Under-reporting of adverse vaccine reactions could jeopardise infants' safety
By Rupa Chinai http://www.timesofindia.com/151199/15mdel16.htm
The Times of India News Service
MUMBAI: Seema, a Mumbai housewife, says her baby was a ``bubbly, smiling, healthy and responsive child''-- that was until the child was given her first shot of the DPT (diptheria, pertussis and tetanus) vaccine at three months. It was after that the baby started to ``rock herself''. The doctors Seema consulted assured her that this was `normal'. When the baby was 15 months, she was administered the MMR (measles, mumps and rubella) vaccine.
``Thereafter, my child completely withdrew. Her babble disappeared, she would not come to us, she would only look at my feet. I strongly suspect that it was because of a defective vaccine that my baby developed features of autism (a neurological disorder).''
There are many Indian parents like Seema whose story has not come to public attention because of the social stigma attached to autism. In Mumbai, the health authorities have not heard of such vaccine-damaged children. This is because doctors who administer the vaccine usually do not report cases of adverse vaccine reactions to the municipal authorities.
In the developed countries, where there is greater public awareness, vociferous questioning has forced governments to look this issue squarely in the face. When some infants in the UK and Japan died after being administered the whole cell pertussis vaccine (the `P' component in the DPT vaccine), a massive public outcry prompted the governments concerned to suspend use of that vaccine.
Harvard University's Dean of Public Health, Barry Bloom, states in a recent interview that while the whole cell pertussis vaccine has worked well, it does have some side-effects, with one in 30,000 children becoming neurologically damaged.
Suspension of the vaccine in the UK, however, led to an increase in the incidence of whooping cough, says Mr Bloom. This triggered research leading to the development of the acellular pertussis vaccine, which Mr Bloom says is more expensive and less toxic.
The acellular vaccine has been licensed for use in Japan since 1981 and in the U.S. since 1996 for children two months and older, confirms Stanley Plotkin, a leading vaccine scientist, who recently visited Mumbai. India, however, continues to use the whole cell pertussis vaccine in its national child immunisation programme.
Cases of healthy babies being damaged by the whole cell pertussis vaccine in the West have been documented by H. Coulter, a medical historian, and B. Fisher, vice president of `Dissatisfied Parents Together', in their book, `A shot in the dark'. The adverse reactions include convulsions, shock, abnormal screaming episodes and `sudden infant death syndrome' (stoppage of breathing). The long-term complications include learning disabilities and hyper-activism, among other forms of brain damage. Such incidents are under-reported by doctors, for fear of malpractice suits, the authors of the study say.
Babies who suffer progressive neurological disease should not be administered the pertussis vaccine, say manufacturers of the vaccine here. But is that condition apparent to parents when the first dose of DPT is mandatorily given at six weeks of age in India?
A spokesperson of The Indian Academy of Pediatrics says, ``The whole cell vaccine does give more local reactions. Unless a control trial is done, it is difficult to talk about the long-term reactions. We have always taken the stand that the acellular vaccine is better than the whole cell, because of the complications that occur after vaccination. But it is not available in our country. We have not, however, advocated use of the acellular vaccine to the government.''
A vaccine against rubella or german measles is now being advocated for inclusion in the child immunisation programme, to be followed by a booster shot for adolescent girls. While Indian data on rubella incidence is inadequate, extrapolations based on worldwide data have resulted in the claim that the estimated prevalence in India is 100-200 per 100,000 population.
A harmless childhood disease, rubella produces mild symptoms that can pass unnoticed. Children who contract the infection are likely to acquire lifelong immunity. Rubella is, however, dangerous for women in the first six weeks of pregnancy, causing congenital malformations, deafness and mental retardation in babies. If rubella occurs after the first trimester of pregnancy, the incidence of foetus abnormality is low, says Mr Plotkin, who developed the rubella vaccine.
U.S. studies show that 36 per cent of the young women vaccinated against rubella in infancy lose their immunity by the time they are adolescents (Neil Miller,`Vaccines and natural health', Mothering, Spring, 1994). Those who have never acquired natural immunity because of the vaccinations in childhood, run the risk of contracting rubella while pregnant.
Mr Plotkin says it is ``easier to vaccinate babies rather than adults''. Routine vaccinations of infants would reduce the circulation of rubella in the population, he adds. But for that to happen, governments must ensure that at least 80 per cent of the child population is covered by their programmes.
A simple but expensive IgM antibody test already exists to detect whether a woman, on the verge of motherhood, has antibodies to rubella. No effort has, however, been made to develop a cheaper test. The vaccine's manufacturers insist that it is easier to vaccinate the entire population of babies instead.
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