Years ago, pertussis (whooping cough), diphtheria and tetanus were amongst the killer diseases of childhood. Today, we have vaccines available to protect children against these and a number of other diseases.

• Pertussis (Whooping cough); Diphtheria; Tetanus; Measles; Rubella (German Measles); Mumps; Haemophilus influenzae type b (Hib); Hepatitis B; Hepatitis A; Poliomyelitis; Influenza; Varicella (Chickenpox); Pneumococcal disease (some types); Meningococcal disease (some types).

How does immunisation work?

Every time your child has an infection, the immune system in their body makes special proteins called antibodies to fight that infection. Immunisation makes the body produce antibodies. The antibodies can survive for a long time; some survive even a lifetime. So your child builds up resistance to the virus or bacteria without having to have the infection with its resulting distress and complication risk. If the vaccinated person comes into contact with the disease in the future, the body is able to make antibodies fast enough to prevent the person getting sick.

These days, children are recommended many more vaccines than in the past. Some parents may be concerned that their baby or small child might not be able to cope with so many vaccines at a time. Many vaccines can safely and effectively be given at the same time and, in fact, more and more vaccines are being made as combination vaccines. Humans are in contact with thousands of “antigens” every day and the small number of antigens in vaccines are just a “drop in the ocean” of those the body can react to at any one time, so it is very safe, and in fact recommended, that all due vaccines are given at the same visit. Giving all due vaccines at the same visit will also cause less trauma for your child and yourself than stringing them out over several visits, and some vaccines actually work better when given with others.

Where to go for immunisation

• Your local doctor.
• Your local council, hospital or community centre may have free immunisation clinics.

The diseases

Pertussis (whooping cough)

Young babies with pertussis cannot stop coughing. When they gasp for air at the end of the cough, it often sounds like a “whoop”. This is how the disease got its common name. When babies get pertussis, they may spend a long time in hospital and most need to be in intensive care; some of these babies die. Babies with pertussis may bleed behind the eyes and in the brain from coughing so much, or become tired from the coughing and stop breathing. More babies are now getting pertussis in countries where immunisation rates have gone down. However, even in countries where childhood immunisation rates are high, like in Australia, babies are still at risk because teenagers and adults are getting pertussis. Unlike many diseases, protection against pertussis wears off several years after vaccination or after having the disease.

There is now a pertussis vaccine available for teenagers and adults and it is recommended that all people planning a pregnancy or who have just had a baby should be vaccinated against this very serious disease.

Diphtheria

Diphtheria affects the nose and throat and can block the windpipe. It can also affect the heart. The vaccine is very effective so we now rarely see diphtheria, with no cases in Australia since 1993. However, diphtheria still occurs overseas and people who are not adequately vaccinated can acquire it overseas or it could be brought into Australia from an overseas traveller and maybe infect young babies or those who are unimmunised.

Tetanus (lockjaw)

Tetanus (lockjaw) is caused by germs from soil entering the body through cuts and wounds. Injuries such as a scratch, a dog bite, or a prick from a thorn can also lead to tetanus. The only people who get tetanus are those who are not immunised. Unfortunately, the tetanus germ is everywhere, so anyone who is not immunised has the chance of catching tetanus. It is even possible to get tetanus twice, as the infection does not protect you long-term whereas vaccination does.

DTPa vaccine is a combination vaccine in which three vaccines (diphtheria, tetanus and pertussis) are combined in one injection to prevent these diseases.

Polio

The polio virus destroys nerves and can leave people permanently paralysed. If the disease affects the breathing muscles then the person will die unless their breathing is helped by medical equipment such as an “iron lung”. Not so long ago, people with polio spent years in iron lungs. The Salk vaccine (injectable polio) was the first polio vaccine to be introduced and it effectively stopped epidemics in developed countries. Oral Sabin vaccine has been used worldwide since the 1960s because it provides protection in the gut where polio is contracted.

Polio is almost wiped out world-wide but until it is completely wiped out, all countries must continue to immunise. The last recorded polio case in Australia was in 1972. Australia, like other developed countries, is moving back to injectable polio vaccine because of the very small risk of vaccine-related polio from the oral vaccine.

Measles

Measles has become rare in Australia since the national measles control campaign in 1998 when all Australian primary school children were offered free MMR (measles, mumps, rubella) vaccine. This campaign was followed by a national campaign for young adults. The only cases now occurring in Australia are brought in from overseas or are in unimmunised contacts of those overseas cases. Children under 12 months of age, who are too young to have had the measles vaccine, and other people who are not vaccinated, are still at risk because the measles disease is very infectious. Measles is a more serious illness than many people realise, with complications such as middle ear infections and pneumonia common and brain damage also a rare but serious complication of the disease. The very young and those with chronic illness are most at risk of these complications. Simply being older without any chronic illness is also an issue.

