The Importance of Childhood Vaccination and COVID-19 VaccinationBy Sunway Medical Centre | Feb 10 2022
The topic of childhood vaccination has been much talked about, especially in recent times. Now, it’s an even more crucial topic for parents as they prepare their young children for the recent government approval and commencement of COVID-19 vaccination for kids aged 5 to 11.
We have the privilege to talk to Dr Cham Weng Tarng, who is a Consultant Paediatrician and Paediatric Rheumatologist at Sunway Medical Centre, Sunway City, regarding the topic of childhood vaccination. He also touches on the COVID-19 vaccination for children.
Read on for his insightful sharing.
#1: How do vaccines work to protect babies/children against diseases?
Generally, vaccines trigger the immune system to produce antibodies and these antibodies protect the child against diseases.
For instance, current vaccines like Measles – Mumps – Rubella (MMR) are live vaccines, which means that the virus is alive but it has been deactivated and cannot do any harm to you such as attacking the person and causing a severe infection.
Even if you get the infection, it can be very mild.
#2: How safe are childhood vaccinations?
Vaccines in general have been around for many years. It started from the day when medical scientists start inoculation for cowpox to prevent small pox. By exposing cowpox to a person, they found that they can generate the antibody against smallpox. This is where modern vaccinations started.
Vaccination today is far more refined where scientists have the means to deactivate the activated part of the virus to generate the antibody. In general, all vaccines are safe. If it is not safe, we will definitely not use it on adults and children.
Almost all vaccines, including the recent COVID-19 vaccines, go through 4 phases of clinical trials on hundreds or thousands of people before they are approved and rolled out. And when they are out, real world data is still collected 24/7 to see if the vaccine is still working.
Every country has an authorised vaccine body to monitor all kinds of vaccination and collect data, including reactions toward the vaccine. Based on these data, most childhood vaccines have been around for many years.
For instance, the diphtheria tetanus and pertussis vaccine have been around for the last 30 years, and the oral polio vaccine has been around for 50 to 60 years. Now there are more combination vaccines and they are shown to be safe.
Vaccines are one of the branches of medicine where it has saved more lives than any medication that has ever been created by mankind.
#3: Are there any conditions in which a child is not suitable to be vaccinated?
There are specific conditions and one of the main reasons is because the mother was given something that suppresses her immune system when she was having the baby. This has potential for the baby’s immune system to also be suppressed.
For example, some mothers may have underlining rheumatoid arthritis or cancers and are on biological therapy that might suppress their immune system. If that’s the case, we normally defer the baby’s live vaccines until the baby is 6 months or older. The other inactivated vaccines can be given as per usual.
The second reason is the baby’s own immunity issue where they are born with a lowered immune system. One of them is what we call Severe Combined Immunodeficiency (SCID). It is a very serious immune condition where the body of the child is unable to generate enough antibodies and they will be affected, especially if they get a live vaccine like MMR.
With this kind of condition, we have to be very careful when vaccines are given to the baby. But most of the inactivated vaccines or the killed vaccines, are safe to be given, because the viruses are already dead and cannot cause an infection.
#4: Is there a link between vaccines and autism?
There was a claim that the measles vaccine causes autism but the World Health Organisation (WHO) embarked on collecting an extensive worldwide population-based data and they found that there is no link between autism and vaccination. This data can be found online and it debunks this myth.
#5: Which vaccines are of utmost importance for a baby/child to be given?
As we all know, vaccines prevent a child from getting infections. In any philosophy of a doctor, prevention is always better than cure. My philosophy is very simple in treating children—if the condition can be prevented, why does the poor child need to suffer?
A common infection like influenza can make a child ill for many days with high grade fever, and there is a chance for the child to get complications such as meningitis and pneumonia. If the child is vaccinated, the risk is very low.
Therefore, I would say all vaccines are important and there is a reason why all these vaccines are needed. Take Malaysia as an example, diphtheria, tetanus, pertussis, polio and Hepatitis A and B, all these infectious diseases are still prevalent in Malaysia.
Influenza is still around and it is back now when COVID-19 is coming down. The chicken pox infection; I have seen many children getting it and some died because of it.
To protect your child, vaccines given by the government are the main ones, but the additional vaccines are just as equally important. In life, we never know when we will meet with an accident, a vaccine is like an insurance for you. There is no 100% cure but at least it can protect the child from getting infections or severe effects from the disease.
