Berita MPA Newsletter October 2009 (English - pdf

THE MALAYSIAN PAEDIATRIC ASSOCIATION
Datuk Dr Zulkifli Ismail
Dr Noor Khatijah Nurani
MPA 2007 – 2009
EXECUTIVE COMMITTEE
Immediate Past President
Datuk Dr Zulkifli Ismail
Vice-President
Prof Zabidi Azhar Mohd Hussain
Hon Secretary
Assoc Prof Tang Swee Fong
Asst Hon Secretary
Dr Noor Khatijah Nurani
Treasurer
Dato’ Dr Musa Mohd Nordin
Committee Members
Dr Koh Chong Tuan
Dr Nazeli Hamzah
Prof Koh Mia Tuang
Dr Hung Liang Choo
Assoc Prof Syed Zulkifli Syed
Zakaria
Dr Selva Kumar Sivapunniam
The 13th Asian Pacific Congress of
Pediatrics (APCP) on 15-18 October 2009
in Shanghai is a continuity of the Asian
Congress of Pediatrics (ACP) that started
in 1974 in Manila. Malaysia had the
honour of hosting and organising the 5th
ACP in 1985 after the late Datuk Dr Sam
Abraham successfully bid for it in Seoul,
Korea in 1982.
That was MPA’s first forray in organising a
large international conference and it gave
us the confidence to host many more.
Host
Year
1st ACP
Manila,
Philippines
1974
2nd ACP
Jakarta,
Indonesia
1976
3rd ACP
Bangkok,
Thailand
1979
4th ACP
Seoul, Korea
1982
5th ACP
Kuala Lumpur,
Malaysia
1985
6th ACP
Tokyo, Japan
1988
7 ACP
Perth, Australia
1991
8 ACP
New Delhi, India
1994
9 ACP
Hong Kong
1997
10 ACP
Taipei, Taiwan
2000
11th ACP
2003
The views & opinions in all the articles
are entirely those of the authors unless
otherwise specified.
Bangkok,
Thailand
12th APCP
Colombo,
Sri Lanka
2007
We invite articles and feedback from
readers – Editor
13th APCP
Shanghai, China
2009
Co-opted Committee Members
Prof Datuk Mohd Sham Kasim
Dr Hussain Imam Haji
Mohd Ismail
Dato’ Dr Zakaria Zahari
Affiliated to:
• Malaysian Council For Child Welfare
•ASEAN Pediatric Federation
•Asian Pacific Pediatric Association
– APPA (Previously Association of
Pediatric Societies of the South
East Asian Region – APSSEAR)
• International Pediatric Association
(IPA)
The Berita MPA is published for members
to keep them informed of the activities of
the Association.
FOR MEMBERS ONLY
Asian Congress, 2012
in Malaysia?
Editorial Board
President
Dr Soo Thian Lian
OCTOBER 2009 th
th
th
th
The Association of Pediatric Societies of
the Southeast Asian Region (APSSEAR)
became the Asian Pacific Pediatric
Association (APPA) in 2004 to encompass
the regions covered. With it, the ACP
became the APCP in Sri Lanka in 2007.
Twenty seven years on and it is time that
we host the Asian Congress in 2012.
MPA will be bidding for the 14th APCP
and we are counting on every single
Malaysian attending the 13th APCP 2009
in Shanghai to help support this bid.
Every little lobby for our country in a
united voice will help to secure the bid.
The other country bidding for the same
congress is India.
The tentative local venue is Kuching,
Sarawak. In this age of easy travel,
almost every traveller knows about KL
and the Twin Towers. Hence the choice
of Sarawak as a mysterious, natural,
culturally rich venue, offering a unique
experience for the congress in 2012.
Sarawak also has a successful health
coverage ensuring a health facility within
5km of any household as claimed by our
Ministry of Health that we should be
proud of. The new Borneo Convention
Centre or the Pullman Hotel are excellent
prospective venues with state-of-the-art
technology and communication. We will
need the Sarawakians to help with local
logistics to make this successful.
Let’s all support this bid for the 14th
APCP 2012 to be held in our country
again. God willing, Malaysia Boleh!
3rd Floor (Annexe Block), National Cancer Society Building, 66, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur.
Tel: 2691 5379/2698 9966 Fax: 2691 3446 E-mail: [email protected] Web page: www.mpaweb.org.my
BERITA MPA – OCTOBER 2009
1
From The President
Going Global
October will be a busy month for the
MPA. October will see us hosting a major
international congress in Kuala Lumpur,
and also see us bidding for another
major international conference for the
year 2012.
The 9th World Congress of the IAAH
(International Association for Adolescent
Health) will be held from 28-30 October
2009 in ShangriLa Hotel, Kuala
Lumpur.
This event will bring
together experts
in the field of
Adolescent Health
from as many as 25
countries. With 6-8
concurrent sessions,
and a variety of
programs including
workshops and
a public forum in
addition to the usual
plenary sessions and
symposia, the program has something
for everyone. And befitting the theme
of an increasingly aware and responsible
youth as a foundation for the future,
there will be a significant component of
youth participation, from the conduct of
the congress to the content.
The congress will also see a record
number of organizing partners, with
the active involvement of the Ministry
of Health, Ministry of Women, Family
and Community Development, National
Population & Family Development
Board, Malaysian Medical Association,
Malaysian Association for Adolescent
Health and the Federation of Family
Planning Associations.
