Our body has a natural immunity

We have miracle-fighters called antibodies which recognize anything that is ‘foreign’ to our body and destroy it. What’s even more awesome is how the immune system then ‘remembers’ these enemies and destroys them  everytime they attack, thus conferring what is called ‘immunity’ to the particular disease. The baby’s immunity is further enhanced by the mother’s breast milk in the first 4-6 months of life.

Then why give vaccines?

Giving vaccines for different diseases confers what is called ‘acquired immunity’ to the disease in the way described above. Some of the diseases like polio, TB, Diphtheria, Tetanus, Measles, Hepatitis B which can be deadly in children can be prevented with vaccines.

In public health practice, vaccination is given to confer community protection so that even unimmunized children will have a reduced risk of getting the disease. This is called as the ‘herd effect’ of immunization. 

What vaccines are available and what diseases are they effective against?

Vaccines recommended by the Government and available at Government hospitals at reduced costs include:

• BCG vaccine (mandatory) – Given as an intradermal injection soon after birth; prevents TB. Can cause a raised area at the site of the injection, do not apply any medicine to the site.
• OPV vaccine (mandatory) – Given orally as several doses till the age of five, this prevents polio. Poliomyelitis is a disease which affects the nerves causing muscle weakness and paralysis. It is given free of cost to all children below five years of age under the Pulse Polio programme.

• DPT vaccine (mandatory) – Given as an intradermal injection, it prevents three diseases (Diphtheria, Pertrussis and Tetanus).
  a. Diphtheria is an infection which starts with a ‘sore throat’ but can rapidly lead to formation of toxins (poisons) causing life-threatening complications.
  b. Pertrussis (whooping cough) affects the lungs in children below 15 months of age. Starting with cold and cough, it progresses to episodes of coughs with a ‘whoop’. Complications include pneumonia, brain damage and death.
  c. Tetanus starts when a wound is infected with bacteria found in soil, it affects the body’s muscles and nerves. The toxin produced by the bacteria causes muscle spasms, interferes with nerves and can be fatal.

• Measles vaccine (mandatory)– The vaccine is given subcutaneously (just below the skin) as the baby completes nine months. A very contagious viral infection, measles starts as cold and cough with rashes progressing from the hairline downwards. It can progress to diarrhoea, pneumonia, infection of the brain leading to death, if untreated.

The immunization schedule as per the Universal Immunization Programme in India:

Other optional vaccines recommended for your child

Things to remember during your child’s vaccination

 Measles is a viral disease and transmitted when an infected person breaths, coughs or sneezes. There is no specific treatment for it and a person’s natural immunity allows them to recover in 2-3 weeks. It can lead to severe complications in particulary indigent demographics like malnourished children and people with weak immunity and can cause serious complications including blindness, encephalitis, severe diarrhoea, ear infections and pneumonia. The disease can be prevented by immunisation and experts say increasing vaccination rates to above 95 percent worldwide and keeping them up is the only way to eradicate measles.

 The WHO study said the even with 74 percent drop meant measles killed an estimated 139,200 people across the world in 2010, down from just over 535,000 in 2000.

India’s poor vaccine coverage

The researchers, led by WHO immunisation expert Peter Strebel, suggested India’s relatively low measles vaccine coverage – 74 percent – is the reason why the disease is still a major cause of death there. It lags behind Africa on 76 percent. The study found that India accounted for 47 percent of measles deaths in 2010, while Africa had 36 percent. The Americas and Europe accounted for less than 1 percent each, but fears about a measles comeback have been growing in these regions too. 

• Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
• In 2010, there were 139 300 measles deaths globally – nearly 380 deaths every day or 15 deaths every hour.
• More than 95% of measles deaths occur in low-income countries with weak health infrastructures.
• Measles vaccination resulted in a 74% drop in measles deaths between 2000 and 2010 worldwide.
• In 2010, about 85% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.

Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.

It remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. An estimated 139 300 people died from measles in 2010 – mostly children under the age of five.

Measles is caused by a virus in the paramyxovirus family. The measles virus normally grows in the cells that line the back of the throat and lungs. Measles is a human disease and is not known to occur in animals.

Accelerated immunization activities have had a major impact on reducing measles deaths. From 2001 to 2011 more than one billion children aged 9 months to 14 years who live in high risk countries were vaccinated against the disease. Global measles deaths have decreased by 74% from 535 300 in 2000 to 139 300 in 2010.

Signs and symptoms

The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands and feet. The rash lasts for five to six days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).

Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.

Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care. People who recover from measles are immune for the rest of their lives.

People who recover from measles are immune for the rest of their lives.

Who is at risk?

Unvaccinated young children are at highest risk of measles and its complications, including death. Any non-immune person (who has not been vaccinated or previously recovered from the disease) can become infected.

Measles is still common in many developing countries – particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

Transmission

The highly contagious virus is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions.

The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts.

Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection.

Treatment

Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.

All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.

Prevention

Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for over 40 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a child against measles.

The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form.

In 2010, about 85% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.

Content Courtesy: WHO

With an estimated 28 million cases and 38,000 deaths in 2010, malaria remains a significant public health problem in WHO’s southeast Asia Region where around 1.32 billion people are at risk.”Malaria is also a socioeconomic and developmental issue. The high burden of malaria is associated with economic and development activities. This is why malaria control should be the collective responsibility of various sectors,” said Samlee Plianbangchang, WHO regional director for Southeast Asia.In WHO’s southeast Asia region, the estimated malaria incidence per 1,000 population at risk was reduced by 27 percent from 30 in 2000 to 22 in 2010.

Source: IANS

In this post, we discuss the other vaccines recommended by the Indian Academy of Pediatricians. Discuss with the doctor about the pros and cons of each one and then decide to go ahead with them :

• MMR vaccine – The vaccine confers protections against mumps, measles and rubella. There is some controversy surrounding this vaccine linking it to autism and inflammatory bowel disease. However, a study by the WHO has concluded that there is no evidence linking the vaccine to these conditions. The child may have slight fever and rash seven to ten days after the injection.
• Hepatitis B vaccine – Added to the Universal Immunization programme in India more recently (2002), the vaccine confers immunity against Hepatitis B. Hepatitis is a viral infection affecting the liver leading to jaundice and other complications in the liver. At birth, if the mother is positive for hepatitis B, the baby needs to be vaccinated within 12 hours of birth.
• HPV vaccine – for preventing cervical cancers; can be given to girls at 10 years of age. However, there has been a debate in recent times regarding usage of the same. Consult your paediatrician; find the pros and cons of the vaccine.
• HiB vaccine – for preventing meningitis (infection in the brain) caused due to Hemophilus B influenza virus.
• Typhoid vaccine – for preventing the bacterial infection called typhoid spread through food or drink contaminated by urine or faeces of an infected person. Starting with fever, headache, diarrhoea or constipation, rose spots on the chest, it can lead to an enlarged spleen and liver.

Other optional vaccines:

• Pneumococcal conjugate vaccine – for preventing pneumococcal meningitis (affecting the brain of children) or pneumonia. Since the cost of the vaccine is quite high (single dose costs as much as Rs.4000), most parents do not opt for this vaccine.
• IPV (Inactivated polio vaccine) – Given as an injection, this is the inactivated form of the virus (unlike the oral one which has live attenuated virus). It confers nasal and throat immunity to the virus.
• Rotavirus vaccine – Recommended by the WHO, it prevents rotavirus infection which causes severe diarrhoea and dehydration in children.
• Influenza vaccine – prevents flu or infection of the respiratory system. The vaccine holds good for a period of one year only as the constitution of the vaccine is changed every year as per the kind of flu virus prevalent at that time.

