Your body has a natural defence system against harmful organisms such as bacteria and viruses. When these germs invade the body, your immune system makes antibodies that help destroy them. The next time you are exposed to the same infection, your body automatically recognises it and produces the same antibodies to destroy it!

Vaccinations work in pretty much the same way. A vaccination shot contains a very small and safe amount of the virus or bacteria, which has been killed or weakened. This helps your body learn to recognise and attack the infection if you contract it later on in life. However, the chances of getting the infection after vaccination are very much reduced, and if you do get it, the infection is often mild.

Pneumococcal disease

Pneumococcal disease is caused by Streptococcus pneumoniae, commonly known as pneumococcus. It attacks various parts of the body, causing serious illnesses in both children and adults. There are generally two types of pneumococcal diseases: invasive diseases and non-invasive diseases.

Invasive diseases are more serious and occur within a major organ, or the blood, and include:

• Pneumonia – Occurs when pneumococcus attacks the lungs.
• Bacteraemia – Occurs when the bacteria spreads and circulates in blood.
• Meningitis – An extremely serious condition whereby the brain covering and spinal cord becomes inflamed.

Both bacteraemia and meningitis are deadly diseases that can kill within hours, and babies and toddlers fall into the high-risk groups of contracting these diseases!

Non-invasive diseases on the other hand, occur outside major organs and the blood. These include:

• Otitis media – An infection of the middle ear.
• Sinusitis – Inflammation of the sinuses.

These diseases are much less severe compared to bacteraemia and meningitis; however, they can still cause serious complications if they’re not detected and treated early.

Prevent with vaccination

There are more than 90 known pneumococcal serotypes, with 13 common ones that cause 80-92% of invasive diseases in young children all over the world. Pneumococcal vaccination is one of the best ways of preventing invasive pneumococcal diseases.

Pneumococcal conjugate vaccines (PCV) protect infants and young children against pneumococcal disease. Young children below two years old are at highest risk of being infected with the pneumococcus. This risk is especially higher if the child is enrolled in a day care or nursery where the infection passes from one child to another via air droplets from sneezing or coughing. Immunisation can begin as early as six weeks of life. The added benefit of the vaccine is that it eradicates the bacteria from the nasopahrynx (back of the thorat and nose) thus preventing its spread to other children and adults. This is known as the indirect benefits of the vaccine, also called herd immunity.

Weighing the risks

Vaccination is the principal means of preventing many diseases, therefore avoiding unnecessary illness, disability and death. Some parents may worry about side effects that may occur from vaccination, but in fact, vaccination remains the best defence against diseases, and its benefits far outweigh its risks.

The most usual side effects from vaccinations may just be redness or swelling at the injection site, which soon goes away. In very rare cases, some may experience allergic reactions, which can be treated effectively when taken care of promptly.

The benefits of vaccination cannot be seen immediately; but with vaccination, you can be quite sure that your child does not contract pneumococcal disease. Though vaccination is not 100% effective in all children, it is far better to be vaccinated than not. They are the best guard against diseases that have the potential to kill or even disable.

Asthma has, for many years, been a significant health problem, and continues to remain so. Being one of the most chronic bronchial diseases, it is also the most commonly diagnosed disease in children. Asthmatic children suffer symptoms that can directly impair their ability to enjoy their childhood.

In general, an asthma attack occurs when a person suffers a recurrent attack of shortness of breath and wheezing caused by the swelling of the bronchial tubes, which in turn, narrows the air passage and reduces the flow of air in and out of the lungs.

Beware of those nasty triggers!

The main factors causing a person to develop asthma are still not known. It could be a combination of genetically-inherited factors and environmental factors, or it could be one of these two factors acting separately. What is known is that there are many triggers for an asthma attack. An asthmatic person must consciously avoid these triggers as they could provoke an allergic reaction and lead to an asthma attack.

The action plan

Asthma cannot be cured, but the good news is, your child’s asthma symptoms can be controlled with proper planning and management.

An action plan developed in coordination with your child’s physician can help you and your child manage and prevent asthma attacks. The objective of this action plan is to inform your family members or your child’s caretakers what to avoid in preventing an asthma attack, or what to do in the event of an attack.

Your child’s personalised asthma action plan should include all relevant and vital information in the event of an asthma emergency. To start with, here is a list of crucial information that should be included:

• All the triggers that could provoke your child’s asthma symptoms and how to avoid them.
• The regular asthmatic symptoms that your child suffers, such as shortness of breath, coughing, wheezing, and chest tightness, and what to do if this happens.
• The name and dosage of the daily asthma medication that your child takes even though no asthma symptoms occur.
• The name and dosage of the fast-relief medication that your child takes when the asthma symptoms start to occur, and the relief medication when the attack actually occurs.
• All emergency phone numbers and locations of emergency services as well as phone numbers of family members to get in contact with in the event of an emergency.
• Some instructions when to contact your child’s physician, whom to call if the doctor is not available, and a list of places where emergency asthma medication can be easily obtained.

It is also crucial that your asthmatic child has enough knowledge about this chronic disease and the medication involved in order to manage and prevent an asthma attack. Sit your child down and explain to him, depending on his age and level of understanding, the effects of asthma. Train him to keep track and faithfully follow his daily medication schedule and how to use an inhaler correctly.

All children using the inhaler therapy should use a spacer device for more effective delivery of the medication as it does not require coordination. Younger children will require a spacer device with a face mask while older children can use a spacer device with a mouth piece. Explain to your child that in order to use an inhaler with the spacer device properly, he must first:

1. Shake the inhaler well before taking the cap off. Then, he must insert it to the spacer device.
2. He must then push the canister to allow the mist into the spacer device slowly, and breathe in while pushing down on the canister to allow the mist into the lungs. Then, instruct him to breathe normally 5-8 times.
3. If your child requires another inhalation dose, he must wait 1 minute before repeating the above technique.
4. Remind him that the inhaler and spacer must always be kept clean and dry (clean it once a week).

These steps should also be written in your child’s asthma action plan and distributed to whoever is in charge of your child, be they teachers or caregivers.

An asthma action plan can help reduce your child’s asthma exacerbations by identifying triggers and facilitating early recognition of an asthma attack. Early treatment with a bronchodilator (inhaler) can reduce the severity and frequency of asthma attacks. If you or your child suffers from asthma, then develop an asthma action plan today.

Pertussis, or whooping cough, is a disease caused by the bacteria Bordetella pertussis. This infectious disease can affect both children and adults. But because the classic symptom of pertussis is hardly present in adult pertussis, the disease often goes undetected and under-treated in adolescents and adults.

As a result, many of them may unknowingly contract and transmit the disease to vulnerable populations - infants and young children who are not fully vaccinated or just partially vaccinated against pertussis. In fact, studies have shown that new parents, especially mothers, are the source of infection in more than 50% of pertussis cases.

If pertussis is passed on to infants and young children, it may lead to severe health complications. The disease is potentially fatal in those younger than 2 years.

Protection against pertussis

The only way to protect against pertussis is through vaccination. The incidence and mortality due to pertussis has dramatically reduced since the introduction of the pertussis vaccine in the 1940s. However, pertussis remains prevalent in certain parts of the world.