This is the first time that MPA is hosting a
conference with the theme of adolescent
health. Traditionally paediatricians
in the country have only dealt with
neonates and children. In the past, the
children’s wards in government hospitals
admitted patients less than 7 years of
age, and later this was extended to 12
years. At present many hospitals use
BERITA MPA – OCTOBER 2009
an operational age of 15 years as the
range covered by paediatric services, and
hopefully in the near future we will be
extending our services to up to 18 years
of age.
Hence it is not surprising that the
paediatric community locally has a
‘blind spot’ as far as adolescent health is
concerned. These ‘old children’ or ‘young
adults’, depending on one’s perspective
constitute a group that has its unique
needs. Adolescence is a confusing time
of physical, sexual and psycho-social
changes that come seemingly without
warning, and at a pace that often leaves
the individual struggling to cope with
the mismatch between the physical
and emotional rates of maturation.
Adolescence (and life in general)
unfortunately does not come with an
instructional manual, neither for the
owner, nor for the caregiver.
These bewildering changes have by
and large not been addressed openly
in our local culture, and the adolescent
is often left to his/her own resources,
learning for better or worse from fellow
journeymen who are at various levels of
disorientation in uncharted waters.
We now recognise that such an
important stage of human development
should not be left unaddressed, but in
fact that they require expert guidance
and management for the child to steer
successfully through the minefield of
adolescence so as to realise their full
human potential.
In October we will also be making a bid
at the 13th Asian Pacific Congress of
Pediatrics (APCP) in Shanghai, China to
host the 14th congress in 2012.
The Asian Pacific Pediatric Association
(APPA) started life in 1974 as APSSEAR
(Association of
Pediatric Societies
of the South-East
Asian Region) and in
2004 was renamed
the Asian Pacific
Pediatric Association
to reflect the growth
and extended reach
of the association.
It now comprises
of 20 national
paediatric societies.
Formed with the
aim of improving
the health status of
children living in the
region, APPA has grown from strength to
strength as the advocate for child health
in the region.
Malaysia hosted the 5th Asian Congress
of Pediatrics in Kuala Lumpur way back
in 1985, and it is befitting that after a
quarter of a century of major strides
in improvement of child health, we
bring the congress back to our shores.
In 1990 our Infant Mortality Rate was
16 per 1,000 livebirths, and it has
dropped steadily to 6.3 per 1,000 in
2007, a figure similar to that of the
USA, and we are confident of achieving
the Millennium Development Goal of
reducing Under-5 Mortality by two-thirds
between 1990 and 2015.
We look forward to hosting our fellow
paediatricians and workers in child
health in 2012 and contributing to the
improvement of paediatric health care by
the mutual sharing of experiences. 2
Soo Thian Lian
President 2007 – 2009
News
Update on Vaccine-Derived
Polioviruses Worldwide
January 2008-June 2009
In 1988, the World Health Assembly resolved to eradicate
poliomyelitis worldwide1. Subsequently, the Global Polio
Eradication Initiative of the World Health Organization
(WHO) reduced the global incidence of polio associated
with wild polioviruses (WPVs) from an estimated
350,000 cases in 125 countries in 1988 to 1,651
reported cases in 2008 and reduced the number of
countries that have never interrupted WPV transmission
to four (Afghanistan, India, Nigeria, and Pakistan)1.
Under current WHO plans, when the goal of eradicating
all WPV transmission is attained, oral poliovirus vaccine
(OPV) use worldwide eventually will be discontinued.
However, because vaccine-derived polioviruses (VDPVs)
can produce polio outbreaks in areas with low rates
of Sabin OPV coverage and can replicate for years in
immunodeficient persons, enhanced strategies are
needed to limit emergence of VDPVs2. This report
updates previous summaries3,4 and describes VDPVs
detected worldwide during January 2008-June 2009.
During this period, 1) two new outbreaks of circulating
VDPVs (cVDPVs) (accounting for 4-20 cases) were
identified in the Democratic Republic of Congo and
Ethiopia; 2) a previously identified outbreak in Nigeria
ultimately resulted in a cumulative total of 292 cases; 3)
two newly identified paralyzed immunodeficient persons
in Argentina and the United States were found to excrete
VDPVs; and 4) isolated VDPVs were found among
persons and environmental samples in 11 countries. All
countries need to maintain 1) high rates of poliovirus
vaccination coverage to prevent VDPV spread and 2)
sensitive poliovirus surveillance to detect VDPVs.
OPV dose. This is substantially longer than the normal
period of vaccine virus replication of 4-6 weeks in an OPV
recipient.
Poliovirus isolates are divided into three serotypes: type
1, type 2, and type 3. Isolates are divided further into
three categories, based on the extent of VP1 nucleotide
sequence divergence from the corresponding Sabin
OPV strain: 1) Sabin VRPVs (≤1% divergent), 2) VDPVs
(VRPVs that are >1% divergent from the corresponding
Sabin strain), and 3) WPVs (no genetic evidence of
derivation from any vaccine strain) (3). VDPVs are
further categorized as 1) circulating VDPVs (cVDPVs),
when evidence of person-to-person transmission in
the community exists; 2) immunodeficiency-associated
VDPVs (iVDPVs), which are isolated from persons with
primary immunodeficiencies who have prolonged VDPV
infections; and 3) ambiguous VDPVs (aVDPVs), which
are either clinical isolates from persons with no known
immunodeficiency or sewage isolates whose ultimate
source is unknown2.
References
1. CDC. Progress toward interruption of wild poliovirus transmission
worldwide, 2008. MMWR 2009;58:308-12.
