Immunisations : Calling the shots
14:10 (GMT+2), Tue, 23 March 2010
Vaccinations are imperative. Don’t hesitate, immunise your child – and help save his life.
I remember going to the clinic when I was a toddler – I was completely terrified! My siblings and I used to hate going for vaccinations, and my mom never told us exactly where she was taking us because she knew she would have to deal with all our tears and pleas for mercy.
Parents don’t like seeing their children sad or scared, but when it comes to vaccinating them for childhood diseases, they have to grin and bear things, while trying to ignore their little ones’ unhappy faces, as vaccinations are crucial. Many parents do, however, have misconceptions about immunisations, which make them hesitant to get their children immunised. Some parents even refuse to have them done, but should realise that immunisations are critical and that the advantages far outweigh possible negative side effects. “Many South African parents believe that because they live in a house with water and sanitation, their kids will be protected against all childhood diseases.
There is no doubt that a clean environment helps keep children healthy, but children can pick up diseases at schools, day care centres, shopping centres, play parks or anywhere else,” explains Professor Haroon Saloojee from the Department of Paediatrics and Child Health at the University of the Witwatersrand in Johannesburg. He adds that there is no doubt that breastfeeding protects children from many diseases, but that it can’t protect them from all childhood illnesses. “It is very important that parents vaccinate their children for added protection against diseases that breastfeeding alone can’t prevent. It is well recognised that vaccination is the single most effective and cost-efficient way of saving children’s lives. More lives have been saved through vaccinations than any other medical intervention, including antibiotics,” says Saloojee.
South African Expanded Programme on Immunisation (EPI) Schedule There are currently eight childhood vaccines offered by SA-EPI at various intervals between birth and 9 months, with further booster doses following thereafter until 6 years of age, explains Saloojee. “Vaccines offered by the SA-EPI programme include BacillusCalmette-Guerin (BCG) for TB, oral polio, diphtheria, whooping cough (pertussis) and tetanus (DPT), hepatitis B, Haemophilus influenzae b (Hib) and measles. These vaccines are available at no cost at well-baby clinics. A number of private practitioners and clincs also offer this service, but for a fee.”
Vaccines provided by the South African EPI BCG vaccine
• This vaccine is widely used in developing countries and is primarily effective in preventing disseminated tuberculosis.
• A normal reaction to BCG is a raised papule at the site of vaccination four to six weeks after immunisation. This resolves spontaneously and may leave a scar in about 40% of vaccines.
Polio vaccine Polio is a contagious disease spread by faeces and saliva and can be fatal, and in some cases may result in lifelong paralysis. • xOne in 20 hospitalised patients who are not vaccinated for polio, dies from this disease each year.
• Less than one in 100 recipients of the polio vaccination develop side effects, such as diarrhoea, headaches or muscle pains.
•Only a mere one in 2,5 million recipients or people in close contact with them, develop paralysis after vaccination. Many vaccinations are now combined, so parents can choose to give their children the 5-in-1 injection instead of vaccinating their children individually. Saloojee says that if South African parents are wary of the live oral polio vaccine, they will soon be able to ask for the 6-in-1 injection, which contains an inactivated virus. However, Saloojee reassures parents, “We haven’t had a case in South Africa where the vaccine has actually caused polio.”
Tetanus (part of the DTP vaccine)
A toxin of bacteria in soil causes tetanus. This disease occurs when a tetanus germ enters a cut or wound. Tetanus can be fatal. It can also cause muscle spasms as well as breathing and heart problems. Saloojee says tetanus used to be common among babies in hospitals, as some parents often placed cow dung, full of tetanus, on their newborn’s umbilical cord as a traditional practice. “The number of babies with tetanus has decreased considerably in South Africa and we had fewer than ten cases of neonatal tetanus countrywide in 2007.”
• xAbout one in ten patients will die from this disease if they aren’t vaccinated, with the risk much greater for young babies or older patients.
• xOnly one in ten patients who are vaccinated will suffer from local inflammation or fever.
Pertussis (whooping cough)
The Chinese call this disease the ‘100-day cough’ because children cough for more than three months when they suffer from pertussis. This disease spreads through coughing or sneezing, making it hard for a child to eat, drink and even breathe. Saloojee says this disease and diphtheria occur infrequently in South Africa because of the number of children who are being vaccinated against the illness. However, in countries like Japan, Russia and Sweden, where vaccinations were temporarily stopped, these two diseases quickly returned, resulting in the resumption of routine vaccination services.
