MyMedR

In Malysia, the proportion of children fully immunized againest diphtheria is generally low (20%). On the other hand, the Schick conversion rate rises with age and reaches 90% by 11 years of age. It is noted that asymptomatic carriers are an important epidemiological factor in diphtheria and that carrier rates for school children are high (prevalence of 7.5% while the rate of coloization with C. diphtheriae over a period of one year was 30%). Although immunization protects against clinical diphtheria, it does not prevent the carrier state. Thus, for the control of diphtheria, one should aim for 100% compliance. Some suggestions as to how higher levels of immunity may be achieved are described.

Matched MeSH terms: Diphtheria/immunology; Diphtheria/epidemiology*

Fulltext Parental refusal to diphtheria vaccine: a fatal outcome

Syafinaz Amin N, Faridah I, Rukman AH, Fathinul Fakri AS, Malina O, Fadzillah G, et al.

Med J Malaysia, 2013 Oct;68(5):435-6.

PMID: 24632874 MyJurnal

We present a case of a four-year-old boy who succumbed to diphtheria following incomplete course of immunisation, which included diphtheria vaccine. This case report focuses on the issues of parental refusal to vaccines and the development of "halal" vaccines for the prevention of infectious diseases.

Matched MeSH terms: Diphtheria; Diphtheria Toxoid

Clinical trial of cephaloridine in diphtheria

Sindhu SS

Med J Malaya, 1968 Jun;23(4):330-6.

PMID: 4235598

Matched MeSH terms: Diphtheria/drug therapy*

The early immunisation of infants in Malaysia

Chen ST, Choong MM

Med J Malaya, 1971 Sep;26(1):15-9.

PMID: 4258569

Matched MeSH terms: Diphtheria/prevention & control*; Diphtheria Toxoid*

Some notes on infectious diseases in Singapore

Gilmour CCB

Malayan Medical Journal, 1935;10:9-13.

Matched MeSH terms: Diphtheria

Fulltext First Draft Genome Sequences of Malaysian Clinical Isolates of Corynebacterium diphtheriae

Ahmad N, Hii SY, Mohd Khalid MK, Abd Wahab MA, Hashim R, Tang SN, et al.

Genome Announc, 2017 Mar 02;5(9).

PMID: 28254972 DOI: 10.1128/genomeA.01670-16

Corynebacterium diphtheriae has caused multiple isolated diphtheria cases in Malaysia over the years. Here, we report the first draft genome sequences of 15 Malaysia C. diphtheriae clinical isolates collected from the years 1981 to 2016.

Matched MeSH terms: Corynebacterium diphtheriae; Diphtheria

Fulltext Seroprevalence of diphtheria toxoid IgG antibodies in the Malaysian population

Yusoff AF, Mohd Sharani ZZ, Kee CC, Md Iderus NH, Md Zamri ASS, Nagalingam T, et al.

BMC Infect Dis, 2021 Jun 16;21(1):581.

PMID: 34134646 DOI: 10.1186/s12879-021-06285-3

BACKGROUND: Despite high childhood immunization coverage, sporadic cases of diphtheria have been reported in Malaysia in recent years. This study aims to evaluate the seroprevalence of diphtheria among the Malaysian population.

METHODS: A total of 3317 respondents age 2 years old to 60 years old were recruited in this study from August to November 2017. Enzyme-linked immunosorbent assay (ELISA) was used to measure the level of IgG antibody against the toxoid of C. diphtheriae in the blood samples of respondents. We classified respondent antibody levels based on WHO definition, as protective (≥0.1 IU/mL) and susceptible (diphtheriae infection.

RESULTS: Among the 3317 respondents, 57% were susceptible (38.1% of children and 65.4% of adults) and 43% (61.9% of children and 34.6% of adults) had protective antibody levels against diphtheria. The mean antibody level peaked among individuals aged 1-2 years old (0.59 IU/mL) and 6-7 years old (0.64 IU/mL) but generally decreased with age, falling below 0.1 IU/mL at around 4-6 years old and after age 20 years old. There was a significant association between age [Children: χ2 = 43.22(df = 2),p diphtheria toxoid IgG antibody level.