2. CDC. Update on vaccine-derived polioviruses. MMWR 2006;55:1093-7.
3. CDC. Update on vaccine-derived polioviruses worldwide, January 2006-August 2007. MMWR 2007;56:996-1001.
4. CDC. Laboratory surveillance for wild and vaccine-derived polioviruses
worldwide, January 2007-June 2008. MMWR 2008;57:967-70.
5. CDC. Laboratory surveillance for wild and vaccine-derived polioviruses
worldwide, January 2008-June 2009. MMWR 2009;58:950-4.
6. CDC. Wild poliovirus type 1 and type 3 importations – 15 countries,
Africa, 2008-2009. MMWR 2009;58:357-62.
7. Alexander JP, Ehresmann K, Seward J, et al. Transmission of imported
vaccine-derived poliovirus in an under-vaccinated communityMinnesota, USA. J Infect Dis 2009;199:391-7.
Properties of VDPVs
VDPVs can cause paralytic polio in humans and have
the potential for sustained circulation. VDPVs resemble
WPVs biologically2 and differ from most Sabin vaccinerelated poliovirus (VRPV) isolates by having genetic
properties consistent with prolonged replication or
transmission. Because poliovirus genomes evolve at a
rate of approximately 1% per year, Sabin VRPV isolates
that differ from the corresponding OPV strain by >1% of
nucleotide positions (usually determined by sequencing
the genomic region encoding the major viral surface
protein, VP1) are estimated to have replicated for at least
1 year in one or more persons after administration of an
8. Blomqvist S, Savolainen C, Laine P, et al. Characterization of a highly
evolved vaccine-derived poliovirus type 3 isolated from sewage in
Estonia. J Virol 2004;78:4876-83.
9. Shulman LM, Manor Y, Sofer D, et al. Neurovirulent vaccine-derived
polioviruses in sewage from highly immune populations. PLoS One
2006;1:e69.
10. Kew OM, Sutter RW, de Gourville EM, Dowdle WR, Pallansch MA.
Vaccine-derived polioviruses and the endgame strategy for global polio
eradication. Annu Rev Microbiol 2005;59:587-635.
Editor’s note: Malaysia will switch from OPV to IPV
this year, thus reducing VDPV circulation.
BERITA MPA – OCTOBER 2009
Report
Asian Vaccine Conference
20-22 August 2009, Siem Reap, Cambodia
ASVAC 2009 group photograph after signing the Siem Reap Declaration 2009.
Cambodian Ministry of Health Underscretary of State is 6th from left.
The above conference, the first of its kind was organised
by the Asian Society of Pediatric Infectious Diseases
(ASPID), National Pediatric Hospital Cambodia (NPH),
Philippine Chapter of the International Society of Tropical
Pediatrics (ISTP-Ph) and the Philippine Foundation for
Vaccination (PFV). Three hundred delegates made up of
paediatricians, child health and vaccine advocates, EPI
managers, vaccine company representatives and others
with an insatiable passion on immunisation were there.
of Metropolitan Bangkok the event also had the support
of the American Academy of Pediatrics (AAP).
The Cambodian Ministry of Health Undersecretary
of State, HE Prof Dr Thir Kruy, described his country’s
decision making process in adding new vaccines into the
EPI in his keynote address on improving child survival in
resource-limited countries. He was noticeably supportive
of new vaccines for the children in his country. He came
back later to sign the Siem Reap Declaration to support
immunisation for the population.
ASPID President Prof Sri Rezeki Hadinegoro from
Indonesia in the opening ceremony said that vaccination
success is a collaboration of academic,
business and government (ABG). The
three parties must be able to listen to
each other and cooperate as well as
update others. Attended by International
Pediatric Association (IPA) President Dr
Chan Chok-Wan, World Society for
Pediatric Infectious Disease (WSPID)
President Prof Ron Dagan, Asian Pacific
Pediatric Association (APPA) President
Prof Sanath Lamabadusurya, Asian
Strategic Alliance for Pneumococcal
disease prevention (ASAP) Chairperson
Prof Lulu Bravo and members, country
EPI managers, and the Deputy Mayor
Malaysian ASAP representitive.
BERITA MPA – OCTOBER 2009
Prof Usa Thisyakorn of Thailand signing,
watched by HE Prof Thir Kruy.
Report
Current research and status of
new vaccines like the dengue
vaccine, adjuvanted influenza
vaccine, and malaria and
Japanese encephalitis vaccines
were presented and discussed. In
addition to advances presented
by renowned experts such as
Prof Kim Mulholand, Ron Dagan,
Joel Ward and others, basic
vaccinology and immunology
were also covered by Asian
speakers for the benefit of
some primary care practitioners.
Controversies were argued and
doubts answered, and unheard
of vaccines and companies were
represented.
Group picture with the Apsara dancers.
L-R (back row): Profs Sri Rezeki (Indonesia), Lulu Bravo (Philippines), Chok-Wan Chan (Hong Kong),
Zulkifli (Malaysia), Sajid Maqbool (Pakistan), Iqbal Memon (Pakistan) and Ron Dagan (Israel/WSPID).
one every year at different resource-limited countries and
regions. These will have to include countries like Nepal,
Bangladesh, Papua New Guinea among others.
Siem Reap Declaration 2009
The landmark Declaration states and makes signatories
commit to the improvement of child survival through
vaccination. More than a hundred people signed the
Declaration. Rhetorics aside, the Declaration makes it
known the commitment of the signatories. It is a historic
moment for vaccinology anywhere in the world and a
credit to the organisers under the leadership of Prof Lulu
Bravo and her team of dedicated workers. Led by the
Cambodian Health Undersecretary, Presidents of IPA,
ASPID and APPA, the signing by representatives and
EPI Directors from different organisations and countries
marked a new written commitment to the promotion of
immunisation in Asian countries.
