Pediatrics

Three new vaccines will be introduced into governments expanded programme on immunisation (EPI) at a cost of R1.1 billion, government spokesman Themba Maseko said on Thursday.

Eleven suspected cases of measles are been treated in the Ndebala village in Eastern Cape, the department of health said on Saturday.

By Brigitte Stark-Merklein. LUANDA, Angola, 21 June 2006 With excitement about the 2006 FIFA World Cup at a peak, Angolan star players are among the most recognizable role models here, inspiring a sense of achievement much appreciated in this war-ravaged country.

More and more babies each year are being born just shy of spending a full pregnancy in their mothers' wombs, putting more infants at risk of health and possibly developmental problems because they enter the world before they are ready.

Promising findings from two studies are offering the hope of a safe and effective vaccine against the most common cause of childhood diarrhoea.

Pigs competing with humans for water in unhygienic conditions is just one of the causes of a parasitic brain infection which left a child dead in the Eastern Cape and landed another 29 in hospital.

The Eastern Cape health department on Tuesday began immunising young people to combat a measles outbreak in villages in the Elliotdale area of Transkei.

More than 700 cases of measles have been investigated by the provincial health department since the outbreak of the infectious viral disease. However, Department of Health spokeswoman Janet Dalton said the disease was now on the decrease. Of these cases, 171 were found to be laboratory confirmed and 206 came from heavily infected areas.

The Integrated Management of Childhood Illness (IMCI) approach helps community nurses and medical assistants assess and treat sick children at primary health facilities in poor countries. They use a combination of symptoms, signs and investigations to decide on treatment and referral. Could this approach also be used for initial diagnosis in hospitals? Nurses and medical assistants often conduct the preliminary assessment of children arriving at hospital, with limited supervision from senior staff and a lack of reliable laboratory services. Researchers from the KEMRI/Wellcome Trust Research Laboratories in Kenya developed an assessment protocol involving replies to eight questions, examination for 12 physical signs, measurement of oxygen levels and microscopy for malaria. These results guide the choice of six different treatment strategies: * anti-malarials * intravenous fluids * specific nutritional support * oxygen * blood transfusion. They tested the protocol at Kilifi District Hospital in Kenya’s Coast Province and compared the results with final diagnoses by a paediatrician. The study included 3 705 children under 13 years-old who did not have an obvious simple diagnosis, such as sickle cell disease. They found that: 63 per cent fit the definition for at least one severe syndrome. Mortality in this group is 7.8 per cent. the 1 378 children without a severe syndrome most commonly have a final diagnosis of malaria (48 per cent), pneumonia (13 per cent) or gastroenteritis (19 per cent) these children have milder disease, lower mortality (one per cent) and short inpatient stays (average two days) mortality is lower among children who need fewer treatments. Two-thirds of all deaths in the severe syndrome group are in those who need two or three treatments positive predictive value (the likelihood that a child really has a certain disease if they receive that initial diagnosis) for the IMCI approach ranges from 46 to 70 per cent for severe pneumonia, diarrhoea and malaria the IMCI approach picks up at least 96 per cent of children who have these three syndromes as their final diagnosis. But it identifies only 56 per cent of children who have meningitis. The researchers conclude that this approach may give clearer guidelines for targeting treatment and making decisions about admission. Syndrome definitions should minimise the risk from failure to treat, promote the rational use of scarce resources and prevent unnecessary invasive procedures. But they emphasise that health planners introducing this approach will need to: balance the risk of not admitting children who are less severely ill with the improved quality of care resulting from having fewer admissions define the syndrome hierarchy – which to tackle first focus on a limited number of features to ensure it works under operational conditions develop a well-organised record form for the protocol to guide the choice of treatment consider adding two additional simple laboratory tests (microscopy of spinal fluid and measurement of blood haemoglobin) to the protocol, which would considerably improve practice. Contributor(s): Mike English (Source:id21HealthNews Number 43, August 2003).

