Nothing can divide a room of parents so quickly or vehemently
as the vaccination issue. I recently addressed a room of concerned
parents regarding a possible Tuberculosis scare. When vaccination
was mentioned the room erupted into bitter dispute. I made
a quick exit stage left as there was no way I was going to
be able to pacify the rowdy mob. Last I heard no major injuries
were sustained, but families that had been previously amicable
and close were now cold and distant.
As a young parent the decision to vaccinate or not to vaccinate
can be baffling. Let’s have a look at this hotly debated
issue, and see if we can make some sense of it all.
What vaccines are recommended for child hood?
This in itself is not a fixed and straightforward issue.
Vaccine programs may differ between countries, and depend
largely on local disease threats and the socio-economic situation
of each population. Generally the vaccines recommended for
children are as follows:
Diphtheria.
Tetanus.
Pertussis (Whooping cough).
Polio.
Influenza type B (HiB).
Hepatitis B.
Mumps.
Measles.
Rubella.
Varicella (Chicken pox).
Meningitis C (Under 2 yrs, Australia and UK)
Meningitis (Meningococcal) ACWY (Over 2 years).
Tuberculosis (High risk areas)
Many of these diseases have been forgotten by modern society.
How many people have you seen with the disfiguring scars of
smallpox? Or the crippling effects or polio? Can we afford
to be complacent about these killers? Lets take a brief look
at why these diseases have been targeted by immunoligists,
governments and parents in the pro-immunization corner.
Diphtheria – Highly contagious bacteria spread by nasal
droplets (sneezing, coughing). The patient suffers severe
sore throat with swollen glands. The disease has a 1:15 fatality
rate. The bacteria releases a toxin that causes nerve paralysis
and heart failure.
Tetanus – A disease caused by the toxin of bacteria
found in animal feces. The disease is contracted when wounds
are exposed to the Clostridium Tetani bacteria. 3 –
21 days after exposure the infection causes painful muscular
spasms and convulsions. About 1 in 10 patients die.
Pertussis - Contagious bacteria spread by nasal droplets (sneezing,
coughing). The infection causes an irritating cough, which
may develop into a characteristic whooping type bark. About
1 in 200 patients under the age of 6 months die from pneumonia
or brain damage.
Polio – Contagious virus spread by feces and saliva.
Headache, nausea and vomiting are followed by severe muscle
pain and neck stiffness of the neck and back. 5% of patients
die, and 50% of survivors are permanently paralyzed.
Haemophilus Influenza type B – Contagious bacteria spread
by nasal droplets (Haemophilus Influenza, despite it’s
name, has no relationship to the common cold or “influenza”).
An acute illness with fever, vomiting and lethargy. About
5% of patients die if the disease progresses to meningitis.
25% of survivors have permanent nerve or brain damage.
Hepatitis B – A contagious virus spread by blood and
body fluids (sexual contact). 2 – 3 months after exposure
the victim may suffer abdominal pain, nausea, rash and jaundice.
Severity of the disease varies. 2-4 % may develop chronic
carrier-state; 5 – 10 % of these may develop cirrhosis
and liver cancer with a 50% fatality rate.
Mumps – A contagious virus spread by saliva. The infection
causes fever and painful neck glands. 1 in 200 children develops
encephalitis. 1 in 5 males past puberty develops inflammation
of the testicles. Mumps can occasionally cause infertility
or deafness.
Measles – A contagious virus spread by coughing and
nasal droplets. The disease generally causes sore throat,
runny nose, cough and characteristic rash. 1 in 25 children
develop pneumonia, and 1 in 2,000 develop encephalitis. 10%
of children that contract measles encephalitis will die, 25%
will have permanent brain damage.
Rubella - A contagious virus spread by coughing and nasal
droplets. The infection causes fever, headache, itchy eyes,
and swollen glands behind the ears and neck. 90 % of babies
infected in the first 10 weeks after conception (inside the
womb) will develop major congenital abnormalities (deaf, blind,
brain damage, or heart defects).
Tuberculosis – A very contagious bacterial disease,
spread by droplets and spores expectorated in sputum. Tuberculosis
can present in many different parts of the body, however is
most commonly found in the lungs causing chronic cough, low-grade
fever and blood stained sputum. If untreated the bacteria
forms cyst type lesions in the lung and other organs and may
eventually cause death.