The interaction among delegates helped make ASVAC
2009 a useful vehicle for networking among the EPI
managers of different Asian countries with vaccine
advocates. It should open some eyes regarding new
vaccines and help the countries in the region stay focused
on vaccinology as a means of promoting child health,
even in resource-deprived regions. 2
Although one of the main aims of holding ASVAC
2009 in Siem Reap was to enable the local Cambodian
practitioners to open up to new ideas and improve
on their vaccination practices, the number of local
attendees was only about 75. Probably owing to work
commitments, the attendance of these was also limited
throughout the conference.
The first ever ASVAC in 2009 has managed to get
many practitioners together with the majority from the
Philippines and Indonesia and it facilitated the signing of
the historic Siem Reap Declaration. It was limited in terms
of helping to increase the level of understanding and
knowledge among the local Cambodians.
Dawn excursion to Angkor Wat.
L-R: Profs Chok-Wan Chan, Sajid Maqbool, Zulkifli and Iqbal Memon.
ASVAC 2009 was indeed historic for being the first Asian
vaccine conference and also for committing policymakers and organisations to improving child survival
through vaccination. It would be a good idea to have
Zulkifli Ismail
[email protected]
BERITA MPA – OCTOBER 2009
Report
Paediatric Revision Course For
Postgraduate Students: ‘Prep 3’
11-12 April 2009, Kuala Lumpur
The idea of forming the MPA Education Subcommittee
was mooted at the MPA Weekend Retreat held
in Cameron Highlands in November 2007. This
Subcommittee is under the chairmanship of Dato’ Dr
Mohd Sham Kassim with Prof Zabidi Hussin as the
secretary. One of its primary aims is to be involved in
educational activities and training for its members and
in particular, to provide a platform whereby senior
members can impart valuable experience to trainee
paediatricians preparing for their examinations. With
this in mind, the ‘Prep 1’ course was held in March 2008
followed by the ‘Prep 2’ course in October 2008. Both
the hands-on courses received overwhelming response
from our trainees who were preparing for their M.Med
(Paediatrics) exam as well as those attempting their
MRCPCH exam. Hence, for the first 2 courses, many
candidates had to be turned down and their names
reserved for the next course.
The participants and senior paediatricians, listening attentively to
Datuk Dr Zulkifli Ismail during the slide session.
As promised to the trainees, the ‘Prep 3 revision’ was
held on the 11-12 April 2009 at the Putra Hotel, Kuala
Lumpur with the support of Paediatric Institute, Kuala
Lumpur Hospital targeting candidates sitting for the
MMed exam in May and the MRCPCH exam in June
2009. Much of the groundwork and preparation for
the 3rd course was masterminded by Professor Zabidi
Hussin of Hospital Universiti Sains Malaysia. However,
due to unforeseen circumstances, he was unable to be
present during the course and was sorely missed. The
total number of candidates was a manageable 17, mostly
those who have pre-registered. Publicity was done via email and no flyers were sent out to announce the course.
Complaints were heard after the course about the lack
of publicity and there were doctors who were interested
but were not aware of the course. Our sincere apologies
to them.
Encounter with MPA President, Dr Soo (seated in centre).
accurately and succinctly; short case teaching sessions
and clerking long cases. To make the course more
relevant for the MRCPCH candidates and in response to
their suggestions, a ‘Communication Skills’ station was
included for the first time and this was well-received by
the candidates. Overall, the active participation of the
candidates was very encouraging indeed.
Feedback
From the feedback forms that were compiled, the
candidates gave their thumbs up for the course
and found it beneficial in their preparation for their
forthcoming exams. In particular, they were happy with
the small group of participants as this provided them with
more opportunities to practice the cases. Most of them
also requested for more short cases and communication
stations. The MPA would like the participants to provide
feedback regarding their exam results as this would serve
as a useful tool in preparing for future courses.
In preparing the course content, feedback from the two
previous courses were taken into consideration to make
it more beneficial for the candidates. An excellent session
on ‘Passing and failing the Clinical Postgraduate Exams’
was given by Prof Asma Omar, imparting her wealth of
experience in being an examiner for both exams. Other
sessions included slide presentation of clinical signs
to enable the candidates to be able to describe cases
BERITA MPA – OCTOBER 2009
Report
It’s Time To Start
Vaccinating People
Against Seasonal
Influenza!
The long case clerking.
The next ‘Prep’ course has been scheduled
for March 2010 as the next exam in October/
November 2009 is too close to the MPA
Congress/ 9th World Congress of IAAH which will
be held on 28-30 October 2009.
Next Course: March 2010
On behalf of MPA, I would like to extend our
gratitude to the senior paediatricians who have
sacrificed their time to be examiners/ tutors for
the course, namely MPA President himself Dr
Soo Thian Lian, Prof Asma Omar, Prof Datuk Dr
Mohd Sham Kassim, Datuk Dr Zulkifli Ismail,
Dato’ Dr Musa Mohd Nordin, Prof Koh Mia
Tuang, Prof Bilkis Abdul Aziz and Dr Hung Liang
Choo. Our sincere thanks to Dr Johan Ariff from
Paediatric Institute for selecting and coordinating
the patients for the clinical cases and Dr
Hussain Imam Hj Muhammad Ismail for his kind
permission to use the patients for the teaching
sessions. As always, the secretariat headed by
Datin Saadiah Ahmad has been most efficient
and accommodating. Last but not least, thank
you to Prof Zabidi Hussin for all his hard work
and the participants for their attendance and
valuable feedback. Hopefully, they will pass their
exams and become MPA life members. 2
Noor Khatijah Nurani
Ipoh Hospital
[email protected]
Editor’s note: The next PREP 3 course is
scheduled for March 2010. Those preparing
for the MRCPCH or MMed (Paed) exams
should register early to avoid disappointment.
