Unless there are very good medical grounds not to vaccinate, all children should receive the full course of injections to protect them against tetanus, whooping cough and diphtheria; the HiB vaccine against Haemophilus influenzae B infections; the measles, mumps and rubella vaccine; hepatitis B vaccine; and the Sabin vaccine by mouth for polio. A chickenpox vaccine has been available since 2000 and is being steadily more widely used. A meningococcal meningitis vaccine was introduced in 2002 and a Pneumococcal pneumonia vaccine in 2003.
The risk of vaccination is infinitesimal, and when compared with the potential side effects of any one of these diseases, it is a far preferable course of action. Another person (adult or child) only has to breathe the infecting germs in the direction of a child and he or she may catch one of these dreaded diseases.
Tetanus is around us constantly in the soil. The bacteria causing this disease are carried by animals and are therefore not likely to be eradicated in the near future. The series of tetanus injections received as a child do not give lifelong immunity. Boosters are required every ten years or more frequently if injury occurs.
Most young doctors have never seen a case of diphtheria. The incidence of this disease is now low, but older citizens may recall losing childhood friends to it. Diphtheria is still around though, and many children still catch the disease each year. They suffer difficulty in breathing and possible heart complications that can accompany it.
Whooping cough is becoming a very worrying problem, as it is increasing in the community due to under vaccination of many children. This is a potentially fatal disease, and even if the child survives the distress of weeks or months of severe coughing, they may be left with permanent brain or lung damage.
Haemophilus influenzae B causes a severe form of meningitis and on rare occasion a throat infection (epiglottitis) that can cause part of the throat to swell so much that the child suffocates. This infection can be prevented by three or four HiB vaccines starting at 2 months of age.
Measles is often considered to be a mild disease, but a small percentage of children even in developed countries develop debilitating ear, chest and brain complications that may affect them for the rest of their lives. The measles vaccine is combined with the mumps and rubella vaccination and is given at 12 months and again at 4 years of age, but it can be given at any age if vaccination has been neglected at the correct age.
Mumps is a relatively benign disease of childhood, but it too may have serious consequences, particularly if it is caught in adult life when it may spread to the testes and cause sterility, or infect the brain and cause permanent damage.
Polio was probably the most feared of childhood diseases. If it didn’t kill a child, it probably left them crippled for life. The year 1956 was the last year before the original Salk injectable vaccine became available and it was the year of the last polio epidemic in Australia. Parents were so scared for their children that when the vaccine became available there were queues down the street from the clinic front doors that rivalled the scene before a modern pop concert. They wanted their children protected, and as soon as possible. The Sabin vaccine is now given by mouth to prevent this disease, but boosters are required into adult life every ten years.
German measles (rubella) vaccination is more important for girls as it can cause severe deformities to the foetus if contracted in pregnancy. To reduce the risk of spreading this disease, the vaccination is given in combination with measles and mumps at 12 months of age and an additional booster is given at 4 years of age.
All routine childhood immunisations are now given by injection. The oral polio vaccine (Sabin) was used until about 2005 and was given as a few drops that were swallowed. If the child has a high fever or other significant illness, the vaccination may be delayed for a few days until they have recovered.
Significant complications after all childhood vaccinations are rare. A sore arm or leg at the site of the injection is relatively common and likely to be worse with bruising if caused by the movement of the child during the injection. Firm restraint by the parent for the 15 seconds that the injection takes can prevent this.
Fever and irritability may occur after a triple antigen, and giving paracetamol before the injection is sensible.
Measles vaccines may cause a very mild case of measles in about 2% of children.
Any other risks are minimal, and certainly far rarer than the serious complications of any of these diseases.