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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Immunisation: A History

Since the development of the first vaccine almost 200 years ago, there have been groups of individuals opposed to vaccination, claiming it to be dangerous and ineffective. Misconceptions about the safety of vaccinations continue to this day.

 

One of the biggest concerns amongst vaccine opponents is the possibility that vaccines could cause autism, a lifelong developmental disorder of unknown cause and without a cure. The controversy began in 1998, when a group of researchers in England published a small case series claiming that the measles vaccine could lead to the development of autism.¹  Since then, other researchers have disproved the possibility of any relationship by not only highlighting the many flaws of the original study (such as the sample size of only 8 children), but also by subsequently performing well controlled studies.²  

 

In the original report, Wakefield et al. described 10 children with autism. In 8 of them, the onset of symptoms was linked by the child’s parents or physicians to their being given the MMR vaccine. The authors proposed that the MMR vaccine (specifically the measles virus) causes intestinal inflammation, allowing specific peptides to cross the intestinal barrier and resulting in an opioid-like effect on the brain, subsequently disrupting normal brain development. However, this was merely a hypothesis.

 

Several subsequent well-controlled studies found no evidence that MMR causes autism. In particular, one of the best-designed studies addressing this issue revealed that the risk of autism was similar in the vaccinated and unvaccinated group of more than 500,000 children studied, that there was no temporal clustering of cases of autism at any point in time after the MMR vaccine, and, most importantly, that autism was not associated with the MMR vaccine.³

 

 After the media published the results of the original report by Wakefield et al.¹ the rate of the MMR vaccination fell drastically and the incidence of measles infection increased. Since then, even some of the authors of the original report by Wakefield et al. ‘retracted’ their conclusions and agreed that ‘. . . no causal link was established between MMR vaccine and autism as the data was insufficient.’ It is now believed that the symptoms of autism typically begin to emerge at the age when children are immunised with the MMR vaccine.

 

Immunisation is one of the greatest medical achievements in human history, and has saved millions of lives in the 20th century. Many serious childhood diseases are preventable by using vaccines routinely recommended for children. Since the introduction of these vaccines, rates of diseases such as polio, measles, hepatitis B, rubella, diphtheria, pertussis (whooping cough), and meningitis caused by haemophilus influenzae type B (Hib) have declined by 90%.

 

According to the World Health Organisation (WHO), immunisation currently saves an estimated 3 million lives per year worldwide. Pertussis vaccine saves over 600 000 lives. Diphtheria has almost disappeared in some major regions of the world.

 

Vaccination not only protects the individual but it curbs the spread of disease within the community. There only needs to be a certain percentage of individuals within a community who are immunised (herd immunity), to prevent the spread of a particular disease. Individuals who are not immunised increase the risk that they and others in their community will get diseases vaccines can prevent. If immunisation coverage drops for conditions like measles, outbreaks may occur. It is important to maintain a high level of immunisation coverage even when the condition is becoming rare. Failure to maintain measles immunisation coverage can lead to re-emergence and outbreaks. South Africa is currently (2010) experiencing an outbreak of measles.

 

1.       Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson M, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351(9103): 637-41.

2.       Offit PA, Coffin SE. Communicating science to the public: MMR vaccine and autism. Vaccine 2003; 22(1): 1-6.

3.       Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, et al. A population-based study of measles, mumps, and rubella: vaccination and autism. N Engl J Med 2002; 347(19): 1477-82.

 

 

The lowdown on the immunisations

 

The disease

Tuberculosis or TB (short for tubercles bacillus) is a common and often deadly infectious disease caused by various strains of mycobacteria. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when people who have the disease cough, sneeze, or spit.

The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs causes a wide range of symptoms. Diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as microscopic examination and microbiological culture of bodily fluids. Treatment is difficult and requires long courses of multiple antibiotics. Antibiotic resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programmes and vaccination, usually with Bacillus Calmette-Guérin vaccine.

The vaccination

Bacillus Calmette-Guérin (or Bacille Calmette-Guérin, BCG) is a vaccine against tuberculosis that is prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its virulence in humans by being specially cultured in an artificial medium for years.

 

WHO BCG policy The WHO recommends that BCG be given to all children born in countries highly endemic for TB because it protects against TB and TB meningitis.

 

The disease

Polio, or Poliomyelitis, often called infantile paralysis, is an acute viral infectious disease spread from person to person, primarily via the faecal-oral route. Although around 90% of polio infections cause no symptoms at all, affected individuals can exhibit a range of symptoms if the virus enters the bloodstream. Spinal polio is the most common form, characterised by asymmetric paralysis that most often involves the legs.

 

There is no cure for polio. The focus of modern treatment has been on providing relief of symptoms, speeding recovery and preventing complications. Supportive measures include antibiotics to prevent infections in weakened muscles, analgesics for pain, moderate exercise and a nutritious diet. Treatment of polio often requires long-term rehabilitation, including physical therapy, braces, corrective shoes and, in some cases, orthopaedic surgery.

