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Dengue Vaccine yet to be approved in Malaysia

Malaysia has no immediate plans to follow in the footsteps of Singapore, which has approved the world’s first dengue vaccine Dengvaxia.

Deputy Health Minister Datuk Seri Dr Hilmi Yahya said the ministry was still doubtful of the vaccine’s efficacy in reducing the four serotypes of dengue: Den-1, Den-2, Den-3 and Den-4.

Studies have shown that overall, the Sanofi-manufactured vaccine is effective at reducing dengue by 60% and reducing severe dengue by 84%.

According to a news report, when used against the Den-1 and Den-2 strains which account for three-quarters of the dengue cases in Singapore, the efficacy of the vaccine is 50% and 40% respectively, compared with 75% and 77% for the other two strains.

“We still have to look into this. The vaccine does not have the same efficacy for all the four strains and in Malaysia, we have more of Den-1 and Den-2.

“We are still in the process of registering the vaccine but this does not mean we will use it immediately. We are still doubtful of its efficacy. As it is, we have no plans to use it commercially,” he told reporters at a press conference at the National Heart Institute (IJN) here yesterday.

According to statistics from the ministry’s Crisis Preparedness Response Centre, 186 dengue-related deaths were recorded between January and Oct 1 this year.

Earlier, Dr Hilmi launched a first-of-its-kind collaboration in Malaysia between IJN and global payments technology company Visa.

With the partnership, IJN offers up to 25% exclusive discounts on all its six wellness packages to all local and international Visa cardholders. Cardholders need to produce their credit or debit cards upon registration.

IJN chief executive officer Datuk Seri Dr Mohd Azhari Yakub said the partnership would further boost Malaysia as the preferred medical tourism destination.

“Our cost here is very competitive compared with other countries because the Government controls the rate,” he said. The promotion starts immediately and lasts until December next year.

/theSTAR 07--10-2016

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Hospital in Kuantan to cater for heart patients

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Heart patients can look forward to better care at a new facility in Kuantan, Pahang.

The KPJ Pahang Specialist Hospital, which opened officially in Tanjung Lumpur on 6th October 2016 will have specialists to attend to such patients.

KPJ Healthcare Bhd chairman Abdul Wahab Baba said the hospital would be developed for healthcare tourism.

The hospital will be able to cater to between 200 and 250 patients. “Presently, we can only provide 110 beds but we will increase the capacity soon,’’ he said.

The hospital was built at a cost of RM110mil, with RM70mil more spent on its clinical information system. He said there had also been an increase in the number of patients needing oncology and kidney treatment in the east coast. “This has prompted us to provide such treatment at our centre in Alor Akar,’’ he added.

/the STAR 07-10-2016

Day Care Procedure & Surgery Encouraged

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Health Insurance providers should do away with mandatory admissions at hospitals – as a requirement for medical claims – because many procedures can be done within a day now.

Most public hospitals now carry out minimal invasive surgeries which require shorter hospitalisation to maximise the use of resources and reduce cost.

But insurance companies do not reimburse patients who are not admitted as a matter of policy.

Health Ministry director-general Datuk Dr Noor Hisham Abdullah said insurance companies may not understand the concept of Day Care Procedures or Day of Surgery Admission – where patients come in on the day of the surgery and are discharged either the same day or the day after.

Previously a patient would be admitted two days before a procedure and discharged after two days – making it a total of five days which may not be necessary, he added.

“We want insurance companies not only to reimburse but encourage day care procedures. This is the message we want to send to them,” he said after delivering his opening remarks at the Ramsay Sime Darby Health Care Group Specialists Conference.

While some companies are considering the move, he said, others were reviewing their process after engaging with the Health Ministry.

Resources are limited at both public and private hospitals, he said, adding that Malaysia wanted to have 2.5 beds for every 1,000 people instead of the current ratio of 1.9:1000.

Currently public hospitals have 40,000 beds and there are another 20,000 at private hospitals. The 16,000-bed shortfall for Malaysia’s 30 million people, he said, could be eased with day care services.

He said public hospitals already have the infrastructure and know how but only 10% of all operations are carried out under day care unlike 70% in the United States and 60% in Britain and Germany.

“We are still behind. The best centre we have is in Ipoh where between 40% and 45% of procedures are carried out under day care.”

Dr Noor Hisham wants other public and private hospitals to step up day care procedures.

He cautioned against the practice of patients dictating how long they wanted to stay in hospital for minor procedures – such as a removal of a lump in the breast – because they had insurance coverage.

“It’s not the patient’s choice to stay longer because a private hospital is not a hotel,” he said.

/theSTAR 26-09-2016

Apex Healthcare: Expanding Manufacturing Capacity

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Apex Healthcare Bhd’s wholly owned subsidiary Xepa-Soul Pattinson (Malaysia) Sdn Bhd will be constructing a new oral solid dosage manufacturing facility (SPP NOVO) that will cost RM68 million on its land in Malacca.

SPP NOVO will be a newly constructed stand-alone facility adjacent to Xepa’s current manufacturing facilities on the same campus at Cheng Industrial Estate. The estimated cost of SPP NOVO includes production machinery and an integrated multi-storey carpark.

“The construction of SPP NOVO will be funded through a combination of internally generated funds and external borrowings. At this juncture, the company has not finalised the terms and quantum of borrowings required,” Apex said in a stock exchange filing.

Xepa is a leading manufacturer of off-patent pharmaceuticals in Malaysia. Its current production facilities for oral solid dosage forms, designed and commissioned in 1996, are reaching optimal designed capacity and cannot be further retrofitted economically to increase output.

