In our last edition we discussed the pros and cons of child-hood
vaccination. As I predicted, this topic generated quite a
bit of interest by our readers and the e-mails have been pouring
in. Here is a selection of questions that may be relevant
to other readers.
Q. My baby was born in the U.K, and the vaccine schedule
there recommends that the first 3 lots of baby vaccines (DTP,
Hib, Polio) are given at one-month intervals, and yet my friend’s
baby who is Australian gets his vaccine every 2 months? Which
schedule is correct?
A. Some countries, including Britain & Indonesia do recommend
that these vaccines are given at one-month intervals. Others
such as Australia & U.S.A do the 2 monthly program. Each
country or region may have a different program. Both of these
programs are effective, however, if these vaccines are given
at 2 monthly intervals there is evidence to suggest that there
is a better overall immune response. It is not dangerous to
give the vaccines one month apart, however you should ensure
that they are not given at less than monthly intervals.
Q. I am married to an Indonesian and my child attends the
local SD school. Last week as part of the national Polio immunization
program, my child was given the polio vaccine. I was not informed
that this was going to happen, and would not have given my
consent to this as my child has already received a full immunization
program at our private doctor’s rooms. Is this dangerous?
What should I do now?
A. This raises a few very important issues. First of all
to put your mind at ease, your child is in no danger. This
vaccine can cause a mild reaction of fever and generally feeling
unwell, it would have been nice to spare your child this if
she did not need the vaccine. If your child has received any
other vaccines in the past month, the polio vaccine may interfere
with the antibody response to the previously given vaccine.
You will have to consult with your private Dr. if this is
the case.
In developed countries giving elective medication to minors
(especially vaccines) without the consent of a parent or guardian
would be a breech of rights. Unfortunately we haven’t
come this far in Indonesia yet. I admire the government for
trying to improve the health of its young population, however
some system of informed consent has to happen. Needless to
say this probably will not happen in the near future.
Another concern for mass immunization programs would be the
use, or lack of, disposable needles (this is not relevant
for the Polio program as Polio is given orally). A friend
of mine once witnessed a class of about 50 children all being
stuck with the same needle. In this day and age the consequences
could be horrifying.
My advise to parents of children at local schools, is to make
it quite clear in writing to all the class teachers and the
head master, that you would not like your child to be part
of any future immunization program at the school. I would
go as far as to keep my child at home on days that you are
aware of these programs being run at the school.
One other point to mention is that all facilities professing
to be vaccination centers should have emergency treatment
options for any child that has a severe reaction to a vaccine.
Most reactions to vaccines are mild, and require nothing more
than Panadol, rest and extra fluids. Rarely a child may suffer
a severe allergic shock reaction (anaphylaxis). The treatment
for this is adrenaline and oxygen. If your practitioner does
not have these available, or does not know how to use them,
find another health center.
Q. My Obstetrician insists that I am vaccinated against Tetanus
while I am pregnant, but according to all that I have read,
vaccinations are not to be given during pregnancy. What is
the reasoning behind my doctor’s suggestion?
A. Your doctor’s suggestion is a standard treatment
recommended to all Indonesian women during their pregnancy.
I suspect that this is a government-instigated program, designed
to combat the massive numbers of infants that die shortly
after birth due to tetanus infection. This is a national tragedy
caused by the ignorance of uneducated birth assistants who
may introduce the tetanus by severing the umbilical cord with
unclean objects (kitchen knives, old razors, ceremonial blades
etc). An elderly Balinese woman once told me how she lost
7 of her 14 children shortly after birth………because
they ceremoniously packed the umbilical stump with dirt from
wasps nests, thereby introducing tetanus. She had no idea
that she was killing her own babies!
Unless you are considering delivering in a back woods village
somewhere, you are correct in declining to accept the tetanus
vaccine while you are pregnant. This is a risk vs. benefit
situation. It’s not worth taking the risk of receiving
the vaccine, if you will gain no benefit, and visa-versa.
Once your baby is born it is worth revising your vaccine status,
and if your last tetanus shot was over 10 years ago, you can
get a booster.
Q. Are there any children that should not be vaccinated?
A. Vaccination should be deferred or refused if the person
to be vaccinated:
Has previously had a severe reaction to a vaccine.
Is allergic to any vaccine component. (E.g. Children allergic
to eggs should not be given the MMR, as this vaccine is cultured
on chick embryos).
Is unwell or has a fever.
Is currently taking antibiotics.
Is receiving treatment that lowers immunity (Chemotherapy,
steroids, radiotherapy).
Has a disease, which lowers immunity (HIV, leukemia, cancer
etc).
Lives with someone receiving treatment that lowersimmunity
(Chemotherapy, steroids, radiotherapy).
Lives with someone who has a disease that lowers immunity
(HIV, leukemia, cancer etc).
Has received a “live” vaccine in the past month
(e.g. BCG, MMR, Polio), or an injection of immuno-globulin
or a blood transfusion in the past three months.
Has a disease of the brain or spinal cord.
There may be other vaccine specific contraindications. If
you are uncertain if your child should or should not be immunized,
I suggest you contact your health practitioner or visit one
of the excellent vaccine information web-sites (webMD, WHO,
CDC).
Q. My baby was born overseas and I have brought her vaccines
back to Bali with me. I am concerned that as we frequently
have power cuts for hours at a time, that the vaccines may
not be cold enough. Should I store them in the freezer to
make sure that they are cold enough?
A. No. While vaccines must be stored cold (2 - 8 C), they
must not be frozen. Most refrigerators will hold their temperature
for up to 8 hours if the door is kept closed. If the door
cannot be kept closed, pack the vaccines in ice or cold packs,
and keep them in an insulated drink box in the fridge until
the power comes on again. Store you vaccines in the coldest
section of the fridge (not freezer), which is on the top shelf
at the rear.
Q. I am currently 8 weeks pregnant and my first child is
due for his MMR vaccine. Is it OK to give him this while I
am pregnant? My friend says that the Rubella component of
the vaccine may cause a problem with my pregnancy.
A. Your friend may be right, although I have never seen any
studies to support this. In theory, as the rubella is a live
vaccine the child that receives the vaccine could develop
the disease (this happens very rarely). Should you also contract
this disease in the first three months of the pregnancy, there
could be ill effects on the unborn child. Just to be absolutely
safe, I would wait to have your older child vaccinated after
the first three months of your pregnancy.
That’s it for this week. For those of you with questions
that have not yet received a reply, I do apologize, and I
will answer all of your queries as soon as I can. Until next
edition, 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
