Monday April 21 2014

What you need to know about immunisation

By Agatha Ayebazibwe

At Mulago hospital’s private wing, I met Janet Kyampaire, an expectant mother of one. Like many of the women waiting in the line, Kyampaire is here to get a tetanus vaccine shot.

She did the same for her first pregnancy, although she says at the time, she missed one of the three recommended shots. Despite taking her tetanus jab religiously now, Kyampaire admits she has no idea why she is being immunised. In fact, she thinks the vaccine is being administered to her because she is pregnant.

According to the World Health Organisation, tetanus is a life-threatening bacterial disease that is caused by the toxin of a bacterium called clostridium tetani. This bacterium enters the body through an open wound such as a tiny prick or scratch on the skin. The infection is more common when there is a deep wound such as a bite, cut, burn or an ulcer.

According to Victoria Nabuule, the nursing officer in charge of immunisation at Mulago hospital, the Tetanus Toxoid (TT) vaccine is administered during pregnancy to prevent a mother and unborn baby from developing the disease.

“When the vaccine is administered, the antibodies formed in the mother’s body are passed on to the baby, giving it protection for least six weeks after birth,” says Nabuule, adding that after six months, the baby should be given its own tetanus shot.

She says: “We give most of the vaccines at six weeks because at that point, the baby is building its own immunity and antibodies. If we give those vaccines before six weeks, a big proportion will not work because the vaccine is destroyed by the antibodies passed on from the mother to the child.”

First pregnancy
During a woman’s first pregnancy, at least two doses of the tetanus vaccine are recommended, with the first to be administered as soon as the pregnancy has been confirmed.

Dr Robert Mayanja, the programme manager in charge of the National Expanded Programme on Immunisation (Unepi), says the second dose of the vaccine should be given at least four- to-eight weeks after the first one.
WHO also recommends that a third vaccine be given six months after the second one to provide protection for at least five years.
Unlike other vaccines which give lifelong protection such as DPT, BCG and polio, the tetenus vaccine, according to Nabuule, gives up to 15 years and therefore, booster doses are recommended thereafter.

At Mulago hospital for instance, the immunisation clinic has tetanus doses for adults in five doses, given to people between the ages of 15 and 45.
“Our emphasis is on pregnant women because they are vulnerable to wounds especially during delivery. But other people in reproductive age, including men can take the shot as long as they are at a risk of being injured and are less than 45 years,” Nabuule explains.

Why vaccines?
According to the Centres for Disease Control and Prevention, vaccines help develop immunity by imitating an infection.
Dr Mayanja explains that when someone is injected with, or swallows a vaccine, their body produces an immune response in the same way it would if exposed to a disease but without the person getting infected from the disease.

“If the person comes in contact with the disease in the future, the body is able to make an immune response fast enough to protect them from getting sick of that particular disease,” he says.

He notes vaccines reduce the risk of infection by working with the body’s natural defence, to help it safely develop a resistance mechanism against particular disease.

A number of immunisations are required and done in the first few years of a child’s life to protect them against many of the serious childhood infections.

“The immune system in young children does not work as well as that of older children and adults. Therefore, more doses of vaccine are needed for younger children,” explains Dr Mayanja.

The first months of life
In the first months of life, a baby is protected from most infections by antibodies from their mothers, which is usually transferred during pregnancy. When these antibodies wear off, the baby is at risk of developing infections and so, the first doses of immunisations should be administered before these antibodies have weakened.

BCG vaccine
One such vaccine is Bacillus Calmette–Guerin (BCG), which should be administered within the first 15 days of a child’s birth. It is crucial in offering protection against childhood tuberculosis, a common disease today.

“In a country like ours where tuberculosis is prevalent, children catch the germs early in life and develop the disease later. In children between the ages of three and five, this can spread and lead to severe and serious forms of the disease,” says Dr Mayanja.

Nabuule says because all individuals carry TB bacteria, if babies are not vaccinated with BCG, their risk of contracting the disease becomes high.
To ascertain that the vaccine was effective, a child who has been immunised with BCG vaccine should have a scar on their upper left arm.

This, Nabuule says it is the only way of determining success of the vaccine. In fact, she says if no scar is visible at all after six months, the child should be given another vaccine.

Oral Polio Vaccine (OPV)
WHO hopes the disease will be eradicated worldwide by 2018, if no major outbreak is reported again.
Polio is an infectious disease caused by a virus that lives in the throat and intestinal tract. It can spread from person-to-person, it can be contracted through the stool of an infected person, and may also be spread through oral or nasal secretions.