The main reason for this is because, unlike other vaccines (eg chickenpox vaccine) that confer life-long immunity, the protective effect of pertussis vaccine lasts for only 4 to 12 years. After completing childhood immunisation, a child may have lost his immunity to the disease upon reaching adolescence.

To re-establish the immunity, a pertussis booster shot is required. It is important for older children, adolescents and adults to receive periodic pertussis booster doses, not only to keep themselves protected, but also to prevent them from passing the disease to vulnerable infants and young children.

Extending the protection

Under the Malaysian National immunisation schedule, the pertussis vaccine is given in combination with diphtheria and tetanus toxoid (DTP) to infants at 2, 3 and 5 months, plus a booster dose at 18 months to reinforce the immunity.

At 7 years old, children receive diphtheria and tetanus (DT) vaccinations or "double antigen", and not the pertussis vaccine. Considering the short-lived protection from pertussis vaccine, children lose immunity to the disease while growing up. Therefore, it is advisable that children get Tdap vaccine instead of DT vaccine at the age of 7 to boost their immunity against pertussis.

Similarly, as children reach the age of 15, they receive tetanus immunisation only. They should be revaccinated for extended protection against pertussis.

Recommendations

The US Centers for Disease Control and Prevention recommends:

• Adolescents aged 11-18 years to receive the Tdap in place of a Td (tetanus diphtheria) booster. Adolescents who have received Td vaccine are also encouraged to get a Tdap dose.
• Adults aged 19-64 years to receive Tdap to replace a Td booster shot.
• Adults, ie parents, grandparents, childcare providers and health professionals, who have close contact with babies below 12 months, to receive Tdap.
• Tdap to replace tetanus toxiod given during injury to prevent tetanus (lock jaw).

In addition, people who are travelling overseas are also advised to get their pertussis booster shots to reduce their risk of contracting the disease while abroad and bringing it home. At the moment, only a single dose of Tdap booster is recommended.

The influenza A (H1N1) pandemic, which occurred in 2009, is now in its post-pandemic stage. Although there have been no large outbreaks of influenza in recent months, it does not mean that influenza is a thing of the past and something we no longer have to worry about. Influenza is not just the “flu” or a common cold, it is a very serious and specific disease of the respiratory system, which can result in hospitalisation and even death if not treated accordingly.

Can influenza cause pneumonia?

Influenza weakens your immune system, leaving you susceptible and vulnerable to various other illnesses which may lead to serious complications. Bacterium Streptococcus pneumoniae is a common cause of secondary pneumonia, following influenza.

Pneumococcus can also cause ear infections, meningitis, as well as bloodstream infections. These illnesses are serious and are a main cause for concern. According to the Centers for Disease Control and Prevention (CDC), about one in 20 people who contract pneumonia die from the infection, two out of 10 people who get bloodstream infections will die and three people out of 10 who contract meningitis will die. The risk of death from pneumonia or influenza is higher for people with heart disease, diabetes, or weakened immune systems such as from AIDS, on steroids or with congenital immunodeficiency disorders.

Higher cases of pneumonia with more influenza cases

Influenza is highly contagious, and is easily spread from person to person, mainly through droplets when an infected person coughs, sneezes or talks and also when a person touches a contaminated surface or object. With the increase of influenza cases worldwide, pneumonia and other pneumococcal diseases have been on the rise as well. Influenza’s infection creates a gateway to other harmful viruses and bacteria into your body.

Death by respiratory infections

According to the World Health Organization (WHO), over 3.9 million deaths are caused by acute respiratory infections and are the leading cause of death in children below the age of 5 years. In addition to pneumococcal disease, influenza increases the risk of other respiratory diseases such as viral upper and lower respiratory illnesses, and bronchiolitis, which are caused by respiratory syncytial virus (RSV) and parainfluenza viruses (PIV).

Prevention starts with YOU

All cases of pneumococcus infection could be treated effectively with antibiotics such as penicillin. In recent years however, the bacteria have become increasingly resistant to antibiotics, making it very difficult to treat such diseases. Therefore, the best and most effective way to treat pneumococcal diseases is by preventing it in the first place, and that is through vaccination.

Although there is a possibility for anyone to get pneumococcal disease, there are still certain groups of people who are at a greater risk of getting the disease, some even becoming seriously ill. Therefore, it is important that these groups of individuals get vaccinated:

• Adults aged 65 years and above.
• Children aged 2 to 24 months, especially those with chronic medical conditions such as, diabetes, lung (except asthma), heart, kidney or liver disease.
• Those with immune systems weakened by conditions such as cancer or HIV infection.
• Those without a functioning spleen or suffer from sickle cell disease.

There are two types of vaccines against pneumococcal disease: A polysaccharide vaccine and a conjugate vaccine. The pneumococcal conjugate vaccine is recommended for children aged 2-24 months, as they fall into the highest risk group for invasive pneumococcal diseases and they do not respond to polysaccharide vaccines. Whereas the polysaccharide vaccines are given to the other group of individuals as stated above.

Weigh the risks

Vaccination is in fact a principal means of preventing many diseases, thus avoiding unnecessary illness, disability and death. Some parents may have concerns about vaccinations, worried about any side effects that may occur. However, vaccinations are among the safest, as its benefits far outweigh its risks. The most usual side effects from vaccinations may be just a redness or swelling at the injection site, which soon goes away. In very rare cases, some may experience allergic reactions, which can be treated effectively when taken care of promptly.

The benefits of vaccination cannot be seen immediately; but with vaccination, it will help to protect yourself and people around you. Though vaccination is not 100% effective in all children, being vaccinated is much safer than not since the vaccine does protect against 88% of the pneumococcal bacteria that cause pneumonia. They are the best guard against diseases that have the potential to kill or even disable millions of children and adults for life.

As parents, we never want to see our children sick, no matter how minor the illness may be. Imagine being able to protect your children from some of the most deadly diseases in the world? According to the Centers of Disease Control and Prevention, vaccinations play a major role in the prevention of disease, ensuring that your child lives a safe, happy and healthy childhood.

Polio once affected 20,000 Americans every year in the 1950s. However, since the introduction of the polio vaccine, there have been no reports of polio. Diphtheria, one of the most dreaded childhood diseases up through the 1920s, killed over 10,000 people every year. After vaccination started in the 1930s’ and 40s’, the disease started disappearing until today. The World Health Organisation (WHO) estimates that up to 552,000 diarrhoeal diseases can be prevented through vaccinations, rotavirus gastroenteritis (338,000) and pneumococcal disease (841,000). Smallpox is now completely eradicated, thanks to vaccination worldwide.

Reducing Childhood Risk

The Government of Malaysia introduced the National Immunisation Programme in the early 1950s and the Expanded Programme for Immunisation in 1989. Cases of vaccine preventable diseases have dropped significantly since the introduction of the programme. From 1979 to 2007, reported diphtheria cases have reduced from 250 to 2, tetanus from 76 to 14 cases, measles from 5,463 to 1,206 cases and polio from 39 cases to zero. To ensure the continued success of the National Immunisation Programme, it is important that parents take the appropriate steps of following through with the schedule accordingly.

