The world of immunizations has changed a lot since Edward Jenner invented the smallpox vaccine in 1796, but the need for those vaccines hasn’t. Arguably the single most important factor in decreasing human mortality, immunization has virtually eradicated several infectious diseases. Most children receive routine vaccinations from the time they’re born, but there are some outside the regular schedule that kids – and adults – living in Beijing should consider getting. beijingkids spoke to Dr. Thilan Fellay, a family physician and pediatrician at International SOS, and Dr. Pauline Tan Ngo, chief of pediatrics at Vista Medical Center, for advice on vaccines. As always, it’s important to speak to your doctor for personalized advice. Dr. Fellay stresses that vaccination schedules can be complicated. If you’re trying to plan which ones to get and when, consulting with your doctor is a must – especially if you want imported vaccines.
Rabies
“I really insist on the rabies vaccine,” says Dr. Fellay. Because doctors in the West do not routinely prescribe this vaccine, most do not mention it to patients who are leaving for China. According to the World Health Organization (WHO), China has the second highest number of reported rabies cases in the world. The good news is, it’s also the world’s largest administrator of rabies vaccines. Dr. Fellay insists on the vaccine not only because of the disease’s prevalence, but also because of the damage it causes. Without the pre-exposure vaccine, a person who contracts rabies through an animal bite immediately requires a series of time-sensitive injections, as well as a course of rabies immunoglobulin. If left untreated, rabies is fatal.
In China, dogs are the most frequent rabies transmitters. However, Dr. Tan Ngo notes that the likelihood of contracting rabies in Beijing is fairly low, as most cases present in rural areas in the south. However, rabies is present elsewhere in Asia, and other countries are not as vigilant about vaccinating their animals.
The most troublesome aspect of rabies is that there’s no way to tell that a person has contracted it until the onset of the virus, well past the point of treatment. If the animal is present, it can be tested for rabies within a few hours. While Dr. Fellay recommends the vaccine to parents and kids alike, she says that kids are more at risk of getting rabies since they are more likely to touch animals without thinking and may not report a scratch, lick, or bite.
The pre-exposure vaccine is a series of three shots administered over the course of one month. After an animal bite, get to the doctor within 24 hours regardless of prior vaccination. An immunized person will require two shots after exposure; an unvaccinated person requires four shots and a dose of rabies immunoglobulin. However, only locally-manufactured rabies immunoglobulin is available in China.
Among the international hospitals in Beijing, only Beijing United Family Hospital (BJU) carries the rabies vaccine. Patients can also visit Chinese disease control centers across Beijing. Ask your health provider for the address of the center closest to you.
Hepatitis A
Dr. Tan Ngo and Dr. Fellay both recommend the Hepatitis A (HAV) vaccine. HAV is transmitted via fecal-oral route – or, more bluntly, when fecal matter enters the mouth, usually via food handled by a carrier who did not wash their hands. “As with rabies, the Hepatitis A vaccine is one that doctors in the West [often]forget to advise,” says Dr. Fellay. “It is rarely fatal, but can cause severe illness in pregnant women.” She recommends that all travelers and expatriates in China consider vaccination, but especially women who are planning to get pregnant while in Beijing.
“HAV is generally mild,” explains Dr. Tan Ngo, especially in comparison to rabies. “It’s usually a few weeks of diarrhea and nausea, but it can lead to liver failure – which is why the vaccine is important.” Other symptoms include fever and jaundice, and can last from three weeks to six months in some cases.
The HAV vaccine is a series of two shots six to 18 months apart. In China, it is only available as a domestic vaccine. If you only feel comfortable with imported vaccines, get yourself or your child vaccinated when visiting home or another country. However, be sure to plan ahead to get the second dose within 18 months.
Meningitis
There are many types of meningitis, a severe bacterial disease, but there are only vaccines for four: A (typically found in Asia and Africa), C (found in Western countries), W, and Y (both typically found in Middle Eastern countries). In the US, there is a meningococcal vaccine that protects against all four strains; in other countries, this is not the case. In China, children are routinely vaccinated against meningitis from a young age, but these vaccines only protect against types A and C.
“The risk of contracting meningitis in China is rather low, as China has a high level of meningococcal immunization,” says Dr. Fellay. It’s still a good idea to get vaccinated, especially for teenagers heading off to university. In fact, many universities in the US require students be vaccinated before attending. “The disease is most prevalent in young people,” Dr. Tan Ngo explains. “I usually advise that a child get vaccinated if he hasn’t [already], as meningitis is debilitating.”
