Has Malaysia Bent the Curve in the Fight Against Hepatitis B & C?

WORDS LIM TECK CHOON

FEATURED EXPERT
DR PHILIP PANG BOON CHEONG
Consultant Gastroenterologist and Hepatologist
Subang Jaya Medical Centre
A QUICK OVERVIEW OF HEPATITIS B & C
Hepatitis B
  • It’s a viral infection that attacks the liver.
  • It’s caused by the hepatitis B virus (HBV)
  • Can be acute (short-term) or chronic (long-term).
  • Transmitted through blood, semen, and other body fluids.
  • Currently, there is no cure available.
  • Vaccination provides a greater degree of protection against HBV infection.
Hepatitis C
  • It’s also a viral liver infection.
  • It’s caused by the hepatitis C virus (HCV).
  • It often becomes chronic or long-term.
  • Primarily transmitted through blood-to-blood contact.
  • No vaccine available, but treatable with direct-acting antiviral medications (97% cure rate).
WHY IS THERE A FIGHT AGAINST HEPATITIS B & C?

Dr Philip Pang reveals the following:

  • Hepatitis B and C are considered silent killers because they are often undiagnosed until health complications arise.
  • These diseases progress while undetected to cause severe liver damage and even cancer.

“Viral hepatitis is preventable and treatable. Thus, it is crucial that effective intervention measures are put in place,” Dr Pang shares.

HOW DO WE FIGHT AGAINST THESE TWO FORMS OF HEPATITIS?
  • 3 doses of the hepatitis B vaccine are administered to all newborns before they turn 1.
  • “The Ministry of Health (MOH) has also implemented targeted health screenings for high-risk populations including pregnant women and those with family history,” says Dr Pang.
  • Wider access to affordable direct-acting antivirals has led to a significant drop in chronic hepatitis C cases.
  • The Ministry of Health has also developed the National Strategic Plan for Hepatitis B and C (NSPHBC) 2019-2023 with the aim of eliminating hepatitis B and C by 2030. This comprehensive plan outlines a structured approach to prevention, diagnosis, treatment, and care to combat viral hepatitis.
HOW ARE WE DOING THUS FAR?
  • Statistics show that in Malaysia, an estimated 1.1% of the population is infected with hepatitis B virus in 2017, and 2.5% with hepatitis C virus in 2019.
  • Viral hepatitis is the seventh most common cause of mortality in our country.
  • 94% of deaths from chronic hepatitis B and C infections are caused by cirrhosis (severe scarring of the liver) and liver cancer.
THE DRIVE FOR GREATER PREVENTION OF HEPATITIS B

Hepatitis B is not treatable at the moment, although early diagnosis can allow for proper measures to be taken so that individuals with this disease can still lead a fairly active and productive life.

However, many individuals with hepatitis B are unaware of their status and often go undiagnosed.

“An individual with hepatitis B is like having a neighbour who lives together in harmony, but you don’t know when your neighbour would one day go crazy,” Dr Pang tells us.

He goes on to say: “If we can fight hepatitis B in this generation, we are well on our way to eliminating it by 2030. Yet, we are far from achieving this goal. More needs to be done to raise public awareness about hepatitis B transmission, prevention methods, and the importance of vaccination.”

Pregnant Moms

The lack of symptoms can lead to pregnant mothers being unaware that they have hepatitis B, which increases the risk of mother-to-child transmission.

Routine blood tests during pregnancy can help identify these cases.

“Early detection allows for proper management, Pregnant mothers may be given antivirals and newborns given an immunoglobulin injection, specifically hepatitis B immunoglobulin, within 24 hours after birth” Dr Pang says.

For the newborn, the immunoglobulin injection provides a temporary protection against hepatitis B infection until the baby’s own immune system can develop immunity through vaccination.

People Living with Hepatitis B

Dr Pang recommends that individuals with hepatitis B should see their doctors once a year and undergo a routine blood test, which monitors their viral load.

Those who are 40 years old and above and present with symptoms should see their doctors more often, every six months, and undergo liver cancer surveillance.

Consider Hepatitis Vaccination and Stay Safe
  • Vaccination is key for improving our protection against hepatitis A and B.
  • Practice safe sex and good hygiene are vital.
  • Avoid sharing needles and personal care items.
  • Ensure safe practices during procedures that involve needles, such acupuncture or tattooing.

