1 Introduction to immunisation

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Contents

• Objectives
• Introduction to immunisations
• Managing an immunisation clinic
• Promoting immunisation
• Case studies

Objectives

When you have completed this chapter you should be able to:

1. Understand immunisation
2. Describe the types of vaccine
3. Explain the importance of immunisation
4. Manage an immunisation clinic
5. Promoting immunisation

Introduction to immunisations

1-1 What are immunisations?

Immunisations are a method of giving a child or adult protection from an infectious illness by giving them a vaccine.

1-2 What is a vaccine?

A vaccine is an organism (bacteria or virus) or part of an organism that can be given to a person to protect them against a serious infection.

1-3 How are vaccines given?

Some vaccines can be given by mouth while others are given by injection.

1-4 Are all vaccines the same?

No. There are a number of types of vaccine:

• Some vaccines are weakened viruses or bacteria which give protection against an illness but do not cause illness (live vaccines). For example oral polio vaccine is a live virus vaccine.
• Other vaccines are made of dead bacteria or viruses (dead vaccines). For example intramuscular polio vaccine is a dead virus vaccine.
• A few vaccines are made of parts of the bacteria or products made by the bacteria which can cause illness. For example tetanus vaccine is made of a protein (a weakened toxic substance) that the tetanus bacteria produce. This protects the body against the illness caused by this toxin.

All types of vaccine protect the child against serious infections. It is important to know which are live virus vaccines as special attention must be made to keep them cool during storage and transport.

1-5 How do immunisations protect against infections?

Immunisations with a vaccine stimulate and strengthen the body’s immune system to produce antibodies which prevent infections. Each immunisation protects against a single type of infection. For example measles immunisation protects against measles but not other types of infection.

1-6 Why are immunisations important?

Immunisations are very important as they protect against a number of dangerous infections that can cause serious illness or even death. Infections such as polio and smallpox used to be common causes of death in children.

1-7 Are immunisations totally effective?

Most immunisations are very effective and give almost 100% protection against that disease. However some immunisations such as TB and influenza only provide partial protection. TB immunisation does not fully protect against TB but prevents some of the most severe forms of TB.

1-8 Have immunisations improved child health?

Immunisation is one of the most important and effective advances made by modern medicine. Smallpox no longer occurs thanks to immunisation. Polio is very rare while measles is no longer a common childhood disease. Immunisation saves millions of lives worldwide every year.

In South Africa, deaths due to pneumonia and diarrhoea have decreased since immunisation for these infections was started.

1-9 Does the protection last a lifetime?

Most immunisations protect the child for their lifetime.

1-10 When are immunisations given?

Most immunisations are given in the first 9 months of life as early childhood is the time that many infectious diseases are most severe and dangerous.

1-11 Are immunisations free?

Immunisations for children are free at state clinics and hospitals in South Africa. They have to be paid for in the private sector.

1-12 Do parents have to give their consent for their child to be immunised?

Yes. A parent or legal caregiver needs to give their consent when their child is immunised.

1-13 Is it illegal if a child is not immunised?

There is no law in South Africa that states that all children have to be immunised. However, parents should be strongly advised to immunise their children.

1-14 Can children go to school if they are not immunised?

All schools ask that the children must be fully immunised. Schools will want to see each child’s immunisation record when children are first registered at the school. However, they cannot refuse to admit a child to school if they are not fully immunised.

Some pre-schools or crèches may also ask to see the the child’s immunisation record.

1-15 Can immunising fathers help to protect their children?

Unlike the mother, the father’s antibodies are not transferred to his children. However, being immunised against infections such as measles and polio will prevent him becoming infected as an adult and possibly passing the infection on to any children who have not been immunised.

1-16 Can pregnant women be immunised?

There are some immunisations, such as tetanus, which are safe to give during pregnancy. Not only do these immunisations protect the mother but the baby is also protected for the first few months of life. This happens as antibodies cross during pregnancy from mother to baby.

1-17 Can childhood infection in a mother protect her child?

Some childhood infections such as measles both protect the mother and her baby for the first few months. Both measles immunisation and infection in the mother will help protect her baby during the first few months. As this may prevent measles immunisation being effective, this vaccine is not given to infants before six months of age.