These are just some of the diseases in which you can protect your child from through vaccinations. The key to public health is disease prevention as it is always better to prevent a disease, rather than treat it. Vaccines not only help to prevent diseases, they are also responsible for the control of many infectious diseases once common in the world.

Diarrhoea is responsible for the death of 1.5 million children all over the world every year, making it the second leading cause of death in children under the age of five. It causes the body to lose a lot of water and salts, which are important for body functions. Diarrhoea deaths usually happen due to complications from severe dehydration and fluid loss.

If there is a significant increase in the fluidity, frequency and volume of your baby’s bowel movements, it could be an indication of diarrhoea in your baby. Breastfed babies often have more frequent bowel movements while some may be affected by a change in the diet. However, very loose and watery stools are usually a clear indication of diarrhoea in your baby and you should consult your doctor immediately to further clarify.

Diarrhoea Danger for Infants

In babies, stomach cramps or pain, vomiting, loss of appetite, sluggishness and less activity than usual as well as less interest in feeding usually comes together with diarrhoea. Because water and salts are lost in great amount during diarrhoea, this often leads to dehydration. Serious health problems may arise should infants suffer from severe dehydration, which may even lead to death if not managed properly. Find out more about the article “Loss of Water” in this issue which is on dehydration.

Rotavirus – the Common Cause

When infants are infected with rotavirus, they will get sudden fever and vomiting followed by watery diarrhoea. Rotavirus is a wheel-like virus, which can cause gastroenteritis – the most common cause of diarrhoea in children less than five years of age.

Rotavirus is very contagious and easily transmitted from personto- person contact via faecal oral route. It also transmits through faecal contact on surfaces, thus contaminating hands, furniture and objects like toys. The incubation period for the virus is very short – 1 to 3 days – and children often start shedding the virus before they even show symptoms. However, the point to note is that rotavirus can survive less than a week in air, for days to weeks on surfaces, and for weeks in recreational or drinking water. Furthermore, it is not easily killed by regular soaps and may be thus hard to be contained.

There are also other types of viruses and bacteria that can cause diarrhoea in children. Here are some of the more common ones:

Prevent Diarrhoea Before It Occurs

As parents, there are ways in which you can help prevent your baby from getting diarrhoea.

1. Exclusive breastfeeding for baby’s first six months
   • Breast milk is the most hygienic source of nutrition for baby, which eliminates the risk of baby consuming contaminated foods that may lead to diarrhoea. Breast milk is also the best source of liquid and food if he already suffers from diarrhoea, preventing dehydration and malnutrition.
   • Breast milk also contains antimicrobial factors, helping to boost your baby’s immune system thus leading to fast recovery during illness.
   
2. Practice good hygiene
   • In most cases, the transmission of diarrhoea-causing viruses or bacteria can be reduced through good and proper hygiene. Always wash your hands and all feeding equipment. The equipment should be sterilised with hot water before use.
   • Wash your hands frequently especially after using the restroom and every time you change your baby’s diaper. Ensure that baby’s environment is kept clean and dirtfree, including bed sheets and toys, as babies are prone to put things into their mouths.
   • Thoroughly clean and disinfect all possible contaminated objects. Discard them if there is a need to do so, especially for bed mattresses that may be infected from the faeces.
   
3. Improved complementary feeding practises
   • Complementary food is usually given in addition to breast milk when your baby is six months old onwards. This is an important transition and involves proper handling of the foods to ensure contamination does not occur. Always ensure that the food and milk is fresh, thoroughly cooked and has not been kept at room temperature for more than an hour.
   
4. Immunisation protection
   • In Malaysia, vaccination for rotavirus is available as an optional vaccine for babies less than six months old. The vaccine is taken orally, in either two or three doses, and helps deal with the infection with minor consequences should your baby be exposed to the virus. Do consult your child’s paediatrician to know more about this optional vaccine.
   

Diarrhoea is a disease that is easily preventable. All it takes is a little bit of effort from your side, in providing and maintaining good hygiene as well as ensuring that your child is protected through other methods such as exclusive breastfeeding and vaccination.

Mouth ulcers are small, round or oval-shaped painful lesions that appear in the mouth. They can occur on the inner side of the cheeks or lips, the edge of the tongue, or at the base of the gums.

Chickenpox is highly contagious and can spread easily from person-to-person through air, saliva or direct contact with an infected person. Thus, anticipate your child to get chickenpox at some point during his childhood. If you have not paid much attention to information on chickenpox, here’s your chance to find out how you can care for your child with this illness.

Reduce the Itchiness

While you cannot completely get rid of the itchiness, you can make him more comfortable.

• Give your child either lukewarm or cool baths every 3 to 4 hours.
• Use mild soap for bathing to avoid irritating his overly sensitive skin.
• Apply calamine lotion, which helps to relieve itchy rashes.
• Dress your child in light clothing that is less likely to irritate his skin.

If your child suffers from severe itch, check with your doctor about prescribing him antihistamines.

Prevent Scarring

When your child scratches himself, bacteria on his hands and under his fingernails may infect the broken skin blisters, causing skin infections that may lead to permanent scarring. Prevent your child from scratching himself. Other tips include:

• Keep your child’s fingernails short so he won’t hurt his skin should he scratch.
• When he sleeps, let him wear cotton gloves or mittens to prevent him from unconsciously scratching himself.
• Pat him dry instead of rubbing him after a bath to prevent breaking the blisters.

Eating Right

Your child may not have the appetite to eat much in the first few days of chickenpox. Blisters may sometimes form in his mouth and throat, making it difficult for him to eat. So, during this period you should:

• Ensure your child gets plenty of fluids (ie plain water or fruit juices) to stay hydrated.
• Feed a well-balanced diet to help your child recover from the disease.
• Offer foods that are soft in texture, cold and bland to make eating more comfortable.

Preventing the Spread

To prevent an infected child from spreading chickenpox to his siblings, here’s what you can do:

• Separate them before any sign of chickenpox rash appears and until the rashes clear up.
• Ensure the siblings wash their hands frequently.
• Caregivers must also take extra care of their hygiene after coming into contact with the infected child.
• Antiviral agent like acyclovir, if given early in the course of the disease, will help reduce the severity.

Preventing Chickenpox

While chickenpox is often mild, seeing your child suffering such discomfort can be distressing. The disease may also potentially develop into a more severe condition. Thus, if parents want to avoid all the hassle that accompanies chickenpox, there are a few things they can do to prevent chickenpox.

Breastfeeding
Mother’s who have had chickenpox are immune to the disease and will probably pass on this immunity to her newborn baby through the antibodies in her breast milk. Thus, mothers are encouraged to breastfeed their newborns for at least the first few months of their life.

Vaccination
According to the Centres for Disease Control and Prevention (CDC), chickenpox vaccine is the best way to prevent chickenpox, offering complete protection to about 80-90% of children who are immunised. Getting chickenpox during the teens or adulthood will have more severe complicatons.