Let’s Talk about HPV with a Doctor

WORDS DR RAHIMAH RAHIM

FEATURED EXPERT
DR RAHIMAH RAHIM
Medical Doctor
Klinik Amaya
Question 1
WHAT IS HPV?

The human papilloma virus or HPV is a very common virus transmitted through skin-to-skin contact, including sexual activity.

Most HPV infections do not cause any symptoms and can clear up on their own.

However, some strains can lead to serious health issues like genital warts and cancers, particularly cervical cancer.

The risk of HPV infection increases with certain behaviors such as having multiple sexual partners, engaging in unprotected sex, and smoking.

How HPV infects human cells. Click on the image for a larger, clearer version.

Question 2
IF HPV INFECTION CAN SHOW NO SYMPTOMS, WHAT CAN WE DO TO FIND OUT WHETHER WE HAVE BEEN INFECTED?

Screening for HPV is vital because it helps detect abnormal cell changes early, before they have the chance to progress into cancer.

Cervical screening, which includes HPV testing, is essential for identifying high-risk HPV strains.

High-risk HPV strains can lead to abnormal cell changes in the cervix, which, if left untreated, may progress to cancer. Hence, early detection through HPV testing allows for close monitoring and timely intervention, preventing the development of cervical cancer. This proactive approach is essential in maintaining women’s health and well-being.

Question 3
CAN YOU TELL US ABOUT THE HPV VACCINE?

The HPV vaccine is the most effective way to prevent HPV infections and the associated cancers.

It is safe, effective, and recommended for both males and females starting at age 9.

The vaccine is administered as a series of shots and provides protection against several high-risk HPV strains.

Vaccination, combined with safe sex practices, using condoms or dental dams, and limiting the number of sexual partners, greatly reduces the risk of HPV transmission.

Question 4
WHAT ARE THE TREATMENT OPTIONS AVAILABLE FOR PEOPLE WITH HPV?

Healthcare providers can offer comprehensive guidance on screening, diagnosis, and treatment options for those affected by HPV infections.

This includes regular monitoring for abnormal cell changes, treatment for genital warts, and appropriate interventions for any pre-cancerous conditions.

Digital health solutions can be leveraged to enhance our approach in managing HPV. These solutions facilitate seamless patient-doctor interactions, enabling us to schedule and conduct HPV screenings efficiently. Patients can conveniently access consultations and receive timely reminders for screenings, which are crucial for early detection. This technology not only streamlines our workflow but also empowers patients to take proactive steps in their healthcare journey.

For further information, individuals can consult with healthcare professionals. Our goal is to provide comprehensive care and support to those affected by or at risk of HPV.

 

Two Experts Explain Why Coaching in Palliative Care Is Necessary for the Wellbeing of Our Population

WORDS DR JESRINA ANN XAVIER & DR LIEW KEAN YEW

FEATURED EXPERTS

DR JESRINA ANN XAVIER
Senior Lecturer
School of Management & Marketing
Faculty of Business & Law
Taylor’s University
DR LIEW KEAN YEW
Palliative Care Specialist
Hospital Ampang
INTRODUCING PALLIATIVE CARE
  • Palliative care is specialized medical care for people living with serious illnesses.
  • It aims to improve the quality of life for patients and their families associated with life-threatening illnesses.
  • Palliative care services were first offered in Malaysia in 1995, and they are gradually being included in the standard healthcare system.
RISING NEED OF PALLIATIVE CARE
  • The need for palliative care is on an upward trend all over the world due to the ageing population and the rising burden of chronic diseases.
  • In Malaysia, the proportion of palliative care needs to deaths hovered at 71% in the observed years. By 2030, it is observed that the growth for palliative care specifically will increase to 240%.
  • Sarawak, Perak, Johor, Selangor, and Kedah will become the top five Malaysian states with the highest needs in 2030.
COACHING IN PALLIATIVE CARE
  • Coaching in palliative care refers to the practice of providing support, guidance, and education to individuals facing terminal or life-threatening illnesses, as well as their families and caregivers.
  • It aims to improve quality of life by early detection and treatment of pain and symptoms.
  • It also enables patients and their families to take an active role in choosing how they will be treated, reclaiming a sense of control over their lives.
THE BENEFITS OF COACHING IN PALLIATIVE CARE
Improved Communication and Expression Skills
  • Anthony Grant, a revered psychologist, informs that coaching can be considered an emerging cross-disciplinary occupation, with the main goals being to improve performance, enhance well-being, and support organizational and individual change.
  • Palliative care coaching adopts a comprehensive strategy, acknowledging that every person’s experience with illness is distinct and multifaceted.
  • Coaching helps individuals develop their communication skills and express their needs, preferences, and concerns more effectively.
  • It can lead to increased satisfaction in care outcomes.
Assists in Enhancing Patient Wellbeing 