 

The vaccination

Oral polio vaccine (OPV) is a live-attenuated vaccine produced by the passage of the virus through non-human cells at a sub-physiological temperature, which produces spontaneous mutations in the viral genome. OPV is usually provided in vials containing 10-20 doses of vaccine. A single dose of oral polio vaccine (usually two drops) contains 1,000,000 infectious units of Sabin 1 (effective against PV1), 100,000 infectious units of the Sabin 2 strain, and 600,000 infectious units of Sabin 3. The vaccine contains small traces of antibioticsneomycin and streptomycinbut does not contain preservatives. One dose of OPV produces immunity to all three poliovirus serotypes in approximately 50% of recipients. Three doses of live-attenuated OPV produce protective antibody to all 3 poliovirus types in more than 95% of recipients.

 

The diseases

 

Diphtheria, Pertussis and Tetanus

Diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a bacterium. It is characterised by sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity. A milder form of diphtheria can be restricted to the skin. Diphtheria is a contagious disease spread by direct physical contact.

Pertussis, also known as whooping cough, is a highly contagious disease caused by the bacterium Bordetella pertussis. It is known to have a duration of approximately 6 weeks before subsiding.

Tetanus, also called lockjaw, is a medical condition characterised by a prolonged contraction of skeletal muscle fibres. Infection generally occurs through wound contamination and often involves a cut.  As the infection progresses, muscle spasms develop in the jaw (hence the name ‘lockjaw’) and elsewhere in the body.

The vaccination

DPT (also DTP and DTwP) refers to a class of combination vaccines against 3 infectious diseases in humans: diphtheria, pertussis (whooping cough) and tetanus. The vaccine components include diphtheria and tetanus toxoids, and killed whole cells of the organism that causes pertussis (wP).

DTP is an inactivated vaccine which does not replicate in the body. Reactions usually are local at the injection site, e.g. pain, swelling, and redness. Any fever that might occur is a result of inflammation at the injection site.

The disease

Haemophilus influenzae type b

Most strains of H. influenzae are opportunistic pathogens – that is, they usually live in their host without causing disease, but cause problems only when other factors (such as a viral infection or reduced immune function) create an opportunity. In infants and young children, H. influenzae type b (Hib) causes bacteremia, pneumonia, and acute bacterial meningitis.

 

The vaccination

Haemophilus influenzae type B vaccine (Hib vaccine) is a vaccine developed for the prevention of invasive disease caused by Haemophilus influenzae type b bacteria. The Centers for Disease Control and Prevention (CDC) has recommended the use of the Hib vaccine.

 

Clinical trials and ongoing surveillance have shown Hib vaccine to be safe. Adverse reactions to the vaccine are generally mild, the most common being transient redness, swelling, or pain at the site of injection, occurring in 5-30% of vaccine recipients. More severe reactions are extremely rare.

 

The disease

Hepatitis B is an infectious illness caused by hepatitis B virus (HBV) which infects the liver and causes an inflammation called hepatitis. Transmission of hepatitis B virus results from exposure to infectious blood or body fluids containing blood.

 

The acute illness causes liver inflammation, vomiting, jaundice and – rarely – death. Chronic hepatitis B may eventually cause liver cirrhosis and liver cancer. The infection is preventable by vaccination.

 

The vaccination

Hepatitis B vaccine is a vaccine developed for the prevention of hepatitis B virus infection. The vaccine contains one of the viral envelope proteins, hepatitis B surface antigen. A course of 3 vaccine injections is given with the second injection at least one month after the first dose and the third injection 6 months after the first dose. Afterward an immune system is established in the bloodstream.

 

The diseases

 

Mumps, Measles, Rubella

 

Mumps and epidemic parotitis is a viral disease of the human species, caused by the mumps virus. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide, and is still a significant threat to health in the third world.

 

Painful swelling of the salivary glands is the most typical presentation. Painful testicular swelling and rash may also occur. The symptoms are generally not severe in children. The disease is generally self-limiting, running its course before receding, with no specific treatment apart from controlling the symptoms with painkillers.

 

Measles is an infection of the respiratory system caused by a virus. Symptoms include fever, cough, runny nose, red eyes and a generalised rash.

 

Measles is spread through respiration (contact with fluids from an infected person’s nose and mouth, either directly or through aerosol transmission), and is highly contagious – 90% of people without immunity sharing a house with an infected person will catch it. The infection has an average incubation period of 14 days (range 6-19 days) and infectivity lasts from 2-4 days prior, until 2-5 days following the onset of the rash (i.e. 4-9 days infectivity in total).

 

Rubella, commonly known as German measles, is a disease caused by the rubella virus. The name ‘rubella’ is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is often mild and attacks often pass unnoticed. The disease can last 1-3 days. Children recover more quickly than adults.

 

The vaccination

The MMR vaccine is an immunisation shot against measles, mumps and rubella.

 

The vaccine is a mixture of 3 live medically weakened viruses. The shot is generally administered to children around the age of one year, with a second dose at the age of 6. It is normally given at schools to the Grade 1. The second dose is not a booster; it is a dose to produce immunity in the small number of persons (2-5%) who fail to develop measles immunity after the first dose.

 

 The most common adverse reactions after MMR vaccination are a mild rash and fever.