#6: If a child has missed some vaccines at the recommended age, is it still possible to take those vaccines?
We should try not to miss any of the child’s vaccinations as it will cause a big headache to the paediatrician. Certain vaccines are very particular in which you must give at a certain time and if you miss the boost, the immunity will fade from the body.
Take Hepatitis B as an example, each time a booster is given, it has to be done again one to two months later. If you were to miss one of the boosters, you will need start it all over again.
Many parents have actually missed coming for vaccinations during the pandemic, and some of these children have missed their vaccinations for too long that they have to start vaccination all over again.
Some vaccines do not have this issue where you can catch up on it later, but you will need to discuss it with your paediatrician.
If possible, try not to skip vaccinations for too long, otherwise it will affect the child’s immune system and the way antibodies are produced.
#7: Other than the list of vaccines given at birth and throughout the first few years of a child’s life, what other vaccines are recommended in the context of our present day situation?
In Malaysia, there are 11 types of vaccines for all children including the HPV for girls. Besides these vaccines that are made available by the government, there are other vaccines such as against the rotavirus, chicken pox, meningococcal, Hepatitis A and influenza. These are optional vaccines but are also equally important for children.
Besides the above, there is the Japanese encephalitis vaccine which is available and usually given to the children from Sarawak. Intermittently we have seen outbreak of this virus in our country and thus it is advised to get it.
Among all these optional vaccines, rotavirus is the only one in which the first dose has to be given at 14 weeks, and the last dose given before 8 months old. The other vaccines can be taken any time in the child’s life.
#8: In light of COVID-19, there are more talks about the annual flu/influenza vaccination. Should a child be taking these yearly shots and when do they start?
Yes, influenza is still present. I recently had four influenza cases at the same time when I was on-call, it was like an outbreak season.
In Western countries, influenza usually comes during the winter months. We don’t have winter in Malaysia but we have rainy season at the end of the year, and this is usually when influenza comes.
Annual influenza vaccine can start as young as more than 6 months old and can be taken as early as this age. Again, protection is better than cure.
#9: Teenagers are already being vaccinated for COVID-19 now, and MOH has plans for children under 12 years of age to be vaccinated, too. Is it truly necessary and safe for young children at this juncture?
COVID-19 vaccine is important and concern about vaccine safety for children is a major issue now. For children under 12, Pfizer has recently published data where more than 2,000 children from 5 to 11 years old have taken the vaccine and shown good efficacy and seroconversion, meaning that the body is able to generate the antibody against the COVID virus with no side effects.
The dose given to these children is only 0.1ml, which is 3 times lower than the adults’ 0.3ml. Based on these data, US Food and Drug Administration (FDA) has given them emergency approval to be used to vaccinate children within this age group.
Based on the data that Pfizer has shown, it seems to be safe and more countries are starting to embark vaccinating this age group.
#10: At what age would the children be suitable to be vaccinated? Which vaccine would be more suitable for them?
Vaccination starts at birth when they get the Hepatitis B and BCG vaccines in the first 48 hours. For the other mandatory vaccines in Malaysia, you can refer to the latest National Immunisation Schedule that was introduced by MOH in November 2020. The new schedule has included Pneumococcal as the latest addition:
#11: Are there any medical conditions in children that would render taking the COVID-19 vaccination unsuitable?
It depends on the condition the child has. So far, MOH has only approved Pfizer and Sinovac to be given to adolescents from 12 to 17 years old in two doses, 3 weeks apart.
For those who have a history of severe allergies, what we call anaphylaxis, the Pfizer vaccine is not recommended as it has a higher risk of developing severe allergies.
If the patient takes the first dose of Pfizer vaccine and develops reactions like chest pain and confirmed myocarditis, they are recommended not to take Pfizer vaccine anymore but they can take the Coronavac, which is Sinovac, as a replacement.
And if the patient has a history of heart inflammation, they should discuss this with their doctor to see if it is advisable to take the Sinovac rather than the Pfizer vaccine.
In general, vaccines are one of the inventions by mankind that is shown to be efficacious to reduce infections. Even with the current COVID-19 pandemic, vaccination data have shown that being vaccinated definitely reduces your risk of getting seriously ill that could result in death.