Healthy children, healthy future

•Why most parents ignore vital vaccines

VINCENT KURAUN reports that some important vaccines that new babies should have at birth are not being administered due to a number of factors. But with the approval of Rotavirus vaccine to be given free of charge, government still needs to do more to prevent infant mortality.

 

Infant immunisation is an important way to protect the health of a newborn baby. It can actually prevent more than a dozen of serious diseases. Thus, failure to immunise a newborn child may mean putting the baby at risk of serious and sometimes fatal diseases. Infants are particularly vulnerable to infections; that is why it is so important to protect them with immunisation immediately after birth as this also helps protect them against dangerous complications.

In Nigeria, the National Primary Health Care Development Agency (NPHCDA) provides a list of diseases that could be prevented with vaccines. The agency also publishes a schedule of immunisations recommended for infants. The World Health Organisation (WHO) and the Paediatric Association of Nigeria(PAN) have also at different times taken similar actions.

According to the National Programme on Immunisation, routine immunisation of children in Nigeria is carried out using vaccines such as“BacillusCalmette Guerin (BCG), given to  prevent mycobacterium tuberculosis infection. In infancy, it is given soon after delivery and this protects against severe forms of tuberculosis for life. Inactivated Polio Vaccine (IPV) is also given to prevent infection from Poliomyelitis virus which causes acute flaccid paralysis. Infants receive IPV at birth, six weeks, 10 weeks and 14 weeks respectively. Hepatitis B is given at birth, six weeks and 10 weeks to prevent a viral disease that primarily affects the liver and its functioning. While Diphtheria, Tetanus, AcellularPertusis(DTaP) is given at six weeks, 10 weeks and 14 weeks respectively, Pneumococcal conjugate vaccine (PCV) is given at 14 weeks and then Yellow fever and Measles both given at nine months and Vitamin A at 12 months.”

The above-named vaccines are considered to be the routine immunisation in Nigeria and a child is expected to receive them during the first year of life to be fully immunised after about five visits to the hospital. Recently, the Federal Government through the Federal Ministry of Health and NPHCDA added Rotavirus vaccine to the list of routine immunisation schedule for new babies, to prevent over 110,000 deaths in children under the age of five. This new vaccine is expected to be rolled out soonest.

 

What is Rotavirus vaccine?

The introduction of Rotavirus as a game changer to prevent child mortality has been hailed by many medical personnel. A medical practitioner, Dr Margaret Obienu, who spoke with Sunday Tribune, commended the government for finally including Rotavirus vaccine as one of the routine vaccinations for children in Nigeria at no cost.

According to her,  “Rotavirus vaccine  has been in existence for a while now; it has been recommended since, but we are just thankful that finally it has been introduced. Rotavirus vaccine is helpful in the prevention of diarrheal. Now diarrheal is one of the common diseases that affect children, especially those under the age of five.

“So, many children come down with diarrheal disease and, most of the time, it is caused by rotavirus. It doesn’t mean that rotavirus is the only organism that causes diarrhoea; there are other ones but the commonest organism, the most implicated, is the rotavirus. So having rotavirus vaccine available for our children means that there is an increased chance of preventing diarrheal disease.

“When this vaccine is given to children, their bodies are prepared so that they can produce the immune response to prevent them from coming down with this kind of disease. So I will say it is a very big plus from the side of the government. I must also say that we have come a very long way as a nation.


Explaining the immunisation routine that medical personnel apply in Nigeria, Dr Obienu recalled that it had been a gradual but rewarding journey for the country’s health sector, adding, however, that there is still a long way to go.

“I remember about 15 years ago,” she enthused, “all we had was a BCG vaccines, oral polio vaccine, hepatitis B, measles and yellow fever. But along the line, other vaccines have been added. Pentavalent vaccine came on board. The inactivated polio vaccine came on board; the pneumococcal conjugate vaccine came on board and now Rotavirus vaccine has come on board.

“But there is still a lot to be done. We still have some other vaccines out there that should be on the routine immunisation schedule so our children can benefit from them. The advantage of having the children vaccinated is that they are not only protected against these childhood diseases, but they also create an opportunity for herd immunity.

“Herd immunity comes about when a lot of people in the community have been vaccinated or immunised. Therefore, the incriminating organism finds it difficult to infect people because a lot of people have been immunised against it and thereby offers protection to the few that are not able to receive that vaccine maybe due to one health challenge or the other.

“It is really important that people get vaccinated not just for themselves but for the sake of other groups of people that may not be able to take the vaccines. For instance, children with cancer may not be able to take certain vaccines because their immune system is suppressed and so they are at the risk of these diseases. But if the other children around them are vaccinated, it offers them some form of protection and, at the end, it is a win-win for us all.”

 

The Other Vaccines

Speaking further, Dr Obienu listed other very important vaccines like varicella, hepatitis A vaccine, among others,  that boost the health of children and their  survival rate, recommending that those who can afford the cost of all the vaccines on the schedule should, as a matter of priority, ensure their children take them.

She said: “Human Papilloma Virus (HPV) vaccine, for instance, is on the schedule but yet to be kicked-off. So, while we are waiting for the government to kick that off, if one has a child that is up to nine years old, please go ahead and get them vaccinated against the HPV virus.