Most people infected with the polio virus show no symptoms. However, for less than one per cent of the population who develop paralysis, it may result in permanent disability or even death.
Oral polio vaccine is given within the first two weeks of a child’s birth, at six, 10 and 14 weeks respectively.

Pentavalent vaccine (combines Diptheria, Hepatitis B and Haemophilus influenza infections)
According to Dr Mayanja, the vaccine is given in three doses, at six, 10 and 14 weeks.

DPT vaccine helps children younger than seven develop immunity to three deadly diseases caused by bacteria including diphtheria, tetanus, and whooping cough (pertussis).

Diphtheria is a respiratory disease that can cause breathing problems, paralysis, heart failure, and death. It is highly contagious and is spread through coughing and sneezing, according to Dr Mayanja.
The disease however has not been seen in Uganda for many years, although it could reoccur if immunisation programmes are compromised.

Whooping cough
Whooping cough, also highly contagious, causes coughing spasms that are severe so that it makes it difficult for infants to eat, drink, or even breathe. It can lead to pneumonia, seizures, brain damage or death.

This is a highly contagious disease 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.
In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year globally. Statistics from WHO indicate that it remains one of the leading causes of death among children despite the availability of a safe and effective vaccine.
Approximately 122, 000 people died from measles in 2012 – mostly children under the age of five.

In Uganda, measles occurred in 10 districts in 2012 and 2013, according to data from the Ministry of Health. Measles vaccine is usually administered as a combination, meaning that it provides protection against three viral diseases; measles, mumps and rubella.

The vaccine is administered at nine months but Dr Mayanja says recent scientific evidence suggests that it could be more effective if administered at six months, especially among children who live in regions prone to measles.

Other crucial vaccines that are required include the pneumococcal conjugate vaccine, used for the prevention of pneumonia in children. In Uganda, most deaths occur among children below the age of five.
The vaccine is usually administered to children at when they reach the age of five. In Uganda, the pneumococcal vaccine was rolled out in all public health facilities last year, as part of a mass vaccination drive.

Other vaccines
Plans are underway to introduce the rota vaccine for babies below the age of one, to protect them against diarrhoeal diseases.

The vaccines to be introduced and rolled out counrtywide, according to the Ministry of Health are malaria and HPV (Human Papilloma virus) vaccine for cervical cancer. “We hope that by February 2015, we will have all young girls aged 10 to 14 immunised against the virus,” says Dr Mayanja.

Some vaccines available for adults only include one against rabies, which is given when a person has been bitten by a snake, and another against yellow fever.

“Because we are in a yellow fever belt, some countries will not allow Ugandans to enter their territories if they have not been immunised,” says Dr Daniel Okello, the acting director of public health at Kampala Capital City Authority.

And health experts say as long as children and adults are fully immunised against many of these vaccine-preventable diseases during childhood, they develop lifelong protection, and are unlikely to suffer from such diseases in the future.

Therefore, to avoid contracting these preventable diseases in adulthood, parents are advised to take their children for the booster immunisation programme that the government will be running this week.

About this week’s immunisation plan
Almost all public facilities offer immunisation services. But doctors advise that for babies who need to get jabs at six weeks, it is recommended that the mother returns to the health facility where the baby was delivered from. This is because the mother is also still being monitored and is receiving post natal care.

Also this week, Uganda will take part in the African Vaccination Week, which will be held from April 21 to 27 in all districts. The national ceremony will be held in Sheema District on April 24.
The African Vaccination Week offers an opportunity to create awareness and demand for immunisation services. According Dr Robert Mayanja, the programme manager in charge of the National Expanded Programme on Immunisation (Unepi), every child should be immunised five times before their first birth day against tuberculosis, polio, pneumonia, meningitis tetanus, measles, whooping cough, diphtheria and hepatitis B.

According to the Ministry of Health annual performance report for 2013, Uganda’s immunisation coverage stands at 98 per cent.

Dr Daniel Okello, the acting director of public health at Kampala Capital City Authority says there is still need to strengthen the service by increase immunisation points, and improving the transport system to ensure availability of vaccines and supplies.

“In this corporate social responsibility concept, we will target phone companies to send out immunisation text messages, radio stations that will air songs and messages, newspapers that run stories and messages. We shall also use local musicians to promote campaigns through music,” says Dr Mayanja.