All childhood vaccination campaigns are necessary

Disregard the naysayers and rumourmongers, all childhood vaccination campaigns are necessary and extremely cost-effective in preventing illness. PHOTO | NATION

What you need to know:

  • Tetanus in newborns mainly affects babies born at home, where unhygienic materials are used to tie the umbilical cord or the cord itself is cut with a rusty blade.
  • Africa is free of polio, yet in the 1970s and 1980s, it was frequent to see a few children on the sidelines of play grounds in Kenyan schools, unable to participate, due to polio paralysis.
  • In 2014, at the Kilifi County Hospital, there were four cases of neonatal tetanus admissions. Researchers suggest that it was the scare by the church that led to a reduction in women seeking vaccinations and a resurgence of the disease.

Childhood illnesses that previously resulted in millions of deaths and disability in children globally are now on the decline, and for some, close to eradication.

Let us take the case of polio. As recently as 1998, it is estimated that globally, 350,000 children succumbed to polio paralysis every year. The world united against polio and launched massive polio vaccination campaigns, and by 2004, cases of polio had fallen by 99 per cent. Currently, only two countries (Pakistan and Afghanistan) are experiencing new polio cases. Africa is free of polio, yet in the 1970s and 1980s, it was frequent to see a few children on the sidelines of play grounds in Kenyan schools, unable to participate, due to polio paralysis.

Because polio is now so rare, there are some who do not understand why the vaccine is still in use. Vaccines have become a victim of their own success.

For Kenya however, polio is still a real risk due to proximity to nations where vaccine coverage is not great. Due to the free movement of people across the world, it is not unlikely that a case of polio could be imported and cause massive public health crisis. It is therefore essential that until the world is totally free from polio, that children continue to be vaccinated.

Tetanus is another disease that has gradually declined over the years to a point where most people alive now, have not encountered it. What many do not know is that this was such a common disease, that in many communities in Africa, children had their two bottom front teeth removed: tetanus in older children and adults presented the ‘lock jaw’ syndrome where the jaws were clenched shut, so one could not eat or drink. The gap between the teeth was used to pass a straw into the mouth through which the sick person would be fed some water.

Adults who have survived the disease have said that they felt as if their whole body was experiencing a severe cramp. They were fully conscious though totally helpless and in extreme pain.

Tetanus is however almost always fatal when it occurs in children under a month old. Neonates are between one to 28 days old, and tetanus during this period is referred to as neonatal tetanus.

Tetanus in newborns mainly affects babies born at home, where unhygienic materials are used to tie the umbilical cord or the cord itself is cut with a rusty blade.

A newborn baby is being attended at the Machakos Level 5 Hospital. PHOTO | MACHAKOS COUNTY DPS

HORRIFYING EXPERIENCE

The bacteria that cause tetanus live free in the soil as spores. Contamination of an open cut or wound allows the spores entry into the human body. It is through the cut umbilical cord that spores gain entry into the body of newborns. These spores generate the bacteria which release the tetanus toxins or poisons, which travel through the nervous system into the brain. The toxins destroy the nerve endings that control muscle activity. This causes all the muscles of the body to have strong, regular, brief contractions called muscle spasms. These muscle spasms are so strong, they can shut the jaws tight and can even break the backbone.

Professor Charles Newton, a researcher at the Kemri-WTRP who has worked in the paediatric ward at the Kilifi County Hospital over many years, describes what he observed in babies with neonatal tetanus.

“When I looked into their eyes, they were in utter distress. During each muscle spasm, the baby stops breathing. A spasm can last 30 seconds, every five to 10 seconds. A baby has barely a chance to get air into their lungs,’ said Prof Newton, ‘In older children and adults, one can see the terror in their eyes, since they are often fully conscious during these severe and frequent spasms.’

The tetanus toxins damage the nerve ends and there is no cure for this. The damaged nerve ends need three to four weeks to regenerate. There is nothing a doctor can do but support the patients by keeping them fed and hydrated until the nerves grow.

During this three-four week period, the baby has to be separated from its mother and put in a quiet, dark room, sedated and if facilities are available, put on a ventilator, to reduce the frequency of muscle spasms which affect the respiratory muscles and cause the baby to stop breathing. It is a horrifying experience for a baby just a few days old.

For the few babies that survive this experience, most have a degree of brain damage. This is because with every muscle spasm, the baby was not able to breath and the brain suffered long periods without enough oxygen. According to Prof Newton, most of these children will not have severe conditions such as paralysis, but their brain is affected in many different ways, most of which are detected when they start school. These children do not progress in school, are hyperactive and difficult to control.

In past records, neonatal tetanus was not differentiated from adult or older childhood tetanus. However, in 1984-1985, house-to-house neonatal tetanus deaths were recorded from three districts in Kenya. It was inferred from this data that a minimum of 8,000 newborns were dying from neonatal tetanus every year in Kenya during this period.