Through a coping mechanism, palliative care coaching assists patients and their families through goal setting, problem-solving, and symptom management.

Empowers Patients and Their Loved Ones to Make Informed Decisions
  • Making decisions about treatment options, advance care planning, and end-of-life care is rather challenging when undergoing treatments.
  • By providing information, the clarification of options, and assistance in weighing the advantages and disadvantages of various possibilities, coaching makes it easier for patients to advocate for their rights and choices.
Providing Patient-Centered Care
  • Coaches can deliver patient-centered care that respects people’s cultural backgrounds, attitudes, and beliefs.
  • Palliative care coaching helps patients, families, and healthcare professionals coordinate and collaborate, which promotes continuity of treatment to achieve shared objectives.

Survivors Speak, Our Hearts Listen: Real and Inspiring Stories & Advice from Cancer Survivors

WORDS LIM TECK CHOON

THE DOCTOR’S STORY

Dr Zahrina Azian Zohadie’s world changed irrevocably when she was diagnosed with stage 4 colon cancer.

Since the cancer is at stage 4, it means that the cancer cells had spread from the colon to other parts of the body.

Staying strong for her children

“My cancer treatment was indeed challenging, but I had no other choice. I had to go through it,” Dr Zahrina said during a recent cancer survivor event at Columbia Asia Hospital–Bukit Rimau. “My children needed their mother. Despite the harsh effects of chemotherapy on my body, I persevered. In my mind, all this hardship will be worth it for those I love and those who love me.”

Once you have cancer, you have no option but to fight it

This was Dr Zahrina’s belief.

“The cancer is already in our bodies, so we must move forward because there’s nothing else we can do,” she elaborated. “We must continue with treatment.”

She was blessed to have encouragement and motivation from a close friend and colleague, an oncology specialist.  “Her advice, no matter the situation, is to keep going with the treatment. Her words of encouragement have been very helpful to me,” she said.

Having survived, she now offers her strength to others living with cancer

As a cancer survivor, Dr Zahrina felt that it was her vocation to offer her support to other cancer patients, bolstering their spirits with encouragement and support similar to what she received during her own cancer journey.

“During treatment, I felt like I was facing this painful challenge alone. But over time, I realize there are many others like me,” she shared.

Dr Zahrina is presently a member of the KanWork Cancer Support Association (link opens in a new tab).

THE BREAST CANCER SURVIVOR’S STORY

Norhaisnah Naian is a breast cancer survivor and a volunteer at KanWork.

Recalling her breast cancer journey, she shared: “In those days, I diligently sought information on how to get assistance from organizations like MAIS, Baitulmal, Lions Club, and many more.”

“When I attended chemotherapy sessions, I met other cancer patients from all walks of life,” she continued. “Naturally, I share information with them like where to find resources related to cancer. This is how I help other patients.”

Seek the company of supportive people with positive energy

“I fully understand how painful the experience of a cancer patient can be,” Norhaisnah said. “My advice is to find friends with positive energy and positive vibes.”

She pointed out that the volunteers at KanWork sought to be these allies for people living with cancer.

“I’ve been with Kanwork for over a year. We meet many former patients and current cancer patients whom we continue to motivate,” she told us.

A MEDICAL OFFICER REMINISCENCES ABOUT HER EXPERIENCES
FEATURED EXPERT
DR HEMA DARSHINEE JOHNSON
Oncology Medical Officer
Columbia Asia Hospital–Bukit Rimau

Dr Hema Darshinee Johnson revealed that a doctor’s approach to cancer patients is not as straightforward as prescribing medications.

