Which shots to get?

By BRIGITTE ROZARIO

Do you know what shots your child is getting annually? In Malaysia, parents are given a schedule of vaccinations that their children should go for. Most parents take their children for the mandatory vaccinations without knowing what the shots are for.

Paediatrician Dr Sanjay Woodhull explains that on top of the mandatory vaccinations, there are also the optional ones. Doctors would normally advise parents on which optional shots their child should get based on the child's medical history.

Here, Dr Sanjay explains the vaccinations available in the country:

Click for easy-to-read list of vaccinations.

MANDATORY SHOTS

Vaccination: BCG
Age: At birth
For: Prevention of tuberculosis
Worst case scenario if you don't get the shot: You can die from TB. It usually affects people whose immune system is compromised, mainly those with cancer and HIV.

“It will prevent to a large extent severe tuberculosis. That means tuberculosis of the blood and the brain. It will not prevent TB of the lung. We don't have anything better for it. It may to some extent help TB of the lung but in most cases, not.

“Some parents don't want to give their children the BCG jab simply because it leaves an ugly scar but I think it's important and TB is a big problem nowadays. It is estimated that almost a third of the world's population harbours the bacteria. It will be a problem when your immune defences are down. That's when it starts to flare up.

“In the past we used to vaccinate the BCG at birth and screen children at school entry and we used to give the second BCG vaccine when they were 12 years of age. We have stopped doing that. Now there is only one BCG vaccination for life. Sometimes for some children there is no scar formation. If we don't see a scar we repeat the BCG otherwise there's only one jab for life.”

Vaccination: Hepatitis B
Age: At birth, 1 month and 5 months
For: Prevention of Hepatitis B
Worst case scenario if you don't get the jab: You can get liver cancer.

“Hepatitis B is endemic in Malaysia. It is transmitted the same way that HIV is – via blood, sexual intercourse. It affects the liver so you get hepatitis, chronic liver damage and jaundice. 10% of carriers will end up with cancer at some point in their life. There's no cure for Hepatitis B.

“We routinely tell parents that if any of their family members – mum, dad or anyone else within the same household – has Hepatitis B, then after the routine vaccination, all the family members, plus the child, need to be checked to ensure they are protected against Hepatitis B. That's the only time we will check the blood. Otherwise, we won't bother checking the blood for Hepatitis B. We just assume they are protected against it.”

Vaccination: The triple (Diphtheria, tetanus and Pertussis) and polio
Age: 3-dose schedule (2-3 months, 3-4 months and 4-5 months) with booster shots given at 18 months-2 years and 5-7 years. In total, five shots.
For: To prevent against diphtheria, tetanus, pertussis and polio
Worst case scenario if you don't get the jab: Diphtheria and tetanus can be fatal. The child might have to be ventilated for pertussis. Polio can affect the lungs, heart and kidneys.

“These are all pre-war diseases. We still have them in Malaysia and throughout the world. People who get diphtheria are those who are not vaccinated against it. We can see it in our illegal immigrants or well-educated parents who oppose the idea of vaccination.

“Diphtheria basically is a bacteria which is soil-bound and it can go through your respiratory tract. It causes a membrane swelling to your throat and if it affects your wind pipe, it can actually block it up and you can die from that. It also releases a toxin into the blood which is harmful to your nerves and heart. It is a disease you can prevent but it's life-threatening.

“Tetanus is lockjaw. Again, you can get this from cuts, bruises and it is soil-bound. It causes muscle spasms, paralysis and seizures. So, it is something you can prevent as well.

“Pertussis is whooping cough. It's a problem in children who are not vaccinated. Children under two months who get pertussis can get it bad. They can end up in the ICU and needing to be ventilated. They cough and cough and cough until they stop breathing.

“The old name for it is the hundred-day cough or the three-month cough. Whatever we do, the child will cough for three months. The treatment for pertussis which is an antibiotic will only prevent pertussis from spreading to another child but once you've established pertussis you can't do anything about it.

“You can only treat and support the child while the coughing episode gets worse and typically that starts around the second week where the coughing gets worse and worse and lasts for about two to three weeks before it gets better.

“Polio is one disease we are trying to eradicate in the world. We used to give oral polio vaccine. I think in some government hospitals they still give the oral polio vaccine but in most private hospitals we give the injection.

“Oral polio vaccine is a live virus but a weakened virus. You can get polio from that. But the risk is very minute – one in a million chance. That's the disadvantage of oral polio vaccine. In the United States they only see vaccine-associated polio, they don't get wild polio. So that's why they have also changed theirs to injection polio vaccine from oral vaccine.”

Vaccination: Haemophilus influenzae B
Age: Given with the triple in three doses and the booster is given at 1½ years
For: To prevent against Haemophilus influenzae B
Worst case scenario if you don't get the jab: The child could die from meningitis

“This is a bacterial infection. Haemophilus influenzae B is the commonest cause of pneumonia and meningitis in children. (Meningitis is an infection of the brain covering.) Prior to the year 2000 it was a huge problem for Malaysia. The introduction of this vaccination has made a big difference. We hardly ever see meningitis caused by Haemophilus influenzae anymore.”

Vaccination: Measles, mumps and rubella
Age: After one year old. This is given in two doses (at one year old and at school entry)
For: To prevent against measles, mumps and rubella
Worst case scenario if you don't get the jab: Measles can cause death. Mumps and rubella can cause encephalitis (inflammation of the brain).