The construction of SPP NOVO is expected to commence in the fourth quarter of 2016 and commissioned in the first half of 2018. Detailed engineering design has been completed and tenders for construction and equipping are expected to be issued in the current quarter.

“The board of directors of Apex is of the opinion that SPP NOVO is a vital infrastructure that will enable Apex to execute and achieve its strategic plans for the future. It is in the best interest of the company.”

As of Sept 15, 2016, Xepa has secured preliminary approval from the Centre for Compliance and Licensing, National Pharmaceutical Regulatory Agency, Ministry of Health for the design and layout of SPP NOVO.

/theSTAR 16-09-2016

Shortage of specialists in Cardiology: Malaysia

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There are not enough heart experts in the country.

Its deputy Director Ggeneral, Ministry of Health, Datuk Dr S. Jeyaindran said presently there are only about 20 experts for each of the heart-related fields covering all seven heart centres nationwide, and that it needed at least double the number.

"In total, we only have about 20 experts each for cardiology, anesthesia, and heart surgeons. It is not enough, we are short-handed. The problem is that the figure is too low, while the number of cases is too high.

"We need about 50 to 60 experts for each of these fields. At least two times the number what we have now."

Jeyaindran, however, said the Ministry would send chronic heart patients, especially children, to India for emergency surgeries if the situation calls for it, while others will see their waiting time (for a surgery) cut short if their situation get critical.

According to him, the current waiting time for patients hoping to get a surgery in Serdang Hospital, for example, is up to ten months.

He added that the ministry is also in the process of establishing a heart centre in Serdang Hospital, which would be under the purview of the ministry, offering heart surgeries for a mere RM500.

"The Centre is expected to be completed by year 2020," he said.

/theSTAR

Shortage of Occupational Therapists in Malaysia

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“In Malaysia, we have around 1,800 occupational therapists but we are required to serve a population of about 32 million. That is a ratio of 1:17,777,” Malaysian Occupational Therapy Association president Mr Soh Say Beng said.

This rate is three times below the global average of occupational therapist-to-population ratio of 1:5,000

Patients in the Klang Valley are in a better position as it has the largest concentration of occupational therapists in the country.

Among others, occupational therapy is required to help surgery patients regain mobility of their limbs or to help children with learning disabilities.

Though all major public hospitals have their own occupational therapists, Soh said the teams were small and the waiting time to receive treatment could be up to two months. “Ideally, patients should receive OT intervention within a week.The longer you wait, the patient’s muscle grows weaker from disuse; their limbs become still and their motivation drops drastically,” he added.

The UMMC’s department of rehabilitative medicine, where Soh works, has 103 OTs and is the largest and most established rehabilitation centre in Malaysia.

“District hospitals and health clinics are not well staffed with OTs. It makes it harder for us to reach out to those who need treatment,” he said.

At present, many Malaysians who suffer physical or mental impairment are unable to return to work, ending up staying at home under their families’ care.“Our task is to get them to regain their independence, so that they can lead a productive life,” he said.

Students of occupational therapy are being offered jobs even before their graduation, said Dr Chai Siaw Chui, who lectures at Universiti Kebangsaan Malaysia’s Occupational Therapy program.

“If you have a qualification in OT, you can go anywhere,” she said, referring to the versatility of the profession. Apart from public healthcare, she said OT specialists could choose to work in pediatric and geriatric care, mental institutions, city councils or the Social Security Organisation.

The starting salary of OTs in public service is usually at RM2,429 (Grade U41) while doctors start at RM2,947 (Grade UD41)

Dr Chai said occupational therapy students were trained to seek creative solutions to their patients’ problems, which range from psycho-social issues to having an ill-equipped working environment.

The ideal ratio, according to Dr Chai, was one occupational therapist for every 2,000 people.

About 90% of the 230 graduates produced annually in the country end up working in the civil service, taking up positions in public hospitals and in the Health Ministry, said Dr Chai.

Those numbers, she said, were not enough to fill up rehabilitative roles, preventing OTs from reaching their potential of promoting health and preventive therapies.

Dr Chai, who specialises in hand therapy, explained that OT played an important role in ensuring surgery patients regain mobility of their limbs.

“Let’s take the case of a patient who has had his hand reattached by surgery. The surgery offers a 50% chance of him regaining his mobility. Another 50% depends on OT,” she said.

She said OTs would also help children with learning disabilities.

Though some functions of OTs overlap with physiotherapists, the latter work primarily with helping individuals recover from injuries with a combination of massage and exercise.

/theSTAR 18-09-2016

Counterfeit Drugs in Malaysia: Statistics

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The Director of the National Pharmaceutical Regulatory Agency, Ministry of Health, noted that based on the volume of counterfeit drug seizures made by the Pharmaceutical Enforcement unit, counterfeits account for between 3-6% of medicines distributed in Malaysia.

The Pharmaceutical Association of Malaysia found, in 2015, that approximately 5% of prescription medicines are fake, including eye drops, inhalers and medicines for erectile dysfunction (ED).

ED medicines are among the most frequented group of counterfeited medicines in the Malaysian market, which is estimated to account for 30-40% of all counterfeits.

As of 2013, counterfeits drugs accounted for 10% of the world's medicines, with an estimated annual growth rate of 13% as reported by the international law firm, Baker and McKenzie. In addition around 40% of illegal pharmaceuticals are said to originate from Asian countries according to a 2011 report by a US based Pharmaceutical Security Institute.

The 2008 European Alliance for Access to Safe Medicines (EAASM) Report also found that 62% of medicines purchased online were either fake or substandard while over 90% of online pharmacies supplied prescription-only drugs without prescriptions from a name verifiable pharmacist.

/MIMS DOCTOR 15-31 July 2016_12-08-2016