Global shortage of DT vaccine shortage fuels SA anxiety

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South Africa’s protracted nationwide shortage of a child vaccine aimed at protecting two common, yet life-threatening diseases, has left a slew of anxious parents in its wake. And, reports City Press, now experts are warning that parents, tired of being sent away from clinics and told to come back another time, could become “vaccine hesitant” putting their and other children at further risk.

Reports of a critical shortage of the DT vaccine – which is the tetanus and diphtheria toxoid immunisation given when a child is six – date as far back as early last year. The report quotes some parents as saying that they still were turned away from their local clinics around Johannesburg as a result of the shortage and the resultant stockouts this year.

Heather Finlayson, a paediatrician with the faculty of medicine and health sciences at Stellenbosch University, said the tetanus vaccination is important when getting a cut or wound especially from a dirty object that might contain the tetanus bacterium.

“Dog bites may also be a risk … Diptheria (vaccine) prevents diphtheria disease. Although rare, there have been a number of outbreaks in South Africa in the past few years,” she is quoted in the report as saying. “These have been mostly in children who have missed a number of previous immunisations. Both these diseases can be treated with antibiotics and antitoxin if picked up early, although there is significant morbidity and mortality (risk of death), thus prevention through immunisation is important.”

And the shortage has not just been a South African problem, but a global one.

The professor of vaccinology at the University of Witwatersrand, Shabir Madhi, said: “Unfortunately the DT vaccine is no longer produced by most multinational companies, and there is no local producer in South Africa, hence the shortage here and globally. The replacement vaccine includes DT and acellular pertussis (for whooping cough). However, this vaccine is available in the private sector, but is not yet used in the public sector.”

A parent who had taken her daughter for the immunisation in January is quoted in the report as saying that the reality of her child missing a vaccine on the government’s list of essential vaccines, was “scary and disappointing”. “Is my child not then in danger? She already contracted chicken pox before – which wasn’t on the government’s list but on the private clinic card of vaccines,” she said. “What is also angering me is that they don’t tell us the truth, they keep telling us to come back later. But I can’t keep taking off days from work or taking my daughter out of school to spend the day at the clinic,” said the 40-year-old Johannesburg woman.

The report says the Stop Stockouts Project (SSP) – a consortium of six civil society organisations dedicated to assisting the thousands of people whose lives are threatened by the chronic shortages of essential medicines and children’s vaccines in South Africa – confirmed that it had received reports of stockouts of the vaccine in Gauteng, Free State, Mpumalanga and Limpopo. The organisation’s Kopano Klaas said it had scheduled a meeting with the Health Department in the coming week about the shortages.

About parents’ concerns, Madhi said: “I fully agree. And it could contribute to vaccine hesitancy because of a lack of confidence in the immunisation programme when parents are repeatedly being turned away or told to return at a later date.

“This could contribute to under-immunisation of children and place the children and others in society at risk.”

But, the report says, he emphasised that the starting point for parents was to make sure that their child received all their vaccines during the first two years of life – which would include four doses at six, 10 and 14 weeks old and between 15 and 18 months old, of DTaP-Hib_HpeB-OPV. This vaccine is a single shot which covers six different pathogens, including diphtheria and tetanus for which there is a recommendation of revaccination at school entry. “If the child has received the full series during early childhood, immunity would last for at least 10 to 12 years, so (it is) less of an issue with regard to not getting re-vaccinated at five to six years old for diphtheria and tetanus at least,” he said.

For parents whose children had missed the vaccine because of the shortages, Finlayson said one could wait for when it does become available and get it then as a few weeks or a month’s delay was unlikely to put a child at significant risk should they have been fully immunised previously.

“If you are able to afford it, you can opt for TdaP (tetanus, diphtheria and pertussis) or TdaP-IPV which are booster vaccines that give extra cover for pertussis (whooping cough) and polio. These are available at private pharmacies,” she said. “Those children who have missed previous immunisations (at six, 10, 14 weeks and 18 months) should receive missed doses according to a catch-up schedule.”

The report says the national Health Department was approached for comment in the past two weeks. Communications director Foster Mohale acknowledged receipt of the questions and undertook to respond. However, no response was forthcoming.

City Press report

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