The influenza A(H1N1) pandemic, which first broke out in mid-April 2009, had relatively quietened down for a period of time. However, the resurgence of the disease early this year could mean that the second wave is already in its infancy. Though the current situation is nowhere near as serious as the situation back in 2009, the public is advised to continue taking precautions and remain vigilant to prevent infection and complication from the disease.

Pneumococcus – Complicating Influenza A(H1N1) Recovery

Though most H1N1 cases have been mild, with many of those affected usually recovering, there have also been more severe cases with complications that can prove to be fatal. Statistics from the CDC show that the more severe cases of influenza are made worse by secondary bacterial infections, particularly by Streptococcus pneumoniae.

The most common complication observed in such cases is pneumonia, an infection of the lungs. In fact, it was noted that during each of the recent influenza pandemics worldwide, secondary bacterial pneumonia was a frequent cause of illness and death. This is because influenza predisposes individuals to developing pneumonia by weakening the lung’s defenses, allowing bacteria like Streptococcus pneumonia to infiltrate and infect lung tissues. Similarly, the disease can also infiltrate the blood and the fluids surrounding the brain, causing bacteraemia and meningitis.

Influenza and Children

Without medical help, it may be difficult to detect influenza in very young children as they may not complain of the common influenza symptoms like fever, sore throat and breathing difficulties. Thus, as parents, it is important to take note of various changes consistent with the onset of influenza in children. Bring your child to the doctor immediately should he exhibit any of these symptoms as he may have contracted the influenza A(H1N1) virus;

• Fever, cough and runny nose.
• Tiredness, lethargy, poor appetite, diarrhoea and/ or vomitting.
• Has severe trouble with breathing.
• Has bluish skin colour/lips.
• Has fits/seizures.
• Is unresponsive and difficult to wake up from sleep.
• Dehydrated (in infants, no wet diaper for 12 hours).

Some children, especially those younger than the age of 2, have a weak immune system or those with lung, heart, liver, blood, brain, muscle, bone or metabolic disorders, are at higher risk for developing severe forms of influenza and contracting a secondary bacterial infection.

Preventing Complications from Pneumococcal Disease

Pneumococcal disease is one of the leading causes of vaccine-preventable deaths and coupled with influenza A(H1N1), the disease may prove fatal.

Thus, to prevent such complications from developing the CDC recommends the public to obtain a yearly seasonal vaccine as the first defense against the common seasonal influenza. Vaccines to protect against the H1N1 influenza are now available and children aged between 6 months and 10 years are given the priority, as they are more vulnerable.

Additionally, pneumococcal vaccines are also recommended by the CDC to reduce illness and death resulting from secondary pneumococcal infections, especially among children below the age of five years. For children, the pneumococcal conjugate vaccine (PCV7) protects against 7 serotypes of pneumococcal strains while the newer Pneumococcal Non-Typeable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) protects against 10 serotypes of pneumococcal strains.

Vaccinate Today

Although influenza, specifically H1N1, is not making the headlines these days, it still remains a very large part of humanity and as with most illnesses, young children are the most susceptible. Parents should play their role in ensuring their child receives the best and is well taken care of during the high-risk periods and through all other times as well. Vaccinate your child before it is too late. Pay close attention to pneumococcal vaccination as well as bacterial infections are one of the complications that arise from influenza A(H1N1).

Pneumococcal disease is the leading cause of serious illnesses in children and adults worldwide. The disease is a bacterial infection caused by Streptococcus pneumoniae, also known as pneumococcus. Across the globe, more children die from pneumococcal infections than AIDS, malaria and measles combined.

Be Aware, Take Care

Pneumococcal disease is highly contagious. S. pneumoniae, commonly found in the nasopharynx of healthy infants and adults can be transmitted from person to person via respiratory droplets expelled through coughing or sneezing.

S. pneumoniae can attack many different parts of the body, causing a wide range of problems. Those infected with the bacteria may suffer a range of debilitating and lifethreatening illnesses such as meningitis (inflammation of the lining of the brain), pneumonia (inflammation of the lungs), bacteraemia (blood infection) and acute otitis media (infection of the middle ear).

Complications and Treatment Difficulties

Pneumococcal infections can develop as quickly as one to three days and complications that arise can be severe. Delayed treatment of pneumococcal disease can lead to hearing loss, paralysis, brain damage and even death.

Infections, in general can be treated with penicillin but recent surveillance studies show that more and more pneumococcal strains are becoming resistant to penicillin and some other commonly-used antibiotics. This situation complicates treatment and may result in costly alternative therapies.

Vaccination, Your Best Form of Defence

The best way to protect your family against pneumococcal disease is through vaccinations. Infants and very young children are at high risk of deadly infections if they are not immunised against the disease.

According to the World Health Organisation (WHO), up to 1 million children die each year from pneumococcal disease worldwide. Published studies on pneumococcal disease in Malaysia have shown pneumonia to be the most common clinical presentation, with morbidity and mortality being highest in children under two years of age.

Pneumococcal conjugate vaccine (PCV) has been proven to safely and effectively reduce the incidence of invasive pneumococcal disease (meningitis, bacteraemia and pneumonia) and otitis media in young children. In Malaysia, since 2005, a 7-valent paediatric pneumococcal conjugate vaccine has been made available for the prevention of pneumococcal infections. There now exists a 10-valent conjugate vaccine, the Pneumococcal Non- Typeable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) which has been specially designed to improve the prevention against invasive pneumococcal disease coverage by providing protection against 3 additional pneumococcal strains (serotypes 1, 5 and 7F) and nontypeable Haemophilus influenzae otitis media.

Additionally, individuals looking to vaccinate older family members and children 2 years and older who are at high risk for disease may request from their family physician, the 23-valent pneumococcal polysaccharide vaccine (PPV23). The two pneumococcal conjugate vaccines and PPV23 are currently available at all government and private hospitals and clinics.

Most children do not like to be given injections as it can be a painful and traumatising experience. This can be a stressful affair, as you will have to deal with your child’s tears and fears.

Under the National Immunisation Schedule, it protects the child from ten diseases and a total of eight injections (excluding booster shots), up to the age of one year. Missing any one of these vaccines is a risk to your child’s health, exposing him to potentially fatal diseases. With combination vaccines, the number of shots can be largely reduced.

In 2009, the Ministry of Health has replaced live oral polio vaccine (OPV) with inactivated injectable one (IPV), and also whole- cell pertussis (whooping cough) with acellular pertussis vaccine. These are improvements to the national schedule and are given in the form of combination vaccines.

Frequently Asked Questions on Combination Vaccines

Combination vaccines have long been incorporated into the National Immunisation Schedule, yet many parents still have questions. Read on as we try to answer these questions and more.

Are combination vaccines effective?

There are factors that need to be considered before vaccines are combined, including the reactivity of vaccine components against each other and the stability of all components in the vaccines. Combination vaccines that have been successfully produced and used are as safe and effective, and possibly more so than individual single-disease vaccines. It has been shown that combination vaccines produce similar or fewer reactions at the injection site and throughout the body when compared to single-disease vaccine.