Meningococcal – A contagious bacterial disease that
infects the brain. There are as many as 13 different serotypes
of the meningococcal pathogen. First signs of this disease
may present as a cold or flu type picture, followed by a high
fever, headache, nausea and characteristic skin lesions. Meningitis
may lead to permanent brain damage, as well as loss of limbs
or internal bleeding. In uncomplicated meningococcal the fatality
rate is 10-20%. In complicated cases (shock, bleeding disorders
and / or skin lesions) the rate is as high as 50%. Those at
greatest risk are children under 1 year of age. 24 fatalities
have been reported in Australia so far this year, and for
this reason the Australian Government has just this week approved
the inclusion of the meningitis vaccine in the recommended
childhood vaccine schedule. A vaccine against types A, B,
C, W135 and Y is available for children over 2 years of age.
A vaccine against meningococcal type C is the only one recommended
for children under 2 years of age.
Now….how many of these diseases are REALLY a threat
to you or your child? As a young student nurse back in the
big smoke, I was told I would be highly unlikely to see such
things as whooping cough, polio, tetanus or tuberculosis unless
I worked with refugees or indigenous (Aboriginal) people.
I have never worked with either of these groups, and I have
seen ALL of these diseases. Not in the villages or the mountains
but right here in Sunny South Bali. I must add however, that
I have also seen one case of the devastating effects of a
severe reaction to a vaccine. So where does that leave me?
Just about as confused as every body else!!!
How Do Vaccines Work?
Vaccination works by introducing an inactivated part of the
disease causing bacteria or virus into the body. This triggers
the production of antibodies to that organism. These antibodies
can usually prevent the disease from developing when an immunized
person is exposed to it.
The case “Against”.
Many people are now sternly against immunizing their children.
Some factors in their argument include:
Vaccines may interfere with the natural development of the
child’s immune system.
Vaccines contain chemicals.
A child with a healthy lifestyle will have an immune system
adequate enough to combat disease.
Vaccines can have severe and lasting side effects (brain damage).
The demise of major diseases has shown no relationship to
the introduction of vaccines. (I have never seen reputable
data to support this, and therefore do not believe it to be
true. Some people do however claim this to be a valid point).
By mass immunizing a population you are creating a “weaker”
generation.
The case “For”.
It’s not too hard to explain why any parents wish to
protect their child in any way they can against the harmful
effects of disease. Apart from the obvious need to nurture
and protect our young, other points to consider would be:
We are living in a “global” environment, where
populations are no longer isolated or live in small rural
communities. People come here from all over the world, and
diseases are imported and travel at a much greater rate than
they would have in the past.
In Bali we live in a “Paradise Created”. This
is a third world country and the exclusive villa may share
the same street address as the humpy with open sanitation.
While vaccines may contain chemicals or foreign substances,
the massive doses of drugs that would be used to treat the
disease would be far more harmful than the vaccine.
Severe detrimental effects of vaccines occur at a much lower
rate than severe effects of the disease.
What is the recommended schedule for vaccinating my child?
Vaccination schedules may vary from place to place, and are
always being reviewed and changed. At present I would recommend
the following regime.
At 2,4 and 6 months
DtaP (Diphtheria, tetanus, whooping cough combined).
Polio (OPV oral polio drops).
Hib (Haemophilus influenza type B).
At 18 months
DtaP (Diphtheria, tetanus, whooping cough combined).
Hib (Haemophilus influenza type B).
At 2 years
Meningitis A,C,W135,Y combined.
At 4-5 years
DtaP (Diphtheria, tetanus, whooping cough combined).
Polio (OPV oral polio drops).
Hib (Haemophilus influenza type B).
This is the primary infant immunization program. These vaccines
will then need to be boosted as follows:
Diphtheria, Tetanus, Hepatitis B and Polio every 10 years.
Meningitis every 3 years.
The mumps, measles, rubella and varicella vaccines are good
for life; and the Hib & whooping cough vaccines are not
recommended past childhood as they are not considered life
threatening diseases in adults.
The Australian Government recommends this schedule. I have
taken into consideration the availability and combinations
of the locally available vaccines. Your child’s schedule
may differ somewhat, depending on where the schedule was issued.
Next issue, vaccinations continued, plus your questions answered.
Until then, stay happy, stay healthy and stay young!!
Kim Patra is a qualified Registered Nurse / Midwife, and
mother of three, who has been living and working in Bali for
past 15 years. She has assisted many traveller (... and others)
either as a flying medical escort or just a voice on the end
of the phone! Kim is happy to discuss any health concerns
that your may have. Her e-mail contact is info@chcbali.com
