Tag Archives: childhood vaccinations

A little incentive goes a long way when it comes to vaccine uptake

Offering people free lentils and metal food dishes substantially improves the number of young children that receive a full course of childhood immunisations in resource poor areas, and is more cost effective than just improving the vaccine services available in the region, according to a new study published free in the British Medical Journal.

Abhijit Vinayak Banerjee and colleagues wanted to assess how effective non-financial incentives—1 kg raw lentils per vaccine and a set of metal thali plates once a child has received all their immunisations—and increased availability of vaccine services were at improving immunisation rates in young children in rural Rajasthan, India. Their study included 1,640 children (aged 1–3 years) from 134 villages who were randomly assigned to three groups:

-          the ‘immunisation camp’ who received reliable, monthly vaccinations from healthcare professionals

-          the ‘immunisation plus camp’ who in addition to reliable, monthly vaccines were also offered cheap little extras of free lentils (costing about $1) for every vaccine and a set of thalis (a snip at $1.50) for a complete set of vaccines (BCG, diphtheria-pertussis, tetanus, polio and measles) received by the children

-          a control group who did not receive any interventions

Taken from Banerjee, A. V. et al. BMJ 2010;340:c2220

The researchers showed that immunisation rates were higher in the children that were offered reliable immunisations plus a little extra (39%) compared with the rates in children who were just offered the reliable immunisations (16%). Interestingly, children in districts neighbouring the immunisation plus camp also had bigger improvements in immunisation rates than those living near the immunisation camp villages. Not only that, these small incentives were cost effective (costing an estimated $17.35 per fully immunised child in camps with incentives compared with $25.18 per fully immunised child in camps without these extras).

The findings from this study by Banerjee et al. could have important implications for vaccine policies. Moreover, the authors question whether offering lentils can even be considered a “cost” as they clearly will have immediate, nutritional benefits to both the vaccinated children and their families.

ResearchBlogging.orgBanerjee, A., Duflo, E., Glennerster, R., & Kothari, D. (2010). Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives BMJ, 340 (may17 1) DOI: 10.1136/bmj.c2220

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Paracetamol can limit effectiveness of vaccines in children

paracetamol-side-effectsTreating vaccinated children with paracetamol as a precautionary measure against fever may reduce the effectiveness of the vaccine itself, according to research by Prymula et al. published in The Lancet on the 17th October.

Fever is classed as a temperature of over 38oC and is a normal part of the inflammatory response to infection, and after vaccination. Fever is worrying in children because of the risk of febrile convulsions (seizures that occur in children with a high temperature). Some countries recommend antipyretic drugs (drugs that reduce the body temperature), like paracetamol, after vaccination in children with a history of febrile convulsions. However, evidence to support their use is scare.

The Czech and Swiss researchers performed a randomised, controlled trial of 459 children receiving primary and booster vaccinations against a combination of common childhood diseases (including vaccines for whooping cough, diphtheria, rotavirus, tetanus) in ten centres across the Czech Republic to test the effects paracetamol during vaccination. Approximately half the children received three doses of paracetamol every 6-8 hours over the 24 hours post-vaccination, whilst the rest did not receive any paracetamol. Treatment with paracetamol after vaccination significantly reduced fever in children, but also significantly lowered antibody responses (including those against tetanus and diphtheria) to several of the vaccine antigens (meaning the vaccine does not produce as effective a protective immune response). The study also showed that high fever (> 39.5oC) is actually a rare event after vaccination, both treatment groups had 2% or less children with a high fever after vaccination.

This research suggests that antipyretic drugs, like paracetamol, should not be routinely given to children after vaccination because it may interfere with how well the vaccine works. A linked article in the same issue of The Lancet discusses some of the important implications following the results of this study. More is needed to understand just how paracetamol reduces the protective host immune response that occurs during vaccination, and whether other antipyretic drugs (such as ibruprofen) also have the same effects as paracetamol.

*The results of the study are listed in ClinicalTrials. gov, numbers NCT00370318 and NCT00496015.

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