Painless Vaccines - All That Glitters Is Not Gold
Timely immunization of babies is one of the most important tasks for the parents. However, most of the vaccines that are given to babies are injectable ones and the very thought of baby crying in pain can be a real time nightmare for the new parents.
With the advent of new technologies and ideas the pharmaceutical companies have come up with ‘painless’ vaccines as a substitute of conventional painful vaccines. As a parent we always strive to give our baby the best thing we can. Sometimes this seems to be an easy task but few other times it gets really tough to decide. Often parents resort to painless vaccines in the hope that they won’t cause any pain to their child. But hold on dear parents!! Just don’t rush by the name and the buzz created around them--there’s much more to know about these vaccines before getting our child vaccinated by them.
This blog is an attempt to provide all the details on conventional vs painless vaccines so that the parents stop juggling between the two and are able to make an informed decision.
Painful and Painless vaccines
When we talk about painful and painless vaccines, we are generally discussing about DTwP and DTaP vaccine respectively. It is a combination vaccine which provides protection against an array of three major diseases that can prove to be fatal during infancy and early childhood. D stands for Diphtheria, T for Tetanus and P for Pertussis (more commonly known as whooping cough).
This is to note that the only difference between the two vaccines i.e. DTwP and DTaP is in the pertussis vaccine that has been modified. Pertussis vaccine comes as whole cell vaccine (wP) or acellular vaccine (aP).
The recommended immunization schedule for DTP vaccine is a 3 dose primary series with the first dose at 6 weeks while subsequent doses at 10 weeks and 14 weeks along with a booster dose at around 1.5 years and 5 years of age.
Among all the vaccines given during an immunization programme, DTwP vaccines are considered to be painful as they can cause fever, pain, vomiting and swelling at the site of injection adding much discomfort to the baby. Hence as their substitute what came in the market was painless DTaP vaccines that claimed to cause lesser pain, fever and swelling at the site of needle prick.
DTaP vaccine actually consists of lesser amount of immunogenic components hence lesser post vaccination effects. However, since these are injectable forms of vaccines, they would definitely cause pain during administration or needle prick; however, the after effects of vaccination are greatly reduced. Hence you may now know that they are not exactly ‘painless’ and the word used for them is just a misnomer.
DTwP vaccines are traded in the market by the name – Pentavac or Easy Five or Comvac. The preparation is given for vaccinating against DTP, Hib and Hepatitis B while DTaP are marketed under the name Pentaxim and is a combination vaccine of DTaP, Hib and IPV (injectable polio vaccine).
The cost of so called painless vaccine is approximately double the amount of conventional ones, so be ready to loosen your purse strings when you choose DTaP over DTwP.
EFFECTIVENESS OF ‘PAINLESS’ VACCINE – DEBATE STILL CONTINUES
The effectiveness of DTaP, whether it is at par with the conventional one or not, is still a topic of debate. The 2014 Report of working group committee on pertussis vaccine of SAGE and WHO postulated that the available licensed aP vaccine has a lower initial efficacy, faster waning of immunity and greater risk of transmission of the disease causing agent.
Why painless DTP or DTaP is less effective?
Vaccines primarily provide protection by producing antigen specific antibodies. Pertussis or whooping cough is caused by a bacterium known as B.pertussis. Recent reports have suggested that B. pertussis is not exclusively an extracellular pathogen but can be intracellular also and survive in cells like macrophages. This intracellular state of B.pertussis cannot be controlled by antibody response alone but a specific type of immunity known as cell mediated immunity triggered by a defence cell known as T-helper cell 1 (Th1) and T helper cell 17(Th17) and somewhat to a lesser extent by T helper cell 2 (Th2), would also be required to control it.
Substantial evidence from various clinical trials have suggested that antibodies to B.pertussis play a role in preventing colonisation of the organism and combating toxin-mediated disease. Complete bacterial clearance, however, requires cellular immune responses mediated by Th1 cells.
Moreover, investigations have also shown that vaccine induced antibody response wanes shortly after immunization but T-cell mediated immunity, especially Th1; persisted far after the decline of antibodies to vaccine constituents.
As reported by various studies, it is this wP vaccine which was associated with the induction of strong Th1 responses whereas aP vaccine preferentially induced Th2 cell due to which aP-vaccinated individuals would be protected from the disease but not from colonization of the organism. Therefore, when a child is vaccinated with aP vaccine he is protected from the disease but the microorganism may re enter the child’s airways and lungs and colonize there. The child would then be a carrier as well as transmitter of the disease especially to people who have not been vaccinated before or who are immunocompromised. wP vaccination on the contrary induced a rapid clearance of the lungs. Infact, adolescents who received DTwP vaccines in childhood were more protected during a pertussis outbreak than were those who received DTaP vaccines.
Similarly, it has also been reported that complete clearance of bacteria usually does not occur before 14 days or more in individuals immunized with aP, whereas individuals primed by immunization with wP clear the bacteria within 5–7 days from the challenge. (Fedele G et al. 2015)
Hence it can now be understood why WHO and Indian Academy of Paediatrics (IAP) strongly recommend the use of DTwP vaccines for primary immunization and restrict the use of DTaP vaccine only for subsequent booster dose or in persons allergic to DTwP or individuals showing severe neurological problems with DTwP.
MEASURES TO REDUCE SHORT TERM AFTER EFFECTS OF PAINFUL VACCINES
As already mentioned, painful vaccines or DTwP vaccines cause pain, irritability, loss of appetite, fever, vomiting and swelling at the site of injection causing moderate to severe distress to the child. However, by taking following measures this short term after effects of DTwP vaccines can be minimized and the apprehension of using painful vaccines over the painless ones can also be reduced. The tips are as follows:
- Breastfeeding: Breastfeeding is one of the best measures to calm a cranky baby after vaccination.
- Application of cool compress or ice cubes at the site of injection. However, care should be taken not to directly place the ice cubes on the baby’s skin else it will worsen the condition. Always cover the ice cubes with a clean cloth or gauze piece and place it over the affected area.
- Distracting the baby by singing lullabies or telling a story, cuddling the baby and remaining close to the baby calms down the baby and gives him/her a sense of security
- Giving paracetamol drops as prescribed by the doctor for fever, pain and swelling.
- One can also consult about numbing creams and sprays with the doctor which will ease the pain.
- Gently rubbing the site of injection immediately after administration for about 10 seconds provides much relief from the pain and discomfort.
- Sweet water: Dab baby’s tongue with sweet water or add it in baby’s pacifier and let him suck it during vaccination. It works well for babies under 6 months of age by reducing the intensity of prick.
It should be kept in mind that the advantages of painful conventional vaccines not only outweigh its short term after effects but are also much greater than its so called ‘painless’ counterpart. It is far better to tolerate the short term post vaccination side effects and get a long term and better immunization with DTwP (or what is more commonly known as painful vaccines) rather than getting relieved from just few of the immediate after effects and remain in constant doubt regarding efficacy of the DTaP, popularly known as painless vaccine.
Hope the article helps the parents in easing their decision making process.
Reference: Fedele G, Cassone A, Ausiello CM. T-cell immune responses to Bordetella pertussisinfection and vaccination. Pathogens and Disease, 2015; 73(7):1-9.
Dr. Supriya Mishra – The author is a Periodontist by profession, a Post Graduate Diploma in Maternal and Child Health Care, a mother of a sweet little girl and a writer by passion. Her posts usually talk about everyday pregnancy and parenting issues, pregnancy and parenting tips and stories of experiences of going through the period of pregnancy, postpartum and during raising up a child.