CONCLUSIONS: About 57% of the Malaysian population have inadequate immunity against diphtheria infection. This is apparently due to waning immunity following childhood vaccination without repeated booster vaccination in adults. Children at age 5-6 years old are particularly vulnerable to diphtheria infection. The booster vaccination dose normally given at 7 years should be given earlier, and an additional booster dose is recommended for high-risk adults.

Matched MeSH terms: Corynebacterium diphtheriae/metabolism; Diphtheria/epidemiology*; Diphtheria/pathology; Diphtheria Toxoid/immunology*

Comparative genomic and phylogenetic analysis of a toxigenic clinical isolate of Corynebacterium diphtheriae strain B-D-16-78 from Malaysia

Hong KW, Asmah Hani AW, Nurul Aina Murni CA, Pusparani RR, Chong CK, Verasahib K, et al.

Infect Genet Evol, 2017 Oct;54:263-270.

PMID: 28711373 DOI: 10.1016/j.meegid.2017.07.015

In this study, we report the comparative genomics and phylogenetic analysis of Corynebacterium diphtheriae strain B-D-16-78 that was isolated from a clinical specimen in 2016. The complete genome of C. diphtheriae strain B-D-16-78 was sequenced using PacBio Single Molecule, Real-Time sequencing technology and consists of a 2,474,151-bp circular chromosome with an average GC content of 53.56%. The core genome of C. diphtheriae was also deduced from a total of 74 strains with complete or draft genome sequences and the core genome-based phylogenetic analysis revealed close genetic relationship among strains that shared the same MLST allelic profile. In the context of CRISPR-Cas system, which confers adaptive immunity against re-invading DNA, 73 out of 86 spacer sequences were found to be unique to Malaysian strains which harboured only type-II-C and/or type-I-E-a systems. A total of 48 tox genes which code for the diphtheria toxin were retrieved from the 74 genomes and with the exception of one truncated gene, only nucleotide substitutions were detected when compared to the tox gene sequence of PW8. More than half were synonymous substitution and only two were nonsynonymous substitutions whereby H24Y was predicted to have a damaging effect on the protein function whilst T262V was predicted to be tolerated. Both toxigenic and non-toxigenic toxin-gene bearing strains have been isolated in Malaysia but the repeated isolation of toxigenic strains with the same MLST profile suggests the possibility of some of these strains may be circulating in the population. Hence, efforts to increase herd immunity should be continued and supported by an effective monitoring and surveillance system to track, manage and control outbreak of cases.

Matched MeSH terms: Corynebacterium diphtheriae/classification*; Corynebacterium diphtheriae/genetics*; Corynebacterium diphtheriae/isolation & purification; Diphtheria/microbiology*; Diphtheria/epidemiology; Diphtheria Toxin/genetics

Influence of immunization schedule on immunization coverage

Chen ST

J Trop Med Hyg, 1989 Dec;92(6):386-90.

PMID: 2607571

The infant immunization coverage for triple antigen (DPT) from 1968 and trivalent oral polio vaccine (TOPV) from 1972 to 1985 for Peninsular Malaysia are presented. It shows that immunization coverage improved when the recommended age for first dose of DPT was changed from the fourth to the second month of life in 1972 and declined when the recommended age for the first dose of DPT and TOPV was revised again from the second to the third month of life in 1980. The advantages of immunizing children early in life are discussed.

Matched MeSH terms: Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage*

The improvement of immunization status in children attending child health clinics

Pathmanathan I

J Trop Med Hyg, 1973 Nov;76(11):294-6.

PMID: 4758753

The Municipal Maternal and Child Health Clinics at Kuala Lumpur were faced with a declining but continuing problem of diphtheria. The arrangements for immunization were such that a low coverage was obtained for triple vaccination, but a high one for smallpox, a disease they had not experienced for many years. By reversing the schedule, so that triple vaccine injections were administered first, and ensuring that fewer children were not immunized because of concurrent minor ailments, the diphtheria immunization coverage was greatly improved. There was some loss of smallpox cover.
The revision commenced in 1970 and the diphtheria incidence rate, which had been falling since 1965, continued to fall but at a lower rate. The author does not discuss possible explanations for this. The article illustrates a dramatic improvement in immunization cover by a simple re-arrangement better suited to the needs of the town

Matched MeSH terms: Diphtheria/prevention & control

Adult diphtheria in Malaysia: A case report

Loganathan T, Mohamed PY

Med J Malaysia, 2018 10;73(5):340-341.