Will children be able to handle the high dosage of antigens introduced in one single combination vaccine shot?

Most vaccines contain a weakened form of antigens from the bacteria or virus that will elicit a response from the immune system, but will not cause the development of a disease. Even with combination vaccines, studies have shown that combination vaccines cannot “overload” your child’s immune system. Children’s immune system is capable of handling many more times the antigens compared to those introduced through combination vaccines.

Where can I get the option of combination vaccines?

Combination vaccines under the National Immunisation Schedule are typically accessible in both government and private hospitals or clinics. Among a few combination vaccines that are now under the schedule are MMR (trivalent) and DTaP-IPV-HiB (pentavalent). Additional combination vaccines (eg; tetravalent MMRV or hexavalent DTaP-IPV-Hib-HepB) are only available in private practices. Hexavalent vaccines protect against diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae b (causing meningitis), poliovirus and hepatitis B in a single shot. If you are interested in getting your child immunised with these combination vaccines, please consult your doctor.

Are combination vaccines cheaper than individual vaccines?

In 1974, the World Health Organization (WHO) launched the Expanded Programme on Immunisation (EPI) to get children less than one year of age immunised. Vaccines under the EPI are free of charge in government hospitals. Combination vaccines under the National EPI are also free at government hospitals. Parents can opt for other combinations that cover more diseases at an additional cost in private clinics. The combinations include MMRV and DTP-Hep B-Hib-Polio vaccines. At first glance, combination vaccines are not necessarily cheaper. However, it saves parents’ time by having lesser doctor visits and injections, thus lowering the total cost.

Types of Otitis Media

Otitis media can be divided into three types:

1. Acute Otitis Media (AOM) – Fluid, typically pus, is found in the middle ear. Your child may experience pain, fever, redness of the eardrum, and irritability.
2. Otitis Media with Effusion (OME) – This is more common than AOM, and the presence of fluid in the middle ear is only temporary. This fluid is not necessarily infected.
3. Chronic Suppurative Otitis Media – This occurs when fluid is in the middle ear lingers for at least six weeks, and is considered a more chronic form of otitis media.

Causes

Bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the most common causes of otitis

Preventive Measures

To prevent your child from getting infected, here are several actions that can be undertaken:

• Breastfeed your child. Breast milk contains antibodies that protect your child from many illnesses and infections. Continue for up to two years or beyond to build up early immunity.
• Avoid exposure to cigarette smoke. Research shows passive smoking can increase the adherence of bacteria to the respiratory passages and depress the immune system, increasing the frequency and severity of ear infections.
• Practise good hygiene. Cultivate good hygiene habits such as frequent hand washing to prevent transmission of germs that can directly or indirectly cause ear infections.
• Get early treatment for the common cold and insist that your doctor look at your child’s eardrums.

Another effective way to protect your child from otitis media is through immunisation. Studies show that the frequency of otitis media among children was considerably reduced in those who had completed their immunisation series. (Weekly Epidemiological Record, 2007 - World Health Organisation)

Haemophilus influenzae type b (Hib) vaccine – This offers protection against diseases like pneumonia, meningitis and otitis media. It is available as a combination vaccine that protects against Hib, diphtheria, tetanus, and pertussis (whooping cough). Available since 2002, it has been included in Malaysia’s National Immunisation Programme.

Pneumococcal conjugate vaccine (PCV) – This guards your child from pneumococcal infections, including otitis media, bacteraemia and sinusitis. It consists of inactivated forms of 7 or 10 different serotypes of the bacteria, protecting against pneumococcal infections.

These strains are responsible for most severe pneumococcal infections among children. PCVs have lowered the number of severe pneumococcal disease by nearly 80% among children under five (Centres for Disease Control and Prevention, CDC, America) in the US where this vaccine is routinely given to all children. Currently an optional vaccine in Malaysia, PCV can be obtained in private hospitals or clinics.

The new 10-valent conjugate vaccine covers up to 10 different strains of pneumococcus, and the vaccine is recently available in Malaysia since October 2009.

For more up-to-date information regarding immunisation and the vaccines, consult your doctor.

Shingles
Shingles/herpes zoster is a rash of painful blisters that can last for 2 to 3 weeks. It is caused when the dormant varicella virus, which remains near the spinal cord, reactivates long after the initial chicken pox illness. About 10-20% of people who have had chickenpox develop shingles, usually occurring to those above the age of 50 years or when immunity is low. Shingles is generally not dangerous, but it can be very painful and often cause lingering nerve pain for months after the rash is gone.

Home Treatment Tips:

• Let your child have cool/lukewarm baths.
• Calamine lotion will help relieve the itchy rash.
• A prescribed antihistamine may relieve severe itch.
• Ensure your child gets adequate fluids and nutrients.
• Give foods that are cold, soft, and bland.
• Avoid acidic or salty foods.
• Give paracetomol, or acetaminophen, if your child is having fever.
• Trim your child’s fingernails. Let him wear gloves when he sleeps to prevent him from scratching. Scratching predisposes to secondary bacterial infection and causes scarring.
• Never give aspirin to reduce pain or fever in children with chickenpox.

Protect Your Family
The varicella virus is highly contagious and it spreads easily through direct contact with the infected person, through a sneeze or cough, or by touching the fluid from a chickenpox blister. It can also spread indirectly, through contact with contaminated surfaces. It is contagious 2 days before the rash appears, up to the time when all blisters have dried up.

Many children get infected through direct contact with their infected sibling. To prevent chickenpox from spreading, keep your infected child away from his siblings and get him to wash his hands frequently.

Acyclovir, an antiviral agent, is only effective when given during the early stages of infection.

Chickenpox in Pregnant Women & Newborn Babies
Chickenpox infection during early pregnancy leads to birth defects, low birth rate, or limb abnormalities in the foetus. If the mother gets infected within 10 days after delivery, her newborn baby may suffer a lifethreatening infection. An immune mother can protect her baby from infection within baby’s first few months of life, as her immunity can pass to the baby through the placenta and breast milk. Hence the importance of breastfeeding!

Varicella Vaccine
In Malaysia, the varicella vaccine has been available since 1997. It contains weakened live varicella zoster virus. The vaccine is given by subcutaneous injection. Two doses of the varicella vaccine are recommended for children with, at least a 3-month interval between the first and second booster dose.

The vaccine is reported to be more than 95% effective in preventing moderate to severe forms of the infection. In rare cases, vaccinated people can get chickenpox, but they experience a milder form of the illness, with fewer blisters and symptoms.

Recommended for:

• Healthy children between 12 months and 12 years of age.
• People above 12 years of age who have not had chickenpox.
• Non-immune family members of people with impaired immune systems.
• Non-immune women before pregnancy or after pregnancy. Those who receive the vaccine should avoid pregnancy for 2 months.
• If you are non-immune and have been around an infected person. Disease is preventable if antibodies or the vaccine is given in the initial stage.

The tetravalent MMR-V vaccine will soon be available in Malaysia. It protects against four illnesses - measles, mumps, rubella and chickenpox. This will reduce the number of shots given to your child but still giving the same amount of protection from these diseases.

