Medicosnext
Words by Dr. Ram Krishna Chandyo
Vaccination is not just an individual obligation but also a social obligation since even a single unvaccinated child may be a risk factor for the spread of disease in the community.
Parents, particularly those new to the journey of parenthood, often encounter the initial challenge of administering vaccinations to their baby or newborn. Vaccination is not just an individual obligation but also a social obligation since even single unvaccinated child may be a risk factor for the spread of disease in the community. It is very appreciable to note that vaccination is almost universal (particularly in urban areas) in our community. Even when parents are not aware for which disease protection their babies are receiving vaccines, they are still very much willing to provide vaccinations to the babies. In the last survey conducted in Nepal, 80% children at 18-23 months of age received full, 16% partial and 4% were not vaccinated. The 4% unvaccinated kids was a relatively high percentage seen in the last survey, which was in part due to the COVID pandemic. This article serves to explain about diseases that are protected by our regular vaccines and some practical information on vaccines in order to achieve maximum benefit from vaccination.
Why does my child need so many vaccines?
Although, more vaccines generally mean protection from many diseases there are multiple factors like fear, pain and logistics we need to take in account while giving multiple shots at one time. After the first vaccine (BCG) usually given at the hospital, in each visit 2-3 vaccines in injection form and 1-2 vaccines orally are given at 6, 10 and 14 weeks and 9 and 15 months of life. Currently, government of Nepal vaccination schedule recommends a total of 13 vaccines with different routes of administration within 15 months of life. This total number of vaccines will further increase if parents are planning to give additional shots such as flu, meningitis and chickenpox vaccines which are not yet included in the Nepal government program.
The chances of development of severe form of tuberculosis are very low among BCG vaccinated people as compared to those who are not vaccinated with BCG.
Does my child get lifelong protection from tuberculosis after BCG vaccination?
One of the first vaccine shot given to newborn is BCG vaccine which protects against childhood tuberculosis both pulmonary and extra-pulmonary form. This protection usually lasts for 10-15 years so it does not offer lifelong protection. However, the chances of development of severe form of tuberculosis is very low among BCG vaccinated people as compared to those who are not vaccinated with BCG.
Is my child protected from pneumonia after vaccination?
Many parents may be not aware that these multiple shots of vaccines administered to the child also contains a vaccine that prevents pneumonia in children. Vaccine given at 6 and 10 weeks and 9 month (PCV-Pneumococcal Conjugate Vaccine) specifically protects against severe form of pneumonia. This PCV vaccine also protects child from meningitis and ear infections caused by pneumococcal infection. Another vaccine that is included in the Pentavalent shot is Hib (Hemophillus influenzae type b) which is given at 6, 10 and 14 weeks. This Hib vaccine also protects child from severe pneumonia, sepsis and meningitis caused by Hemophillus influenzae type b. Sometime pneumonia may be caused due to complication of diseases such as measles (दादुरा), rubella (रुबेला) and chickenpox (ठेउला). So vaccination against these diseases also will also help protect the kids from the pneumonia. At the same time it is important to know that pneumonia may be caused by many other viruses or bacteria. So, our children are protected from severe form of pneumonia caused by pneumococcal or hemophillus influenza type b but not from all types of pneumonia.
Does regular vaccination help protect my child from diarrhea?
Rotavirus vaccine given orally at 6 and 10 weeks protects against diarrhea caused by this virus. Rota virus caused diarrhea is commonly known as winter diarrhea and in Nepali culture it is also believed that this is due to sudden frightening of child (सात्तो जाने). This Rota virus diarrhea usually start with sudden onset of vomiting followed by profuse foul smelling watery diarrhea leading to severe dehydration. Although, Rota virus diarrhea is a self-limiting disease, many children may require hospitalization due to severe dehydration. We also need to be aware that there are many other causes of diarrhea and sometimes it also ensues as a result of food poisoning. Diarrhea some time may be combined with the presence of blood in stool which is called dysentery which is also not protected with the vaccination. So, the Rotavirus vaccine only prevents against diarrhea due to Rota virus.
Why does my child need two types of polio vaccines?
This is a common question many parents may interested to know as polio is on the verge of eradication from the world. By giving injection form of polio at 14 weeks and 9 months and oral drops at 6,10 and 14 weeks our children are well protected from all types of polio just in case any outbreak occurs in future. The oral polio vaccine contain live (weakened) form of polio virus. In near future, administration of the oral form of polio vaccine will be stopped and only injection form of polio will be given.
Does MR vaccine protect my child from mumps (हाँडी)?
Unfortunately, with the regular vaccines given by the government of Nepal, our children are not protected against mumps. The MR vaccine (for prevention of measles and rubella) given at 9 and 15 months of age does not contain vaccine against mumps. For the protection of mumps, it is recommended to give MMR vaccine which is available at many health centers with some payment.
Why do we still vaccinate against uncommon diseases?
It is true that many diseases included in the regular vaccine program in Nepal are not so common and almost at the elimination phase (that mean disease prevalence is almost zero in a defined area). These diseases are tetanus, diphtheria (भ्यागुते रोग) and recently the prevalence of measles and rubella is also in the decreasing trend. However, vaccination against these diseases is very essential as outbreak may occur anytime. Due to low coverage of vaccination against measles, recently many parts of Europe are having outbreak of measles. This highlights the importance to maintain vaccine coverage even during times when the disease prevalence is low.
Currently, the government of Nepal vaccination schedule recommends a total of 13 vaccines with different routes of administration within 15 months of life.
Do we have vaccines to protect mosquito borne diseases?
Due to tropical and humid weather in many parts of Nepal, different species of mosquito are present and they are fairly seasonal. These mosquitoes are responsible for the spread of many diseases such as malaria, dengue fever, Japanese encephalitis, filariasis (हातीपाइले), chikungunya and others. The cases of malaria is continuously decreasing in Nepal but recently we are having many cases of Dengue fever. However, only vaccination against Japanese encephalitis is available currently in Nepal and given at one year of age.
How long my child is protected following typhoid vaccination?
For the long time typhoid fever has been very common disease in Nepal due to poor hygiene and sanitation. Recently typhoid vaccine was also included in the childhood vaccine schedule and now is given at the age of 15 months. The typhoid vaccine campaign was also carried out at the schools and all the children below 15 years are now protected with typhoid fever. But the protection will last only for 4 years and additional booster dose may be required for continued protection from typhoid fever.
Conclusion
In essence, this exploration of childhood vaccinations in Nepal serves not only to educate parents but also to underscore the collective responsibility we bear in safeguarding the health of our communities. From guarding against childhood tuberculosis through the BCG vaccine to shielding against severe pneumonia and meningitis with PCV and Hib vaccines, each vaccination plays a crucial role in fortifying a child’s immune system. Informed decisions, ongoing awareness, and sustained vaccination efforts are crucial components of a resilient public health system, ensuring a healthier and more protected future for our children.