Many healthcare professionals
have been asking if
it’s too soon to start
vaccinating patients
against seasonal
influenza. The
answer is no
– CDC advises to
begin administering
seasonal influenza
vaccine as soon as vaccine
becomes available.
Vaccinating now with seasonal influenza vaccine will
allow more time for healthcare providers to focus on
later immunization efforts when vaccine for 2009 H1N1
influenza A virus becomes available. You will be vaccinating
against both seasonal influenza and 2009 H1N1, so it’s best
to get a head start on your efforts starting now.
In addition, early vaccination of children younger than age
9 years who are first time vaccinees (or who failed to get
their second dose in the preceding season) can be helpful
in assuring routine second doses before the influenza
season begins.
Finally, it’s always a good rule of thumb to take advantage
of an opportunity to vaccinate instead of relying on patients
to come back for another appointment.
Many resources regarding influenza disease and vaccination
are available to healthcare professionals and the public.
To access the National Influenza Vaccine Summit website,
go to: www.preventinfluenza.org
BERITA MPA – OCTOBER 2009
Report
The Sarawak Chapter
MPA Sarawak 2009-2010 Annual Report
Dr Wilson Pau giving his lecture.
The Malaysian Paediatric Association (Sarawak
Branch) was first established in November 2004 with
its first meeting held in Hilton Hotel, Kuching.
The following list was the office bearer that was
elected for the term 2009-2010.
President
Secretary
Treasurer
: Dr Chan Lee Gaik
:Dr Mohd Ameenudeen B.A
Sultan Abdul Kader
: Dr Wong Ann Cheng
Committee member :
Dr Kok Juan Loong
Dr Teh Hsiao Hern
Dr Ong Gek Bee
Dr Hii King Ching
Dr Siew Hui Fen
Activities
Over the year of 2009, the following activity was
carried out successfully;
BERITA MPA – OCTOBER 2009
Paediatric Infectious Disease and
Immunology Update
It had been the practice of the MPA Sarawak
branch to organise at least one Paediatric Update
course per year. In the previous years we organised
update courses on Paediatric Urology, Paediatric
Gastroenterology, Rheumatology, Endocrinology as
well as Paediatric Neurology And Metabolic Diseases.
We had invited various prominent speakers from our
country.
This year the Paediatric Department, Sarawak General
Hospital in collaboration with the Sarawak branch of
the Malaysian Paediatric Association (MPA) recently
held a one-day seminar on Paediatric Infectious
Disease And Immunology Update on 11 July 2009 at
Dewan Pesona, Sarawak General Hospital. This annual
event was held to provide a platform for paediatricians
and other healthcare workers caring for children in
Sarawak to keep abreast with the current update and
to refresh their knowledge on specific areas in the care
of children.
Report
This year’s theme of infectious disease and immunology
Paediatric Infections
was chosen in anticipation of the outbreak of hand-footOn the other hand, Dr Wilson gave lectures on paediatric
mouth disease (HFMD) predicted for 2009 following
infectious diseases from selected topics pertinent to
a 3-yearly cycle observed since 1997 with the last
our local setting from hospital acquired infection and
outbreak being 2006. The outbreak did not materialise as
candidal infection
predicted but instead
to the management
the country is faced
of typhoid and
with global outbreak
paratyphoid fever
of the novel pandemic
as well as the novel
influenza A(H1N1).
treatment option for
The update could not
pediatric HIV. An extra
have come at a better
session was added at
timing coinciding with
the end in which Dr
the rapid increase in
Wilson gave a lecture
A(H1N1) cases and
on the management
the eminent shift from
of A(H1N1) in children
containment phase
and helped to clarify
to the mitigation
some of the queries
phase. As a result, the
and uncertainties
update has garnered
brought up by the
an overwhelming
Prof Amir Hamzah receiving souvenir as a token of appreciation from Dr Chan Lee
participants.
Gaik, state paediatrician and head of department.
response with 115
participants made up
On the whole, the
of 71 nurses, 38 doctors and six healthcare workers from
paediatric update was a success. The participants were
the private medical centre.
generally satisfied and learnt a lot from a concise one-day
seminar. It is hoped that we will be able to hold more of
The panel of speakers invited for the update were
such educational events in the future in a venue of bigger
Professor Amir Hamzah, paediatric immunologist from
capacity to accommodate more participants.
Universiti Putra Malaysia, and Dr Wilson Pau, paediatric
infectious disease specialist from Hospital Tuanku
Election of a new treasurer
Ampuan. The lectures were divided into 3 sessions
During our recent MPA branch meeting on the 29 July
with each session alternating between immunology
2009 at The Banquet, Kuching, Dr Wong Ann Cheng had
and infectious disease topics. There were also two
been elected as the new treasurer to replace Dr Siew Hui
case presentations in between the sessions to keep the
Fen who requested to vacate the post. The committee
discussion lively.
acknowledged Dr Siew Hui Fen for her excellent
commitment for many years. 2
Immunodeficiency and MyPIN
Professor Amir started by giving an overview on
primary immunodeficiency, the laboratory investigations
and ended by introducing the Malaysian Primary
Immunodeficiency Network (MyPIN) online registry. He
has emphasised that there have often been a delay in
diagnosis of primary immunodeficiency and uncertain
management resulting in poorer outcome for the
patients. It is hoped that with the MyPIN, there will be a
better collaboration in the management of patients with
primary immunodeficiency.
