CHILD IMMUNISATION - Full extract 

A stroll through any cemetery reminds us how many children used die in early infancy. In the last century it was not uncommon for several children in the one family to die from overwhelming infections. The weathered headstones do not say but we know that pneumonia, measles, gastroenteritis, diphtheria and whooping cough were the main causes of death. 

How appalling it must have been for the parents of these children; there was so little they could do to prevent the illnesses and even less to offer once the children became sick. The same illnesses still claim millions of children's lives in poorer countries around the world. 

Routine childhood immunisation has greatly reduced the incidence of many infectious diseases in Australia. However, continuing large outbreaks of whooping cough, measles, and rubella show that we cannot afford to become complacent. Regulations to check that children's immunisation schedules are up to date before starting school have been an excellent prompt for parents to check their records and when necessary organize catch-up immunization doses. Parents and doctors should utilize routine consultations to have an on-the-spot immunisation wherever possible. The Australian Childhood Immunisation Register has also been established to help prompt doctors and parents to check that childhood immunisation schedules¹ have been properly completed.

About 90% of Australian children have the first three doses of Triple antigen (diphtheria, tetanus and whooping cough), Hib vaccine and oral Sabin (polio). However, considerably less have their booster doses. Until fairly recently some suburban areas of Melbourne and Sydney were said to have immunisation rates of 40% and less. Continued public health education programs are necessary if these rates are going to be improved. 

A number of basic misunderstandings prevent some parents from having their children immunised. A cold or the snuffles is not a reason to postpone a child's immunisation. Likewise, prematurity, being on antibiotics, and the mother breastfeeding or being pregnant are all of no concern. Minor local reactions and a fever after Triple antigen are not unusual and should not prevent further immunisations. 

There is no such thing as a perfect vaccine or a perfect medication. Exceedingly rare side-effects can occur from immunisation but the risk is much less than the risk of complications from the diseases that are being prevented. There are few reasons these days for the Triple antigen vaccine being withheld; unstable epileptic conditions and a previous convulsion just after an immunisation might make us exclude the whooping cough component of the vaccine. These reactions are even less common than they used to be since the new acellular whooping cough component Triple antigen vaccines such as Infanrix have become available. Likewise, immune deficiency conditions and severe egg allergies may preclude the use of other vaccines and should be discussed with the family doctor or a paediatrician. (see Common myths )

Along with Triple antigen and oral Sabin (polio) there are a few relatively new vaccines currently being used. Hepatitis B vaccine is available for children and has now become universal, rather than for those especially at risk. Since May 2000 the recommendation has been for all Australian-born infants to be routinely immunised against hepatitis B.
Catch-up immunisations are also encouraged for all other children at or before Year 7 at school.

We also have a vaccine against Haemophilus Influenza Type b, or Hib disease. The condition was long regarded as the most serious bacterial infection of childhood. It causes meningitis (infection of the tissues surrounding the brain and spinal cord) and acute epiglottitis (infection and swelling of the flap of tissue that sits over the upper windpipe). Up till recently there were about 700 to 800 cases in Australia per year and it has been a major cause of death and disability. Since about 1993 Hib vaccine has been routinely  given with Triple antigen and Sabin from two months of age, or as a single catch-up dose for unimmunised children between the age of 18 months and five years. 

Varilix, a new vaccine against chicken pox has also recently been released. Its main application initially will probably be in higher risk children, or adults who have never had chicken pox and are at risk of catching the infection.  

Health Tips:
* If you have any concerns about the safety of childhood immunisations discuss these concerns with your local doctor or a paediatrician. 

Web links:
¹ Commonwealth Health & Family services website. http://immunise.health.gov.au/
  NEV information: Common myths of immunization:
  www.nevdgp.org.au/other/project/ImmunisationProject97.html

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001