In a country once swamped by often fatal communicable diseases such as, small pox, poliomyelitis, neonatal tetanus, diphtheria, whooping cough, rubella, congenital rubella syndrome and measles among others, most of these diseases are now virtually unheard of. Epidemiologists believe the key to relegating them to diseases that no longer pose a threat to public health is Immunization.
As today is World Health Day The Sunday Observer spoke to Consultant Epidemiologist Dr Deepa Gamage , Epidemiology Unit , Health Ministry, to find out the role of the National Immunization Program and its importance in safeguarding the overall health of the future citizens of the country.
Excerpts …
Q. Vaccination has become the buzz word for saving lives. Yet, despite their outstanding success in the different parts of the world where mass vaccinations are carried out, there are mixed opinions and fears surrounding immunization among some populations, especially, when it comes to children. In this context tell us why it is important to get a child immunized?
A. Children getting immunized is important for two reasons. It gives protection to the particular child vaccinated against highly contagious, deadly diseases, and it protects people around the vaccine protected child as the child will not transmit the disease to others.
Q. What are these deadly diseases you refer to? Do we see them today?
A. Poliomyelitis, diphtheria, neonatal tetanus, whooping cough, rubella and congenital rubella syndrome and Japanese encephalitis are a few cases that exist, while diseases such as poliomyelitis are not seen today in Sri Lanka.
Q. Does this justify the continuation of vaccination through the National Immunization Program?
A. Yes. Continuing essential vaccination through the National Immunization Program given according to the Government schedule is very important. For example, during the past 2-3 years, there were vaccine preventable disease outbreaks such as diphtheria, whooping cough and measles and deaths occurring in some developed and developing countries. The reason identified in most cases was the lack of attention to continue childhood vaccination, due to the diseases not being seen in those countries.
Q. What are the advantages of immunizing children?
A. Vaccination is a simple and effective way to get protection against these fatal diseases. It protects children suffering from long term complications resulting from these fatal diseases and prevents deaths due to such diseases.
Q. Is child immunization different from adult immunization?
A. There is nothing called child or adult immunization. But experts take decisions on the most appropriate age to provide vaccination to prevent diseases, and the best age to stimulate or trigger the immune system to provide maximum protection with minimum adverse effects.
The decision to vaccinate only children or whether to include adults, would depend on the requirement of the country policy of specific preventive strategy such as, control of the disease to some extent, elimination or eradication.
Q. Explain how vaccines protect children from communicable diseases.
A. Vaccination triggers or stimulates the immune system in the body to produce the adequate amount of disease specific protective force which we call, ‘protective level antibodies and immune cells to provide protection,’ for specific diseases. If they get exposed to these diseases in future, they will be protected because of this already developed immunity (antibodies and immune cells). This is called immune memory or protective immunity existing in the body through vaccination, which prevents deadly diseases in the future.
Q. It is said that different vaccines give protection for different kinds of organisms. What are they?
A. Most vaccines are developed against highly contagious easily transmissible virus diseases such as, poliomyelitis, measles, rubella, mumps, Japanese encephalitis, chicken pox and influenza. But, some vaccines are developed against bacterial diseases such as, childhood tuberculosis (milliary TB), whooping cough, haemophyllus B (Hib B) and tetanus. There are some vaccines preventing viruses and providing protection for non communicable diseases. There are two vaccines in our National Immunization schedule : Hepatitis B vaccine to prevent liver cancers and HPV vaccine to prevent cervical cancers.
Q. What is the immunization schedule in Sri Lanka to meet these needs?
A. BCG for childhood TB prevention is given 24 hours after birth at hospitals, failing which through Medical Officer of Health Offices. Then, two and four month Pentavalent vaccine (DPT,Hib B, Hep B) and polio vaccines (oral polio and injectable polio), followed by six months with Pentavalent and oral polio vaccine (OPV). At nine months , MMR vaccine, 12 months Live JE vaccine, 18 months Triple (DPT vaccine) are given. It is important to give MMR 2nd dose at three years and DT at five years, aTd at 12 years (Grade 7 in school), as already received vaccines at childhood would be a boost to give long term immunity and protection assured by these vaccine doses.