She explained: “As doctors, we give treatment plans, and we tell patients to take certain medicine. On top of that, we tell them the side effects. Sometimes we tell them up front. But for them, even trivial things like brushing teeth can eventually become difficult at some point. It is always easier to say, ‘Be positive!’, but we will never understand what it’s like to be in their shoes. Their life turns upside down. That’s why it amazes me to see how they find the strength to continue.”

Grit and determination 

She recalled a domestic helper that had to travel back and forth to the hospital for treatment. “This lady took an 8-hour bus ride starting at midnight to arrive early at KL Sentral, then took a Grab to the hospital and then back. She knows the costs beforehand, so she cleans more houses to be able to afford the trip.”

Dr Hema felt humbled by these courageous people. “At the end of the day, my role as a doctor is only to assist them. I am only providing some form of lifeline, but they are the ones who are holding on to it and swimming across. It is all them.”

A reason to keep fighting

“It is beyond me to understand the grit they have but it is always about the ‘why’,” she mulled. “Everyone will have a reason to continue fighting whether it is their spouse, parents, children, or just not wanting to take life for granted and to give it their best. When you have found your reason; this journey becomes that much more purposeful. Together, we can surely win this.”

OVERCOMING THE STIGMA

Rozita Shafei, who has stage 1 cervical cancer, shared that people living with cancer often become stigmatized by others.

She said, “At first, I felt down. Friends distanced themselves because they fear they may get cancer. I felt isolated but thankfully, I received much support from my children and husband.”

She emphasized that emotional support is crucial for someone undergoing cancer treatment.

“My advice to those undergoing cancer treatment is to stay positive, strengthen your spirit, and believe in yourself.”

Her advice was echoed by Nurul Balqis, who was diagnosed with breast cancer since September 2023.

“All my children understand is that Mama always goes to the hospital. If I don’t go for a few days, they ask, ‘Mama didn’t go to the hospital today?'” she shared, adding that their concern strengthened her determination to continue her treatment.

“Besides that, I try to look forward and stay positive,” she further said.

RECOGNIZING THE RESILIENCE AND COURAGE OF CANCER SURVIVORS

This sharing session was held in conjunction with Cancer Survivors Month in June.

Additionally, Columbia Asia Hospital—Bukit Rimau announced a 3-year partnership with the Breast Cancer Welfare Association (BCWA) through a memorandum of understanding.

This partnership aspired to empower volunteers from KanWork, who are cancer survivor themselves, to provide emotional and moral support to cancer patients.

The ceremony was attended by guest of honour YB Puan Jamaliah Jamaluddin, the Selangor State Health & Environment Exco.

“Today, as we celebrate Cancer Survivors Day, we honor those who have fought and survived cancer, acknowledging their resilience and strength,” she said in her speech.

 

Experts Highlight the Urgent Need for Blood Donation in Malaysia and What We Can Do about This

WORDS DR FARZANA RIZWAN & DR IMAM SHAIK

FEATURED EXPERTS

DR FARZANA RIZWAN
Senior Lecturer
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University		 DR IMAM SHAIK
Senior Lecturer
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University

Blood transfusion is a lifesaving medical intervention for patients undergoing complex surgeries, experiencing blood loss due to trauma or childbirth, suffering from chronic illnesses and blood disorders, and even during cancer management.

VOLUNTARY BLOOD DONATION PROGRAMMES ARE CRUCIAL FOR MAINTAINING A SAFE AND ADEQUATE SUPPLY OF BLOOD AND BLOOD PRODUCTS
  • That said, currently only 2.2 % of Malaysians donate blood in a year, compared to 3.5–5% in the developed countries.
  • The pre-pandemic blood donation rate was 22.8 donors per 1,000 people, which declined to 19.7 to 22.5 donors per 1,000 population between 2020 and 2022.
  • However, the demand of blood and blood products has increased due to a rise in motor vehicle accidents and the increase in the number of transfusion-dependent patients.

According to our Health Minister Datuk Seri Dr Dzulkefly Ahmad, the country needs more blood donors to maintain a ‘safe zone’ of blood stock to meet the nation’s daily demand of at least 2,000 blood bags.

The Ministry of Health targets 35 to 40 donors per 1,000 population by 2030.