• One in 200 whooping cough patients under the age of 6 months who is not vaccinated, dies from pneumonia or brain damage each year.
• The side effects of the pertussis vaccine are similar to those of diphtheria and tetanus.
Measles, mumps and rubella (MMR)
Measles, mumps and rubella can spread very easily through coughing, sneezing or even talking.
Measles is a highly infectious virus that is spread through droplet infection. It causes the ‘Three Cs’ – coughing, coryza (a runny nose) and conjunctivitis (red eye). A high fever and a widespread rash are characteristics of this disease, which can be fatal. It can lead to hearing loss, pneumonia and brain damage. Saloojee says South Africa has managed to control measles amazingly well over the past ten years – in 2001 there were only eight confirmed cases of measles, compared to more than 15 000 cases per year before 2001. “However, in 2004 there was an outbreak of measles and we had more than 750 cases in children. We have since managed to get measles under control again by using mass immunisations (vaccinating all children again, including those who received the vaccine previously). We are optimistic that South Africa could be measles-free by the end of 2009,” says Saloojee.
• One in 25 children who aren’t vaccinated against measles can develop pneumonia.
• One in 2 000 children can develop encephalitis (brain inflammation) if they are not vaccinated.
• One in ten children who develops mea-sles gets encephalitis, one child dies and up to four children have permanent brain damage.
• One in 25 000 children develops SSPE (brain degeneration), which is always fatal.
• One in ten recipients of the vaccination may have discomfort due to side effects, such as inflammation or fever.
• One in 100 children who are vaccinated develops a rash, which is non-infectious.
• Only one in a million people who is vaccinated, develops inflammation of the brain.
Mumps is a contagious virus spread through saliva. It can cause headaches, fever, swelling of the glands of the jaw and neck, and swelling of the testicles in adolescents and adults. Mumps can cause hearing loss, meningitis and brain damage and infertility.
• One in 200 children who doesn’t receive the MMR-vaccine develops brain inflammation.
• One in five boys develops inflammation of the testicles after puberty. Mumps can occasionally cause infertility or deafness.
• One in 100 recipients of the MMR-vaccine may develop swelling of the salivary glands.
• One in three million children who is inoculated can develop mild inflammation of the brain as a serious side effect of the vaccination.
Rubella (German measles)
Rubella is very contagious, which causes a slight fever and a rash on the face and neck. It is ubiquitous in children and frequently not diagnosed. Saloojee says rubella is particularly risky in pregnant women, as they can lose the foetus or give birth to a baby with severe birth defects.
• ive in ten patients who do not receive the MMR-vaccine develop a rash and painful swollen glands.
•One in 3 000 patients develops bruising or bleeding and one in 6 000 develops inflammation of the brain.
•Nine in ten babies who are infected with the virus during the first ten weeks after conception will have a major congenital abnormality, such as deafness, blindness, brain damage or heart defects.
•One in ten recipients of the MMR vaccine may have discomfort, such as local inflammation or fever as a result of side effects from the vaccine.
•One in 20 patients may have swollen glands, a stiff neck or painful joints.
•One in 100 children may develop a rash that is non-infectious.
•One in 30 500 patients may have bruising and bleeding after the first dose of MMR.
(Hib) Hib-disease is a contagious bacterium, which can be fatal, which can cause pneumonia, meningitis, infections of the joints, skin and blood, and is most serious in infants under 1 year.
•One in 20 meningitis patients who doesn’t receive the Hib-vaccine, dies each year.
•One in four survivors has permanent brain damage or nerve damage.
• One in 100 epiglottis (respiratory obstruction) patients dies from this disease.
•One in 20 recipients of the Hib-vaccine experiences mild side effects, such as inflammation, and only one in 50 patients develops a fever.
Hepatitis B (Hb)
Hepatitis B is a virus that causes infection of the liver. It is contagious and spreads mainly through blood, sexual contact or from a mother to her newborn. It can also cause liver cancer. This disease can be fatal and is second only to tobacco in causing cancer in humans.
