1. Which vaccination schedule (government or private) is better?
The South African government’s Expanded Programme on Immunisation (EPI) allows for all children to be vaccinated, for free, against the following 10 diseases: polio, tuberculosis, diphtheria, tetanus, pertussis (whooping cough), haemophilus influenzae type B related meningitis and pneumonia, hepatitis B, rotavirus infection, pneumococcal infection and measles.
As of February 2014, the HPV vaccine against the human papillomavirus, which causes cervical cancer, will be added to the public sector schedule for nine-year-old girls.
“The South African government schedule is pretty comprehensive and certainly ranks with the best in the developing world,” says Cape Town paediatrician Dr Paul Sinclair. In the private sector (and therefore at a cost to you), children can additionally receive vaccines against chicken pox and hepatitis A, as well as measles, mumps and rubella in the MMR vaccine, explains Lee Baker, MD of the Amayeza Information Centre, which runs the Vaccine Helpline. You can call this service on 0860 160 160 between 9am and 5pm with any vaccination queries.
“The private schedule offers the ‘luxury’ vaccines,” says Dr Sinclair. “The 6-in- 1 Infanrix Hexa vaccine in the private sector does not contain the preservative thimerosal so you might choose that if it’s important to you.”
Note: there is no scientific or evidence-based reason to fear this mercury-based preservative found in some vaccines.
2. Can I change from the one schedule to the other and when is best to do this?
You could certainly receive the government’s free vaccines from a clinic and then supplement these with the additional vaccines that are available in the private sector, but do so in consultation with a nurse or doctor.
Note that identical diseases are covered by both the EPI and private schedules until the nine-month vaccines, after which the schedules deviate. “The hepatitis A, chicken pox and MMR vaccines will not interfere with the public sector vaccine schedule, so they could be given in addition,” says Lee.
“The 18-month measles vaccine in the public sector would be replaced with the MMR if you choose the MMR vaccine from the private schedule. In the private sector there are a number of ways to combine vaccines that aren’t offered in the public sector,” explains Lee.
“Though it is not perfect, you can change between the two options if you wish,” agrees Dr Sinclair. “You will only need to make small adjustments to timing.” Remember to discuss this with your healthcare provider before going ahead with it.
3. Are there too many vaccines in our schedule?
“All the vaccines offered free by the SA government health services are essential,” says Dr Rosemary Burnett, a senior lecturer at the South African Vaccination and Immunisation Centre in the Department of Virology at Medunsa.
“The government does not have money to waste, and South African scientists have to give them irrefutable evidence that a disease causes major morbidity and mortality before they will include a vaccine on the schedule.”
The long-term aim of a vaccine is to work itself out of a job, such as what happened after the smallpox vaccine was so effective that the disease became eradicated and we no longer needed to immunise children against smallpox.
Polio is the disease that the World Health Organisation (WHO) next targeted for eradication, but it still occurs in Nigeria, Afghanistan and Pakistan. In the shorter term though, more vaccines can be expected to be added to the EPI as they are developed.
The vaccine against cervical cancer is one such example. And wouldn’t it be wonderful if an effective vaccine for HIV or malaria were to be developed?
4. What about the viral load from vaccinations - can our children's bodies cope with so many antigens being injected into them at once?
Antigens are the active component of a vaccine – the modified form or part of the virus or bacteria that causes the disease against which the vaccine protects. When multiple vaccines are given to small babies at the same time, such as when babies are vaccinated against tetanus, diphtheria, pertussis, polio, haemophilus influenza type B and hepatitis B at once, it feels worrying.
Aren’t our children receiving too many antigens at once? Actually, as vaccines have become more sophisticated over time, the number of antigens used per vaccine has decreased dramatically. According to Dr Burnett, in 1926 the pertussis vaccine contained 3 000 antigens, but the version introduced in 1991 contains just two to five antigens.
The overall effect on the body from these antigens is far, far smaller with modern vaccines. Besides, she says, babies are exposed to many more antigens than are contained in vaccines in their everyday lives just by, for example, crawling and mouthing – all necessary for development and immunity.
5. Isn't it better for my child to get the actual disease than to vaccinate against it?
Some parents argue that is it healthier for their children’s immune systems if they contract the actual disease and fight it off rather than obtain immunity to it via a vaccine. But Dr Burnett says science simply does not support the view that a child’s immune system is in any way harmed by vaccine-induced immunity.
The immunity provided by vaccines is not “fake”, it is real, nor is it worse for your child’s body. When receiving a vaccine against a disease, your child’s body is manufacturing the same antibodies as it would have to do when fighting the actual disease, but with far fewer, lighter symptoms.
And of course there’s more to consider, as contracting the actual disease can actually cause severe illness, disability or death, which is exactly what vaccines prevent. Remember, quite a few serious illnesses are covered by vaccines.