In China, the shot that prevents against both A and C may be available in limited quantities as an imported vaccine, but the type that protects against A, C, W, and Y, is not available. The number of shots and follow-up boosters depend on which type of vaccine you’re getting.
Japanese Encephalitis
Though there is generally a low risk of contracting Japanese encephalitis in Beijing, the disease is endemic to China. Both doctors agree it is worth considering. This mosquito-borne illness is an infection of the brain covering.
There is no treatment for the disease itself, only for its symptoms, which include high fever, disorientation, coma, and tremors.
“It’s a severe disease that can result in physical and mental disabilities,” says Dr. Fellay, though it is fatal in one in four cases. The vaccine is available as a local immunization. The American CDC recommends it for travelers who are planning to spend more than one month in an area with endemic Japanese encephalitis, especially if they will be traveling outside of urban centers. Additionally, those visiting forests, fields, or pastures during the summer tick season in China should consider vaccination against tick-borne encephalitis.
Parents: Get Your Updates
Dr. Fellay recommends that adults around the age of 30 get an update on their pertussis (or whooping cough) vaccine, especially if they are around infants. Dr. Tan Ngo concurs. She explains that the Td vaccine, which covers tetanus and diphtheria, used to be given as a routine immunization. Now, children are routinely inoculated with Tdap, which includes pertussis.
Pertussis is highly contagious and causes serious, occasionally life-threatening complications in infants younger than 1. In the US, the Advisory Committee on Immunization Practices now recommends that pregnant women receive the Tdap vaccine. If you’re planning to have a baby soon, talk to your doctor about whether you need a Tdap update.
Dr. Tan Ngo recommends that prospective parents also ensure they are up-to-date on their rubella vaccine, which is given in conjunction with the MMR vaccine (the immunization for measles and mumps). Rubella is dangerous for pregnant women and can cause a host of birth defects. Prospective mothers and pregnant women should get their rubella antibody tested to see if they require a booster, continues Dr. Tan Ngo.
Imported Vaccines
In China, regulations over imported vaccines have become very strict. The list of available imported vaccines can change rapidly from day to day. Vaccine manufacturing practices have improved vastly in recent years, but talk to you doctor if you have any concerns about available vaccines. If you’re worried about domestic vaccines, the last thing you should do is try to sneak some back from your home country. Not only is this illegal, it’s also forbidden for doctors in Beijing to inject anyone with unofficially-imported vaccines.
The Anti-Vax Movement
The controversy surrounding vaccines is as old as vaccines themselves. Some believe that vaccines are not safe and can cause developmental delays or even autism. However, Dr. Tan Ngo points out that there is no study linking vaccines to autism, and that autism has no known single cause. A famous 1998 article by Dr. Andrew Wakefield linked the MMR vaccine to autism and bowel disease, but was later proven to be grossly falsified. Wakefield had been paid to find evidence against the vaccine and had a financial stake in his findings. His study was retracted and labeled an “elaborate fraud” by The British Medical Journal. A later study by the US Institute of Medicine found that “the MMR vaccine doesn’t cause autism, and the evidence is overwhelming that it doesn’t.”
Vaccines can cause adverse reactions. Usually, these reactions present as a low fever and soreness and swelling at the site of injection. Serious adverse reactions, however, like anaphylactic shock, are extremely rare. If you are worried, talk to your doctor and be sure to inform them if you or your child have ever had an adverse reaction to a vaccine.
Resources
International SOS 国际救援中心
Daily 9am-6pm. Suite 105, Wing 1, Kunsha Building, 16 Xinyuanli, Chaoyang District (Clinic 6462 9112, 24hr hotline 6462 9100, china.inquiries@internationalsoschina.com) www.internationalsos.com, www.clinicsinchina.com 朝阳区新源里16号琨莎中心座105室
Vista Medical Center 维世达诊所
Daily 24hrs. 3/F, Kerry Center, 1 Guanghua Lu, Chaoyang District (8529 6618, vista@vista-china.net) www.vistachina.net 朝阳区光华路1号嘉里中心3层
Center for Disease Control and Prevention (CDC)
www.cdc.gov
World Health Organization (WHO)
www.who.int
The History of Vaccines
www.historyofvaccines.org
The Institute of Medicine: Adverse Effects of Vaccines: Evidence and Causality
tinyurl.com/n3w6a9d
My Health Beijing – Vaccines Review: Few Major Side Effects – and No Autism
tinyurl.com/ka3ryv4
photo by Littleones Kids & Family Portrait Studio
This article originally appeared on p24-25 of the beijingkids August 2013 issue.
Check out the PDF version online at Issuu.com
