JOIN THE HERD
There’s so much noise about vaccination out there, so what’s a new mom to do? Fortunately, we’re here to give you the hard cold facts so you can make an informed decision that’s best for your baby’s health, and the rest of the population’s...
IT’S BEEN 200 YEARS since the first vaccination was given. Since then, millions of lives have been saved, thanks to vaccines being made freely available across the planet. Yet, in some firstworld countries parents are choosing to opt out of vaccination. The effects are starting to be seen with breakouts of diseases that have been practically non-existent for decades. Measles, for example, was declared eliminated in the USA nearly two decades ago. But in 2014 an unvaccinated traveller visited Disneyland, was exposed to a person suffering from measles, and went on to infect more than 100 people. Similar outbreaks have been seen in Australia, Canada and Europe. South Africa also experienced a measles outbreak between 2009 and 2011 with 18 000 cases. There were a significant number of deaths and longlasting damage to children from this outbreak. South Africa experienced a total of 15 cases of diphtheria – and four deaths from this bacterial infection – between April and July 2015. If you think measles “isn’t a serious disease”, and therefore it’s not important to vaccinate against it, your privilege is showing. It merely means you are healthy and have access to good
IF YOU THINK MEASLES ISN’T A SERIOUS DISEASE, AND YOU DON’T HAVE TO VACCINATE AGAINST IT, YOUR PRIVILEGE IS SHOWING
healthcare and nutrition – many South Africans, including ones who might work for you in your home – do not, and their children are at risk from your unvaccinated ones. The measles virus, which, according to the World Health Organisation (WHO), is one of the leading causes of death among young children, is so contagious that 90 percent of the people close to a person who is not immune to it will also become infected. This is why maintaining “herd immunity” for this virus, among others, is critical.
THE UMBRELLA OF IMMUNITY
Vaccines work in two ways, explains Dr Melinda Suchard of the Centre for Vaccines and Immunology at the NICD. “The first, obvious way, is that it will protect your child from acquiring that disease. The second way is preventing your child from spreading the disease. So having your child vaccinated will prevent your child being a link in the transmission into somebody else.” This is very important because there are some people who can’t be vaccinated. Children who are too young (below the age at which you can give a vaccine) or children with specific medical conditions and compromised immune systems, such as leukaemia, can’t be vaccinated. Dr Suchard also explains vaccines are not effective for everyone, so about five percent of the community are susceptible to infections even though they have been vaccinated. “Vaccinating your child helps protect the whole community. It’s also critical to have high vaccination levels as part of a coordinated global effort to try to interrupt the transmission of dangerous circulating viruses and bacteria and to ensure coverage if there is an infected traveller who comes into the country,” she says. A success story of global vaccination programmes is the eradication of smallpox in the 1970s, which means no one needs to be vaccinated against it anymore.
Smallpox may be one less vaccine your baby requires, but over the course of the next 12 years she will get close to 20 shots. Getting your head around the fact that she needs to be injected with a disease to ultimately protect her can be difficult, but understanding how vaccines work should allay your fears. When you’ve had an infection once, you should be protected against acquiring that infection again – you will be immune to it. Vaccines mimic this natural infection by taking a small part or a weakened form of the virus or bacteria and giving it to a person so that they can mount an immune response (with little to no side-effects). “This means the next time they encounter the organism that causes an infection their immune system will immediately recognise that organism and respond to it, preventing them from becoming ill,” explains Dr Allison Glass, a specialist virologist at Lancet laboratories.
WEIGHING UP ALL THE OPTIONS
Whether you decide to vaccinate your child by following the government Road To Health card or go to a private clinic really comes down to questions of cost and convenience and what your time or budget allows. At a state clinic all the vaccines on the Department of Health’s Extended Programme on Immunisation (EPI SA) are offered for free. The disadvantage is that you can’t book an appointment so you may experience long waits at the baby clinic. You also won’t get the “personal touch” and follow-up contact you get from a private nursing sister. However, you could always contact the vaccine helpline Amayeza on 0860 160 160 for advice and information. The major benefit of the EPI SA is that all the vaccines are offered for free, whereas if you go to a private clinic you will have to pay for each vaccine as well as an additional consultation fee, which can range from R100 to R300. “In the past, at some of the private clinics you could also get some of the vaccines from the state so you wouldn’t have to pay for them, but this has been stopped,” says Sister Ingrid Groenewald, a registered nurse and private midwife. It can become very expensive if you don’t have medical aid to cover it. “The vaccines your baby needs at six and 14 weeks can add up to almost R2 000 for each visit and if you are already earning less because you are on maternity leave or haven’t been paid out your benefits yet, this can cause financial pressure,” says Sr Ingrid. She recommends you start putting aside some money for the vaccines while you’re still pregnant, or asking friends or family to gift the money for vaccines instead of giving your baby toys or clothes at birth. The quality of state and private supplied vaccines don’t differ. “Both schedules are excellent,” confirms Dr Suchard. “The state schedule is based on what is going to protect South Africans from a herd immunity perspective, and what is going to prevent transmission of these diseases, so that we can aim for disease eradication.” The private schedule includes a few additional beneficial vaccine options, but they are expensive and the government has considered them not cost effective for inclusion into the national vaccine programme, usually because there’s no indication that the vaccines would prevent transmission of the disease to others, she says. So they are really for individual protection, but they wouldn’t help prevent that disease circulating around the country. The vaccine programmes are interchangeable, confirms Sr Ingrid. “If you start at a private clinic it doesn’t mean you can’t go to a state clinic at a later stage. You can alternate between them. Some patients attend the state clinics for the vaccines that are offered for free, and then come to the private clinic for the optional ones,” she says.