HOW CAN WE ACHIEVE THIS TARGET?
  • Young people 17 years old and above are urged to come forward to help achieve this goal.
  • The community needs to choose the right direction, have a positive mindset, and move away from the myths and negative perception surrounding blood donation.
  • Seek guidance from the good practices that are in place in other countries. For example, we can focus more on ‘targeted recruitment’ to obtain donations from specific ethnic groups if there are certain blood groups that are difficult to find in others.
  • Adopt innovative methods of education and engagement of young students to promote school-, college-, and university-based blood donation drives.
  • The use of mobile apps to facilitate online bookings, reminders, re-scheduling, and appointment cancellation systems provides convenience to the community. The use of mobile technology in tracking the donor eligibility and getting donor feedback would be helpful to make blood donation experience more pleasant and smooth.
DO YOU KNOW THAT DONATING BLOOD CAN ALSO BE GOOD FOR YOUR HEALTH?
  • Improves blood circulation to your tissues and organs.
  • Maintains iron balance—the difference between the amount of iron taken up by the body and the amount lost—in the body.
  • Reduces the risk of hardening and narrowing of the arteries from the accumulation of iron in the artery walls.
  • Reduces the risk of heart attack by reducing arterial blockages.
  • Reduces excessive iron in the blood and decreases the risk of certain cancers. Iron is a source of cancer-causing free radicals, which can damage cells and alter their functions.
  • A therapeutic phlebotomy—a procedure to reduce the excessive iron and number of red blood cells in the body—for individuals with blood diseases such as hereditary hemochromatosis, polycythemia vera, and other rare conditions.

Additionally, there are many medical privileges offered to donors in Malaysia, such as free outpatient treatment and hepatitis B vaccination, among others.

BECOMING A BLOOD DONOR IS A SIMPLE WAY TO CONTRIBUTE TO YOUR COMMUNITY

Check with local hospitals or blood donation centers to find out where and when you can donate your blood.

Why Is the Dengue Vaccine Needed? An Associate Professor Answers More Questions About the Vaccine

WORDS ASSOCIATE PROFESSOR DR VERNA LEE KAR MUN

FEATURED EXPERT
ASSOCIATE PROFESSOR DR VERNA LEE KAR MUN
Family Medicine Specialist
IMU Healthcare
WHY IS THE QDENGA VACCINE NECESSARY? WE ALREADY HAVE PREVENTIVE MEASURES SUCH AS FOGGING TO PREVENT THE AEDES MOSQUITO FROM BREEDING.

Fogging is effective in killing the Aedes mosquitoes. Its effect is immediate, extending to an average of 72 hours.

Fogging Works, but There Are Some Drawbacks

While fogging has been the main means to mitigate dengue infection in Malaysia, however, health offices are usually informed after the infection have been notified. As a result, fogging by itself does not reduce severe dengue infection that requires hospitalizations.

Furthermore, the resistance of the Aedes mosquitoes to insecticides is increasing. This decreases the effectiveness of fogging to control the population of these mosquitoes.

The Role of Dengue Vaccines

On the other hand, dengue vaccines have been proven to be effective in reducing the numbers of severe dengue infection requiring hospitalizations.

THERE WAS SOME CONTROVERSY WITH REGARDS TO THE SAFETY PROFILE OF THE PREVIOUS DENGUE VACCINE. SHOULD WE BE CONCERNED ABOUT THE QDENGA VACCINE?

Just like any new drug or new medical technology, there is very limited data from clinical practice in the early days. There would be many concerns.

Dengvaxia, the First Dengue Vaccine

The first dengue vaccine, Dengvaxia, was approved in April 2018.

It is safe in persons who have had dengue virus infection in the past (seropositive individuals), but it also increases the risk of severe dengue in those who experience their first natural dengue infection after receiving their vaccination (seronegative individuals).

Hence, pre-vaccination screening for past dengue infection is recommended before one receives the Dengvaxia vaccine. Only people with evidence of past dengue infection—indicated by the presence of dengue IgG antibody in their blood—would receive this vaccination.

About the Newest Vaccine, Qdenga

A second vaccine for dengue, Qdenga, received prequalification from the World Health Organization (WHO) on 10 May 2024.

Is it safe?

