Vaccination associations and public concern
Beyond the true vaccine reactions that are well documented, the notion that vaccine could be responsible for serious health problems has led to many allegations and many scientific reviews. Some allegations often based on unfounded rumours or poor science have, at time, profoundly affected the performance of immunization programmes and limited the ability to prevent serious diseases.
Tetanus toxoid vaccine example
Tetanus is caused by bacteria that enter the body through open wounds. The bacteria cause an increased tightening of muscles, resulting in spasms, stiffness, and arching of the spine. Ultimately breathing becomes more difficult, and spasms occur more frequently.
People of all ages can get tetanus. But the disease is particularly common and serious in newborn babies. This is called neonatal tetanus. Most infants who get the disease die. Neonatal tetanus is particularly common in rural areas where most deliveries are at home without adequate sterile procedures.
Tetanus can be prevented by immunizing women of childbearing age with tetanus toxoid, either during pregnancy or before pregnancy. This protects the mother and-through a transfer of tetanus antibodies to the fetus-also her baby.
People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized. To be protected throughout life, and individual should received three doses of DTP in infancy, followed by a booster containing tetanus toxoid (TT)-at school-entry age (4-7 years), in adolescence (12-15 years), and in early adulthood.
Tetanus
Worldwide, all countries are committed to “elimination” of maternal and neonatal tetanus (MNT), i.e. a reduction of neonatal tetanus incidence to below one case per 1000 live births per year in every district. All women of of childbearing age, either during pregnancy or outside of pregnancy, should be vaccinated against tetanus to protect themselves and their newborn babies. Neonatal tetanus is almost always fatal and is completely preventable by ensuring that pregnant women are protected through vaccination. Benefits of vaccinating pregnant women usually outweigh potential risks when the likelihood of disease exposure is high, when infection would pose a risk to the mother or fetus, and when the vaccine is unlikely to cause harm. This should be assessed on a case-by-case basis.
Immunization and pregnancy
WHO’s Strategic Advisory Committee of WHO (SAGE) has recently discussed seasonal influenza vaccination and recommended pregnant women as the most important risk group for seasonal influenza vaccination. SAGE also supported the recommendation, in no particular order of priority, of vaccination of the following targeted populations:
Immunization and pregnancy
Influenza
Inactivated influenza vaccine is now recommended for pregnant women in many industrialized countries because of evidence of benefit to the mother and the infant. LAV vaccines pose a theoretical risk to the fetus and are generally contraindicated in pregnant women.
An additional vaccination recommended for pregnant women is seasonal inactivated influenza vaccine. It is considered safe and is recommended for all pregnant women during the influenza season. This recommendation is motivated not only by the potential severe course of influenza during pregnancy, but also to protect infants against influenza during their vulnerable first months of life.
BCG vaccination for infants at risk for HIV infection
As in infants symptoms of HIV-infection rarely appear before several months of age, BCG vaccination should be administered to those infants regardless of HIV exposure, especially considering the high endemicity of tuberculosis in populations with high HIV prevalence.
Close follow-up of infants known to be born to HIV-infected mothers and who received BCG at birth is recommended in order to provide early identification and treatment of any BCG-related complication.
In settings with adequate HIV services that could allow for early identification and administration of antiretroviral therapy to HIV-infected children, consideration should begiven to delaying BCG vaccination in infants born to mothers known to be infected with HIV until these infants are confirmed to be HIV negative.
Immunizing the immunocompromised
People may be immunocompromised due to HIV/AIDS, congenital immune deficiencies or drug treatments such as chemotherapy for cancer and other conditions and high dose steroids.
The potential risks of live vaccines need to be weighed against the benefits in immunocompromised clients who may be particularly vulnerable to the vaccine-preventable disease. Concerns are that they may not respond adequately to subunit and inactivated vaccination and that LAV vaccines are potentially pathogenic.
Routine childhood vaccination-except BCG vaccination- are not contraindicated in children with asymptomatic HIV-infection; however, timing of vaccination may be earlier or more frequent in this subgroup.
In symptomatic HIV/AIDS, LAV vaccines are contraindicated, e.g. measles and yellow fever vaccines should not be given.
Anaphylaxis
Using adrenaline to treat anaphylaxis
Adrenaline stimulates the heart and reverse the spasm in the blood vessels and the lung passages, reduces oedema and urticaria, thus countering the anaphylaxis. But this very potent agent can cause irregular heartbeat, heart failure, severe hypertension and tissue necrosis if used inappropriately, although not when treating true anaphylaxis.
Anaphylaxis
Anaphylaxis of unknown cause and unrelated to vaccines increases during adolescense, being more common among girls. Vaccinators should be able to distinguish anaphylaxis from fainting and vasovagal syncope (which is also common in adolescents), as well as anxiety and breath-holding spells, which are all common benign adverse events.
Anaphylaxis
Anaphylaxis is a very rare allergic reaction (one in a million vaccinees), unexpected, and can be fatal if not dealt with adequately. Vaccine antigens and components can cause this allergic reaction. These reactions can be local or systemic and can include mild-to-severe anaphylaxis or anaphylactic-like responses (e.g.generalized urticaria or hives, wheezing, swelling of the mouth and throat, breathing difficulties, hypotnsion and shock). Reports of anaphylaxis are less common in low- and middle-income countries compared to high-income countries, probably because of reduced surveillance sensitivity and as the event may not be recognized (i.e. death attributed to another factor).
Misdiagnosis of faints and other common causes of collapse, such as anaphylaxis, can lead to inapropriate treatment (e.g.use of adrenaline and failure to recognize and treat other serious medical conditions).
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