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. 2018 Dec 22;18(1):1402.
doi: 10.1186/s12889-018-6316-6.

Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme

Nor Asiah Muhamad  1   2 , Saidatul Norbaya Buang  3 , Safurah Jaafar  3   4 , Rohani Jais  5 , Phaik Sim Tan  3 , Normi Mustapha  6 , Noor Aliza Lodz  7 , Tahir Aris  7 , Lokman Hakim Sulaiman  4   8 , Shahnaz Murad  9
Affiliations

Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme

Nor Asiah Muhamad et al. BMC Public Health. .

Abstract

Background: In 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were developed for Malaysia's HPV school-based immunisation programme. It was approved for nationwide school base implementation for 13-year-old girls or first year secondary students in 2010. This paper examines how the various strategies used in the implementation over the last 7 years (2010-2016) that unique to Malaysia were successful in achieving optimal coverage of the target population.

Methods: Free vaccination was offered to school girls in secondary school (year seven) in Malaysia, which is usually at the age of 13 in the index year. All recipients of the HPV vaccine were identified through school enrolments obtained from education departments from each district in Malaysia. A total of 242,638 girls aged between 12 to 13 years studying in year seven were approached during the launch of the program in 2010. Approximately 230,000 girls in secondary schools were offered HPV vaccine per year by 646 school health teams throughout the country from 2010 to 2016.

Results: Parental consent for their daughters to receive HPV vaccination at school was very high at 96-98% per year of the programme. Of those who provided consent, over 99% received the first dose each year and 98-99% completed the course per year. Estimated population coverage for the full vaccine course, considering also those not in school, is estimated at 83 to 91% per year. Rates of adverse events reports following HPV vaccination were low at around 2 per 100,000 and the majority was injection site reactions.

Conclusion: A multisectoral and integrated collaborative structure and process ensured that the Malaysia school-based HPV immunisation programme was successful and sustained through the programme design, planning, implementation and monitoring and evaluation. This is a critical factor contributing to the success and sustainability of the school-based HPV immunisation programme with very high coverage.

Keywords: Cervical cancer; HPV; Immunisation; Malaysia; School based.

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Conflict of interest statement

Ethics approval and consent to participate

For developing this report, formal ethics approval was not required as the analysis was mainly a retrospective programme evaluation conducted at the policy and programme level. The report was based on existing data and documentation with any data aggregated at the population level. All data from key informant interviews and stakeholder meetings was analyzed in the aggregate and quotes anonymized, except where approval to quote was specifically provided. Written parental consent was obtained prior to vaccination. The consent forms were distributed to parents through school teachers prior to scheduled vaccination visits. The parents returned the consent form to the school team. Whenever the children were refused immunization by their parents, the school health teams would call the parents to determine reasons for refusal and made a remark on the student registration form.

Consent for publication

This manuscript has obtained the approval for publication from Director General of Health, Ministry of Health Malaysia. For the purpose of this reports, consent from the people portrayed in Fig. 1 was obtained prior to starting the programme.

Competing interests

All authors read and understood the policy on declaration of interest and declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Tagline (Translation “Lindungi Anak Gadis Anda dari Kanser Serviks”: Protect Your Daughter from Cervical Cancer) (Translation “Pastikan anak anda mendapat pelalian HPV hari ini”: Ensure your daughter receives HPV vaccination today) (Translation “Dapatkan pelalian HPV di sekolah atau di klinik kesihatan Kementerian Kesihatan Malaysia”: Get the HPV vaccination in school or government health clinic, Ministry of Health Malaysia) (Translation “Diberi percuma untuk murid perempuan tingkatan 1 dan remaja perempuan 13 tahun pada tahun semasa”: Given free of charge to form 1 school girl and adolescent girl aged 13 in the index year) (Translation “Dapatkan pelalian yang lengkap (3 suntikan) untuk perlindungan terbaik”: Get complete HPV vaccination (3 injections) for best protection)(Translation “Pelalian HPV mencegah anak anda dari kanser servik akibat jangkitan HPV”: HPV vaccination prevent your daughter from cervical cancer due to HPV infection) (Translation “Untuk maklumat lanjut: Ο Kunjungi klinik kesihatan dan hospital berhampiran atau Layari www.myhealth.gov.my”: For further information: Visit nearest clinic and hospital or surf www.myhealth.gov.my)
Fig. 2
Fig. 2
Percent of girls with parental consent who had first and third vaccination dose, 2010–2016
Fig. 3
Fig. 3
Percent of 13 year old girls vaccinated, 2010–2016 *Source for all figures: Family Health Department, Ministry of Health Malaysia 2018
See this image and copyright information in PMC

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