‘Benefits of immunization outweigh risk’

As the world mark World Immunization Week, April 24 to 30, parents have been advised to ensure complete adherence to all the schedules of immunization for their children and get them protected, resistant and prepared for the challenges ahead from infectious diseases.

Consultant Pulmonologist and Senior Lecturer, College of Medicine, University of Lagos (CMUL), Dr. Obianuju Ozoh, in an interview with The Guardian disclosed that parents due to some cultural, religious belief, illiteracy and hearsay deprive their children of life-saving vaccinations made available through immunization thereby, exposing them to infectious diseases that cause deaths and deformities.

A pulmonologist, or pulmonary disease specialist, is a physician who possesses specialized knowledge and skill in the diagnosis and treatment of pulmonary (lung) conditions and diseases.

Ozoh said that immunization is making a person resistant to a disease, particularly, infectious disease, and this is often achieved by vaccination. She stated that a person is given a vaccine that contains a modification of organisms that causes the infection such that when the person is exposed in the future to that organism, he is protected from that disease.

Ozoh noted that the benefits of immunization cannot be overemphasized revealing that it is important to get babies immunized because when a child is born, they have no immunity at all and are therefore prone and at risk of infectious diseases. She however said that they are a little bit protected from their mother’s immunity but that it wanes within a short time.

Meanwhile, the World Health Organisation (WHO) has decried low progress towards global vaccination targets for 2015, stating that it is far off-track with one in every five children still missing out on routine life-saving immunizations that could avert 1.5 million deaths each year from preventable diseases.

According to WHO, in 2013 nearly 22 million infants missed out on the required three doses of diphtheria-tetanus-pertussis-containing vaccines (DTP3), many of them living in the world’s poorest countries. It called for an end to the unnecessary disability and death caused by failure to vaccinate.

On when is the right time to immunize a child and why is it important to get them immunized? Ozoh said: “The time to immunize a baby is right from birth and if you understand the immunization protocol, it is followed right from birth. The children have no immunity; they are not able to fight infections by themselves. Therefore, you give vaccination to protect them and get them prepared for the challenges ahead from these infectious diseases which are going to occur.”

How many times can a child be immunized? She said: “There is always a programme for immunization in every country. In Nigeria, we have a National Programme on Immunization (NPI), which stipulates the number of immunization that a child should get; the schedule and all that. Some of them are mandatory, some of them are optional but there is standard set by every country and that is often adopted. What you are seeing is they’re actually following a schedule that is already approved by the government or the Ministry of Health and this is evidence-based. They are not doing it out of their will or desire to have mothers come every day. They are doing it because that is the right thing to do; it is evidence-based that they should come at a certain time that this immunization is given.”

How effective is the first milk from the mother after birth (Colostrum) in helping the babies fight off diseases? The pulmonologist said: “It is high in what we call immunoglobulin that is protective for the child but it does not replace immunization. It helps the child to fight particularly infections in the … but as I said, it is not immunization. The effect lasts only a short time. But immunization, some of them are lifetime protection and some of them will protect you beyond just one condition. Vaccinations are combinations and so, with just one shot, you can get protection for up to five different conditions.”

As an expert, where would you advise mothers to get their children immunized because there is this issue of whether mothers should go to the public hospitals rather than private ones for the exercise? Ozoh said: “Immunization has been made available to everybody. This is one good point in which government has made a lot of progress in getting it to the grass root. So, at every health centre, at every general hospital, every government hospital has an immunization clinic and run a programme that mothers can take their children for regular immunization.

“When you go to private hospitals to get immunized, you pay more. At government hospitals, immunization is free for the ones that are in the national programme and are not optional. If you go to a private hospital, you are going to pay for immunization but the government has recognized that there must be a public/private mix because some people will still not go to government hospitals. So, many private hospitals also run immunizations.

“It is the same programme that is run by every hospital that run an immunization programme; they follow the National Programme on Immunization, they have a standard card and they must make sure that they maintain the code chain to make sure that the vaccines are safe.”

We have cases of parents who do not believe in this programme either because of some sort of cultural, religious or personal beliefs. What is your advice to these kinds of people? She said: “My advice to them is that the benefit of immunization far outweighs the risk. A child having whooping cough, diphtheria can kill that child but the side effects of immunization, fever, a much milder and often goes even without treatment. A lot of people also have belief of long term side effects but it is shown that those side effects are minimal compared to the protection received from immunization.

“The important thing is that you want to understand first when a mother is resistant to immunization, why are they resistant? You want to ask them, what is the reason of their resistance? Is it cultural belief? Is it religious belief? Is it what they heard? Because many times, it is out of ignorance. They overheard someone talking that ‘ahh, his thing is not good’ and that means they will not give their child immunization. It is then the duty of the healthcare provider to understand why somebody is resistant and explain to her that the benefit far outweighs the risk.

“It is because immunization is being done now and people are no longer seeing those diseases that killed children, some people are now taking it for granted. It is because this immunization has been taken up by other people that those diseases are not even available to infect other people. so, if many people drop from the immunization programme, those diseases will come back and the risk for those who are not immunized will increase.