  • Overall, during the clinical trials, the vaccine was well tolerated. The most frequent reported vaccine-related adverse events were injection site itchiness, bruising, and fever.
  • An excess of hospitalized dengue virus serotype 3 (DENV3) infections was reported among baseline seronegative children, but it was not statistically significant.
  • There was also an excess of cases of severe dengue among seronegative vaccinees, all of which were caused by DENV3, but, again, the difference was not statistically significant.
  • An increase in the risk of dengue infection requiring hospitalization or severe dengue due to DENV3 in vaccinated seronegative subjects cannot be conclusively ruled out. We probably need to wait for more data.

How about allergy reactions?

During the clinical trial, no cases of severe allergy reaction or anaphylaxis were observed.

However, cases of anaphylaxis associated with this new vaccine occurred following the vaccine’s introduction to children between the age of 10 and 14 years in Brazil since February 2024, with 16 cases were reported (4.4/100,000 doses administered), including 3 cases of anaphylactic shock (0.8/100,000 doses administered).

The currently approved package insert for the vaccine describes precautionary measures to mitigate the risk of anaphylaxis. A full assessment of the national immunization programme is underway.

THE QDENGA VACCINE IS SAID TO BE ABLE TO IMMUNIZE AGAINST ALL FOUR SEROTYPES OF DENGUE VIRUS. WHY IS THIS A GOOD THING?

Dengue viruses belong to the genus Flavivirus.

The dengue virus. Click on the image for a larger, clearer version.

Flaviviruses are lipid-enveloped, single-stranded RNA viruses. The structural pre-membrane (prM) and envelope (E) proteins are embedded in the lipid envelope and are displayed on the surface of virions.

There are 4 dengue virus serotypes (DENV1, DENV2, DENV3, and DENV4); the serotypes share structural proteins (prM and E) but are genetically and serologically distinct.

Infection with 1 serotype induces sustained protection against the same serotype only. Although uncommon, an individual without a vaccine can be infected by each serotype for a total of 4 infections during their lifetime.

Serotypes and Infections

People who acquire a second dengue infection caused by a different serotype are at a higher risk for severe dengue once cross-protection induced by the first infection wanes.

Potential mechanisms for increased risk of severe dengue caused by a second infection include:

  • Cross-reactive antibodies binding to a different DENV serotype, which then enable uptake in inflammatory cells. This leads to higher and more prolonged virus count in the blood circulation (higher temperature and prolonged fever) that induces imbalanced pro-inflammatory and anti-inflammatory responses often referred to as antibody-dependent enhancement.
  • The action of the non-structural protein 1 (NS1) on the blood vessel wall or endothelium can trigger the release of active chemicals from immune cells.
  • Both the above will result in endothelial hyperpermeability and vascular leak (leading to hypovolemic shock and bleeding).

How the Vaccine Is Beneficial

Both dengue vaccines are tetravalent live-attenuated vaccines.

The new vaccine, Qdenga, induces a broad spectrum of immune responses which include:

  • Neutralizing antibodies with a 50% reduction against all 4 dengue virus serotypes.
  • Cross-reactive antibodies that block the activity of the NS1 protein.
  • Type-specific memory B cells to all four serotypes.

This means the vaccine can protect us from severe dengue infection by all the 4 serotypes. This is a good thing.

Expert Answers All the Important Questions You Have about the New Dengue Vaccine

WORDS LIM TECK CHOON

With the Qdenga® dengue vaccine officially launched by pharmaceutical company Takeda Malaysia in Malaysia on 11 June 2024, we manage to get some important answers from Dr Goh Choo Beng about dengue and this vaccine.

FEATURED EXPERT
DR GOH CHOO BENG
Head of Medical Affairs
Takeda India & Southeast Asia
What does it do?

Prevention of dengue caused by any of the 4 dengue serotypes.

The clinical trial of the vaccine found that it can:

  • Prevent 80.2% of symptomatic dengue cases at 12 months after receiving the vaccination.
  • Prevent 90.4% of hospitalizations at 18 months after vaccination.
Who can receive the vaccine?

Qdenga® can be administered to individuals 4 years old and above.

How many doses do I need?

Two doses. The second dose will be given three months after the first dose.

Where can I get it?

Currently it’s available at general practitioner or GP clinics as well as private hospitals.

How much is the vaccine?

The price will be set by the clinic or the hospital, so it’s best to consult them about the price.

How does this vaccine work?