Mohd Ameenudeen B.A Sultan
Secretary, MPA Sarawak Branch
[email protected]
Editor’s note: Congratulations to the Sarawak
chapter. We look forward to more activities from
other state committees. Let’s keep the activities going
and send your reports to us.
BERITA MPA – OCTOBER 2009
Report
Diabesity Camp 2009
16 August 2009, Putrajaya, Selangor
Participants and Facilitators of Diabesity Camp.
Diabesity is a term coined from the word diabetes and
obesity. Increasing prevalence of childhood obesity
has led to the increasing incidence of type 2 diabetes
diagnosed in the young. Management of type 1 and
type 2 diabetes mellitus and obesity has always been a
challenging task. Reinforcement of behavioral change
and counseling conducted in a doctor’s office often
prove difficult mainly due to the limited time.
2. to create awareness of obesity and the importance
of having an ideal body weight
3. to promote the sharing of knowledge and ideas
among the participants.
A total of 33 children and adolescents aged 7 to 17
years from Hospital Putrajaya, Hospital Kuala Lumpur
and Malaysian Diabetes Association participated in
the event. There were 6 doctors, 1 diabetes educator,
2 dietitians, 1 counselor and 20 facilitators. Parents
were not allowed to be present in the campsite
to allow more freedom and independence for the
children.
As part of our annual educational program, the
Paediatric Department of Putrajaya Hospital organised
the Diabesity Camp on 16 August 2009, at Wetlands,
Putrajaya. As the name suggests, Diabesity Camp
saw a mix of both diabetic and obese patients. A
catchy theme of ‘I Love Me’ (Saya Sayang Diri Saya)
was chosen to create the feeling of loving and caring
for oneself by better understanding of their medical
conditions. All participants wore T-shirts displaying the
theme on that day. This will motivate the participants
to be more responsible in taking care of themselves.
Registration took place in the lobby of Hospital
Putrajaya at 7.00am. In view of the current A(H1N1)
pandemic, all participants were given facemasks and
their temperature was measured. Goody bags with
hypo-kits were given to the diabetics while the obese
children received happy-kits that contained a healthy
snack - an apple. The children boarded the Nadi Putra
buses to the campsite. Everybody was eager to see
the campsite, which was surrounded by nature that
proved to be both welcoming and exciting.
The objectives of the Diabesity Camp
were as follows:
1. to increase the patients’s knowledge on
diabetes care
BERITA MPA – OCTOBER 2009
10
Report
Exercise!
rice bags were heavy, invariably all answered yes.
They were then reminded that they were actually
carrying the weight with them everyday
At the campsite, the program kicked off with
light stretching
exercise followed by
aerobics. Then there
was a demonstration
of taekwondo by the
Malaysian Taekwondo
Federation Troupe.
Many children, though
untrained in the martial
art were amazed and
excited to imitate the
high-powered moves
We brush our teeth daily.
and kicks. In fact, some
actually did pretty well
for first timers. We wanted to show the children
that taekwondo is another form of exercise besides
self defense. Hopefully one day they will take up
taekwondo as a hobby.
Nature Walk
After a light breakfast, they took the trams to
the interactive centre of Taman Wetlands. Upon
arrival, everyone had to perform the infamous
chicken dance, a light-hearted but surprisingly
vigorous dance-exercise. The nature walk began
with a visit to the museum displaying the way
of life of the Orang Asli, local fresh water fishes,
marshland vegetations and an array of migratory
birds. They then embarked on the nature trail and
were introduced to an amazing variety of plants/
trees by the knowledgeable guides of Perbadanan
Know your excess weight
After exercise, the diabetics had their glucose
monitored, while the obese participants were
introduced to the ‘Know Your Excess Weight
Session’. Selected obese participants were invited
to the stage to lift their excess weight in the form
of bags of rice. Bags of rice of 1kg each were
chosen to simulate excess weight that they have
been carrying everyday. Most of them could not
manage to hold more than 5kg of rice bags in
their palms, though that was still far below their
excess weight. When they were asked whether the
Look at us! The future Taekwando experts.
Putrajaya. Among the highlights of the nature
walk were the pelicans and the observatory tower
that overlooked the scenic Putrajaya. Though they
were tired after the 1.5km walk, one could see
from their expressions that they were excited and
intrigued by a dose of Mother Nature.
Celebrating Ramadan
The participants were then introduced to the ‘do’s
and don’ts’ of eating during Ramadan. The obese
patients were taught how not to overeat during
breaking fast as well as to identify foods that are
both healthy and wholesome. The diabetic patients
were taught on how to alter their insulin regime
during the fasting month and Hari Raya.
You are 12 kg overweight but carrying 9 kg is
already a challenge!
11
BERITA MPA – OCTOBER 2009
Report
selected. Games such as filling up a bottle
with water and blowing balloons was
accompanied with much laughter and
joy not only from the participants but the
facilitators as well. Some decided to cheat in
order to help their teams to win.