Rubella (German measles)

Rubella is usually a mild illness in children but can be more severe in older people. If a woman catches rubella in early pregnancy, her baby may be born deaf and/or blind and suffer from heart defects and/or intellectual disability. It is important that everyone, but particularly women prior to pregnancy, are protected against rubella by having received two MMR vaccines at least one month apart. Pregnant women generally have a blood test in early pregnancy. Rubella has become rare in Australia for much the same reason as measles. However, cases of congenital rubella can still occur when a pregnant woman is exposed to an infected person. Women born in some overseas countries who may not have received rubella vaccine are at particular risk.

Mumps

Mumps is caused by a virus. Before immunisation, mumps used to be one of the most common causes of meningitis in children. After puberty, mumps can cause inflammation of the testes in men or the ovaries in women. Mumps can affect the inner ear and cause deafness at any age.

MMR is a combination vaccine in which three vaccines (measles, mumps and rubella) are combined in one injection to prevent these diseases.

Haemophilus influenzae type b (Hib)

Haemophilus influenzae type b (Hib) is not a “flu” virus. It is a type of bacteria which can cause meningitis (inflammation of the tissues around the brain) and other life-threatening illnesses like epiglottitis which blocks the upper airway. Since the Hib vaccine was introduced in 1993, these diseases have gone from over 500 cases a year to becoming very rare. All children should have the Hib vaccine, starting at 2 months of age.

Hepatitis B vaccine

Hepatitis B is a virus that infects the liver. Individuals, and especially babies, who get this disease may have no or only mild symptoms to start. However, when the virus is caught in infancy or childhood, it is likely that it will remain in the blood (this is called being a “carrier”) and is able to be passed on to other people. As many as 25% of hepatitis B carriers develop chronic liver disease, liver cancer or liver failure later in life. The hepatitis B vaccine prevents this infection – the first dose is now given at birth to maximise the protection against catching hepatitis B from a family member. For later doses, starting at 2 months, the hepatitis B vaccine is given in combination with other vaccines as a single injection.

Varicella (chickenpox)

Chickenpox is a viral illness, which is usually a mild disease of short length in otherwise healthy children, but can sometimes cause complications. Only a small percentage, the most severe cases of chickenpox, result in hospitalisation in Australia. However, as almost everyone contracts chickenpox sooner or later, this small percentage translates to 1500 Australians hospitalised each year with chickenpox. It is particularly likely to be severe in older children and adults or children with other medical problems. Vaccines against chickenpox have been available in Australia since 2001, and are now included in the free childhood immunisation schedule (at 18 months of age). Children require one dose only, but individuals over the age of 14 years require two doses, 2 months apart.

Invasive pneumococcal disease (IPD)

The term invasive pneumococcal disease (IPD) refers to the most serious types of pneumococcal infection, where the bacteria “invade” the bloodstream. The bacterium Streptococcus pneumoniae (the pneumococcus) also causes respiratory infections like pneumonia and middle ear infection without getting into the blood, but meningitis (inflammation of the tissues around the brain) and septicaemia (or “blood poisoning”) are always “invasive”. Until recently, no effective vaccine was available for children under 2 years of age to prevent IPD. Between 2001 and 2005, a selective program offered free pneumococcal vaccine to infants and children most at risk of IPD, and since January 2005, all children aged less than 2 years have been eligible to receive this vaccine free of charge. The first dose is recommended at age 2 months, with the number of doses varying depending on age of first dose and medical risk. It is important for infants to start immunisation at age 2 months. Children who do not have the first dose until after 6 months require fewer doses. For more information about the vaccine ask your local doctor or clinic.

Meningococcal disease

Meningococcal disease is a bacterial infection that can cause meningitis (inflammation of the tissues surrounding the brain) and septicaemia (infection of the bloodstream). There are several strains of meningococcal bacteria in Australia, with two of these (B and C) being the most frequent causes of meningococcal disease. Meningococcal C vaccine has been available in Australia since 2002 but is protective against meningococcal C disease only. The C type of meningococcal disease accounts for around one third of meningococcal cases (and about half the deaths), so until vaccines effective against other strains, especially type B, become available, meningococcal disease will continue to be a concern. Meningococcal C vaccine is effective in all age groups including infants. A mass campaign of all pre-school and school children was carried out during 2003 and 2004, and the vaccine is now recommended at age 12 months.

Side-effects of immunisation

Immunisation is very safe and very effective. The huge benefits of immunisation far outweigh the very small risks. Like any substance, whether a medication, food or lotion, vaccines can have some side-effects in some individuals. These are usually minor, such as soreness at the injection site, mild fever or being a bit irritable. In very rare cases, a child may get a more serious reaction to a particular vaccine due to an unknown sensitivity to some component. Discuss side-effects with the doctor or nurse giving the vaccine. They will advise ways to reduce side-effects. Having a cough or cold is not a reason to delay immunisation.

Australian Baby Guide acknowledges the co-operation of The Children’s Hospital at Westmead and Sydney Children’s Hospital, Randwick, in making this fact sheet available. Disclaimer: This information is for education purposes only. Please consult with your doctor or health professional to make sure this information is right for your child.