Vaccination: It’s just a jab to the left

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As the search to cure even more pernicious diseases continues apace, vaccinations stir up controversy wherever they go and SA is not immune.

A nurse vaccinates a child in the Internally Displaced People’s camp in Kibati, about 10km north of the provincial capital of Goma in the eastern Democratic Republic of Congo. (AFP PHOTO/ YASUYOSHI CHIBA)

In 1986, Roald Dahl said: "Olivia, my eldest daughter, caught measles when she was seven years old. One morning I noticed that her fingers and her mind were not working together and she couldn’t do anything. In an hour, she was unconscious. In 12 hours she was dead."

Since mid-2014, measles has found a new foothold in the US and taken adult lives in Swansea, England. Whooping cough has hit epidemic proportions in both the US and in Australia and polio is leaving a trail in the Middle East.

The famous writer’s statement suddenly doesn’t seem quite so out of date, especially in light of the anti-vaccination movement and how important it is that a high percentage of people are vaccinated to achieve the “herd immunity” effect and potentially wipe out a disease. “I spend a lot of time counselling my patients about the benefits of herd immunity. The community needs high immunity levels to prevent vulnerable individuals from contracting disease,” says Dr Karen Blackburn, a general practitioner in private practice in Johannesburg.

“These vulnerable individuals include babies who are too young to be immunised yet.” In South Africa there have been impressive strides in vaccinating children and adults against common childhood diseases that range from polio to rotavirus gastroenteritis and a rolled-out and generally easily accessible vaccination schedule is available across the country.

“The risk of infective pneumococcal disease went from 100 per 100 000 population pre-vaccine to just 21 per 100 000 after it was introduced,” says Dr Alan Fuller, a general practitioner at Sunninghill Medical Centre in Johannesburg. “Both the rotavirus and pneumococcal vaccines available in South Africa have strong safety and efficacy records, including clinical trials involving tens of thousands of children.”

Dr Gary Reubenson, a paediatrician for the department of paediatrics and child health at the Rahima Moosa Mother and Child Hospital and Wits, agrees: “Early signs are that both pneumococcal and rotavirus vaccines have improved the health of South African children with some evidence of few hospital admissions and probably fewer deaths since their introduction.”

South Africa has become the first African country to fund out of government coffers and deliver the cervical cancer vaccine to girls in government schools. The HPV vaccine immunises against the human papilloma virus (HPV) that is the cause of around 70% of cervical cancers and the South African government is delivering two free shots per girl in grade four in government schools.

“The introduction of the HPV vaccination in schools has the potential to substantially reduce cancer of the cervix in women, but we will need to wait years to start seeing the real impact as there is a long time between infection and symptomatic disease,” says Reubenson.

Vaccines are continually undergoing research and development, and the search to cure even more pernicious diseases continues apace. GlaxoSmithKline is currently working towards regulatory approval for its first malaria vaccine after a trial that showed a drop in cases by 25% in infants and 50% in older babies. HIV vaccines are shifting gear, with two recent studies finding 100% protection in monkeys with an experimental drug that may yet go into the human trial phase.

“Research and development is a massive field, which has probably been biased in the past towards first-world illnesses. However, with the involvement of the world’s largest philanthropic groups, many of those with relevance to the third world are being challenged,” says Peter Schmidt, director of the neonatal intensive care unit at Gold Coast University Hospital in Australia. Schmidt believes that the next 20 years will see advancements in vaccinations for these complex illnesses that could include hepatitis C, hookworm, HIV and malaria. Vaccinations are not exclusively the domain of the young — they are also a fundamental part of travel, work and pleasure.

People who travel abroad need to consider the health risks that exist on the other side of the border. It’s an issue that’s gained plenty of traction as the Ebola virus moves across West Africa. “If a traveller arrives at an airport without their vaccination certificate, they may face time in quarantine or be forced to have an injection administered on the spot,” says Andrew Stark, general manager at travel company Flight Centre.

“Often business travellers may be at higher risk due to the destinations they fly to, and we are seeing a rise in business travel to destinations in Africa.”

According to Stark, South Africa has its own strict rules that expect, for example, a traveller to have had a yellow fever vaccine when returning from a high-risk country. Dr James Hubbard, a US-based family doctor and author of Living Ready Pocket Manual: First Aid, a book on survival medicine, says: “Don’t forget basic precautions such as hand-washing. Even if you’re vaccinated against a disease, that doesn’t mean you are 100% immune. All travellers should make sure they’re up [to date] on their basic vaccines and on the recommended time intervals before boosters.”

There is a growing anti-vaccination theme shifting across the globe however, with many attributing mumps, whooping cough and measles infections to this movement. “This is increasingly a problem in the private sector in South Africa, although we have almost no anti-vaccine activity in the public sector,” says Reubenson.

“The anti-vaccine movement is responsible for recent outbreaks of measles and whooping cough; it also has the potential to adversely affect global efforts to eradicate polio.”

Vicki Compere, a homoeopath at the Centre for Holistic Health in Fourways, Johannesburg, disagrees. “Vaccination does not mean immunisation. There are no proven assurances that the vaccine will protect a child from contracting the illness. The only way that we can become immune to an illness is by contracting it and developing antibodies naturally,” Compere says.

“We do not know what the impact on the immune system will be by introducing a microorganism into the body purposefully, bypassing the body’s natural immune response, normally through inhalation, by injecting it straight into the bloodstream,” she continues.

“I see it as a great positive for children to contract chicken pox, mumps, measles or German measles, as these illnesses are well managed with natural medication and have great benefits on the immune system’s development.”

The figures disagree. Measles killed about 200-million people worldwide until the vaccine was introduced in 1963; the incidence of the disease in the US dropped from 530 217 deaths in the 20th century to 61 in the first decade of the 21st century, indicating that herd immunity has taken root in the US. Smallpox in the US had a death rate of 29 005 in the 20th century, without a single case reported in the 21st century (figures from 2010) and a 100% success rate, and mumps had a death rate of 530 217 in the US in the 20th century, with 2 528 cases reported and a 98% success rate (from 2000 to 2010).

Sources: Hands On Magazine, official magazine of South African Physiotherapy Society and JAMA. 2007;298(18):2155-2163, CDC. MMWR January 7, 2011; 59(52);1704-1716. (Provisional MMWR week 52 data)

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