World Immunization Week: The importance of vaccination throughout life

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bear with siringe (1)Prior to the introduction of vaccines, it was common for people to die from diseases such smallpox or measles. Thankfully, today such occurrences are almost unheard of, with smallpox declared eradicated in 1980 following a global immunization campaign led by the World Health Organization (WHO),[i]  and a reduction in measles deaths by 75 %, following a rise in measles vaccination coverage to 85 %.[ii]

When looking back in history, it becomes apparent as to why vaccinating our children has become a routine part of parenthood. Vaccinations are proven to be safe[iii] and to prevent deadly illness.[iv] The 24th-30th April 2017 celebrates World Immunization week, with a focus on the critical importance of full immunization throughout life. This year also marks the halfway point for The Global Vaccination Action Plan (GVAP), which was endorsed by the World Health Organization (WHO) in May 2012 and aims to prevent millions of deaths by 2020 through more widespread access to vaccines.[v]

Vaccines work by exposing the body to a small but safe amount of the germ causing the disease. This allows the body’s immune system to build a defense against the germ, so that it is prepared when next exposed. The South African national expanded programme on immunization (EPI) schedule includes vaccines against 11 potentially life-threatening diseases, with dosing recommendations between birth and 12 years of age.[vi] The schedule closely follows recommendations by the WHO[vii] and there are also several private schedules available.

It’s important to remember that vaccines don’t end with childhood. For example, The Human Papilloma Virus (HPV) vaccine is recommended for administration between the ages of 9 and 45, with more specific age recommendations dependent on gender and vaccine choice.

injectionHPV is the most common infection of the reproductive tract. It can cause cervical cancer, other types of cancer and genital warts, in males and females. In South Africa, cervical cancer is the most common cancer in women aged 15 to 44 years. Two HPV vaccines are available in South Africa. Both vaccines are highly efficacious at preventing infection with virus types 16 and 18, which are responsible for approximately 70 % of cervical cancer cases globally. These are available for females aged 9 to 45. Additionally, one of the vaccines protects against genital warts, and is also approved for administration in males aged 9 to 26. Dosing is either a 2 or 3 dose regimen, depending on your age. [viii]

The HPV vaccine is preventive, and needs to be administered before exposure to the virus. In 2014, the South African National Department of Health implemented a school-based HPV vaccine program for girls aged 9 and over in grade 4 in public schools. This continues as part of the Integrated School Health Programme, with an estimated 91% of girls in this group receiving HPV vaccines since the initiative began. Unfortunately, vaccination outside of this selected population is underutilized. Dr Trudy Smith, a Johannesburg-based gynaecologist, cites potential reasons for this as being a “lack of education (despite)…good quality evidence” and states that the “key to improving this (is) education” of both healthcare providers and the general public. The cost of HPV vaccines has been reduced significantly, making it more affordable in the private sector.

baby getting injectionThe other important vaccination to remember is that which protects against herpes-zoster, more commonly known as shingles. Shingles is a re-activation of the chickenpox virus (varicella-zoster), and often causes a painful blistering rash. The associated pain can be very severe and may persist even after the rash has resolved. This is referred to as post-herpetic neuralgia (PHN). The lifetime risk of developing shingles is estimated at 30 %, with a significantly increased risk after the age of 50.[ix]  A live varicella zoster vaccine has been shown to decrease the risk of shingles infection by 51 % and PHN by 67 %.[x]  A single dose is recommended for adults over the age of 50 years, even if they have already had an attack of shingles. [xi]

Global health organisations, such as the WHO, have worked closely with national authorities and leading healthcare professionals to establish immunization recommendations. These are aimed at eradication of dangerous diseases and at improving the health of our population. History has proven that vaccinations are safe and effective, with potential for global benefits. However, it is still up to us to take responsibility for our own health and the health of our children, to ensure that vaccines are administered appropriately during the different stages of our lives. This will ensure that vaccination initiatives are able provide the maximum benefit for our families and our country. As Mark Pilgrim, well known presenter and father of two young girls, has so precisely pointed out “… the role of immunization in (his family’s) health care, for now and the future, is vital”.


References
[i] World Health Organization. Emergencies, preparedness, response. Smallpox. WHO (Internet). 2017, cited 6th April 2017. Available at: http://www.who.int/csr/disease/smallpox/en/.
[ii] Centers for Disease Control and Prevention. Global Health – Measles, Rubella and CRS. CDC (Internet). 31st March 2015, cited 6th April 2017. Available at: https://www.cdc.gov/globalhealth/measles/.
[i] World Health Organization. Emergencies, preparedness, response. Smallpox. WHO (Internet). 2017, cited 6th April 2017. Available at: http://www.who.int/csr/disease/smallpox/en/.
[ii] Centers for Disease Control and Prevention. Global Health – Measles, Rubella and CRS. CDC (Internet). 31st March 2015, cited 6th April 2017. Available at: https://www.cdc.gov/globalhealth/measles/.
[iii] World Health Organization. Questions and answers on immunization and vaccine safety. WHO (Internet). March 2017, cited 3rd April 2017. Available at: http://www.who.int/features/qa/84/en/.
[iv] World Health Organization. Media Centre. Immunization coverage. WHO (Internet). March 2017, cited 3rd April 2017. Available at: http://www.who.int/mediacentre/factsheets/fs378/en/.
[v] World Health Organization. Immunization, Vaccines and Biologicals. Global Vaccination Action plan 2011-2020. WHO (Internet). 2017, cited 6th April 2017. Available at: http://www.who.int/immunization/global_vaccine_action_plan/en/.
[vi] National Institute for Communicable Diseases and Centre for Vaccines and Immunology. Vaccine Information for Parents and Caregivers, First Edition, November 2016. Available at: http://www.nicd.ac.za/assets/files/NICD%20Vaccine%20Booklet%20D132%20FINAL.pdf
[vii] World Health Organization. Table 1 – Summary of WHO Position Papers – Recommendations for Routine Immunization. WHO. March 2017. Available at: http://www.who.int/immunization/policy/Immunization_routine_table1.pdf?ua=1.
[viii] Richter K. Public Health Association of South Africa: Implementation of HPV vaccination in South Africa. Feb 26, 2015. Available at: https://www.phasa.org.za/implementation-hpv-vaccination-south-africa/.
[ix] Kawai K, Gebremeskel BK and Acoste CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. British Medical Journal Open. 2014. Vol 4(6). Available at: doi:10.1136/bmjopen-2014-004833.
[x] Centers for Disease Control and Prevention. Shingles (Herpes Zoster) Vaccine & Preventable Disease. CDC (Internet). 22nd Nov 2016, cited 7th April 2017. Available at: https://www.cdc.gov/vaccines/vpd/shingles/.
[xi] Baker L. Handbook of Infectious Diseases: Immunizations, New Vaccines, Schedules, Catch-ups and Contra-indications. Amayeza Info. Services. 2014; p221-229. Info. Services. 2014; p221-229.

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