“Measles – the symptoms we are familiar with are high fever, some rashes, maybe a bit of conjunctivitis, cough and flu. For most people who get it, they're fine in a couple of days. But for about one in 1,000 children, measles can cause encephalitis – brain infection. That's brain damage and it's permanent. Measles can cause death. It can cause bad pneumonia. About one in 250 or 300 children with measles will get pneumonia.

“These are viruses for which there is no treatment. The care is all supportive; that's why it's important to prevent.

“Mumps may be known for the swelling of the glands but it can also cause encephalitis – the brain infection which you want to prevent. Mumps can also cause infection of the testes in males and that can lead to infertility. That's why you want to prevent it and the only way to prevent it is with the vaccine.

“Because we give two doses of the measles, mumps and rubella vaccine, girls at the age of 13 years do not require the shot anymore. But if you're going through the government schedule then you will need the rubella shot at 12 or 13. In Malaysia, the rubella vaccine is mandatory for girls.

“Inadvertently sometimes the child might go for the extra shot because they've got their shots at the private hospital and then they follow the government schedule and get another shot. It is safe to get the extra shot. It is not going to cause them harm. It is just an extra boost. It isn't necessary but no harm.”

RECOMMENDED SHOTS

Vaccination: Influenza
Age: Given annually
For: To protect against influenza
Worst case scenario if you don't get this jab: Child gets influenza

“The strain keeps varying. Every couple of months it varies. Personally I think giving influenza vaccine routinely for children may not be so beneficial simply because the influenza outbreaks here have two peaks and it keeps varying from year to year. Some years it makes a difference and some years it doesn't.

“So we tend to be selective. We give it to children who have problems – kidney problems, lung problems, heart problems – if they were born with it or if they just have bad lungs and heart whereby if they get influenza they can be significantly unwell.

“The recommendation as it stands is to vaccinate all children between six months to five years of age. After five years you don't require it unless you have heart, lung or kidney problems. And children with asthma have been added on to this recommendation but I explain to parents that if I think the asthma is well-controlled it is up to them. If I think it's not well-controlled I would recommend giving it.”

Vaccination: Chickenpox
Age: One jab for life
For: To protect against chickenpox
Worst case scenario if you don't get this jab: In rare cases it can cause encephalitis or affect the lungs.

“Many parents think chickenpox just causes a few spots, no big deal. Rarely, it can affect the brain and cause encephalitis and chickenpox can affect the lungs. This is usually seen in extreme ages – in the very young and the elderly.

“The chickenpox vaccine itself can prevent 95% of children from getting chickenpox. The 5%-7% will still get chickenpox in the future. However, if they do get it it's usually just a few spots, nothing severe. It will certainly protect the brain and the lungs. That's really why we give the chickenpox vaccine, not so much for the scars.

Vaccination: Pneumococcal
Age: Given as three doses in the first six months and the booster after a year. Can be given with the triple shot.
For: Prevent against pneumonia, meningitis and infections
Worst case scenario if you don't get this jab: Can be fatal

“The other optional vaccine that we are currently recommending is the pneumococcal vaccine. It's almost RM300 per jab. Pneumococcal is a bacteria and it is the second commonest cause of meningitis and pneumonia in children next to Haemophilus influenzae. Since children have been getting the Haemophilus influenzae vaccine they hardly get meningitis and pneumonia. If they do get it it's usually from the pneumococci bacteria.

“To prevent it, you get the vaccine done. It contains seven strains of the commonest pneumococci bacteria. Some parents can't afford it because it is expensive. Some parents opt to give it after a year so then they just need two doses. Or some parents opt to give it after the child's second birthday when they get only one dose which is adequate.

“It is fine to delay it a bit but you are only protected after you get the vaccination. I always explain to parents that the first two years are when the risk is highest to get the disease.

“The pneumococci bacteria cause ear, brain and lung infection.”

Vaccination: Rotavirus
Age: It is given in three doses, a month apart. Given with the triple shot.
For: To prevent against rotavirus infection
Worse case scenario if you don't get this jab: Child gets diarrhoea

“This vaccine was introduced about six or seven years ago initially but it was taken off the market because of concerns of intussusception where the children's intestines telescopes in itself and it causes bowel obstruction. The risk of getting that was very minute but nonetheless the Government saw an increased risk of it so they stopped it. And they re-introduced it a couple of years ago, about three years ago. The new vaccine is safe; it shows no problems at all.

“Rotavirus is the commonest cause of diarrhoea in children under the age of three years.

“This vaccine is given in the form of drops in the mouth.”

Vaccination: Hepatitis A
Age: Above the age of two, given in two doses, six months to a year apart.
For: Protects for life against Hepatitis A
Worse case scenario if you don't get this jab: Liver damage

“Hepatitis A is usually food borne. It is very uncommon for kids to get it because most children don't eat out. We tend to see it in teenagers. But we would advise parents definitely before going to school to get the Hepatitis A vaccine. It's endemic in Malaysia so you want to consider getting this jab.

Hepatitis A can cause liver damage. Jaundice, fever, vomiting and tummy upset are the typical symptoms. It usually lasts about a week and then it gets better but bad Hepatitis A can cause permanent liver damage. And there's no cure for it so prevention is advisable.”

Conclusion