The new immunisation schedule for the Nigerian child
Immunisation is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease.
Newborn babies are immune to many diseases because they have antibodies they got from their mothers. However, this immunity goes away during the first year of life. Vaccines are given to babies before the mother’s antibodies completely disappear. If an unvaccinated child is exposed to a germ, the child’s body may not be strong enough to fight the disease. Before vaccines, many children died from diseases that vaccines now prevent, such as whooping cough, measles, and polio. Those same germs exist today, but because babies are protected by vaccines, we don’t see these diseases nearly as often.
Vaccine-preventable diseases have a costly impact, resulting in doctor’s visits, hospitalisations, and premature deaths. Sick children can also cause parents to lose time from work. Vaccine preventable diseases account for approximately 22% of child deaths in Nigeria, amounting to over 200,000 deaths per year. Vaccine preventable diseases include; chicken pox, hepatitis A and B, diphtheria, tetanus, HIB, Influenza, measles, mumps, rubella, Typhoid fever, Rabies, rota virus, Yellow fever, whooping cough etc.
How do Vaccines Work?
When disease germs enter your body, they start to reproduce. Your immune system recognises these germs as foreign invaders and responds by making proteins called antibodies. These antibodies’ first help destroy the germs that are making you sick. They can’t act fast enough to prevent you from becoming sick, but by eliminating the attacking germs, antibodies help you to get well. The antibodies’ second job is to protect you from future infections. They remain in your bloodstream, and if the same germs ever try to infect you again even after many years, they will come to your defence. Only now that they are experienced at fighting these particular germs, can they destroy them before they have a chance to make you sick. This is immunity. It is why most people get diseases like measles or chickenpox only once, even though they might be exposed many times during their lifetime.
Vaccines offer solution to this problem. They help you develop immunity without getting sick first. Vaccines are made from the same germs or parts of them that cause disease. Once vaccines are introduced to the body, your immune system reacts to the vaccine in a similar way as if it were being invaded by the disease by producing antibodies. These antibodies destroy the vaccine germs just as they would the disease germs. Then they stay in your body, giving you immunity. If you are ever exposed to the real disease, the antibodies are there to protect you.
What are the classes of vaccines?
There are five classes of vaccines available;
1. Live attenuated vaccines;
They typically fight viruses and they contain a weakened part of the virus that does not cause serious disease in people with healthy immune systems. Examples; measles and mumps vaccines.
2. Inactivated vaccine: They also fight viruses. They are made from inactivating or killing the viruses during the process of making them. e.g polio and influenza vaccines.
3. Toxoid vaccines prevent diseases caused by bacteria that produce toxins (poisons) in the body. In the process of making these vaccines, the toxins are weakened so they cannot cause illness. e.g. diptheria toxoid vaccine.
4. Subunit vaccines contain only parts of the virus or bacteria instead of the entire germ. Side effects are less common with these vaccines because they contain only the important antigens and not the whole germ. e.g pertussis component of DTP vaccine.
5. Conjugate vaccines fight bacteria that have coating which makes it difficult for a child’s immune system to recognize and respond to the bacteria causing serious disease,e.g Haemophilus Influenzae type B (Hib) vaccine.
Components of the new immunisation schedule
At birth (0 week)- BCG, OPV-0, HBV-1
BCG is the tuberculosis vaccine. Tuberculosis causes pulmonary infection, but can spread to many other organs, causing serious illness, disability and death.
OPV-0 is oral polio vaccine. Polio mainly affects children under five years of age. It causes nausea, vomiting, sore throat, paralysis (usually irreversible) and death.
HBV-1 is the Hepatitis B vaccine. Hepatitis B can cause chronic liver disease and put people at high risk of death from cirrhosis of the liver and liver cancer.
At 6 weeks- OPV1, Pentavalent 1, PCV (optional), Rotavirus 1(optional)
Pentavalent vaccine is a combination of five vaccines-in-one that prevents diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza type B, all through a single dose.
Diphtheria is a fatal disease causing upper repiratory infection and swollen ‘bull’ neck.
Tetanus is a bacterial infection that causes fatal disease manifested by muscle spasms, neck stiffness as a result of wound infection.
Whooping cough (Pertussis) is a bacteria infection that causes severe cough, vomiting after cough and feelings of strangulation.
Hepatitis B is a virus that causes severe liver damage and if not treated liver cancer and liver failure.
PCV (Pneumococcal Conjugate Vaccine) protects against Pneumococcal disease, an infection caused by the bacteria Streptococcus pneumoniae which can lead to pneumonia, meningitis.
Rotavirus vaccine is an oral vaccine against rotavirus infection, a common cause of diarrhoea and sickness. Rotavirus usually affect babies and young children, causing an unpleasant bout of diarrhoea, sometimes with vomiting, tummy ache and fever.