PMID: 30350821 MyJurnal

In November 2016, a 28-year-old Malay man presented to the emergency department in respiratory distress, with a history of fever and sore throat. A clinical diagnosis of acute diphtheria was made and the patient was isolated and ventilated in the intensive care unit, and received diphtheria antitoxin and intravenous antibiotics. Initial laboratory findings failed to confirm diphtheria, leading to discontinuation of antibiotics and quarantine. Public health measures were reinstated after a reference laboratory cultured Corynebacterium diphtheriae. Although there was no contact with ill persons, investigation revealed incomplete immunisation history, and injection of high dose steroids prior to onset of symptoms.

Matched MeSH terms: Corynebacterium diphtheriae; Diphtheria; Diphtheria Antitoxin

Fulltext Economic impact of switching from partially combined vaccine "Pentaxim® and hepatitis B" to fully combined vaccine "Hexaxim®" in the Malaysian National Immunization Program

Aljunid SM, Al Bashir L, Ismail AB, Aizuddin AN, Rashid SAZA, Nur AM

BMC Health Serv Res, 2022 Jan 05;22(1):34.

PMID: 34986870 DOI: 10.1186/s12913-021-07428-7

BACKGROUND: The decision to implement new vaccines should be supported by public health and economic evaluations. Therefore, this study was primarily designed to evaluate the economic impact of switching from partially combined vaccine (Pentaxim® plus hepatitis B) to fully combined vaccine (Hexaxim®) in the Malaysian National Immunization Program (NIP) and to investigate healthcare professionals (HCPs)' and parents'/caregivers' perceptions.

METHODS: In this economic evaluation study, 22 primary healthcare centers were randomly selected in Malaysia between December 2019 and July 2020. The baseline immunization schedule includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses), whereas the alternative scheme includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses) and hepatitis B (one dose) administered at birth. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct non-medical (cost for transportation) and indirect costs (loss of productivity) were derived from parents'/caregivers' questionnaire. Also, HCPs' and parent's/caregivers' perceptions were investigated using structured questionnaires.

RESULTS: The cost per dose of Pentaxim® plus hepatitis B vs. Hexaxim® for the baseline scheme was Malaysian ringgit (RM) 31.90 (7.7 United States dollar [USD]) vs. 17.10 (4.1 USD) for direct medical cost, RM 54.40 (13.1 USD) vs. RM 27.20 (6.6 USD) for direct non-medical cost, RM 221.33 (53.3 USD) vs. RM 110.66 (26.7 USD) for indirect cost, and RM 307.63 (74.2 USD) vs. RM 155.00 (37.4 USD) for societal (total) cost. A similar trend was observed for the alternative scheme. Compared with Pentaxim® plus hepatitis B, total cost savings per dose of Hexaxim® were RM 137.20 (33.1 USD) and RM 104.70 (25.2 USD) in the baseline and alternative scheme, respectively. Eighty-four percent of physicians and 95% of nurses supported the use of Hexaxim® in the NIP. The majority of parents/caregivers had a positive perception regarding Hexaxim® vaccine in various aspects.

CONCLUSIONS: Incorporation of Hexaxim® within Malaysian NIP is highly recommended because the use of Hexaxim® has demonstrated substantial direct and indirect cost savings for healthcare providers and parents/caregivers with a high percentage of positive perceptions, compared with Pentaxim® plus hepatitis B.

TRIAL REGISTRATION: Not applicable.

Matched MeSH terms: Diphtheria-Tetanus-Pertussis Vaccine*

Fulltext Parents' and healthcare professionals' perception toward the introduction of a new fully liquid hexavalent vaccine in the Malaysian national immunization program: a cross-sectional study instrument development and its application

Al Bashir L, Ismail A, Aljunid SM

Front Immunol, 2023;14:1052450.