Talk to your doctor if you have any questions regarding chickenpox or the varicella vaccine.

Watch Out for Symptoms of Hepatitis:

• Nausea/vomiting
• Lack of appetite
• Weakness & tiredness
• Fever
• Abdominal pain on the upper right side
• Yellowing of the skin and eyes (jaundice)
• Diarrhoea
• Dark urine
• Light-coloured stools

Hepatitis A
Hepatitis A is a disease that goes away within a few weeks. It rarely leads to permanent liver damage in healthy people. The Hepatitis A virus is found in stools of the infected person.

People most commonly get infected when they consume food or drinks that are contaminated with the infected person’s stool. Lightly cooked seafood like cockles contaminated by faeces or sewage also provides a suitable medium of spread for Hepatitis A.

Hepatitis A in children below 6 years of age usually does not manifest any symptoms. Only 10% of infected children develop jaundice. On the other hand, infection causes clinical disease among older children and adults, with jaundice occurring in more than 70% of cases.

Hepatitis B
Hepatitis B can cause chronic liver disease, which is potentially lifethreatening. The chances of Hepatitis B developing into a chronic disease depends on the age at which a person becomes infected. The younger you are, the higher the risk of a chronic infection. Chronic infection occurs in 90% of infants infected at birth, 30% of children infected at age 1-5 years and 6% of people infected after age 5 years. The good news is that Hepatitis B vaccine is in the National Immunisation Schedule since 1989.

Prevention
Prevention of Hepatitis A is possible through good hygiene practices. However, the best way to protect your child from both Hepatitis A & B is through vaccination.

The Hepatitis A vaccine is now available in Malaysia for those above 1 year of age. Two doses given 6 months apart are required for full immunity against Hepatitis A. The duration of protection is 14-20 years for children and at least 25 years for adults. It has also been reported that the vaccine is 85% effective in protecting against the virus.

The Hepatitis B vaccine, the first vaccine indirectly related to the prevention of liver cancer, has been a mandatory vaccine under the National Immunisation Schedule since 1989. Full immunisation requires the administration of three doses. The Hepatitis B vaccine is 90% effective in protecting against the virus, its chronic consequences, and liver cancer. Protection lasts at least 20 years and could be life-long.

Advancements in Vaccines for Hepatitis
A combination vaccine for Hepatitis A and B is now available for those above 16 years of age. It combines inactivated hepatitis A and recombinant hepatitis B. This combination vaccine consists of 3 doses. In addition, Hepatitis B vaccine has also been incorporated in the Primary Diphteria , Pertussis, Tetanus, Haemophilus Influenzae type b (Hib) and polio vaccines making it a 6-in-1 vaccine that is available in clinics.

Technology today has made protection against Hepatitis A & B available and reducing the number of shots and yet with the some amount of protection from the diseases. There will be more vaccines to come in the future.

Safe and Sure
Combination vaccines are as safe and effective as individual singledisease vaccines. Many factors need to be looked at before these vaccines can be combined. There cannot be any adverse interaction among the vaccine components, one component should not denature the others, adjuvants used must ensure stability of all components and not react with the vaccines, and the combination should not be more reactogenic than the individual component vaccines. Parents need not worry about the multiple vaccines given at the same time. It has been calculated that the child’s immune cells can handle many more times the antigen found in the combination vaccines.

Speak to your doctor if you are interested in giving fewer shots to your child while giving him maximum protection.

Sometimes, diarrhoea can be accompanied by vomiting, fever, loss of appetite, stomach pain/cramps or a bloated stomach.

Rotavirus Gastroenteritis
Rotavirus gastroenteritis is a common cause of diarrhoea among children under the age of 5 years. In Malaysia, out of the total children hospitalised due to diarrhoea in Hospital Kuala Lumpur and Sarawak General Hospital, 49% were reported to be caused by rotavirus. Most other hospitals report 20-30%.

Parents play a role in reducing the risk of diarrhoea and rotavirus infection in their babies. Exclusive breastfeeding for babies up to 6 months of age is recommended as it eliminates the risk of your baby consuming contaminated food. Breast milk also has added benefits of boosting baby’s immune system. Parents can also play their part in keeping their home environment clean by practising good home and personal hygiene, practising proper disposal of sewage and ensuring sanitary food handling as well as providing clean drinking water.

Vaccinate
The rotavirus vaccine is available as an optional vaccine for babies aged less than 6 months in Malaysia. This vaccine prevents severe disease by simulating the natural infection. The vaccine is given orally, in 2 or 3 dosages depending on vaccine’s manufacturer. It is given every 4 weeks between the ages of 6 and 24 weeks. It is available in private practices in Malaysia. You need not restrict your baby’s food or milk intake before or after vaccination.

Vaccinate to protect your baby.

“We tried everything to bring down Deena’s fever,” said Hashim. “We sponged her body and even tried feeding her icecream! Nothing worked, so we quickly took her to the hospital.”

Meanwhile, not too far away, Farihan and her husband Anizam were worried that something was wrong with their son, one year-old Amzar. Ever since Farihan brought him home from the nursery on Friday, he had been cranky. He started vomiting the next day. On Sunday, Farihan brought Amzar to the GP clinic where he was diagnosed with stomach wind and was prescribed some wind and anti-vomit medications.

Monday lolled around and because Amzar’s condition seemed to have improved, he was sent back to the nursery while Farihan returned to her full-time job as a university lecturer. But when Farihan picked up her elder daughter, six-year-old Fawza, from preschool that day, she found Fawza with the same symptoms as Amzar: a stomach ache and by night time, severe vomiting.

“The first cause that sprang to mind was food poisoning. I had read about Rotavirus but I never made the connection!” said Farihan. “The next day, Amzar started to have a fever and began vomiting again! We knew we had to bring the children to the hospital.”

THE DIAGNOSIS
Just like Deena, Amzar and Fawza were diagnosed with Rotavirus infection. Finally, the parents knew that this was no ordinary case of diarrhoea and vomiting. The next question was, “What is Rotavirus?”

Rotavirus is a highly contagious virus that infects the bowels. It is usually found in the faeces of infected children and is transmitted via contact with infected faeces.

Rotavirus can easily spread in numerous ways: when children do not wash their hands after using the toilet or before eating, or from adults who have the infection or are handling infants who are infected. Because Rotavirus can survive for hours on the human hand and days on hard and dry surfaces, it can also spread via contaminated water, food or when a child touches contaminated objects and surfaces, and then touches her mouth.

AT THE HOSPITAL
For five days, Deena lay in the hospital. She was put on an intravenous drip to replace all the fluids she had lost from vomiting and diarrhoea. To her anxious parents’ relief, her condition gradually improved. Had Deena been younger, the dehydration she had experienced may have been fatal. For children between 6 and 24 months, severe dehydration can result in shock, kidney failure, brain damage and even death.

As for one-year-old Amzar, the threat of dehydration was very real. “Being older, Fawza recovered from the Rotavirus infection more easily. With Amzar, I noticed his skin getting saggy. He was also very weak. But once he was put on the drip, he improved rapidly. Five days later, he is eating porridge again!” said Farihan with a smile.