The highlight of the game was to dress up a
team member from each team as creative as
possible using newspaper, toilet paper, leaves
and twigs found from the campsite. Each
team dressed their models up as a princess,
bride, etc. The children showed teamwork
amidst the excitement to complete the task
in time. They were then made to model
their creations as a
fashion show which
generated much laughter
and applause from the
audience.
Participants and Facilitators of Diabesity Camp.
Motivating the participants
The need to motivate a patient to adhere to
strict regiments of therapy is often difficult and
frustrating. A pep talk was given to increase their
motivation in combating their condition. The
concept of ‘Saya Boleh’ was reinforced by making
them say ‘Saya boleh’ out loud and to sing the well
known ‘Fikirkan Boleh’ which was first popularised
in the late 80s.
Finally, the fun-filled day
ended with a prize giving
ceremony. All teams for
the telematch were given
prizes according to their
standing. Special prizes
Uncle Ernie is my new best friend.
were also given to the
most active obese patient
and diabetic with the best glycaemic control for
the day.
Understanding
the complication
of diabetes and
obesity
After lunch, the diabetic
participants were given a
lecture on hypoglycemia
- focusing particularly on
identifying hypoglycemia,
measures to be taken
to prevent and treat
Puteri Indera Kayangan.
hypoglycemia. Concurrently,
the obese participants were
lectured on the ills of obesity. They were both
shocked and amused by the story of a 570-pound
Manuel Uribe from Mexico with pictures portraying
his immobility.
From the feedback forms analysed, almost all
participants commented that they had fun, made
new friends, gained knowledge and expressed their
interest to join the next camp. Many of the obese
children wanted to lose weight, indicating that they
have learnt from the camp. Though the facilitators
were tired, we were all very happy to be able to
contribute to the learning process of these children
and make some impact in their lives. 2
Jagdev Singh, Eugene Yeoh, Nur Arina,
Rodhyah Abdul Rahman,
Janet Hong, Fuziah Md Zain
Paediatric Department, Hospital Putrajaya
[email protected]
Telematch time
In order to break the monotony of lectures, a
telematch was conducted. Games that promoted
physical activity and group co-operation were
BERITA MPA – OCTOBER 2009
12
News
ACIP Recommendations For
Use Of Influenza A(H1N1) 2009
Monovalent Vaccine
August 24, 2009
CDC published “Use of Influenza A (H1N1) 2009 Monovalent Vaccine: Recommendations of the Advisory
Committee on Immunization Practices (ACIP), 2009” in an August 21 MMWR Early Release. The summary
follows in its entirety.
This report provides recommendations by CDC’s Advisory Committee on Immunization Practices
(ACIP) regarding the use of vaccine against infection with novel influenza A(H1N1) virus.
Information on vaccination for seasonal influenza has been published previously (CDC.
Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory
Committee on Immunization Practices [ACIP], 2009. MMWR 2009;58 [No. RR-8]). Vaccines against
novel influenza A(H1N1) virus infection have not yet been licensed; however, licensed vaccine is
expected to be available by mid-October 2009. On July 29, 2009, ACIP reviewed epidemiologic
and clinical data to determine which population groups should be targeted initially for vaccination.
ACIP also considered the projected vaccine supply likely to be available when vaccine is first
available and the expected increase in vaccine availability during the following 6 months. These
recommendations are intended to provide vaccination programs and providers with information
to assist in planning and to alert providers and the public about target groups comprising an
estimated 159 million persons who are recommended to be first to receive influenza A(H1N1)
2009 monovalent vaccine. The guiding principle of these recommendations is to vaccinate as many
persons as possible as quickly as possible. Vaccination efforts should begin as soon as vaccine is
available. State and local health officials and vaccination providers should make decisions about
vaccine administration and distribution in accordance with state and local conditions. Highlights of
these recommendations include:
1
The identification of five initial target groups for vaccination efforts, viz:
• Pregnant women
• Persons who live with or provide care for infants aged <6 months
• Healthcare and emergency medical services personnel
• Children and young adults aged 6 months to 24 years, and
• Persons aged 25-64 years who have medical conditions that put them at higher risk for
influenza-related complications
2
3
Establishment of priority for a subset of persons within the initial target groups in the event that
initial vaccine availability is unable to meet demand, and
Guidance on use of vaccine in other adult population groups as vaccine availability increases.
Vaccination and healthcare providers should be alert to announcements and additional
information from state and local health departments and CDC concerning vaccination against
novel influenza A(H1N1) virus infection. Additional information is available from state and local
health departments and from CDC’s influenza website.
Source: www.cdc.gov/flu
13
BERITA MPA – OCTOBER 2009
Positive Parenting Reaches out to
Selangor Community!
Mid this year, Yayasan Warisan Anak Selangor (YAWAS), an organisation under the Selangor state government
that looks into the welfare programmes, invited Positive Parenting to give talks in their events for Majlis
Penyerahan Kad Si Manja TAWAS (Tabung Warisan Anak Selangor). TAWAS is the Selangor’s Merakyatkan
Ekonomi Selangor (MES) where a saving fund is set up for registered TAWAS children in the state.
Venue
Date
Speakers
Shah Alam
June 21
Nutritionist Assoc Prof Dr Poh Bee Koon
Paediatrician Dr Rajini Sarvanathan
Hulu Langat
July 26
Nutritionist Assoc Prof Dr Norimah A Karim
Many parents, together with their young ones, benefitted from the
educational talks on healthy nutrition and simple yet practical tips; and
immunisation and common childhood diseases.
Positive Parenting aims to reach out further to the rural community and
beyond the boundaries of Selangor in 2010.