Due to the presence of a research program at the paediatric ward of the Kilifi County (then District) Hospital from 1989, it has been possible to look at changes in neonatal tetanus over the years.

A paper published in the International Journal of Epidemiology in 1993 by Dr Peter Bjerregaard and colleagues, estimated that about 110 babies were dying of neonatal tetanus every year in Kilifi District.

The late Fredrick Ibinda, who was a PhD student at the Kenya Medical Research Institute–Wellcome Trust Research Programme (Kemri-WTRP) in Kilifi, was studying trends in Neonatal tetanus from 1999 to 2013 at the Kilifi County Hospital at the time of his death. In a paper published in PloS ONE journal in 2015, Mr Ibinda reported that in the 15-year period, the hospital had admitted 191 babies with neonatal tetanus. Of the 191 cases admitted, only 73 survived. In most African hospitals, 80 per cent of babies admitted with neonatal tetanus die, so a death of two out of three reported in this hospital was a credit to the paediatric unit.

However, major tetanus immunisation campaigns by the Ministry of Health were undertaken for all women of child-bearing age (15 -49 years) in 2002, 2008 and 2013. So effective were these campaigns that for the year 2013, Mr Ibinda found there were no admissions for neonatal tetanus at the hospital and therefore no deaths.

SCARED BY CHURCH

Although this does not mean that there were no deaths at all in the community, it does show that the disease could be completely eradicated by vaccinating women and girls. The late Ibinda was in the process of analysing data from the community, looking at disabilities in children and trying to work out what proportion of the disability was due to various childhood conditions including neonatal tetanus.

“The most important thing is to prevent neonatal tetanus with vaccinations. If we don’t, we must accept the increase in disabilities,” said Mr Ibinda, when interviewed last year.

In 2013, opposition to tetanus vaccinations for women arose from the Catholic Church. They claimed that the vaccine was laced with contraceptives that would in future lead to a reduction in fertility.

In 2014, at the Kilifi County Hospital, there were four cases of neonatal tetanus admissions. Researchers suggest that it was the scare by the church that led to a reduction in women seeking vaccinations and a resurgence of the disease.

Efforts to control neonatal tetanus should be supported fully by all to ensure that not a single child need go through this horrific condition. Polio vaccinations should also continue to ensure that the world remains polio free.

Measles is so transmissible that even small proportions remaining unvaccinated can allow persistence and outbreaks. All childhood vaccination campaigns are necessary and extremely cost-effective in preventing illness.

 

 

Carers are often left wondering why there is a disconnect between the regular clinic vaccinations and the campaigners. How many injections or drops will children receive of this same vaccine before these campaigns stop? PHOTO | NATION

People need assurance, not threats of imprisonment

The Ministry of Health needs to change its approach to vaccination campaigns. Most of the campaigns are targeted to areas which neighbour countries with poor vaccination cover. These are the most at risk and therefore face many vaccination campaigns. Many people are unaware of this and start rumours of tribal targeting. Such rumours can lead to serious public health problems and disease outbreaks.

The rumour mongering about vaccination programs is a global phenomenon. In the UK, a rogue researcher claimed a link between MMR (Measles, Mumps and Rubella) vaccinations and autism. This research was published in a leading journal, The Lancet, and was hyped by the media. As a result, parents refused to take their children for vaccinations. Measles outbreaks started to occur in England and the rest of the UK, the latest outbreak being in 2012-2013 in Wales, where 1,200 cases of measles and one death were reported.

In Nigeria, rumours that the polio vaccination was laced with contraceptives led to a massive boycott of the immunisation campaigns in 2003. In 2003, polio cases stood at 355 in Nigeria and this shot to 1,122 cases of children paralysed by polio in 2006. This outbreak spilled over to another 19 countries. This was because of a lack of leadership to engage with religious leaders on matters of public health importance such as vaccination.

Health officials need to ask why it is that there are no rumours about vaccines provided at the health facility and why problems only erupt during the campaigns. The aggression with which campaigners go door-to-door, coercing people to bring their babies out for vaccination, makes people believe that there is an ulterior motive to the campaigns.

Having personally experienced the vaccinators’ behaviour, I know that some do not even ask for the child’s immunisation card. They do not record these vaccinations. They just want a child to vaccinate and report on the numbers and meet their target. They are aggressive and threaten those who do not want their children vaccinated. Carers are often left wondering why there is a disconnect between the regular clinic vaccinations and the campaigners. How many injections or drops will children receive of this same vaccine before these campaigns stop? People need assurance, not threats of imprisonment. These questions need answering and nobody should be made to feel stupid asking them.

Tabitha Mwangi has a Phd in epidemiology and is senior lecturer in Public Health at Pwani University. She is a freelance writer here is her blog