Dr Goh explains that the Qdenga® vaccine has a backbone that is based on the live-attenuated DENV2 serotype of the dengue virus, with recombinant strains expressing surface proteins for DENV1, DENV3 and DENV4.

This way, the vaccine will protect an individual from all 4 dengue serotypes.

Is it safe for individuals that have not contracted dengue before?

Yes. People that have no history of dengue fever as well as people that have had dengue can safely receive the vaccine.

No blood tests are necessary before receiving the vaccine.

What are the side effects?

Short term side effects are common ones associated with vaccination, such as redness and soreness at site of injection. These side effects are mild and temporary.

At the time of writing, there is an ongoing clinical trial that is monitoring and closely following selected individuals that have received the vaccine since about 4.5 years ago. So far, the investigators have found that:

  • The protection afforded by the vaccine persists 4.5 years after receiving the vaccine.
  • There is no long-term serious side effect seen so far.

Must-Know Migraine Facts & Hacks from a Consultant Neurologist

WORDS LIM TECK CHOON

FEATURED EXPERT
DR JULIA SHAHNAZ MERICAN
Consultant Neurologist
Prince Court Medical Centre
DR JULIA SHAHNAZ BOILS DOWN MIGRAINE INTO 6 SIMPLE-TO-UNDERSTAND POINTS
  • It causes moderate to severe throbbing headaches that between 4 and 72 hours. These headaches can affect the back of the head and neck or around the eyes.
  • It is frequently accompanied by symptoms such as nausea, vomiting, dizziness, sensitivity to light (photophobia), and/or sensitivity to loud noise (phonophobia).
  • The headache is typically made worse by movement or activity. Most people with migraine tend to avoid routine physical activities because of this.

A summary of migraine symptoms. Click on the image for a larger, clearer version.

  • Many people that develop migraine have family members that also have migraine; family history is one of the main risk factors of this condition.
  • Women are more susceptible than men.
  • Sometimes, children as young as 5 may begin having recurrent abdominal pain called abdominal migraine, only to start to experience typical migraine headaches at puberty or early adulthood.
DO YOU HAVE MIGRAINE?

Dr Julia offers three questions. If you answer “YES” to at least 2 of these questions, there is a chance that you have migraine and should consult a doctor.

  1. Has a headache limited your activities for a day or more in the last 3 months?
  2. Are you nauseated or sick to your stomach when you have a headache?
  3. Does light bother you when you have a headache?

The medical specialist that can help treat migraine is the neurologist.

KEEP A HEADACHE DIARY

Dr Julia recommends keeping a headache diary.

The diary can be a physical journal, a monthly calendar, or one of many smartphone apps available.

Record the following:

  • The number of monthly migraine days—the most important information for a doctor to advise on treatment strategies.
  • Days when headache medications are taken—helps to spot whether your headaches may also be caused by overuse of medications (‘medication overuse headaches’).
WHAT’S NEW IN MIGRAINE TREATMENT?

Dr Julia reveals that researchers have found that during a migraine, the brain is flooded by various chemicals released by nerves and blood vessels, including calcitonin gene-related peptide antibodies (CGRP).

Thus, some of the most recent treatments target the production of CGRP in order to reduce both the frequency and intensity of migraine attacks significantly.

Human Clinical Trial Shows That Tocotrienol-Incorporated Oats Can Benefit People With Metabolic Syndrome (Mets)

This pioneering clinical trial, led by Dr Lee Lai Kuan from Universiti Sains Malaysia, involved 81 MetS patients that consumed two sachets (equivalent of 60 g) of Bioley Toco Oats daily for up to 12 weeks.

RESULTS
Improved Key MetS Parameters
√ 5.5% reduction in fasting blood sugar.
√ 4.3% reduction in diastolic blood pressure.
√ 23% increase in HDL (good) cholesterol.
√ 11.8% reduction in blood triglycerides.

Enhanced Antioxidant Levels
√ Significantly elevated total antioxidant capacity (TAC) and superoxide dismutase (SOD) levels.
√ Reduced protein carbonyl concentration, a marker of oxidative stress.

Anti-Inflammatory Effects
Lowered concentrations of multiple inflammatory biomarkers such as tumour necrosis factor-α (TNF-α), histidine-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and matrix metalloproteinase-3 (MMP-3). Tolerance Participants did not show any gastrointestinal side effects after prolonged consumption of Bioley Toco Oats.

