To vaccinate or not to vaccinate? That is the question. Well, if you're a parent anyway. All parents invariably have to face the question of vaccinations — a matter fraught with uncertainties, fears and misinformation.

The advantages of vaccinations are fairly obvious. At a societal level, they can result in the complete eradication of an otherwise lethal disease, such as that of smallpox in South Africa. At an individual level, they can prevent your child from contracting a potentially life-threatening illness.

Not without warning

However, vaccinations are not without their disadvantages. Although it only occurs in a small number of cases, it is possible for your child to have a severe adverse reaction to the vaccine (particularly the pertussis vaccine), which can include febrile convulsions and potential brain damage.

In rare instances, when live 'attenuated' vaccines are used, it is also possible for your child to contract the very disease (such as polio) against which he or she is being vaccinated.

Because vaccines contain additional materials (proteins, antibiotics, gelatine, yeast) your child can have an allergic reaction to the vaccine — characterised by sweating, swelling of the throat, difficulty breathing, hives, and a sudden loss of consciousness — which will usually set in within a few minutes to hours of the vaccination.

Naturally, when faced with these potential outcomes, parents become hesitant about getting their children vaccinated.

Even more disturbing

Add to this the more disturbing — and subsequently disproved — claim that the MMR (Measles, Mumps and Rubella) vaccine causes autism and it easy to understand the backlash against vaccinations.

Furthermore, not all vaccines are completely successful (you might still contract the illness) and in many cases, the effectiveness wears off after a number of years.

However, when weighing up the odds, it's also important to consider the prevalence of some of these illnesses in society and their potential to cause harm.

According to the World Health Organisation (WHO), an estimated 610 000 children die from measles every year, the majority of them in sub-Saharan Africa. Since implementing compulsory measles vaccinations, South Africa has a zero mortality rate for measles.

Although there are dissenting voices, most agree that in the case of potentially life-threatening or crippling diseases (most of which are highly contagious) the benefits of the vaccinations outweigh the considerably smaller risk of negative side-effects as a result of the vaccination.

Routine immunisation in SA

The vaccinations included in the Expanded Programme of Immunisation in South Africa (EPI-SA) follow the recommendations of the WHO. Additional — but generally considered less vital — vaccines are also available in the private sector.

All the vaccines are manufactured according to strict safety guidelines and are monitored by the Medicines Control Council.

Bacillus Calmette-Guerin (BCG)

When: At birth

Protects against: Tuberculosis. This vaccine functions primarily as prevention against TB meningitis in infants and will not provide lifelong immunity to TB.

Side-effects: Reactions are rare, but your child may get a small blister or sore at the site of the injection.

Oral Polio Vaccine (OPV)

When: At birth, at six weeks, at 10 weeks and at 14 weeks. Booster immunisation at 18 months and at five years. Some vaccines do not produce a strong enough immune response. In such cases, there is normally a primary course of immunisation (three injections/doses at one month intervals) followed by booster immunisation (usually every five years) if immunity is to be maintained.

Protects against: Poliomyelitis (polio). Polio is a virus that attacks the nervous system and can cause permanent muscle paralysis. If the virus affects the chest muscles it can be fatal. The vaccine is administered orally through drops.

Side-effects: Because the vaccine is a live 'attenuated' vaccine, there is a rare (one in 1.5 million) chance of developing polio from the vaccine.

Diphtheria, Tetanus and Pertussis (DTP)

When: At six weeks, at 10 weeks, at 14 weeks and a booster at 18 months. A DT booster at five years.

Diphtheria: A bacterial disease which begins with a sore throat and may lead to obstruction of the airways and, in extreme cases, death.

Tetanus: Tetanus spores are found in the soil and generally enter the body through a cut. It is painful disease (known as 'lockjaw'), which causes severe muscle rigidity and agonising contractions. If not treated quickly, it can be fatal. This disease is not contagious.

Pertussis (Whooping cough): This distressing illness, which can last for several weeks, is characterised by long bouts of coughing which cause vomiting and choking. It can be fatal, especially in newborns, and can occasionally lead to brain damage and pneumonia. In milder cases it can lead to dehydration and exhaustion.

Side-effects: Mild reactions may include grumpiness, a transient fever, tiredness and swelling/redness at the site of the injection. The pertussis vaccine is linked to more serious side-effects, which could include febrile convulsions, decreased levels of consciousness, prolonged inconsolable screaming and even brain damage.

The pertussis vaccine should never be given to children with a history of convulsions, an established central nervous system disorder or a previous negative reaction to the vaccine.

Haemophilus influenza type b (Hib)

When: At six weeks, at 10 weeks and at 14 weeks.

Protects against: Haemophilus influenze type b — a common cause of bacterial pneumonia and meningitis and a number of other serious and potentially life-threatening conditions.

Side-effects: Redness or swelling at the site of the injections, grumpiness.

Hepatitis B vaccine (HBV)

When: At six weeks, at 10 weeks and at 14 weeks.

Protects against: Hepatitis B, which is passed through infected blood and can be sexually transmitted, causes inflammation of the liver. Some people carry the virus without actually having the disease themselves. The vaccine provides immunisation for at least 15 years and possibly life.

Side-effects: Tend to be mild, with pain or swelling at the site of the injection.

Measles

When: At nine months.

Protects against: Measles is a highly contagious infection that causes a high fever and a rash. Complications include middle-ear infection, chest infection, pneumonia, febrile convulsions and brain damage. In extreme cases it can be fatal.

Side-effects: The vaccine may result in a fever and mild rash.

Additional vaccines

There are a number of optional vaccines, which are not part of the government immunisation programme, available in the private sector. The most common of these is the MMR (Measles, Mumps and Rubella), which takes the place of the measles vaccination.

Mumps, a viral infection which causes swelling of the salivary glands, is a fairly mild childhood disease. In adults however, complications such as meningitis and orchitis (inflammation of the testicles) are relatively common. Rubella (German measles) – another mild childhood disease characterised by a rash, fever and sore eyes and muscles — is dangerous if contracted by pregnant women as it can harm the foetus. It is advisable that if a girl has not contracted rubella by the age of 12 she should receive the vaccine.

Because mumps and rubella are fairly harmless childhood diseases and because the vaccine has (rarely) some severe side-effects (fever, rash, febrile convulsions) some doctors advise against the vaccine.

Other optional vaccines include those against varicella (chickenpox), rotavirus, influenza and the Prevenar vaccine for streptococcal pneumonia infection.

Vaccines and HIV

Obviously, HIV-positive children need protection against these diseases more than children whose immune systems are not compromised; however they are also more vulnerable to the side-effects of the vaccines.

Most of the standard childhood immunisations, in the usual doses, are recommended for HIV-positive children. Live vaccines, which are safe in other children, should be replaced with the killed vaccine (polio). Although measles (or MMR) has a live vaccine, this vaccine should be administered anyway (unless the child already has advanced immune suppression) because the risk of severe natural measles infection in HIV-positive children is so very high.

For HIV-negative children, the issue of a compromised immune system is less pressing, but not absent. Inform your doctor if your child has a fever, has had a severe reaction to an earlier vaccination, has a blood disorder, has recently been treated for a serious illness or has another illness which affects their immune system. The doctor may advise you to delay the vaccination or forgo it completely.