Drs Poh Bee Koon
and Rajini handling
questions (note the
kebaya and baju
kurung).
Annual General Meeting
MPA’s 31st AGM will be held on Wednesday, 28 October 2009, at the Shangri-La Hotel,
Kuala Lumpur starting at 4.00 pm. All members are invited to attend. One of the decisions to be made is
the tagline for MPA from the four that were presented in the July issue of Berita MPA. This year is also
Election Year so see you there to decide on the short-term future of MPA for the next two years.
To remind you, the four short-listed taglines are:
• Building the foundation for our children’s future
• Meeting our children’s needs
• Working for children, the nation’s future
• Working for the health of our children
BERITA MPA – OCTOBER 2009
14
Announcements
9th World Congress of International Association for
Adolescent Health,
in conjunction with 31st Malaysian Paediatric
Association Annual Congress
19th Annual Meeting Of The Medical Research
Society Of Pakistan
Date
: 31 October 2009
Venue
: University of Health Sciences (UHS), Lahore
Secretariat : Ms. Aniqa Agha
Shaukat Khanum Memorial Cancer
Hospital & Research Center
7 - A, Block R-3, Johar town
Lahore, Pakistan
Tel
: + 92 42 594 5100 ext 2524
Fax
: + 92 42 594 5205
E-mail
: [email protected]
Private Lives, Public Issues: Global Perspectives on
Adolescent Sexual Health
Date
: 28-30 October 2009
Venue
: Shangri-La Hotel, Kuala Lumpur
Secretariat : IAAH 2009, Malaysian Paediatric Association
3rd Floor, Annexe Block
National Cancer Society Building
66 Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur
Tel
: + 603 2698 9966, +603 2691 1537
Fax
: + 603 2691 3446
Email
: [email protected], [email protected]
Website
: http://iaah2009.com
5th Asia Pacific Congress in Maternal
Fetal Medicine
Date
Venue
: 6-8 November 2009
: Hyatt Regency Hong Kong, Shatin, Hong Kong SAR,
China
Secretariat : APCMFM Secretariat
1/F, Block E, Dept of O&G
Prince Wales Hospital, Shatin, Hong Kong
Tel
: + 852 2632 1535
Fax
: + 852 2636 0008
Email
: [email protected]
Website
: http://www.fetalmedicine.hk/en/apcmfm/apcmfm.asp
Annual Paediatric Postgraduate Course (UM
Faculty of Medicine, Department of Paediatrics)
Paediatric Infectious Diseases
Date
: 12-13 November 2009
Venue
: Dewan Jemerlang, Pharmacy Building
Faculty of Medicine, University of Malaya
Enquiries : Professor MT Koh, [email protected]
Cik Natasha Alia bt Md Yusof, [email protected]
8th ISPCAN Asia Pacific Regional Conference on
Child Abuse & Neglect
2nd International Conference of Rural Medicine
(ICORM) 2009
Incorporating the 12th Australasian Conference on
Child Abuse & Neglect
Child Abuse & Neglect: Looking Through the Lens of Prevention
Facing Global Challenges in Rural Medicine: An International
Collaboration
Date
Venue
: 23-25 November 2009
: Universiti Malaysia Sabah; Rural Medicine Education
Centre (RMEC); Grand Ballroom, 1 Borneo
Secretariat : School of Medicine, Universiti Malaysia Sabah
Locked bag 2073, 88999 Kota Kinabalu, Sabah,
Malaysia
Tel
: + 6 088 320 000 (5552), + 6 019 870 8766
Fax
: + 6 088 320 039
Email
: [email protected]
Website
: http://www.ums.edu.my/conferences/ICORM2009
Date
: 15-18 November 2009
Venue
: Perth, Australia
Secretariat : Expertevents
PO Box 377, Moorooka QLD
4105 Australia
Tel
: + 61 7 3848 2100
Fax
: + 61 7 3848 2133
Email
: [email protected]
6th World Congress of the World Society for
Pediatric Infectious Diseases
11 Annual Conference of Pediatric Cardiac Society
of India
th
Date
: 18-22 November 2009
Venue
: Buenos Aires, Argentina
Secretariat : Kenes International
1-3 Rue de Chantepoulet
PO Box 1726
CH-1211 Geneva 1 Switzerland
Tel
: + 41 22 908 0488
Fax
: + 41 22 732 2850
Email
: [email protected]
Website
: http://www2.kenes.com/wspid/pages/home.aspx
Postgraduate Institute of Medical Education & Research (PGIMER)
Date
: 23-25 October 2009
Venue
: Advanced Cardiac Centre, PGIMER, Chandigarh, India
Secretariat : Advanced Cardiac Centre
PGIMER, Sector 12
Chandigarh, India. Pin – 160012
Tel
: + 91 99142 19552, + 91 98155 53602
Fax
: + 91 172 2744401
Email
: [email protected]
Website
: http://www.pcsi2009.org
The Executive Committee
wishes all members
13th National Health Science Research Symposium
Impact of Water & Sanitisation on Health: Our Problems &
Our Solutions
Happy
Deepavali
Date
: 27-28 October 2009
Venue
: Aga Khan University, Karachi, Pakistan
Secretariat : Aga Khan University
PO Box 3500, Stadium Road, Karachi, 74800 Pakistan
Tel
: + 92 21 3486 4584
Fax
: + 92 21 3493 4294
Email
: [email protected]
Website
: http://www.aku.edu/events/nhsrs2009/index.shtml
15
BERITA MPA – OCTOBER 2009