CLOSING THE IMMUNITY GAP: A NARRATIVE REVIEW ON IMPROVING HEALTHCARE WORKER PERTUSSIS VACCINATION IN MALAYSIA THROUGH LESSONS FROM THE GLOBAL EXPERIENCE

Abstract

Pertussis remains a significant public health concern despite widespread vaccination programs, with healthcare workers (HCWs) increasingly recognised as both susceptible populations and potential sources of nosocomial transmission to vulnerable infants. While many high-income countries have established comprehensive HCW pertussis vaccination policies, Malaysia lacks formal national guidelines despite documented infant pertussis burden. This narrative review examines global healthcare worker pertussis vaccination policies and their applicability to Malaysia, evaluating evidence on nosocomial transmission, vaccination strategies, cost-effectiveness, and policy implementation. A narrative review was conducted in accordance with established guidelines for literature synthesis. Multiple databases, including PubMed, Scopus, and Web of Science, were searched for peer-reviewed literature on pertussis vaccination policies, nosocomial outbreaks, HCW immunisation strategies, and economic evaluations. Grey literature from government health agencies was included to capture policy documents. Healthcare workers demonstrate substantial pertussis susceptibility globally, with seroprevalence studies showing 48.3-51.7% lacking protective immunity. Documented nosocomial outbreaks indicate a significant risk of transmission to vulnerable infants. International policies vary considerably: Australia, the United Kingdom, and Canada mandate or strongly recommend Tdap vaccination for HCWs as part of occupational health programs, while Malaysia lacks specific HCW vaccination guidelines. Cost-effectiveness analyses show that HCW vaccination programs yield net savings of $17.84 per dollar spent when productivity losses are included. Substantial evidence supports the implementation of mandatory Tdap vaccination policies for Malaysian healthcare workers. Recommendations include establishing national HCW vaccination guidelines, providing free workplace vaccination programs, and implementing pre-employment vaccination requirements.