Childhood Immunisation Schedule
World Health organisation supply the recommended vaccine schedule for each country. This is called the EPI schedule.
Listed below are the vaccines available for infants and children. Not all the vaccines listed here are on the EPI schedule. There are vaccines available to give extra protection to you child, these are marked with an*. These are available only at private clinics/pharmacies.
Immunisation: Is it necessary and what does it do?
By Dr Steffen Bau, Paediatrician
Our body is a marvellous system of cells and every single cell in it has its place and task. If everything goes well and the body is healthy, we will experience perfect harmony.
Unfortunately, other microorganisms are looking for ways to profit from this extraordinary system. Bacteria and viruses surround us all the time and while some live in symbiosis with our body, others disrupt the healthy interaction between our cells for their own benefit.
The system in our body that prevent a hostile takeover by diseases is our immune system. It acts like a policeman checking every passer-by for identification. Our body cells all have markers that identify them as part of our body, very much like passports. As intruders like viruses and bacteria don’t have these passport markers, it gets screened by the immune system. If the intruders are known to the body’s police force – similar to identifying a mug shot – it will trigger an immune reaction, leading to ‘arrest’ and destruction.
However, new unknown infectious agents can cause a lot of damage before the infection police become aware of it.
Immunisations can be categorised as a mechanism that creates ‘a mug shot for the body’, to recognise real infections when it comes along. Immunisations can be administered via different agents, such as drops in the mouth, or via an injection in the skin or muscle. The immunisation substance can be from the actual infectious agent, weakened in its ability to infect the body (similar to an injured or paralysed criminal), or from one that has been killed before administration. For some immunisations, only parts of the microorganism are presented to our police system, similar to identifying the look of a gangster. Our body police then store the image in our memory cells and when the real infection comes along, the body can recognise and neutralise it efficiently.
Immunisations are available for many of the potentially dangerous childhood diseases. It is sometimes difficult to understand why a usually mild disease, like measles, needs preventing in the first place. Wouldn’t it be good enough to catch it and be done with it?
The problem is that in some people this simple disease can cause severe and life threatening conditions, such as diarrhoea, meningitis or chest infection. At its most extreme, a delayed brain infection could potentially lead to the death of your child, a condition called SSPE.
Other diseases, like German measles (rubella), are not harmful to most people, except to pregnant women. During pregnancy, the unborn baby can either die or become severely handicapped with blindness, heart defects, or intellectual impairments.
Unfortunately, we still do not understand why some people react with such severe reactions to certain diseases, and neither can we predict who will react in what way. Prevention remains the best cure.
One can learn from an interesting discovery in North America, where hundreds of thousands of native Indian people were killed by a simple flu virus. Because they had not known flu until the pilgrims arrived and brought the virus with them, their body police could not identify the virus fast enough to defend itself.
Let’s look at a few general questions regarding immunisations:
Does everyone need to be immunised for vaccine preventable diseases?
Not necessarily. Only a certain amount of the population needs to be vaccinated to prevent spreading of the disease. The amount of people required to be immunised to prevent outbreaks range from as low as 15% for some influenza strains, to 95% for the measles vaccine.
The concept of mass immunisation is known as herd immunity. It works by interrupting the transmission of the infectious agent from one person to the next, as it stops microorganisms from finding people to infect. For the superheroes in our population, who are convinced that nothing can kill them and decide that they can get away without vaccination: these vaccines are essentially a social responsibility construct. It is not as much as preventing yourself from infection as it is about protecting everyone else.
Does immunisations not have side effects, and are these not more dangerous than exposing a few people to the actual disease?
Well, everything has side effects. To illustrate this, let me ask you to drink adequate water during the day. This is an action everyone will agree with, right? If I were to produce a package insert with the side effects of this recommendation, I would need to warn you about common reactions like the increased need to urinate, but also about rare side effects like water intoxication, which leads to brain swelling and death. Would you still be willing to drink so much water?
Rather common side effects of vaccinations are local reactions (pain, swelling and redness) on the injection site, mild fever (less than 38 degrees), shivering, light headache, some joint and muscle pain, as well as slight fatigue. More severe side effects are exceedingly rare.
The most common misconception regarding immunisations is that it can cause permanent diseases, like autism. This notion has been reported by Andrew Wakefield and his colleagues in 1998 in a Lancet Series of 12 cases. Despite their report, since then no scientific study could find any supporting findings for this accusation. In February 2010, the Lancet retracted Wakefield’s research as fraudulent and fabricated. However, the discussion he sparked with his paper is still ongoing and has led to numerous studies regarding negative long-term effects of immunisations.
In general, most vaccinations have extremely rare serious side effects, which occur far less commonly than the severe effects of the prevented disease.
When should I immunise? Is between birth and 6 weeks not far too young?
The nice thing about this early age is that we do not have any recollection of this time. Short-lived pain episodes, even though uncomfortable, are not going to leave any mark on our developing brain and nerve system. We do not remember our first immunisations.
Secondly, vaccines have been extensively studied and in order to be effective most require the administration of more than one shot. For very small children, special formulations have been produced to trigger a reaction in the still immature immune system. One can obviously wait until later in life to start immunising children, however, those worst affected by vaccine preventable diseases are small babies.
A simple disease like whooping cough (pertussis) can cause life-threatening apnoea episodes (cessation of breathing) in infants. If infants are protected from this bug at an early age, they are less likely to get a more acute infection.
In my personal opinion, vaccines are useful to prevent some of the more severe infections we are faced with. I have seen kids die from every one of these vaccine preventable diseases, parents regret not having vaccinated their kids, and others having a fallout with friends for not vaccinating their child who had passed on the microorganism to their now suffering kid. I have also had more time with my grandparents, due to herd immunity preventing transmission of deadly diseases in their age group.
We live in an era where small pocks, one of the nastiest childhood diseases, has been completely eradicated, and where polio (poliomyelitis) is on the verge of extinction. These successes are mainly due to vaccination efforts.
Remember that vaccinations strengthen our immune systems, so we can handle the bad infections. Immunisation gives our society an advantage the native Indians didn’t have.