Tolerance
Participants did not show any gastrointestinal side effects after prolonged consumption of Bioley Toco Oats.

CONCLUSION
The clinical trial findings demonstrate the potential of Bioley Toco Oats in improving metabolic parameters, enhancing antioxidant capacity, and reducing inflammation in individuals with metabolic syndrome.

IMPORTANT NOTE
This product is not intended to diagnose, treat, cure, or prevent any disease. Individual results may vary. A balanced diet and regular exercise are essential for good health. This product should not replace conventional treatments or consultations with qualified healthcare professionals for any medical condition.
Always seek proper medical advice for diagnosis and treatment.

 

This is an educational article brought to you by

References:

1.    Tan, D. T., Khor, H. T., Low, W. H., Ali, A., & Gapor, A. (1991). Effect of a palm-oil-vitamin E concentrate on the serum and lipoprotein lipids in humans. The American journal of clinical nutrition, 53(4 Suppl), 1027S–1030S.
https://doi.org/10.1093/ajcn/53.4.1027S
2.    Ajuluchukwu, J. N., Okubadejo, N. U., Mabayoje, M., Ojini, F. I., Okwudiafor, R. N., Mbakwem, A. C., Fasanmade, O. A., & Oke, D. A. (2007). Comparative study of the effect of tocotrienols and -tocopherol on fasting serum lipid profiles in patients with mild hypercholesterolaemia: a preliminary report. The Nigerian postgraduate medical journal, 14(1), 30–33.
https://pubmed.ncbi.nlm.nih.gov/17356586/
3.    Mottram, P., Shige, H., & Nestel, P. (1999). Vitamin E improves arterial compliance in middle-aged men and women. Atherosclerosis, 145(2), 399–404. https://doi.org/10.1016/s0021-9150(99)00073-8
4.    Khanna, S., Roy, S., Parinandi, N. L., Maurer, M., & Sen, C. K. (2006). Characterization of the potent neuroprotective properties of the natural vitamin E alpha-tocotrienol. Journal of neurochemistry, 98(5), 1474–1486.
https://doi.org/10.1111/j.1471-4159.2006.04000.x
5.    Mangialasche, F., Kivipelto, M., Mecocci, P., Rizzuto, D., Palmer, K., Winblad, B., & Fratiglioni, L. (2010). High plasma levels of vitamin E forms and reduced Alzheimer’s disease risk in advanced age. Journal of Alzheimer’s disease : JAD, 20(4), 1029–1037.
https://doi.org/10.3233/JAD-2010-091450

New Enzyme Replacement Therapy Announced in Malaysia to Treat Pompe Disease

WORDS LIM TECK CHOON

Sanofi Malaysia announced this month that Nexviazyme® (avalglucosidase alfa), a new enzyme replacement therapy (ERT), has been approved in Malaysia for the treatment of Pompe disease, a rare and progressive genetic disorder that is often fatal if left untreated.

A QUICK PRIMER ON POMPE DISEASE
  • It is caused by a deficiency in acid glucosidase (GAA).
  • This deficiency causes an accumulation of a substance called lysosomal glycogen in the body’s tissues. This primarily affects the muscles.
  • As a result, the affected person will experience symptoms like muscle weakness, breathing difficulties, and heart problems. They may require the use of wheelchairs and respiratory support.
  • Pompe disease can affect individuals of all ages, but it is broadly divided into infantile onset Pompe disease (IOPD) and late onset Pompe disease (LOPD).
BENEFITS OF NEXVIAZYME® 
  • It can improve the lung function and walking distance of people living with Pompe disease.
  • There is also evidence that it can also help improve their muscle strength.
  • Certain clinical studies indicated that people with infantile onset Pompe disease exhibited improved motor functions, despite showing suboptimal response to previous treatments.
  • Other clinical studies found that those with late onset Pompe disease exhibited improved function of their respiratory muscles and increased ability to walk farther.

Nexviazyme® is approved for use in long-term enzyme replacement therapy, delivered via a drip or intravenously every 2 weeks.

Reference: Sanofi Malaysia. (2024, May 15). New ERT Nexviazyme® (avalglucosidase alfa) MAL23086006AZ approved for treatment of Pompe disease [Press release, KKLIU 1420/EXP 2/11/24].