Sunday, 24 July 2011

Vaccination - How Efficacious?

Published in City Times

What you need to know about vaccination schedules

Vaccination - it is one of the holy cows of modern medical science. For quite a while in recent times it’s assumed a debatable hue even as most parents take it for granted and believe it’s the done thing when their child is born. While many medical practitioners believe that parents should take an informed decision on the issue, Dr.Huda Noori Salih, Paediatrician, Al Rafa Polu Clinic, Gardens, Jebel Ali, is firmly of the opinion that the decision to vaccinate is best left to the medical fraternity, even if it means additional responsibility on their shoulders. According to her, the thumb rule is, no child should be deprived of it.

There’s been plenty of debate on the issue of vaccination. What’s your personal view on it?
Dr.Salih: Of course, we should vaccinate every single baby; we should not deprive him/her of the right of enjoying this new technology and new advancements in this field. I feel that while we should keep parents informed of the pros and cons of vaccination, we should not give them the decision of whether to vaccinate their babies or not. Even if it means more responsibility on our shoulders, this decision is best left to us, doctors.

Even among the medical fraternity, some professionals claim that since vaccines are prepared from suppressed, disease-causing organisms, these dormant organisms could get activated in later life and cause the very disease against which they have been vaccinated. What do you have to say on this?
Dr.Salih: No, this does not happen if the person has a normal immune system which is functioning well. But yes, in immuno-compromised people, even children who contract AIDS or are born with immune deficiency, this could happen.

What about the efficacy of vaccines in general, in protecting us from various diseases where the immune system is functioning normally?
Dr.Salih: I would say, more than 90% protection is there. However, regarding certain vaccines which is not recommended to be given routinely, as for instance, the chickenpox vaccine which is a one time shot meant to provide lifelong immunity against the disease. A child may still get it after being vaccinated. This is not because the vaccine itself is not efficacious enough, but the way it is administered may have been defective and the vaccine may not have been maintained or given under ideal conditions. In fact, I recommend this vaccine, especially for malnourished children or the chronically ill and underweight children, because if these children contract the infection, it is likely to be more severe in them.

What about serious complications from other vaccines? Even vaccination deaths have been reported?
Dr.Salih: Death complication from vaccination is very, very rare because every care is taken to see the kind of entity that is to be included in a vaccine. A lot of studies and experiments have been carried out with modifications whenever necessary, to make the vaccines safe for administration. So severe complications are extremely rare, but mild complications may be there. Even in the case of chickenpox vaccine, I would be very careful because the worst complication is having very generalized rashes resembling the chickenpox rashes. Again, I would be very careful in giving smallpox vaccine to children born with congenital immune deficiency.

What are the normal reactions to most vaccines?
Dr.Salih: Fever is the commonest reaction and it lasts usually, for a day and very, very rarely for more than a day. Also, there may be generalized body pain. We generally give the baby some anti-pyretic medication for the first 24 hours following vaccination.

What is the typical vaccination schedule followed here?
Dr.Salih: Vaccination of a newborn with start soon after birth. BCG (anti-Tuberculosis : Bacillus Calmette Guerin) vaccine is the first to be given in the hospital where the child is born, soon after birth. This vaccine will leave a scar on the baby’s arm where it is given. This is an indication of the vaccine’s efficacy in providing immunity against TB. Sometimes, we check to see if the scar is well-developed in school children. If it is not well developed, these children may require another dose of the vaccine. We check for this with the Mantoux Test, which if positive, implies the vaccine is still effective. In most instances, the BCG vaccine, a single shot given at birth, provides lifelong immunity.

BCG at birth is followed by the first dose of the anti Hepatitis B vaccine, while the child is still in the hospital. The 2nd and 3rd doses of this vaccine are given at the end of one month and six months. This vaccine does not give lifelong immunity and will therefore have to be repeated after 10 years.

At the end of 2 months, the child will receive the first dose of oral polio and DPT (Diphtheria, Pertussis (Whooping Cough) and Tetanus). At the end of 4 months the child will get its 2nd shot of oral polio DPT and the 3rd shot of the same vaccines when it is 6 months old. A booster does of oral polio and DPT are given when the child is 18 months old.

The Measles vaccine is a new routine which is given when the child is 9 months old. MMR (Mumps, Measles, Rubella (German Measles)) vaccine is given when the child is 12-13 months old. This vaccine again is very important for babies.

Why is there a need for the specific Measles vaccine when it is already included in MMR?
Dr.Salih: As I mentioned earlier, this is a new routine and it does not matter that it is included yet again in MMR.

How often is a booster DPT repeated after the first booster?
Dr.Salhi: Following the first booster, the second one is given when the child is 2 ½ years old and then again when it is about 4 years old. However, after this, we have to consider the Pertussis fraction of the vaccine because of its possible side effects. In rare instances, the Pertussis fraction of the vaccine is associated with some kind of complication for the children, especially those children who have seizure disorders, epilepsy or convulsions, especially during high fevers. We have to be very, very careful in these children while giving the Pertussis fraction after 4 years. Even some schools feel it is better to avoid this component of the vaccine after 4 years and administer children only D and T.

Suppose a child has been given all the vaccines as per schedule at the appropriate times till the age of four. The child injures itself from a fall, say at the age of 7, resulting in skin abrasion. Would it need to be given the anti-tetanus shot?
Dr.Salih: This depends on where the child has had a fall or what is the agent with which the child has injured itself. If there is even the slightest suspicion of contamination as in a wound from rusted nail or a fall in an unclean area, tetanus shot is certainly advised. On the other hand, if the child hurts itself with a kitchen knife which is normally expected to be clean, it should not be a cause for concern.


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