Time is of the essence

Pertussis and measles. In the past week, you must have either heard or read of the urgent call to vaccinate against these diseases due to recorded outbreaks from low immunization coverage rates. The implications are far-reaching for not only are confirmed cases potential sources of continued transmission, but also speak of opportunities lost, and are painful reminders of the need for more concerted efforts to spread disease awareness and espouse the importance of prevention.

“How are things coming along?” I called a good friend and colleague in the Bangsamoro Autonomous Region in Muslim Mindanao region to discuss how we can be of assistance. The conversation included an initial mention of logistical concerns but eventually drifted into a more intense exchange on what specific area of the outbreak response we could focus our energies on. Well attuned to how she likes to keep one thinking, she started by saying,“Do you know that there are people who still cannot fully grasp what a pentavalent vaccine is?” It was clear that as a community we had to improve our communication strategies beyond just talking about the disease. Please find below some of the more common questions encountered in a clinic visit.

“Doctor, do you think my child can take it?” Their baby was six weeks of age and was due to be immunized after a birth dose of hepatitis B and BCG (bacille Calmette-Guérin). We were talking about the different diseases that could be prevented and available as single or combined preparations.

Answering in the affirmative, I enumerated the components of a combination vaccine namely diphtheria, pertussis, tetanus, poliovirus, Haemophilus influenzae Type B (Hib), and hepatitis B, before explaining that there is a considerable amount of scientific data to support that a child’s immune system will not be overwhelmed with the receipt of these antigens, nor would its effectiveness be diminished if given in a single shot.

I gave them time to digest this information before discussing the two other recommended vaccines, namely the pneumococcal vaccine which would entail another injection on a separate limb, and the rotavirus vaccine which was to be given orally.

“Will there be fever and what should I watch out for?” There is a possibility that fever may occur but the more common reactions to be expected would be swelling on the site of injection and tenderness. Absence of fever is not a measure of vaccine effectiveness.

“How many injections will my child need and how long will protection last?” The number would be dependent on the type of the vaccine, the age, and the presence of underlying conditions. In general, immunity for live vaccines is lifelong and would not require boosting. Examples would include your BCG, measles, mumps, rubella, and varicella vaccines. Inactivated vaccines, on the other hand, do not provide long-lasting protection and would require multiple doses and periodic boosting as antibodies produced may wane with time. Influenza, diphtheria, and tetanus vaccines are some examples that you may be familiar with.

“My child has missed out on the recommended vaccines, is it too late?” Absolutely not!

There is a chance to catch up and your health-care provider can schedule accordingly. It is better that protection is provided before one becomes vulnerable to the disease and suffers from its acute or long-term complications, some of which may be irreversible.

“I missed out on the required number of doses that you recommended, do we need to start from scratch?” In general, it is not necessary to start all over again. One just needs to review the immunization record and continue to completion.

“I am breastfeeding, isn’t that enough to provide protection?” While breastfeeding may have immeasurable benefits, immunity diminishes with time, and protection for certain diseases can only be obtained from the receipt of specific vaccines.

“My child was diagnosed with an ear infection and about to finish his course of an antibiotic, can he still be vaccinated?” The answer is yes. Minor illnesses are likewise not a contraindication to having your child vaccinated.

I am quite sure that there are more questions but due to limited space let me end by sharing a story on how one grandmother became a champion for immunization. Her grandchild was brought in for admission because of severe pneumonia. She had delayed the receipt of some recommended vaccines mainly because of financial concerns. Engaging her in a discussion, she expressed her regrets. Rather than admonishing her, I told her that we still had time.

At two and a half years old, he was diagnosed with cancer. We were lucky to have completed the required vaccinations. Though we eventually lost him to the disease, complications of infection with vaccine-preventable diseases were nonexistent. No vaccine can claim to be 100 percent effective but I hope that this particular story leaves you enough room for thought.

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