PMID: 37180162 DOI: 10.3389/fimmu.2023.1052450

A newly developed fully liquid hexavalent vaccine that comprises six antigens for Diphtheria, Tetanus, acellular Pertussis, Inactivated Poliomyelitis, Haemophilus Influenza type b., and Hepatitis B, is proposed to be introduced in the Malaysian national immunization program, instead of the non-fully liquid pentavalent vaccine and monovalent Hepatitis B vaccine that is currently employed in the immunization schedule. Although the introduction of new vaccines is a necessary intervention, it still needs to be accepted by parents and healthcare professionals. Hence, this study aimed to develop three structured questionnaires and to investigate the participants' perception and acceptability toward the incorporation of the new fully liquid hexavalent vaccine. A cross-sectional study was conducted among a sample of 346 parents, 100 nurses, and 50 physicians attending twenty-two primary health care centers in the states of Selangor and the Federal Territory of Kuala Lumpur and Putrajaya during 2019-2020. The study found that Cronbach's alpha coefficients for the study instruments ranged from 0.825 to 0.918. Principal components analysis produced a good fit with KMO>0.6. For the parents' perception questionnaire, the only extracted factor explained 73.9 % of the total variance; for the nurses' perception toward a non-fully and fully liquid combined vaccine, there was a sole extracted factor that explained 65.2 % and 79.2% of the total variance, respectively. Whereas for the physicians' perception, there was one factor extracted that explains 71.8 % of the total variance. The median score for all the questionnaire items ranged from 4 to 5 (Q1 and Q3 vary between 3-5). Parents' ethnicity was significantly associated (P-value ≤ 0.05) with the perception that the new hexavalent vaccine would reduce their transportation expenses. Moreover, a significant association (P-value ≤ 0.05) was found between physicians' age and the perception of the hexavalent vaccine's ability to decrease patient overcrowding in primary healthcare centers. The instruments used in this study were valid and reliable. Parents of Malay ethnicity were the most concerned about transportation expenses since they have the lowest income and are more concentrated in rural areas compared to other races. Younger physicians were concerned about reducing patient crowding and hence reducing their workload and burnout.

Matched MeSH terms: Diphtheria-Tetanus-Pertussis Vaccine*

Fulltext Atypical mycotic lesion in the guttural pouch of a thoroughbred race horse

Yiew, X.T., Khairuddin, N.H., Murdoch, A.I.K., Patil, P.V., Shashi Singam, R., Koay, C.P.

Jurnal Veterinar Malaysia, 2015;27(2):8-11.

MyJurnal

A six-year-old Thoroughbred race horse was presented with left unilateral mucopurulent nasal discharge. Endoscopic examination revealed atypical mycotic lesion within the guttural pouch in which the fungal mass was not located on any neurovascular structures. This case was successfully treated by the combination of manual debulking of fungal diphtheritic plaques and medical treatment that included daily local irrigation and systemic medication. There were no complications and the horse returned to race three weeks later.

Matched MeSH terms: Diphtheria

Misidentification of toxigenic Corynebacterium diphtheriae as a Corynebacterium species with low virulence in a child with endocarditis

Pennie RA, Malik AS, Wilcox L

J Clin Microbiol, 1996 May;34(5):1275-6.

PMID: 8727917

A 6-year-old boy presented to a university hospital in Malaysia with infective endocarditis complicating cyanotic congenital heart disease. Blood cultures showed a gram-positive, aerobic, coryneform-like bacillus identified by the hospital laboratory as Corynebacterium xerosis, but a reference laboratory identified the organism as a toxigenic strain of Corynebacterium diphtheriae. The two laboratories concurred on all biochemical test results except for sucrose fermentation.

Matched MeSH terms: Corynebacterium diphtheriae/classification*; Corynebacterium diphtheriae/isolation & purification; Corynebacterium diphtheriae/pathogenicity; Diphtheria/complications; Diphtheria/diagnosis*; Diphtheria/microbiology*

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