•One in three chronic carriers who are not vaccinated will develop cirrhosis (scarring of the liver) or liver cancer.
• One in 15 to one in 100 patients who is vaccinated against Hb may experience side effects, such as pain and fever. Early vaccination against this disease can save your baby’s life.
Chickenpox is caused by a virus and is common in childhood. It’s extremely contagious. Patients who are infected may have skin lesions and scarring due to a bacterial infection, or may even suffer from pneumonia.
•Nine out of ten people, who have not had chickenpox before, will become ill if they have not been vaccinated and are exposed to an infected family member.
• Less than one in 1 000 patients who is vaccinated against chickenpox may experience side effects, such as seizures caused by fever.
Hepatitis A is a liver disease that is caused by the hepatitis A virus. It results in the swelling of the liver, and can also damage its cells irreparably. A person with this disease can easily pass it on to others within the same family, as it usually spreads through close personal contact and sometimes when eating food or drinking water containing the virus. Saloojee says hepatitis A is common among children who live in poor economic and social conditions.
Rotavirus is the most common cause of childhood diarrhoea. • xOne in four children with diarrhoea usually has rotavirus, even in developed countries. Saloojee says the vaccine prevents the most severe forms of the illness – particularly extreme dehydration and hospitalisation. • xIt has recently been estimated that more than 140 000 children younger than 5 die each year as a result of this infection.
“Pneumococcal disease is a bacterial infection. It’s the most common cause of pneumonia and meningitis in children in South Africa,” says Saloojee. This disease is spread through sneezing, coughing or through direct oral contact with an infected individual. • xOne in ten meningitis patients who is not vaccinated, dies each year. • xLess than one in 20 recipients of the vaccine will experience side effects, such as pain. Saloojee says getting vaccinated against pneumococcal disease is a very expen- sive endeavour. But the Department of Health intends to make this vaccine, and the rotavirus vaccine, available free of charge at public clinics in the next year or two.
It is now recommended that young child-ren be vaccinated against ‘the flu’ annually. As influenza mutates easily, it’s imperative that children get this vaccination.
Does the MMR-vaccine cause autism in children?
There has been a lot of controversy surrounding the MMR-vaccine over the past few years, as it has been linked to the occurrence of autism in children. Questions were raised about the safety of the vaccine after Dr Andrew Wake-field from Britain published his research on the topic in 1997. The study resulted in a health scare because it suggested that there is a possible link between the MMR-vaccine and autism. Saloojee says that while autism rates have indeed been on the increase, particularly since the 1980s, there is no evidence to suggest that this is due to the MMR-vaccine.
The reason for the increase of autism in children is still unclear. “More than 20 studies involving over 250 000 children have failed to find convincing evidence of a link between the MMR-vaccine and autism. Indeed, the vaccine has been used long before autism rates started escalating and in cases where parents have stopped vaccinating their children, autism didn’t decrease,” says Saloojee.
Concerns: the pertussis vaccine
Some parents are extremely concerned about the immediate side effects their children experience when they are vaccinated against pertussis, as little ones get sick immediately after receiving the vaccination. Saloojee explains that developing symptoms after being vaccinated is a positive indication, as it confirms that their immune systems are responding to the antigens in the vaccines. “No vaccine is 100% safe and while there is a risk of side effects, these are usually minor compared to the risk of contracting pertussis and possibly dying from it,” says Saloojee.
Prevention is better than cure “Vaccines have been remarkably successful in controlling certain diseases. For ex ample, in the 80s and early 90s when not all children were vaccinated against measles in South Africa, about 20 000 children suffered from measles and over 300 died annually as a result. In 2001, only eight children in the country contracted measles and they all survived. There is no explanation for this unbelievable fact, other than the increase in measles vaccinations in children over the past six years. Similarly, there has been a dramatic decrease in haemophilus influenza meningitis since a vaccination programme against this disease was introduced in 1999, in South Africa. In the UK, the number of cases of this type of meningitis dropped by 96% once vaccination began, and we are experiencing similar success stories locally,” says Salojee. •
Professor Haroon Saloojee from the Department of Paediatrics and Child Health at the University of the Witwatersrand in Johannesburg; Sister Amanda Spruit, clinic sister for Dr S Strachan, Johannesburg, The Australian Immunisation Handbook, 8th edition, 2003.