At 10 weeks- OPV2, Pentavalent 2, PCV (optional)
At 14 weeks- OPV3, Pentavalent 3, PCV, Rotavirus 2 (optional)At 9 months- Measles, Yellow Fever
Measles vaccine is a highly effective vaccine used against measles.
Yellow fever is a potentially fatal viral infection, transmitted by mosquitoes in tropical regions. There is no specific treatment for yellow fever.
At 15-18 months- MMR, OPV, chicken pox (optional)
MMR is the measles, mumps and rubella vaccine. Measles, mumps and rubella cause serious complications, including deafness, brain swelling, severe infection among others.
Chickenpox (varicella) vaccine protects against chicken pox.
At 24 months- Meningitis, Typhoid fever (optional)
Meningococcal vaccine is a vaccine used against Neisseria meningitidis, a bacterium that causes serious brain infection.
Typhoid vaccine helps prevent typhoid fever.Typhoid is a serious disease caused by bacteria called Salmonella typhi. Typhoid causes a high fever, weakness, stomach pains, headache, loss of appetite, and sometimes a rash.
What is the difference between the current immunisation schedule and the old one?
Previous National Programme of Immunisation for Children
At birth: BCG, HBV -1, OPV-0
6 weeks: DPT-1, HBV-2, OPV-1
10 weeks: DPT-2, OPV-2
14 weeks: DPT-3, OPV-3, HBV-3
9 months: Yellow fever, Measles, Vitamin A
The new schedule at a glance
At birth: BCG, HBV -1, OPV-0
6 weeks: OPV-1, Pentavalent 1, PCV- 1, Rotavirus -1
10 weeks: OPV-2, Pentavalent 2, PCV-2
14 weeks: OPV-3, Pentavalent -3, PCV-3,
9 months: Measles, Yellow Fever
15-18 months: OPV, MMR,chicken pox
24 months: Meningitis, Typhoid fever
The new immunisation programme has newer vaccines that help to protect against meningitis, rota virus and pneumococcus. It also has a combination vaccine, comprises five vaccines (pentavalent) making it more tolerable to your children.
What is uniquely Nigerian about it?The World Health Organization monitors vaccination schedules across the world, noting what vaccines are included in each country’s program, the coverage rates achieved and various auditing measures. Vaccines for preventable diseases are given in a specific country based on the prevalence or risk of contacting that specific disease in a country or region. E.g vaccine against Japenese encephalitis is included in the immunization programme of Japan, China and India because the disease is prevalent in these countries.
Importance of immunisation
1. Over two million deaths are prevented through immunization each year worldwide.
2. Provision of individual immunity: It provides long-term, sometimes lifelong protection against a disease. The vaccines recommended in the early childhood immunisation schedule protect children from measles, chicken pox, pneumococcal disease, and other illnesses. As children grow older, additional vaccines protect them from diseases that affect adolescents and adults, as well as for diseases they may encounter during travel to other regions.
3. Herd/ Community immunity: This refers to the protection offered to everyone in a community by high vaccination rates. With enough people immunised against a given disease, it’s difficult for the disease to gain a foothold in the community. This offers some protection to those who are unable to receive vaccinations—including newborns and individuals with chronic illnesses—by reducing the likelihood of an outbreak that could expose them to the disease. It also protects vaccinated individuals who may not have been fully immunised against a disease.
4. Immunisation saves your family time and money. Some vaccine-preventable diseases can result in prolonged disabilities and can take a financial toll because of lost time at work, medical bills or long-term disability care.
4. Immunisation saves a child’s life: Immunisation helps to protect your child against various diseases.
5. Immunisation is safe and effective: All vaccines that are given to children are completely safe and effective, as various medical professionals have tested them.
6. Immunisation prevents spread of diseases: If a person is immunised, there is little to risk of an epidemic. Thus, it also prevents spreading of the disease.
7. Immunisation protects future generation: Immunisation has helped to eradicate small pox. If we keep on practising immunisation, in near future we will be able to eradicate other diseases completely.
What to do when immunisation is missed?
For most vaccines, it is never too late to catch up on missed vaccines. Children who are 2 months of age and have not gotten any vaccines can still be vaccinated. If your child misses any dose, just continue where you left off. Don’t postpone your child’s immunisations just because you know he or she can catch up later. Every month a child goes without scheduled immunisations is a month that the child is not fully protected from vaccine-preventable diseases If you have children who were not immunised when they were infants, or who have gotten behind schedule, contact your doctor or the nearest immunisation clinic. They will help you get your children up to date on their immunisations.
Dr. Lala .A.
Lagos State, Nigeria.