As the world marks this year’s immunisation week, April 24-30, Consultant Pulmonologist (specialist in the lungs and breathing), Dr. Obianuju Ozoh, highlights the challenges of childhood and adult immunisation in Nigeria. In this interview with Sola Ogundipe, Ozoh, who is also a Senior Lecturer at the College of Medicine, University of Lagos, identifies the role of healthcare providers in preventing and reducing the burden of Vaccine Preventable Disorders, including pneumonia and other pneumococcal disorders through immunisation. Excerpts:
WHAT is immunisation? Immunisation is when a person is made resistant to an infectious disease and this is often achieved by vaccination. Immunisation is a protection that is given by vaccination. The person is given a vaccine that contains a modification of the organism that causes the infection, such that when the person is exposed in the future to that organism, he or she is protected from it.
Why is it important for babies?
It is important to get babies immunised because when they are born, they have little or no immunity, so they are prone to infectious diseases. They have a little protection from their mothers’ immunity but that wanes within a short time. The time to immunise a baby is right from birth.
There is an immunisation protocol that is followed. The vaccination protects them and prepares them for the challenges ahead from the infectious diseases that can occur.
In Nigeria, the National Programme on Immunisation, NPI,stipulates the number of immunisations and the schedule. Some of them are mandatory, others are optional, but what you are seeing in Nigeria is a standard that has been approved by the Federal Ministry of Health.
Is immunisation for every child and why are there so many visits required?
Immunisation is for every child and protects for a long time.It gives good protection but it has been shown that no vaccine is 100 percent protective, however when some children get the disease after vaccination the severity is much reduced. An unvaccinated child has not received protection as required. The schedule for immunisation that has been designed is evidence-based and the timing of each vaccine determined, therefore multiple visits may be required.
Is immunisation for children only?
Children under the age of five are mainly vaccinated but there is also immunisation for 12-13-year-olds and for adults too.
Can the first breast milk from the mother serve as immunisation?
The first breast milk that comes from the mother is high in immunoglobulin that is protective of the child, but it does not replace immunisation. It helps the child to fight infections but it is not immunisation and the benefits last only for a short time. Some immunisations shots protect beyond one condition, some vaccinations come in combinations, so with one shot a person can get protection for multiple infections.
Where can people get immunised?
Immunisation has been made available to everybody. At every health centre, General Hospital, and government hospital, there is an immunisation centre that runs a programme for mothers to take their children for regular immunisation. At the government hospital, immunisation is free for the diseases that are in the national programme. It is not optional.
If you go to a private hospital, you are going to pay for immunisation. But government has recognised that there must be a public private mix, because some people will still not go to the government hospitals therefore many private hospitals also run immunisation programmes. . They follow the NPI and must make sure they maintain the cold chain so that the vaccines are safe.
It has been recognised that some mothers are resistant to immunisation, how can this be addressed?
Benefits of immunisation far outweigh the risks. The side effects of immunisation such as fever are mild and will resolve even without treatment. Some people often have the concerns of long-term side effect but it has been shown that these side effects are rare compared to the protection received from immunisation. To address this, it is first important tounderstand why a woman is resistant to immunisation.Many times it is out of ignorance and proper education can suffice.
Sometimes it is as a result of cultural and religious factors and again presenting the facts will help to over come some of these. It is important to understand that because immunisation has been taken up by so many people some of those diseases that are covered are no longer affecting others even those who have not received the vaccination (herd immunity). But if many people stop getting theimmunisation, those diseases will come back and the threat for those who are not immunised will increase. So we need to encourage everybody to get immunised.
Do adults require immunisation?
Yes a number of vaccinations such as the pneumococcal vaccine, HPV, chicken pox, typhoid fever and influenza vaccines may be required by adults. The indications for some adult immunisation include age and the presence of certain medical conditions.
Tell us a little about the pneumococcal vaccine
The pneumococcal conjugate vaccine has been shown to be effective in preventing infection from the pneumococcal organism which causes pneumonia, meningitis and blood infection. This is a major cause of death among the elderly and those with many medical conditions.
It is recommended for children and it is included in the NPI. It is also recommended for adults over the age of 65 years and also for those less than 65 years but who have other conditions such as diabetes, HIV infection, cancers, sickle cell, lung diseases etc. There is a guideline that is usually followed for adult pneumococcal vaccination.
What is the role of healthcare providers in closing the immunisation gap?
Their role is to educate and advise patients on the benefits of immunisation and to identify those who have fears and concerns regarding immunisation and to address them. Sometimes people are not aware of the vaccine they need, so the health care provider has a role in educating their patients about the right vaccines that are available and encouraging them to get those vaccines.
The government is trying to reach the rural areas that were not adequately covered by decentralising immunisation and scaling it down appropriately and the reach has increased. Pneumococcal vaccine uptake particularly among adultshas not been optimal and I think we need to highlight its benefits in reducing the burden of pneumococcal infection.