MOST children do not like to be given injections as it can be a painful and traumatising experience.

How often do you see a child sit still and utter not a single sound while receiving a shot? Hardly.

Many parents have to deal with their child's tears and fears whenever they take their little ones for scheduled vaccination injections. It can be equally tormenting for the parents as they watch their child going through the pain and distress.

10 diseases, eight injections

Did you know that under the National Immunisation Schedule (NIP), children in Malaysia are protected from up to 10 diseases? The diseases that are covered are tuberculosis (TB), hepatitis B, diphteria, pertussis (whooping cough), tetanus ("lockjaw"), polio, Haemophilus influenzae type b (Hib), measles, mumps, and rubella.

Children receive more than eight mandatory doses of vaccination (excluding booster shots) through injections by their first birthday.

While it may be a harrowing process bringing your child for their shots, remember that missing any one of these vaccines is a risk to your child's health, exposing him to potentially fatal diseases.

Just because we do not see these vaccine-preventable diseases any more does not mean we should stop being vigilant.

Things have now changed for the benefit of both children and parents worldwide, including Malaysia. With the availability of what is known as combination vaccines, parents can now lessen those dramatic moments in the doctor's office, minimise their child's distress, and at the same time ensure their child is well protected against several common diseases.

Safer and better

The Ministry of Health has recently replaced live oral polio vaccine (OPV) with inactivated injectable one (IPV), which is safer (no vaccine-associated paralytic polio and other serious complications) and also more flexible as it can also be used by people with impaired immune systems, autoimmune diseases, and organ transplants.

Additionally, whole-cell pertussis (whooping cough) vaccine has also been replaced with acellular pertussis vaccine, which causes fewer reactions and less fever.

These are improvements to the national schedule and are given in the form of combination vaccines.

What are combination vaccines?

Combination vaccines consist of two or more individual vaccines that have been combined into one single injection. This is a practical way to protect children against as many preventable diseases in as little time and hassle as possible.

If you are in doubt on whether or not you should give your child combination vaccines, take a look at what both you and your child stand to gain;

Benefits for children:

- Fewer injections

- Less pain, discomfort, and fear

- Offers protection against a wide range of diseases

Benefits for parents:

- Fewer doctor visits (less time off from work)

- Less visits, less hassle, and less cost

- Less stress of watching your child in pain

 
Frequently asked questions on combination vaccines

Combination vaccines have long been incorporated into the National Immunisation Schedule, yet many parents still have questions. Read on as we try to answer these questions and more.

1. Are combination vaccines effective?

There are many aspects that need to be considered before vaccines are combined, including the reactivity of vaccine components against each other and the stability of all components in the vaccines.

Combination vaccines that have been successfully produced and used are as safe and effective, and possibly more so than individual single-disease vaccines.

It has been shown that combination vaccines produce similar or fewer reactions at the injection site and throughout the body when compared to single-disease vaccine.

2. Will children be able to handle the high dosage of antigens introduced in one single combination vaccine shot?

Most vaccines contain a weakened form of antigen from the bacteria/virus that will elicit a response from the immune system, but will not cause the development of the disease.

Even with combination vaccines, studies have shown that combination vaccines cannot "overload" your child's immune system. Children's immune systems are capable of handling many more times the antigens compared to those introduced through combination vaccines.

3. Where can I get the option of combination vaccines?

Combination vaccines under the National Immunisation Schedule are typically accessible in both government and private hospitals or clinics. Among a few combination vaccines that are now under the schedule are MMR (trivalent) and DTaP-IPV-HiB (pentavalent).

Additional combination vaccines (e.g. tetravalent MMRV that covers measles, mumps, rubella, and chickenpox or hexavalent DTaP-IPV-Hib-HepB) are only available in private practices. Hexavalent vaccines protect against diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae b (causing meningitis), poliovirus, and hepatitis B in a single shot.

If you are interested in getting your child immunised with these combination vaccines, please consult your doctor.

4. Are combination vaccines cheaper than individual vaccines?

In 1974, the World Health Organization (WHO) launched the Expanded Programme on Immunisation (EPI) to get children less than one year of age immunised. Vaccines under the EPI are free of charge in government hospitals. Combination vaccines under the National EPI are also free at government hospitals.

Parents can opt for other combinations that cover more diseases at an additional cost in private clinics. The combinations include MMRV and DTaP-HepB-Hib-Polio vaccines. At first glance, combination vaccines are not necessarily cheaper. However, it saves parents' time by having lesser doctor visits and injections, thus lowering the total costs.

Datuk Dr Zulkifli Ismail is a Consultant Paediatrician and chairman of the Positive Parenting Management Committee.