Total Protection, Fewer Shots

Combination vaccines mean full protection and
less discomfort for your child, peace of mind and convenience for you

By Dr Zulkifli Ismail, Consultant Paediatrician

To Vaccinate Or Not To Vaccinate?

Dr Musa Mohd Nordin, Consultant Pediatrician & Neonatologist and
member of the Positive Parenting Management Committee, gives you the answers.

Protect for Life

Vaccination is the most effective way to protect your child from fatal infections and diseases.

– Prof Dr Zulkifli Ismail, Consultant Paediatrician

Before the age of modern medicine, infectious outbreaks were common and often resulted in death. People lived in dirty conditions, where germs spread easily.No one knew how to prevent, much less treat these diseases.

Today, we have the advantage of vaccines, a scientific discovery that has saved millions of lives.Yet, some parents remain skeptical, leaving their children to pay the deadly price.

DEFENDING AGAINST DISEASES

Your child’s body is designed to produce cells and antibodies that can combat viruses and bacteria. An attack by these viruses or bacteria will produce a complex immunological ‘memory’, which is what gives your child immunity against future invasions by the same germs.

However, there are certain types of germs that the body cannot protect itself against, without the help of vaccines. These germs include bacteria that cause tuberculosis (TB), diphteria, pertussis, tetanus and meningitis, as well as viruses that cause hepatitis, polio, measles, mumps, rubella and chickenpox. Without vaccination, these germs could wreak havoc on your child’s body, causing disability, even death.

HAVE YOUR CHILD VACCINATED

There are currently six types of vaccines recommended by the Ministry of Health Malaysia to protect your child. Your child will receive his first vaccination at birth, and should continue receiving all the other doses of these vaccines, following the recommended schedule (please see table below).

Apart from the mandatory vaccines, optional vaccines are also available to protect him against other diseases, such as chicken pox, Hepatitis A and Japanese encephalitis (JE).

Don’t Forget The Boosters

By Dr Yong Junina Fadzil, Paediatrician

Daily pressures can make you forget to follow up on your child’s immunisation needs and, thus, put his life in danger.

Today’s lifestyle is a hectic whirlwind where both parents may work to meet expenses. When time goes by in a flash, parents can unintentionally forget important things; one of them being follow-up immunisation for their kids.

It is extremely important for babies and children to be vaccinated over a period of time (please refer to the schedule below). If your children do not get their follow-up shots, you are leaving them open to the risk of contracting dangerous diseases.

At birth, all babies are immunised at hospitals and parents faithfully bring their babies in for their follow up shots until babies are 3 months old.

Then mothers return to work and this is when they tend to forget about the booster shots. Long working hours, crazy deadlines and work stress can push baby’s vaccination appointments with the doctor out of the way.

Baby being unwell on the appointment date may also contribute to shots being missed. Although it is safe to vaccinate baby when he has a slight running nose or cough, most parents prefer to postpone until baby is better. This, unfortunately, throws mom’s and baby’s schedule into disarray The problem may only come to light when baby is due for the next shot.

Shots also tend to be more easily missed when baby comes along years after his older brothers and sisters have grown up. Mom may have to get accustomed to raising a baby all over again and unintentionally forget his booster shots.

In some cases, the shots are not forgotten but simply neglected. Being in a relatively developed country with a low incidence of complications from immunisable diseases, it’s easy for some parents to be lulled into a false sense of security. However, let's not forget that the diseases may once again rear their ugly heads if we fail to either immunise our children or ensure that they get their booster shots (see boxed article, Immunise Your Child Against These Deadly Diseases).

If you realise that you have missed your child’s booster shots and now want to catch up with them, see your doctor. Don’t worry that your doctor will scold you. Doctors are there to help ensure that your child is wellprotected (they do not eat children or their parents). They will be able to advise you on what to do.

Handy Reminders For Booster Day

At Home

• Hang calendars around your house and mark the booster dates on the calendars that you see and use most often.

• Write booster dates down on a note and stick it on your fridge. If you already have lots of notes and bills on your fridge, then make sure that the booster note sticks out prominently.

• Write the dates down on a note and use the note as a bookmark if you are an avid reader.

• Write the dates into your diary if you keep one.

• Key in the dates into your PDA or handphone and set the reminder alarm.

At The Office

• If you have a secretary, get her to remind you.

• Write the dates down and stick it on the wall right next to, or in front of, you.

• Plan booster day as one of your leave days.You will not forget your holidays so make booster day a holiday with a mission.

With Your Doctor

• If your doctor is a private practitioner, you can request that the clinic call to remind you of the next follow up immunisation appointment.

Gear Up For Booster Day

• If you need someone to take you and your child to the clinic on booster days, make prior travel arrangements.

• Arrange for someone to take care of your other kids on booster day and maybe even for someone to take them to school.
  

• Hepatitis B. This disease can cause your child to develop yellow fever and put him at an increased risk of getting liver cancer later. Hepatitis B is transmitted through contaminated body fluids. Immunisation is, therefore, particularly important if you are a carrier.

• DPT. Diphteria is rare today. However, failure to ensure adequate immunity may lead to its resurgence, resulting in disability and even death. Pertussis can put a child at risk of lung damage. Tetanus remains a threat especially amongst children who may sustain injuries from rusty metals, penetrating injuries or snake bites. Booster doses are usually given following such injuries, in addition to booster doses given in school. In addition, pregnant mothers are often given a tetanus booster in their third trimester to reduce the risk following delivery.

• Polio. Although extremely rare, this disease is still very serious. It can cause paralysis and in severe cases can lead to death.

• Hib. The Haemophilus Influenzae B organism can cause meningitis, deafness and brain damage even with antibiotic therapy. Prevention through immunisation remains the best option.

• MMR. Although common childhood diseases, measles, mumps and rubella are not without risks. Measles in acute stages can cause diarrhoea, pneumonia (particularly in very young or immunocompromised children), convulsions, meningoencephalitis, and can lead to brain and lung damage, and even death. Mumps, on the other hand may cause sterility in males, something which may not come to light until the unfortunate child is all grown up and married. In rare instances it may lead to pancreatitis, an inflammation of the pancreas. One aim of immunising children against rubella (or German Measles as it is commonly known) is to minimise the risk of transmission to pregnant mothers as this may result in baby being born with multiple defects. The other aim is to also ensure that when girls marry and become pregnant, they are immune to rubella, thus conferring protection on their unborn foetus.

Optional Vaccines

Torn between wanting to protect your child from diseases and
being concerned over side effects and cost?
Here’s what you should know about optional vaccines.

By Dr Musa Mohd Nordin, Consultant Neonatologist

There are deadly diseases out there. The good news is, you can protect your child by vaccinating her - a list of mandatory vaccinations recommended by The Ministry of Health and the Malaysian Paediatric Association ensures this.

But this is not all. Did you know there are optional vaccines you can consider? You might be wondering why these are necessary when your child has already received her standard early childhood vaccinations. Well, here are answers to the questions parents commonly ask: “Why should I consider optional vaccines?” Optional vaccines have been shown to be a safe and effective method to protect your child from unnecessary suffering and the risk of complications from seemingly innocuous diseases.

