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...

Your Pregnancy - - The Dossier Vaccinations -

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


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.


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.


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.


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.


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.


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.


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.


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.


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.

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