“The importance of that is we are aware of cervical cancer. We know it is very much around us, very much with us. So, when we get our children vaccinated against HPV, then, we would be reducing the incidence of cervical cancer. We know the effect that cervical cancer has on, not just the individual, but the family and the nation as a whole. It has social implication and economic implications and so, in as much as we join the WHO in the fight to eradicate cervical cancer, I would encourage everyone to get on board for the vaccines that are not covered on the routine immunisation schedule but are available in our nation. Let  us go ahead and get our children vaccinated. It will help them.

“HPV is just one; you know we have hepatitis A vaccine and hepatitis is a disease of the liver and the liver is a very important organ in the body. So we need to protect ourselves and if you can get children to receive those vaccines, please go ahead.

“There is also varicella vaccine (chickenpox). You know how the chickenpox is, once it comes, it spread like wide fire; one child gives it to the other child and then, it continues. But there is a vaccine for it, meaning you can protect your child against chickenpox. No one likes to see a child in that state who would be crying. The blisters are itchy, making  the child uncomfortable and having fever and all that. But it can be prevented as there is a varicella vaccine that can be used to prevent chickenpox.

“We also have MMR vaccine against measles, mumps, and rubella which our children can be vaccinated against. The routine immunisation schedule covers only measles for now, but you can go for MMR which protects against mumps and rubella as well. Mumps affects the parotid glands and the reproductive organs (ovaries and testes). This may pose challenges with fertility in the future.

“If we want to protect our future generation, vaccination is the way to go. I would encourage everyone to get their children vaccinated. There is also a malaria vaccine; we don’t even need to talk so much about it. While we are waiting for malaria vaccine to get to us in Nigeria, it is a good time to start sensitising ourselves in Nigeria, creating the awareness of the malaria vaccine, so that once it comes, we just receive it with open arms,” she said.

A family physician, DrAdokiyeBerepiki, also spoke with Sunday Tribune on Rotavirus, explaining why some vaccines are yet to be provided by government. He attributed funds and data as the reasons  for non-inclusion of some of the vaccines to the routine immunisation schedule in Nigeria despite their importance.

“It is a combination of two things on the part of the government: the fact that the government doesn’t have enough data and also possibly because of funds. One of the things that lead to government prioritising on a particular vaccine depends on studies, research and data. Data in the sense that, when government found that there is an increase in amount of diarrheal diseases in children under five years all over the country, then, it is likely to channel the resources and ensure that they are able to get those vaccines available and ensure that children have been vaccinated. But when there is no enough data, then, the government might not be aware of how much the diseases are affecting the children. And when government is not having that information, it will not be prompted to divert resources in that area,” he explained.

Talking about the importance of the optional vaccines, Dr Berepiki said “all the vaccines on the schedule are very important and not just Rotavirus alone which specifically helps prevent episodes of diarrheal in children. Parents who are aware of these vaccines don’t necessarily wait for federal government to make these vaccines available, because already private facilities offer them at a cost. The essence of vaccine is to prevent disease conditions, so most parents who have the finances should make sure their children take these vaccines”.

A consultant family physician and Medical Director of Nathaniel Health Consulting, a family hospital at Matogbun, Ogun State, who is also a Fellow of the West African College of Physicians, Dr Ademola Orolu, while also speaking with Sunday Tribune agreed that funding might have been a major factor that inhibited government from introducing some of the other important vaccines as well as lack of prioritisation of public health in having a comprehensive immunisation schedule for Nigerian children.

Dr Orolu who acknowledged government’s decision to foot the cost of Rotavirus explained that, indeed, every “vaccine comes at a cost. The cost is paid by the individual, a health insurance company or the government. And Rotavirus being a vaccine recently introduced to Nigeria less than 15 years ago, the cost is still considerable. This perhaps explains why it has not been part of the vaccines given freely by the government. Until now, babies who received the vaccine had their health insurance or parents pay for them. It is good news now that all babies will have access to the vaccine. It will help reduce childhood morbidity and mortality.”

But is there sufficient information for parents on the importance of most of these vaccines and why they must ensure that their children get them even if they are not free?

A paediatrician with a federal university teaching hospital, who craved anonymity while speaking with Sunday Tribune, shed light on the role parents play in the administration of these vaccines.

According to him, many parents know the significance of these vaccines but would rather choose to ignore them. “It is not as though the Rotavirus vaccine has not been part of the routine vaccines. Parents who have taken their children in for vaccination, know that by the time they start the vaccination programme, they are given a card. In that card, there is a timetable of all the  vaccines. However, the ones that are free, or have already been paid for by the federal government through donor agencies are the ones that are given to children by the health officials. The other vaccines which include Rotavirus,  would be taken as optional.

“So what has changed now is that the Rotavirus is now available free of charge, which means everybody is likely to get it as far as the parents don’t say ‘I don’t want to.” Before now,  parents would have noticed that Rotavirus was on the card. It is when they said ‘I want this vaccine’ that they were usually told that so and so vaccines were not free and that they would have to pay so and so amount.”

As things stand, it is not enough to have on the card a number of vaccinations meant to protect young children from diseases; it is obvious that ignorance could be a costly mistake. Thus government needs to do more, not only to enlighten mothers about available vaccines but to also ensure provision of these vital vaccines in order to ensure full vaccination for young babies and thus prevent avoidable cases of infant mortality.

 

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