What Are My Options?

• WHO estimates that one million children under five die each year from PnD
  
  
• PnD kills one child every minute (WHO).
  
  
• The Malaysian Ministry of Health estimates that pneumoccocal bacteraemia occurs in 30 out of 100,000 children under five, with at least 750 cases and 20 deaths per year.

DEADLY ENEMIES

1. Tuberculosis (TB)
   What: Contagious and fatal, tuberculosis can cause lung damage, TB meningitis, bone disease
   Prevented by: BCG vaccine
   When: At birth
   
   
2. Hepatitis B
   What: A viral infection that can lead to jaundice or liver cancer
   Prevented by: A series of three injections of Hepatitis B vaccine
   When: At birth; at 1 & 5 mths
   
   
3. Diphtheria
   What: Diphtheria causes obstruction of the airway and can lead to heart and brain damage
   
   
4. Pertussis (Whooping Cough)
   What: Severe, prolonged coughing fits that can cause lung and brain infections
   
   
5. Tetanus (Lockjaw)
   What: Severe muscle spasms that can lead to death
   
   
6. Poliomyelitis (Polio)
   What: Permanent muscle weakness that can cause paralysis, especially of the legs
   Prevented by: Polio vaccine either given orally or injected with DTP
   When: At 2, 3 & 5 mths; 1st booster shot at 18 mths; 2nd booster shot at 6 to 7 yrs
   
   
7. Haemophilus influenzae B (HIB)
   What: Inflammation of membranes around the brain and spinal cord (meningitis), pneumonia, bronchitis, bacteremia, ear infection and epiglottitis
   Prevented by: HIB vaccine
   When: At 2, 3 & 5 mths; given with DTP
   
   
8. Measles
   What: Highly contagious, measles is characterised by fever, cough, runny nose and rashes
   
   
9. Mumps
   What: Highly infectious, mumps causes swelling of the glands behind the jaws. It is characterised by fever and pain when chewing, and can lead to inflammation of testicles, ovaries, brain and pancreas.
   
   
10. Rubella (German Measles)
    What: With symptoms similar to measles, Rubella may be passed from pregnant women to their babies. Main danger is to babies born with congenital rubella syndrome.

We have become victims of our own success. George Santayana (1863-1952) said, “Those who cannot remember the past are condemned to repeat it”.

A few parents have been frightened away by reports of possible side effects associated with certain vaccines. However, the risks of not receiving immunisations are immense. As a responsible parent, you need to ensure that your child receives all of the currently recommended vaccines. Today’s vaccines are safe and generally produce only mild side effects (such as fever or localized redness). Severe adverse reactions are extremely rare.

When your child is given a vaccine, he actually receives that part of the “weakened” or infectious organism that has been killed but is still able to stimulate his body to produce antibodies. These antibodies then protect him against the disease, should he ever come in contact with it. This protection is virtually life long!

For maximum effectiveness and protection, immunisations should be administered at particular ages.Your child should receive most of his childhood immunisations before his second birthday. These will protect him against 10 major diseases: tuberculosis, polio, measles, mumps, rubella (German measles), pertussis (whooping cough), diphtheria, tetanus, diseases caused by Haemophilus influenza (Hib) and hepatitis B. Immunisations are also available against a host of other communicable diseases including chicken pox, diarrhoea, influenza, rabies, meningococcal meningitis, pneumococcal infection and hepatitis A.

Children currently receive the following shots before they enter school, including:

• 3 doses of Hepatitis B
• 1 dose of tuberculosis
• 5 doses of DTwP (diphtheria, tetanus, whole cell pertussis) or DTaP (acellular pertussis available from the private sector)
• 3 – 4 doses of Hib
• 5 doses of IPV or OPV (Inactivated polio vaccine or Oral polio vaccine)
• 2 doses of MMR (measles, mumps, rubella)

They may also get a chicken pox shot after age 1 year, an annual influenza shot and 2 shots of Hepatitis A as an option. Every parent and paediatrician would like their kids to get less shots. However, there are only a few ways for this to happen:

• You could choose not to vaccinate your kids and put them at risk of vaccine preventable illnesses. This is not an option for most parents, given the seriousness of the diseases and the permanent sequelae that could occur if your child fell sick.
  
  
• You could hope that vaccine preventable diseases will be totally eliminated worldwide, so that the vaccine isn’t needed any more. This has already happened for smallpox. The last naturally acquired case of smallpox was a Somali cook on 26 Oct 1977. The next likely candidate for global eradication is poliomyelitis, which the WHO targets for 2005. The eradication of other illnesses (such as measles) is still so far off that there are no real target dates set for them as yet.
  
  
• A more realistic, safe and effective option would be to request for combination vaccines to decrease the number of shots your child gets. The Ministry of Health currently recommends 10 vaccines for routine use in all children as enumerated earlier. Of those 10 vaccines, six are given in combination. The diphtheria, tetanus and pertussis vaccines are combined to make DTwP. And the measles, mumps and rubella vaccines are combined to make MMR.

Very careful studies have been designed to evaluate these combination vaccines. Before a combination vaccine can be licensed for general use, it has to be tested to check:

1. How effective is it? Does it stimulate the child’s immune system to produce protective levels of antibodies to all the diseases being immunised against?
2. How safe is it? Are there any side effects due to the combination?

With the DTwP and MMR combinations, it has been conclusively shown that the combination vaccines are as effective and as safe as when given individually.

However, the recent introduction of new vaccines (such as Hib, acellular pertussis, varicella and IPV) has raised some pertinent questions about the effectiveness of some combination vaccines. These are all excellent vaccines on their own right.

The Hib or “meningitis vaccine” has dramatically reduced the chances of acquiring Haemophilus influenzae B which causes inflammation of the lining of the brain (meningitis), blood stream infection and pneumonia. The varicella or “chicken pox vaccine” is gradually attaining widespread acceptance because the benefits clearly outweigh the risk of the disease. Unlike the whole cell pertussis (wP) vaccine, the acellular pertussis (aP) works equally well with the added advantage of causing less adverse effects. The OPV is an excellent vaccine against polio but has a 1-in-a-million probability of causing the disease. With IPV, this adverse reaction is zero.

Combining these excellent new vaccines in a single syringe has been a bit more problematic compared to the conventional DTwP and MMR. It is not as simple as drawing the different vaccines into a single syringe and administering it as a single shot. That is why your doctor cannot just mix the shots together.

A lot of research has to go into making sure that the combination shots are safe and they work well. Sometimes, various components of the new vaccine may interfere with the ability of a particular vaccine to induce immunity and hence protection. The interfering portion may be the stabilizer or buffer or even the vaccine itself. For reasons that still remain unclear, it has proven surprisingly difficult to combine a DTaP vaccine with an Hib vaccine without impairing the immunogenicity (effectiveness) of the Hib vaccine.

In his choice of vaccines, your doctor would have considered all these intricacies and selected the combination that would ensure your child’s protection from the target diseases are not compromised.