“So we need to encourage everybody to get immunized. Although there are risks which includes fever, swellings, abscess and others, those risks are minor as compared to protection you receive from immunization.”

Is it only children that require immunization? Ozoh explained: “Interestingly, the answer is no. Many times, people think that immunization is just for children; there’s also immunization for adults. Immunization for adults include the Influenza Vaccine in areas that it is prevalent, Pneumococcal Vaccine for adults at a certain age and those with certain clinical conditions, we also have the Typhoid Fever Vaccine, Varicella-Chickenpox Vaccine, Human Papilloma Virus (HPV) Vaccine for young men and girls and these are all for adults with so many others. So, it is not just children that need vaccines and these vaccines are highly effective among these set of humans.”

Does this immunization for adults have age limit? The consultant physician explained: “For children, you aim to give them most of their immunizations under the age of five but these days, that’s not true. There’s now immunization for 12-year-olds, 13-year-olds and so on. You get boosters, they are not new immunizations; you just get boosters of what you took earlier and that is part of the programme.

“But when we talk about adult immunization, the immunization you get depends on your age. For instance, for you to get a pneumococcal vaccine, you have to be at least, 65 years old. But if you are less than 65 and have certain medical condition such as diabetes, Human Immune Virus (HIV), cancer, cancer treatment, sickle cell, all those can make you require to receive those vaccines much earlier than the normal age.

Why pneumococcal vaccine? Ozoh further explained: “It is actually a vaccination against the pneumococcal organism. The vaccine is recommended for children; it is part of the NPI, though right now, I don’t know whether it is compulsory. However, the vaccine is for children and for adult.

“For adults, pneumococcal vaccine protects against pneumonia, meningitis and blood infection by this pneumococcal organism. This vaccine has been shown to be effective in preventing pneumonia and you should understand that one of the major causes of death in elderly people and people with medical many conditions is pneumonia. So it is very important.”

What is the recommended vaccine for children and adults? She explained: “Part of NPI, immunization for a child is three doses and that protects him for life. For adults, depending on the vaccine that is being used, they can take one dose or two doses. Like I said earlier, there are guidelines which one of them is age; age above 65 is an indication for a pneumococcal vaccine.

“Other guidelines says, if you are 50 and you have diabetes, heart failure, kidney disease, liver disease and so on, then the person should be immunized. Then, if the person has HIV at any age, sickle cell among others, that person needs to be immunized. So it depends, but there are guidelines to follow regarding its administration.”

Apart from the routine schedule for children, are there some other special arrangements on it? Ozoh said: “We are talking about pneumococcal vaccine for children; it is for every child. As part of NPI, the child takes three doses which is full protection for the child. Remember, no vaccine is 100 per cent effective. It is shown however that even when they get the disease after vaccination, the severity of the disease will not be as bad as somebody who did not get the vaccine at all because no vaccine is 100 per cent effective. But when you are looking at what is the size of the effect and the effect of the vaccination is very high.

“For the children, they follow a programme, but for the adults, it depends on the age and the presence of medical condition. If anybody is 65, he/she should receive pneumococcal vaccine.”

What is the consequence for the child if he/she is not vaccinated? “It means you haven’t received protection the way you are supposed to receive it and you are prone to the diseases which it is immune to,” Ozoh said.

How readily available is the vaccine in the country? “Recently, the vaccine is available in Nigeria for uptake,” she added.

What is the role of healthcare providers in driving immunization home to Nigerians? Ozoh explained: “The role is to advise patients on the benefits of immunization, know those who have fears and address those fears and concerns such that they will understand that they benefits outweighs the risks. Also, sometimes, some people are not even aware of the vaccines they need to receive. It is also the role of the healthcare provider to educate patient on the vaccines available to them to receive and encourage them to get it.”

On the part of the government, what do you think they can do to improve the uptake of the vaccines? The pulmonologist said: “Well, the NPI is trying, the coverage is increasing and the government is trying to reach even the rural areas that were not initially covered, which is a good thing. This, they have achieved by decentralizing immunization and working with the tiers of government.

“But the uptake of pneumococcal vaccine has not been high in Nigeria particularly, among adults. This is because it wasn’t available and may be people didn’t understand that there is protection that it can give. So now that we have the vaccine more available for adults, it is for doctors to understand the indication, know the patient that require the vaccine and educate those patients to receive it.”

Is a person who has received pneumococcal vaccine and still exposes him or herself to cold immune to pneumonia? Ozoh said: “You get pneumonia from inhaling the organism and not just by exposure to cold. For you to have pneumonia, you have to inhale pneumococcal organism, which is why the vaccine is important because it protects you from one of the causes of pneumonia. Not all pneumonia is caused by pneumococcal organism but the organism is one of the very important and major causes of pneumonia. Someone who has received pneumococcal vaccine can still get pneumonia from another organism but you target what is most important and most important organism that causes pneumonia is pneumococcal organism and this why the vaccine targets the organism.

“For the children, they receive other vaccines that also protect them from pneumonia, that’s when you talk about HIV3 which Hemophilic Influenza Vaccine. It also protects from pneumonia in children.”