Since 2017, HPV vaccine is being given to Grade 6 girls through school based programs.
Those who have not received rubella containing vaccine dose during their childhood will receive one MMR dose at the reproductive age before first pregnancy (at least three months before) .
During pregnancy, a pregnant mother will receive Tetanus toxoid vaccine to protect the newborn from tetanus (neonatal tetanus) as two doses in the first pregnancy, followed with each dose in consecutive pregnancies till they receive 5 doses which would give protection for 10 years.
Q. From where can one get information about the National Immunization schedule?
A. National Immunization schedule is usually displayed at the Medical Officer of Health (MOH) offices and field level immunization clinics and also in hospitals. These details can be obtained from Consultant Epidemiologists of the Epidemiology Unit, as the main implementation agency for the National Immunization Program (also available in the website), Consultant Paediatricians in any institution, mainly responsible for child health, Consultant Community Physicians in the Family Health Bureau, Consultant Physicians, Consultant Gynaecologists, Obstetricians and Family Physicians.
However, any parent could easily access the Public Health Midwife and Public Health Inspector in their area to obtain such information. Public health nursing sisters, MOH or Regional Epidemiologists are the frontline officers of the vaccination program. Community level public health staff provide quality vaccines to children throughout the country at community and school health clinics. In addition, hospitals conduct vaccination clinics where Consultant Paediatricians are available.
Q. How do you ensure that quality and safe vaccines are given to children through the National Immunization Program?
A. All vaccines given through the national immunization schedule are registered at the National Medicinal Drug Regulatory Authority (NMRA), Sri Lanka, after a thorough review by experts to ensure quality. Sri Lanka does not produce any vaccines given in the National Immunization schedule, all vaccines are imported. The Ministry of Health is authorized to get down only World Health Organization (WHO) ‘pre-qualified’ vaccines which means quality ensured standardized vaccines.
Q. Any adverse effects from vaccines?
A. Vaccines also like other drugs can have some unwanted effects. But all precautions are taken by health staff for the prevention of such adverse events.
Q. Rubella vaccine – Why is it given and to whom?
A. The National Immunization schedule includes MMR vaccine which has a Rubella vaccine component. Rubella vaccination was given at schools from 2002 to 2010 and continues as MMR at nine months and three years.
The disease is no more seen in the country as a majority of females and children have been vaccinated against rubella by now. After 2014, we do not see Congenital Rubella Syndrome babies due to high vaccination or protection of the pregnant women population in the country. WHO has certified Sri Lanka as a Rubella and CRS controlled country and certificate of this was provided to the Minister of Health during the South East Asia Regional Commission meeting in 2018.
Q. The same MMR vaccine provides protection for measles. What is the situation of measles in the country now?
A. Measles is a highly contagious disease. From a measles infected person it can spread to 16-18 unprotected individuals (susceptible to disease) . Unprotected means they have not been vaccinated or have not contracted the disease before. At present, the country is reviewing all cases of fever and generalized rash to identify, test in the laboratory and exclude as non-measles cases. However, while identifying and excluding such cases we ensure no active measles cases are in the country but need to continue MMR vaccination to all children at nine months and three years with a high coverage of 95% to ensure that measles will not be transmitted in the country.
The Government is planning to eliminate measles during the next two years (2019-2020). Hence it is important to maintain vaccination and surveillance standards to ensure a measles free status in the country as a significant number of countries are currently experiencing measles outbreaks.
Q. Do you have a follow up program on children who have been vaccinated?
A. We have Child Health Development Records (CHDR) for every child who is vaccinated which the child is expected to keep throughout life until marriage. All vaccination details and child health development records, school health assessment records and all relevant information to the mother are included in it. The Family Health Bureau regularly updates such records and distributes them to all newborns countrywide.
Q. Your message to the parents on this World Health Day?
A. Make sure your child gets all vaccines provided through the National Immunization schedule at the appropriate recommended age, on time, as mentioned in the CHDR of the child. Communicate with your area Public Health Midwife regularly for the next vaccination for your child to save your child and others in the community.