Most scheduled medical visits during the first two years of life involve vaccinations. Living in an expat environment presents a great number of challenges to parents wishing to get their child vaccinated; is the local vaccination schedule similar to the one followed in the home country? Are there vaccinations that are not given locally that might be needed in the home country? What is the quality and safety profile of the vaccinations given locally?
Fortunately, armed with a little knowledge, it is reasonably easy to navigate through the apparent maze of information that surrounds immunizations. Almost every country in the world has a basic vaccination schedule. At the core of all schedules is a series of vaccinations against Diphtheria, Pertussis (whooping cough), Tetanus and Polio as well as some sort of vaccination against Measles. The number and timing of each of these vaccinations varies from country to country, but by the end of the first year most schedules call for three Diphtheria, Pertussis and Tetanus vaccinations, three Polio and one Measles vaccination. This type of schedule is typically found in poor countries where resources are limited. Unfortunately, some of the most effective vaccinations against severe illnesses are expensive and as a result poorer children are deprived of their protection. In the first year of life, there are a number of additional vaccinations that are highly effective in saving lives. Vaccinations against Streptococcus Pneumoniae (an important cause of meningitis, ear infections and pneumonia), Rota-virus (cause of severe gastroenteritis that kills 500 000 children per year), Hepatitis B, Rubella and Varicella (chickenpox) are typically included in a first world immunization schedule. Many countries also include the BCG vaccination (protects against tuberculosis) in the first year immunization schedule.
The availability of vaccinations against a wide range of infections inevitable results in a great number of different vaccination schedules. Individual countries construct schedules based upon their own specific disease profiles and the resources available to pay for vaccinations. One example is that the BCG vaccination is not given in the United States where the prevalence of tuberculosis is so low that there is no value in immunizing. Resources are rather invested on detecting and treating the very few cases that occur during the course of any given year. In the United Kingdom, a number of other Western European countries and Australia, there is sufficient prevalence of Neisseria Meningitidis C meningitis that it is effective to vaccinate the whole community against this disease.
This is where living in Dubai poses a problem. Due to the cosmopolitan nature of the population of Dubai and the extent to which this population travels, one is faced with an infinite number of variations in ways to vaccinate children. One has, also, to be aware that children from every corner of the world play together in the park – each child bringing his or her vulnerabilities and regional variations – the adopted child from Central Africa may be recovering from tuberculosis whilst playing with her American friend who has not received BCG vaccination. There is nothing particularly different about the pattern of disease seen in Dubai that necessitates a special vaccination programme. One has just to be aware that the “travel-hub” nature of this City is such that one needs to opt for a reasonably comprehensive immunization programme. We have found that by making minor modifications to the schedule proposed by the CDC and American Academy of Pediatrics (attached) we have been able to satisfy almost everyone’s immunization requirements.
With respect to vaccine safety and efficacy, the vaccinations imported into the UAE are of a very high standard. They are manufactured by large pharmaceutical companies mainly in Europe and are registered with the European Medicines Agency, many are also licensed by the US Food and Drug Administration. In order to achieve this high level registration, the vaccination manufacturers have conducted rigorous safety and efficacy trials and the vaccines are all subject to ongoing post-marketing surveillance.
The topic of vaccinations is large and complex, this brief overview cannot provide comprehensive information about specific vaccinations. Vaccine specific questions should be directed towards a physician well versed in vaccine administration.
This article was written by Dr Michael Loubser, Infinity Health Clinic.