. Therefore, the parents (and especially the grandparents) said this is because of the "Wind", "Angin", "风" (the term depends on the language). The doctor, being professionally trained and tends to label medical jargon, agreed with them but labelled the condition as "colic".
So, both parties agreed on the description of the problem but the importance is how to help the baby?
Nobody has the exact idea as no one reall know the cause??!! (that's why the name is so weird.)

There are many postulated, possible causes (but none of them explain all scenarios):

diagram taken from here

There are also many possible treatments (but none is definitely effective and you have to try them one by one):

Feed your baby. A hungry man is an angry man, this saying applies to your little baby as well. If you think your baby may be hungry, try a feeding. Hold your baby as upright as possible, and burp your baby often.

Hold your baby. Cuddling helps some babies. You can also try to use baby sling to relieve your arms. Don't be afraid to pamper your baby at this difficult time.

Keep your baby in motion. When you are holding your baby in your arms or putting baby in a sling, you can provide some movement. They seemed to like movements.

Give some music. You must use your soothing sounds. If this is too difficult, try some music.
Offer a pacifier. For many babies, sucking is a soothing activity. Even if you're breast-feeding, it's OK to offer a pacifier to help your baby calm down.

Soft massage at tummy. You might wonder the baby enjoy massage, like adults.
Give your baby (and yourself) some private time. If everything failed, you should give your baby and yourself some time to rest. Just to make sure your baby in a safe place and come back to see him/ her after 10 - 15 minutes. If needed, ask someone to take over the care for a while.

You may need to mix the methods above from time to time.

The good news is normally this condition spontaneously resolved by 3 months. Nevertheless, the new problem may follow --- the teething.

"Pearls" in the mouth - epithelial pearls

A mother told me she saw two white dots in the baby's mouth. I have a look and found 2 pieces of "pearls" inside. Diagram taken from here for illustration purpose.

This is in fact called epithelial pearls, commonly found in the newborn.They normally disappear by 1-2 months of age and no treament is necessary.

Should we give our baby this vaccine?

For children, there are 2 groups of vaccines:

• The "compulsory vaccines" - This is the basic vaccination programme for every child in Malaysia. Therefore, we can get it free from Klinik Kesihatan (government clinic). Nevertheless, we can also get it from private clinics or hospitals. For the latter, we need to pay.
• The "extra vaccines" -  These are the vaccines not available in the Klinik Kesihatan, and therefore we cannot get them free. However, we can get it from most children clinics and private hospital.

For "compulsory vaccines", we should have no questions whether to give to our children, as this is consistent with the basic healthcare standard of Malaysia. The choice is either to get them from the government clinics or the private clinics/ hospitals.
For "extra vaccines", we should decide whether they are necessary for our babies. To answer this question, I suggest you to consider the following factors:

1. Safety - the vaccines should only have minimal side effects and statistically negligible major side effects. For example, pneumococcal conjugate vaccine had been extensively investigated for its safety profile before and after launching in the market (refer here). The long history of use with no reported major side effects should be an added advantage. After all, we do not want our children to be guinea pigs, right?
2. Effectiveness - the vaccines should be effective and protect the majority of vaccinated people.  The chickenpox vaccine is about 70% to 85% effective at preventing mild infection, and more than 95% effective in preventing moderate to severe forms of the infection (refer here). Some vaccinated children do still get chickenpox but they have very mild disease (typically lesss than 50 spots).
3. Preventing common disease - There is no point to prevent a disease that is not common in Malaysia because the risk of infection is very, very low. For example, we do not need to prevent againt yellow fever (don't worry if you never hear of this term, because it is not reported in Malaysia.) It is a different story if you are travelling to Africa or South America.
4. Preventing serious disease - there are thousands of diseases and it is impossible to prevent each and eveyone of them. However, we should try to prevent the serious diseases. Vaccines are considered to be the most effective way of disease prevention, after clean water! Our government had in the past provide hepatitis B vaccine, and now going to give free HPV vaccines to the 13 years old girls (read here). 
5. Cost - I think we have to be practical in life. Everyone of us has limited budget and resources. We do not need to give all the available vaccines in the world to our baby. We should instead think of the potential benefit of the vaccines. For example, pneumococcal vaccines can cause more serious disease than influenza in general. So, a parent should choose the former over the latter if he dicides to give either one of the vaccines to the baby.

I hope the above principles can help some parents to make an informed choice of their children vaccineation programme.

Vaccines -- Sufferings or Gains ?

The children nowadays receive many vaccines. As a consequence, the parents and babies suffer a lot! The parents' losses are as follows:

• Before the child is in the clinic, the parents are imagining all possible scenarios -- the cry, the shout, the fight.... -- the parents are suffering the fear.
• When the child is in the clinic, the parents have to do much persuasion, reassurance and encouragement. If all these sweet words failed, they would come out with carrot (promise to buy this or that) or stick (threaten to punish them if not obedient).
• After the child is home, the parents watch out for the possibility of fever -- by feeling the child body or forehead every now and then.
• Time loss - sacrifice a weekend or evening in order to bring the child to clinic. If the clinic has a long queue, the waiting may take hours.
• Financial loss - with the escalating cost of living, the parents have to allocate budget for these vaccines. Less holidays and candle light dinners.

The children's losses are as follow:

• The anxiety of anticipation of an injection.
• The pain after receiving the injection.
• If the fever is high, the child may need to miss the school or even PLAY.

With so much suffering, then why the parents bring the children for vaccination? This is because of the gains, as the examples below:

• The eradication of diseases, e.g. smallpox. (We achieved this in 1977, thus the new generation does not need vaccination against smallpox).
• The near eradication of diseases, e.g. tetanus. (As this is not completely eradicated, we still need the vaccine.)
• The reduced incidence of invasive diseases, e.g. invasive pneumococcal disease. (We cannot prevent all diseases, but should try to prevent serious diseases with complications.Simple upper respiratory tract infection does not clear, but lung, blood and brain infection does kill.)
• Less hospitalization e.g. rotavirus vaccines can prevent against hospitalization due to rotavirus gastroenteritis. [In Malaysia, 38% of hospitalizations for diarrhoea in children yonger than 5 years old are caused by rotavirus (Hung LC et al. Int J Infect Dis 2006; 10:470-4)]
• Reduced disease severity, e.g. the children who had been vaccinated with chickenpox vaccine had milder disease (< 50 lesions), should he developed breakthrough chickenpox.
• Less risks of cancer e.g. human papilloma virus vaccines (HPV) can prevent HPV infection, subsequently prevent cervical cancer.
• Less occurence of common diseases e.g. influenza.

So, back to our question: Vaccines -- sufferings or gain?
What is your opinion?

Malaysian Children Resources - Grand Opening

Welcome to Malaysian Children Resources -- a one-stop website for everything related to Malaysian children.
For the time being, I will concentrate on the following areas:

1. Health
2. Education
3. Social

When we look at the cute little faces of the infants, deep into our hearts, we may wonder -- who shall he become? what shall she achieve?
Like wise, what is going to happen to this website? No one has the answer. Nevertheless, I shall nurthure it with tender, loving care.
A journey of a thousand miles began with a single step [Lao-tzu (c 604-c 531 bc]. Let's go!