Infection or immunisation in the mother will not protect her child after a few months of age. Therefore all children must be immunised.

1-18 Should immigrant children be given immunisations?

Yes. It is important to check that children who have come to South Africa from other countries have had all their immunisations. Some countries do not give all the immunisations given in South Africa. In addition, some children may not have received all the immunisations available in the country that they come from.

1-19 How are immunisations given?

Some immunisations are given as drops into the mouth while others are given by injection.

1-20 Are immunisations painful?

Mothers should be told that immunisations by injection are only slightly painful. However BCG is painful as it is given into the skin. Babies need to be cuddled by their mother or given a feed after the immunisation to settle them.

Managing an immunisation clinic

1-21 What is an immunisation clinic?

All health clinics and hospitals must be able to provide immunisations. However most have special days when immunisations are given. This is often at a well baby clinic. All parents must know where and when to take their children to an immunisation clinic. There should be signs directing parents to the correct place.

1-22 How can community health workers promote immunisation?

Community health workers should educate parents and help them understand the enormous benefits of having all of their children fully immunised. Listen to their queries and worries and give positive and simple answers. Every opportunity must be used to promote immunisation. Always check a child’s immunisation record.

1-23 How can community health workers help in an immunisation clinic?

The most important role of community health workers is to encourage parents to bring their children for immunisation and to check that all children are fully immunised.

Some community health workers may assist the professional staff in an immunisation clinic. Therefore it is important that they know about vaccines and immunisation.

Promoting immunisation

1-24 How can parents be educated about immunisation?

There are a number of ways:

• Mothers should be informed before they are discharged after delivery
• The list of immunisations in the baby’s Road-to-Health booklet should be explained to mothers
• Parents often ask their friends, family or neighbours about immunisation
• The benefits of immunisation should be advertised on local radio or in newspapers and magazines

1-25 Which children are at high risk of not being fully immunised?

Two high risk groups are:

• Immigrants
• Children of parents who do not believe in immunisation

1-26 Why do some parents not believe in immunisation?

Because:

• They never see infections such as polio, measles and diphtheria
• They incorrectly believe that immunisations are dangerous. This “false news” is common in some countries like the USA
• They may hold religious beliefs that teach that children should not be immunised
• They think that immunisations are painful and cruel

It is very important to educate these parents. If many people do not immunise their children then epidemics of measles or polio may occur.

1-27 How can community health workers help promote immunisation?

By speaking to parents about the safety and benefits of immunisation and checking children’s immunisation record at every home visit.

Case study 1

Two community health workers are talking about immunisations and one asks whether all immunisations use live vaccines. She also wants to know how immunisations work. Her colleague wonders how long the protection of immunisation lasts.

1. Which are live vaccines?

BCG, oral polio, Rotavirus and measles vaccines.

2. How do immunisations protect a child?

They stimulate the immune system to produce antibodies which protect against dangerous infections.

3. Is it true that most immunisations provide lifelong protection?

Yes.

4. Is it safe to immunise women during pregnancy?

Yes. Tetanus immunisation during pregnancy is given in regions where newborn tetanus is still a common cause of death.

Case study 2

A school teacher wonders how she can help prevent her pupils getting serious infections such as polio and whooping cough. She asks her neighbour who is a community health worker.

1. Do children need to be fully immunised before they are admitted to school?

Yes. They should have all their immunisations up to date. If not, the parents will be asked to take their child to a local clinic for the missing immunisations. Crèches and “pre-schools” will also want all of their children to be immunised to prevent an outbreak of infection such as measles.

2. How can the school teacher help ensure all her pupils are immunised?

She could ask them to bring their Road-to-Health booklets so that she could check their immunisation record. The school nurse could also do this.

3. How can a school teacher promote immunisation?

She can educate both pupils and their parents that immunisation is safe and has many health benefits.

4. Which group of school pupils is at great risk of not being fully immunised?

Children who have come from other countries where all children are not routinely immunised. Also children whose parents say they do not believe in immunisations. Community health workers should encourage both groups of children to be fully immunised.