The use of paracetamol post infants' vaccination in Malaysia

Abstract

The practice of dispensing paracetamol (PCM) post infants’ vaccination in Malaysia remains doubtful. The objectives include to explore the effectiveness of PCM and breastfeeding post infants’ vaccination, PCM dispensing practice in Malaysia (possible associated factors: age and types of vaccination) and prevalence of Adverse Events Following Immunization (AEFI) with/without PCM to be prescribed post infants’ vaccination in Malaysia (possible associated factors: age, types and stages of vaccination, concomitant vaccines and drugs and/ vitamins). Systematic reviews were conducted using electronic search using 6 databases and manual references in English Language; published between 1978-2017. Retrospective cross-sectional study on PCM dispensing practice (2015-2017) was done in the Government Health Clinics (GHC) and evaluated by Pearson chi-square tests; meanwhile prevalence of AEFI with/without PCM to be prescribed post infants’ vaccination (2011-2017) was analysed using Microsoft Excel 2013 and Logistic Regression Tests, SPSS version 22. 3 studies on breastfeeding for pain showed significantly benefited. Studies on prophylaxis PCM for fever (2 studies) and fussiness (1 study) showed significantly benefited and 1 study found non-significant benefit for fever. 1 study in 2009 showed antibody responses to several antigens were significantly reduced, and 1 study in 1988 found antibody titres of placebo and PCM did not differ significantly. The trend of the PCM dispensing practice (248 samples) indicated that there was an increase for “Not Giving PCM” from 2015-2017 with weak positive association (p<0.05) for age of infants upon vaccination and types of vaccination. Various AEFI cases (359 infants) were reported between 2011-2017. DTaP/Hib/IPV and MMR showed higher prevalence of AEFI with/without PCM to be prescribed post infants’ vaccination cases per 100, 000 populations (2.07 and 2.21 respectively) than other types of vaccinations. 2 months DTaP/Hib/IPV vaccination showed the highest value (3.00) among other age groups. Backward Elimination presented 3-4 months DTaP/Hib/IPV (95%CI; 0.231, 0.899%; p=0.023) was the associated factor. PCM post infants’ vaccination may not be recommended due to its safety issues. Breastfeeding before, during, and after immunization are effective for pain reduction. Age and types of vaccination were the associated factors of PCM dispensing practice. 2-4 months DTaP/Hib/IPV and 12 months MMR groups were the associated factors of AEFI with/without PCM to be prescribed post infants’ vaccination groups. Thus, dispensing of PCM post infants’ vaccination may be confined to these groups.