1. Discuss the vaccine with the doctor first and understand the problems ( if any) associated with it.

 2. Tell the doctor if your child:

• has fever or cold
• has allergies
• has issues with previous immunizations
• is on steroid treatment or other drugs affecting the immune system (for cancer or kidney transplants).
• has a history of fits or convulsions
• has intolerance to eggs; in such a case, your doctor may suggest your baby has his MMR vaccination in hospital.
• has family members with HIV/AIDS or other immune system diseases.

 3. Take the child’s favorite toy or doll along so that he/she can hold on to it for emotional support after the shot.

 4. Kids older than two years of age might throw tantrums at the doctor’s. It is advisable to let the child know about the vaccine a little prior to the visit. Straight forward talk about the shot is best. Tell your child why he/she is getting it and that all kids of her age get it.

 5. Stay at the clinic for 15 minutes after the vaccine is given, just in case your child reacts to it.

 6. The child may be a little low after the injection and may be irritable. Avoid making any big plans after the appointment. Let the child rest at home.

 7. There might be some swelling and redness at the site of the injection. Don’t worry about it. Do not apply any medicine to the area.

 8. The child may have slight fever after the appointment. However, if the temperature is very high or if the child has convulsions (or fits), call your doctor immediately.

1. Immunization prevents between 2-3 million deaths every year

Immunization prevents deaths every year in all age groups from diphtheria, tetanus, pertussis (whooping cough), and measles. It is one of the most successful and cost-effective public health interventions.

2. More children than ever are being reached with immunization

In 2010, an estimated 109 million children under the age of one were vaccinated with three doses of diphtheria-tetanus-pertussis (DTP3) vaccine. These children are protected against infectious diseases that can have serious consequences like illness, disability or death.

3. An estimated 19.3 million children under the age of one did not receive DTP3 vaccine

Seventy percent of these children live in ten countries, and more than half of them live in WHO’s Africa and South-East Asia regions.

4. Over 1 million infants and young children die every year from pneumococcal disease and rotavirus diarrhoea

A large number of these deaths can be prevented through vaccination.

5. Public-private partnerships facilitate the development and introduction of vaccines

For example, a new vaccine which prevents the primary cause of epidemic meningitis in sub-Saharan Africa, meningococcal A, MenAfriVac, was introduced in Burkina Faso, Mali and Niger last year. At the end of 2011. Cameroon, Chad and Nigeria are vaccinating more than 22 million individuals with the vaccine which has the potential to eliminate the leading cause of meningitis epidemics in Africa.

6. The supply of influenza vaccines has been significantly expanded

The expansion has been possible as a result of WHO supporting the efforts of vaccine manufacturers to produce and license influenza vaccines in 11 developing countries.

7. Global measles mortality has declined by 78%

Global measles mortality has been reduced from an estimated 733 000 deaths in 2000 to 164 000 deaths in 2008, thanks to intensified vaccination campaigns.

8. Polio incidence has been reduced by 99%

Since 1988, polio incidence has fallen by 99%, from more than 350 000 cases to 1410 cases in 2010. Only four countries remain endemic – Afghanistan, India, Nigeria and Pakistan – down from more than 125 countries in 1988. However, India was recently taken off the polio endemic list after a zero-polio year.

9. Annual deaths from neonatal tetanus have fallen

Neonatal tetanus deaths have declined to an estimated 59 000, down from 790 000 deaths in 1988.

10. Immunization provides an opportunity to deliver other life-saving measures

Immunization not only protects children from vaccine-preventable diseases. It also serves as an opportunity to deliver other life-saving measures, such as vitamin A supplements to prevent malnutrition, insecticide-treated nets for protection against malaria and deworming medicine for intestinal worms. In addition, the benefits of immunization are increasingly being extended across the life course to include adolescents and adults, providing protection against life-threatening diseases such as influenza, meningitis, and cancers that occur in adulthood.

Content Source: WHO