THE EXTRA MILE
So why would your baby need these optional vaccines if the state doesn’t consider them essential? There are numerous benefits to preventing your child from getting these infections, confirms Dr Glass.
THE CHICKEN POX VACCINE
Given from nine months. Chicken pox is an uncomfortable infection that can lead to scarring and, in some cases, there can be complications such as pneumonia and even death. It’s also important to remember that chicken pox is a risk to an unborn child throughout pregnancy and also to a newborn baby straight after birth. “Vaccinating against chicken pox also significantly reduces the risk of developing shingles as an adult,” adds Dr Glass.
THE HEPATITIS A VACCINE
Given from 12 months. The hepatitis A vaccine protects against a viral infection that can cause inflammation of the liver that results in severe illness for a number of weeks.
“Infection of children with hepatitis A does not usually result in severe illness in the child, but can result in severe illness for the adults at home who are exposed to the infected child,” says Dr Glass.
MEASLES, MUMPS & RUBELLA (MMR) VACCINE
The MMR vaccine is given from 12 months at private clinics. At a state clinic your baby will be given the measles vaccine. In private clinics it is combined with two other vaccines: rubella (German measles) and mumps. Rubella is usually a mild infection in childhood, but if a woman is infected for the first time during pregnancy it can have devastating effects on her unborn baby, resulting in miscarriage or severe birth defects. “Vaccinating your child against rubella will protect her future pregnancies and will protect pregnant women who may be exposed to your child,” says Dr Glass, adding that there has been an increase in rubella cases in South Africa over the past three years. Again, herd immunity is key in preventing infections from spreading. Mumps is a viral infection that leads to painful swelling of the salivary glands. Complications of this infection can include meningitis and deafness, among others. The measles vaccine is given at six months and again at 12 months at a state clinic. But in a private clinic, the shot given after measles is the MMR. So if one just attends a state clinic you won’t have the MMR. However, there are plans for the single measles vaccine to be phased out and only the MMR will be offered soon, confirms Sr Ingrid.
MENINGOCOCCAL DISEASE VACCINE
This vaccine is given from nine months. Prevenar 13 and Synflorix are vaccines offered by the state for free to prevent bacterial pneumococcal disease (which, among other things, causes meningitis). But there is also another strain of bacterial meningitis called meningococcal disease that causes a very aggressive form of meningitis that is often deadly before it has even been diagnosed.
FACING YOUR FEARS
It’s only natural that as a parent you want to know what possible sideeffects your baby could suffer from vaccinations, but the overwhelming scientific consensus is that vaccines are rigorously tested and safe to use. Dr Suchard says the mild side-effects that can occur include fever, redness, some swelling at the vaccine site and a bit of tenderness. “These are all signs that there has been an immune response and the vaccine is working,” she says. Thanks to improvements that are regularly made to vaccines, Sr Ingrid has noticed babies in her clinic have suffered fewer side-effects in the past two years. “It’s very unlikely now that your baby will be unhappy or a bit feverish after a vaccine, where in the past it was common,” she says. The BCG vaccine, which protects against tuberculosis, is given to your infant while still in hospital after birth. Perhaps because everything is so new to you and you’re having so much information thrown at you, many moms forget the advice they’re given around the care of the vaccine site, says Sr Ingrid Groenewald, a registered nurse and private midwife. “When they go home, they’re often surprised to see a pimple developing on the vaccine site. This is a sign that the vaccine is working – the best thing to do is leave it alone and keep it dry. It will drain by itself and doesn’t need any pressing or squeezing,” she says. “If your child is on any medication, specifically antibiotics, I would recommend delaying the vaccination until they’re better,” says Sr Ingrid. When they’re healthy their immunity is better, and the immune response to the vaccine will be better. “Plus, you already have a miserable child and you don’t want to add anything further to make the child more unhappy.” Feeding your baby during or directly after the vaccination will soothe her quickly. But don’t delay a feed so they are hungry when they are vaccinated, warns Sr Ingrid. “This will only make them irritated. Rather feed as you would normally before the vaccination so your baby is happy and calm. Most babies will feed again if they are offered milk after a vaccine anyway.” In the past it was recommended you give your baby pain relief (a dose of paracetamol, for example) before a vaccination, but new research has shown that it can interfere with the immune response. “We also advise you don’t give it afterwards, unless your child is very miserable, because it makes it easier for the body to produce antibodies,” says Sr Ingrid. “Rather cuddle and feed your baby to soothe her.” However, if your baby develops a fever higher than 38°C you can bring the fever down with the appropriate dose of paediatric paracetamol or ibuprofen. Your baby may experience a small lump in the vaccination site. Sr Ingrid recommends you massage the vaccination site for a couple of days afterwards to improve the blood flow and promote healing.