6. I vaccinated my child and he still got that disease. Why should I vaccinate?
It’s true: your baby can get ill from a disease he was vaccinated against. Vaccines have about an 85 to 95 percent success rate. This example from the WHO is useful: imagine a school has 1 000 pupils, 995 of whom are vaccinated against measles. All 1 000 children are now exposed to measles. All five unvaccinated children and seven of the vaccinated children then contract measles.
So in percentages, 100 percent of the unvaccinated children but only 0.7 percent of the vaccinated children got sick. But stated differently, the same statistic sounds dreadful: of the sick children, 58.3 percent (seven out of 12) got sick despite being vaccinated!
Put this way, it sounds as if more vaccinated children actually get sick from the disease than unvaccinated ones (which is an argument often seen on anti-vaccinators’ websites). In fact, vaccinations protect the overwhelming majority of children, and in addition, a vaccinated child will usually become less seriously ill if he does contract the disease than an unvaccinated child.
7. Will the MMR vaccine give my kid autism?
No. Signs of autism are often first noticed around the same time as the MMR vaccine is generally given in the UK (18 months) and a link has been incorrectly ascribed between the two events. Says the US Centers for Disease Control and Prevention: “Carefully performed studies have found no relationship between the MMR vaccine and autism.”
The UK doctor responsible for this widespread, but false, belief – Andrew Wakefield – has since been struck off the medical register and his research declared fraudulent. But a lot of damage has been done by these false reports as uptake of the MMR vaccine in developed countries has plummeted.
Yes, most healthy and wealthy children (though not all) survive measles, mumps and rubella, but some don’t. Furthermore, very young children, or those who may not be vaccinated for health reasons, as well as unborn babies of pregnant mothers, are at risk of death or permanent disability if others don’t vaccinate against them.
The MMR vaccine is not on the government schedule but it is offered in the private sector and you can have it administered to your children with confidence.
“The MMR is a ‘luxury’ vaccine in South Africa and though no causal link with autism was ever made or found, I find it best to educate parents, and if they are still concerned, to administer two measles vaccines at nine and 18 months, and then commence an MMR schedule (in two doses) once the developmental milestones to exclude an autism-spectrum disorder (ASD) diagnosis have been met and the parents are more comfortable with its administration,” says Dr Sinclair. “The vaccine is safe, but parental peace of mind is also important.”
8. Should I give my baby paracetamol before his vaccinations so that he doesn't get a fever?
It’s natural to want to minimise your baby’s pain by giving him a painkiller before his vaccination. “But recent studies have shown paracetamol should not be given before a vaccination,” says Dr Sinclair.
“Even the mild effect of paracetamol can affect the immune reaction. It is, however, safe to give painkillers after the event.” Remember that an injection causes only a tiny and passing amount of pain. Latching your baby to the breast or letting him suck his dummy during his shots may even let the whole episode pass incident-free.
9. My baby's vaccinations have made him sick. What do I do now?
It is very hard to prove that a vaccination caused a subsequent illness – diseases often have an incubation period and so the onset of your baby’s illness could be coincidental. Some babies have symptoms such as fever, redness, swelling, tenderness or fussing after their vaccinations as their bodies react to the antigens in the vaccines and start manufacturing those lifesaving antibodies.
“In the case of live virus vaccines such as measles or chicken pox, a child can get a mild form of the illness a few days after the vaccination,” says Dr Sinclair. “Occasionally an abscess can form at the injection site due to the needle introducing an organism from the skin’s surface – an unfortunate and uncommon risk.”
According to Dr Burnett, “Very rarely does a vaccine cause a severe adverse reaction (one per several thousands or millions, or so rare that one cannot calculate the risk).”
10. I've been told to rub Vicks onto my baby's vaccination injection site. Why?
Rubbing Vicks onto the injection site has the effect of numbing the area, but it’s not a recommended practice. Says Dr Sinclair: “Any rubbing over a needle penetration site can introduce infection and cause irritation, so it’s best avoided.”
11. My baby has a cold. Can I still take him for his vaccinations?
“A cold is not a contra-indication to vaccinate,” says Dr Sinclair. While it is best not to avoid a vaccine opportunity where possible, you should delay vaccinating if your child has a significantly high temperature, of more than 39°C.
12. There's a big "pimple" where my baby had her BCG injection. Should I pop it?
No. Most children will show a reaction on their right upper arm at the site a few days after the administration of the BCG. “A BCG cold abscess will open on its own and drain some pus,” says Dr Sinclair. “It should be kept clean, but left open to drain as necessary. Don’t pop or lance it. If you are concerned, and especially if a large gland develops under the right arm or armpit, then seek medical attention.”
13. Should my HIV-positive child be vaccinated?
“HIV positive or exposed children should not receive the BCG at birth, like other children,” advises Dr Sinclair. “Only give the vaccine if the HIV PCR test is found to be negative after six weeks. Other live virus vaccines should only be given to children who are HIV positive, but are not suffering from AIDS. Such children should receive antiretroviral treatment and only be vaccinated once AIDS is controlled.”