It was never too late for Elisha to get vaccinated

Maryvelena Bajungu, 56, from Buangaruti village in Missenyi district, in Kagera, has bite scars on her fingers, three in the left hand and two in the right hand. She reveals to Your Health how she got the scars, saying she was attacked by her daughter, Jonesia, who is mentally unwell and is HIV positive.

Were they fighting? No! Maryvelena further reveals that she suffered the bites when she tried to grab her grandson, Elisha, from his mother’s hands so that she can take him to the hospital to be vaccinated after the child had missed on the immunisation schedule.

Growing up with a parent who is mentally ill, Elisha, at the age of one year and seven months, missed on the vaccines because his mother who gave birth at home didn’t want to allow anybody to touch her child or take him away from her.

“She was very aggressive and she did not want anybody to touch the child. ButI had to use force to grab the baby and take him to the hospital to be vaccinated,” says Maryvelena, who believes that she was very lucky not to get infected with HIV following that horrifying incident.

She recalls that her daughter had developed the mental disease after she was informed that she tested HIV positive during pregnancy.

“She refused the antiretroviral (ARV) treatment for HIV. She also later broke up with her man, criticising him that he was the one who infected her with the disease,” Elisha’s grandmother, Maryvelena, informs Your Health.

“She also refused to attend the remaining clinic sessions,” she adds.

Maryvelena recalls that she met up with Ms Novat Amlberiga, the Community Health Worker (CHW) in the village who advised her to take Elisha (currently 1 year and 9 months old) to a near Mugana hospital for further medical examination and access vaccination services for the child. Ms Amlberiga is among the CHWs in Kagera who received training under the Maternal and Child Survival Programme (MCSP) implemented by Jhpiego in partnership with the Ministry of Health, Community Development, Gender, Elderly and Children and President’s Office – Regional Administration and Local Government aimed to improve vaccination coverage in Kagera and Mara regions, among other key objectives. The $32 million project was funded by the USAID.

Tanzania Demographic and Health Survey (TDHS) for the year 2015/16 reveals that basic vaccination coverage increases with household-wealth, from 65 per cent among children from the poorest households to 83 per cent among children from the wealthiest households.

Basic vaccination coverage also increases with mother’s education. Children in urban areas are more likely than children in rural areas to have received all basic vaccinations.

Coverage is lowest in Katavi and highest in the Kilimanjaro (54 per cent versus 93 per cent). In Kagera, basic vaccination stands at 88 per cent. Basic vaccination coverage has increased slightly from 71 per cent in 1991-92 to 75 per cent in 2015-16. But the gap is still huge on children missing out on their basic vaccinations.

Delayed vaccination

At the hospital, the medical examinations results showed that Elisha had no HIV infection, but he was found with malnutrition. The doctor, therefore, recommended that Elisha must start the first dose of all necessary vaccines without further delay.

The scientific studies indicate that two HIV-positive parents can give birth to an HIV-negative child, although HIV can pass from a woman with HIV to her child during pregnancy, at the time of birth, or when breastfeeding the infant, medical treatment of both the mother and her infant can minimise the chances of that happening.

“Elisha received MR vaccine at the age of a year and seven months instead of at the age of 9 months as required. And he received the second MR dose at the age of one year and eight months instead of at the age of one year and five months,” says Ms Widelina Kawegere, the Reproductive and Child Health (RCH) in charge of Mugana Hospital in Kagera.

Adding: “He also missed on accessing to other vaccines at the right time such as Bacille Calmette-Guérin (BCG) vaccine for tuberculosis (TB), bivalent Oral Polio Vaccine (bOPV), DTP-HepB-Hib vaccine , hepatitis B vaccine, and PCV vaccine. But he also missed on the Rotarix (rotavirus) Vaccine completely.”

The RCH further reaffirms that Elisha has now completed all the crucial vaccines as required by immunisation schedule and his condition has improved. However, his mother had died of HIV a few months ago. He is now being raised by his grandmother who is a small scale farmer, growing beans.

The MR vaccine is a vaccine against measles and rubella. The Centers for Disease Control and Prevention (CDC) recommends children get two doses of MR vaccine, starting with the first dose at 9 through 15 months of age, with a second dose at 18 months to 23 years of age, with at least 4 weeks between the doses. The World Health Organisation (WHO) recommends that measles vaccines should be given routinely to potentially susceptible, asymptomatic, HIV-infected children, adolescents and young adults.

Given the high risk of measles at 9 months of age, WHO further recommends that infants infected with HIV receive an early dose of measles vaccine at 6 months of age, followed by a routine dose at 9 months (or according to the routine immunization schedule).

“Infants born to HIV-infected mothers are at higher risk for measles from 9 months of age,” says Dr William Mwengee, WHO immunisation advisor when he spoke to Your Health last week as Tanzania joined other nations in the World to commemorate World Immunisation Week 2019.

Celebrated in the last week of April – the week aims to promote the use of vaccines to protect people of all ages against disease.

The risks of incomplete vaccination

There are several risk factors for incomplete vaccination and missed opportunity for immunisation in children under five years old.

“Inadequate levels of immunisation against childhood diseases remain a significant public health problem in resource-poor areas of the globe,” Dr Dafrossa Limo, the Programme manager of Immuniaation programme at the Ministry of Health, Community Development, Gender, Elderly and Children said this during the one-day seminar on Immunisation Coverage held in the city recently.

She further said that the reasons for incomplete vaccination was associated with accessibility to the vaccination sites, no schooling of mothers and children born at home.

“Missed opportunities for vaccination and incorrect vaccination need to be avoided in order to increase the vaccine coverage for those clients that reach the health facility,” she further added.

Dr Limo also alerted that if one person in a community gets an infectious disease, he can spread it to others who are not immune.

“But a person who is immune to a disease because she has been vaccinated can’t get that disease and can’t spread it to others,” she said.

According to available statistics, more than 3 million people die from vaccine-preventable diseases each year. Approximately 1.5 million of these deaths are in children less than 5 years old.

World Health Organisation further reveals that immunisation has proven the test of time as one of public health’s most cost-effective interventions.

In 2017, the number of children immunized – 116.2 million – was the highest ever reported. Since 2010, 113 countries have introduced new vaccines, and more than 20 million additional children have been vaccinated.

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