I AM WRITING to support the recent the Ministry of Health’s recent consideration of including the 3-in-1 Tetanus-diphtheria-pertussis (Tdap) vaccine in the public vaccination program for expectant mothers – especially with the latest rise in pertussis cases in the country namely in Rompin and Alor Gajah.
I am heartened by the fact that the ministry is looking to take proactive measures to enhance accessibility to relevant preventive measures.
Despite the significant global progress in reducing childhood mortality since 1990, driven by the United Nations Sustainable Development Goals (SDGs) aiming to eliminate preventable deaths of newborns and children under five by 2030, there has been a slowdown in survival gains since 2010, particularly in neonatal mortalities.
Approximately 6,400 newborns lose their lives daily, nearly 47% of child deaths under age 5, while in Malaysia, the neonatal mortality rate in 2021 was 4.1 per 1000 live births, slightly higher than 2020’s rate of 3.9.
Improving newborn survival is essential, and prioritising disease prevention becomes crucial when vaccine-preventable infections have been identified as significant contributors to neonatal mortality.
However, there is a considerable challenge to protect infants less than 3 months of age who are too young to be vaccinated from infectious diseases like pertussis without active vaccinations.
Need for maternal immunisation or vaccination in pregnancy
To bridge this gap, maternal immunisation emerges as one of the most effective solutions, as this approach is already widely practiced in many developed countries.
By receiving vaccinations during pregnancy, a mother can achieve a dual advantage: boosting her own immunity and providing vital protection for her unborn child. The antibodies developed in the mother’s body are transmitted to the baby through the placenta, giving essential protection at the time of birth and continuing to shield the child for several months until the baby receives its own vaccinations.
This unique phenomenon of a single intervention benefiting both the mother and her child is a noteworthy achievement in public health. In Malaysia, maternal Tetanus Toxoid (TT) vaccination is included in the public program for pregnant mothers.
Pertussis (Whooping Cough)
The WHO’s Expanded Program on Immunisation has initially reduced global pertussis cases, but the disease is now re-emerging due to waning immunity and vaccine refusal or delay.
South and Southeast Asia have high neonatal pertussis burdens, with cases increasing in infants under three months, leading to mortality rates of 5.6% to 14.7% in the region. In our country, pertussis cases have risen for the last 20 years, with vaccine refusal rates escalating from 600 in 2013 to 1,600 in 2016.
The presentation of pertussis in adolescents and adults differs from infants, and the diagnosis is not often made. They are very infectious and can have a significant impact on infants. As of August, this year, there have been 329 cases of pertussis with 23 deaths reported nationwide, with 189 (57.4%) of the reported cases involving babies below 12 months.
Also, a recent 12-month observation of several hospitals found that 89.3% of confirmed pertussis cases occurred in infants too young to be fully vaccinated or were under-vaccinated for their age.
On-time infant vaccination to prevent vaccine-preventable infectious diseases must be emphasized, and maternal immunisation is an important strategy to reduce the disease burden of infections like pertussis.
Safeguarding our youngest from pertussis
Multiple studies show that passive immunity from maternal immunisation has the highest impact in preventing pertussis in new-borns. Despite the potential benefits and WHO’s recommendation to consider the Tdap vaccination for pregnant women, many countries in this region continue to recommend the TT vaccine for pregnant women or women of childbearing age.
Singapore has introduced Tdap vaccination for pregnant mothers in their health program, and we should follow a similar step.
In Malaysia, many women are missing maternal vaccinations due to factors such as low awareness, vaccine hesitancy, safety concerns, and financial constraints.
The uptake of the Tdap vaccine in Malaysia is mainly in private healthcare and relies on individual doctors’ recommendations. I am a strong advocate of vaccine and has incorporated the Tdap vaccine for our pregnant mothers to replace the stand-alone TT vaccine since 2021 in Hospital Al-Sultan Abdullah (HASA) Puncak Alam UiTM. We are the first public hospital that provides the Tdap vaccine on-site, given the proper counselling results in the willingness of mothers to bear the cost of the vaccine.
By working together to prioritise new-born health, we can address the gap in protection during a baby’s early months of life, ultimately moving Malaysia closer to achieving the SDG targets by 2030. It is my sincere hope that we can join forces to create a healthier future for our nation’s children.
Note: The author is a Consultant Fetomaternal Medicine, Department of Obstetrics & Gynaecology at Hospital Al-Sultan Abdullah UiTM Puncak Alam.