Anti-vaccination movements are not a new phenomenon. The Society of Anti-Vaccinationists was established in 1798, two years after Edward Jenner demonstrated that cowpox material was effective in preventing smallpox. In 1853 the Anti-Vaccination League was founded in London to provide a nucleus for anti-vaccination groups to oppose the compulsory vaccinations acts of Great Britain instituted between 1840 and 1853. While methods of propagating information may have changed radically since the 19th century, the basic concerns and the activities of these groups have changed little since then. The views of those against vaccination appear to be gaining in influence. With the visible disappearance of many vaccine-preventable diseases and the rise of New Age philosophies combined with the power of the media, the views of the anti-vaccination lobby appear to be gaining in influence. There is now a real concern that they could seriously threaten the remarkable gains made in controlling and eliminating many of the scourges that have beset mankind. Vaccines represent one of the most successful and effective interventions in medicine. A dramatic example is smallpox, which was responsible for some of the most formidable epidemics of humankind. In 1967 it was the cause of 2-million deaths; a decade later it was totally eradicated from the planet by a concerted global vaccination programme. This and other dramatic successes of vaccinations are still being attributed by anti-vaccination groups to improved hygiene, sanitation, nutrition and living standards. This is simply not so. Universal vaccination against Haemophilus influenzae, Hib, (a major cause ofmeningitis and pneumonia in infants) was introduced only in 1990 in the United States when living standards were hardly different to the present and this rapidly resulted in a precipitous drop in the number of cases and is now close to being eliminated in that country. Where anti-vaccination sentiments have unfortunately influenced public opinion the result has been immediate and dramatic. For example, in the UK a drop in vaccination against whooping cough in 1974 was followed by an epidemic of over 100 000 cases and 36 deaths in 1978. Outbreaks of vaccine-preventable diseases occur periodically in communities refusing vaccination on religious grounds. Among members of the Dutch Orthodox Reformed church (about 2% of the population of the Netherlands), two outbreaks of paralytic poliomyelitis occurred in 1978 (110 cases) and in 1992 (71 cases) and measles in 1999-2000 (2 961 cases, 3 deaths). There are some 30 dedicated anti-vaccination sites on the web and an additional 300 sites also lobby against vaccination. What moves the anti-vaccination groups? Broadly speaking, objections to vaccines can be grouped into three categories. Firstly, general fears about safety; secondly, misconceptions and myths; and thirdly, philosophical and religious objections. Safety is an issue in the development and manufacture of vaccines, because vaccines are generally administered to healthy people, mainly children, to protect against diseases that the recipient may only potentially be exposed to. Globally, safety standards for vaccines are extraordinary high and in South Africa, as elsewhere in the world, any possible side effects are monitored, recorded and investigated by a system known as VAERS (vaccine adverse events reporting system). The second category of vaccine objection is based on myths and misconceptions that surface from time to time and are repeatedly used by anti-vaccinationists to substantiate the hazards or the irrelevance of vaccines. An example is the supposed association between the MMR (measles,mumps and rubella) vaccine and autism and chronic bowel disease. In nearly all cases they are products of the logical fallacy of post-ergo propter hoc (after this, therefore because of this), which mistakes association for causation. However, despite the overwhelming scientific evidence to the contrary, objections to vaccination persist. With some parents there may be an intuitive perception that injecting a foreign material into a child is a cruel and unloving act. The refusal of vaccination is often born from a New Age value system that supersedes rational analysis and reasoning. More basic are those objectors that fall into the free-loading category as long as everyone else gets the vaccine there is no reason my child should get it. In an industrialised country such as the US, those choosing exemption from statutorily compulsory vaccination were 35 times more likely to contract measles than vaccinated persons In response to what is often seen as scientific arrogance and sometimes called scientific terrorism, New Age and Mother Earth thinking and related alternative health practices have flourished under the guise of promoting informed choice. Parents want the best for their children. Unfortunately a worryingly strong message is going out to parents to play-it-safe and avoid vaccination. On the other hand for a parent nothing could be more heart-rending than seeing a child severely damaged by a disease that could so easily have been prevented by a simple vaccine. Professor Barry D Schoub is executive director of the National Institute forCommunicable Diseases.(Source: The Star, 24 June, 2003).