The Observer (Kampala)

Uganda: Immunisation - From Six to Eleven Killer Diseases

Besides the likes of measles and TB, parents now have to consider immunization against threats like pneumonia and rotavirus, writes Diana Nabiruma.

Before 2002, Ugandan children were vaccinated against six "killer" diseases, namely diphtheria, polio, tetanus, tuberculosis, measles and whooping cough. In 2002, government introduced the Hepatitis B and Hib (for H. Influenza) vaccines. This brought the number of immunisable killer diseases to eight.

Last year, cervical cancer was added onto the list of immunisable diseases - with girls 12 years and below being immunised in 14 districts; and beginning this April, government will immunise children against pneumonia with the pneumococcal conjugate vaccine. They will also be immunized against rotavirus infections, beginning next year. In total, Ugandan children, will by next year be being immunised against 11 diseases.

Do they need all these vaccines, some parents have wondered, citing themselves as examples of people who did not get all these vaccines but survived. Some also wonder whether natural immunity - achieved sometimes through surviving a bout of infection - isn't better than the artificial one. However, Dr Edward Kasirye, a paediatrician, says: "Prevention is better than cure." He also says it results in a reduction of the country's disease burden, saving government's and parents' economic and other costs and ensuring a child's well-being.

"If vaccines are properly administered, with children getting all doses, infections come down," he says.

According to Uganda National Expanded Programme on Immunisation (UNEPI), all immunisations that the country carries out are necessary.

"We carry out studies to determine our biggest disease burden [in children], its cause and effects and advise vaccination where necessary," an official from UNEPI says.

She says because 35% deaths in children under five were as a result of pneumonia (caused by pneumococcal bacteria), the government decided to introduce the pneumococcal conjugate vaccine.

"The good thing about this vaccine is that it will reduce on common colds, chest and ear infections," the official who requested anonymity, says.

Just as the pneumococcal conjugate vaccine is being introduced because of a great need, the Hib vaccine was also introduced because influenza in children was causing a high number of children to catch meningitis. Hepatitis, on the other hand, easily spreads and starts killing liver cells soon after infection, while cervical cancer is the leading cause of cancer deaths in women in Uganda.

"What people have to know is that disease burdens change. Children in the 1980s might not have been at risk of a disease which today's children are at risk of," the UNEPI official explains the need to immunise children against diseases that their parents were not immunised against.

She adds: "And because we have realized that vaccination is helpful in disease prevention, we immunise against those diseases that were not immunised against before." So good is immunization against disease prevention that individuals born after the advent of diphtheria vaccination wonder what diphtheria is.

Is it prudent to wait for your child to get natural immunity as opposed to the artificial one? UNEPI officials say no.

"If an unimmunised child gets measles, they will suffer complications. They might get meningitis, pneumonia and may become deaf and blind. However, a child that was immunised, you will find them playing and generally unaffected. [during a bout]"

Cost-benefit of immunisation

Children ought to be immunised before their first birthday but where they haven't been, can a parent get a child immunised? Only for certain vaccines. It is assumed that an unimmunised child is exposed to the germs during day-to-day living and the body will have produced an immune response to the disease. Vaccines that may not be helpful to a child after the child's first birthday are those that are given soon after birth (for example BCG for tuberculosis) and in early infancy.

Measles and polio vaccines may be given after the first birthday. However, this is not ideal.

"Vaccination carried out after a child's first birthday isn't as effective as that carried out before the first birthday," according to UNEPI.

While vaccination is free, it might prove costly should a parent decide to forgo it and a child falls prey to an immunisable disease. It costs government Shs 2.56bn a year to treat pneumonia, according to UNEPI. Should a parent decide to seek medical attention from a private facility for their child, that parent might spend Shs 200,000 on antibiotics for the pneumonia for a five-day treatment period.

They will also have to spend on antipylotics (medicines for fever), water for the drip, the drip itself, a canular, feeding pipes (if a child can't feed) not to mention costs for specialised staff that can ably handle pneumonia treatment.

Should a child suffer mental retardation or get visually impaired, they will require special education, which is not easily available and might be expensive.

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