Immunisation in Sri Lanka and its benefits

By Nilma DOLE

The National Immunization Programme is of great public concern and Sunday Observer interviewed Dr. Paba Palihawardena, Chief Epidemiologist at Epidemiology Unit coming under the Health Ministry, on the importance of uplifting the National Immunisation Program.

Dr. Paba Palihawardena

Q: Why is it important to reposition the National Immunisation Program in Sri Lanka?

A: Sri Lankans have taken immunisation for granted because they don’t realise the gravity of an illness that is non-existent. The main reason why we decided to initiate the program was because we wanted to highlight that if we don’t immunise ourselves, it would have dramatic consequences in the long run. Most importantly, it’s our children who would have to suffer which is not fair. At a time when rubella was almost eradicated, it reappeared with five cases last year, three in 2009 and two in 2008. This shows a dangerous trend in which people do not take their children to be immunised due to sensationalised media reporting.

Q: What sort of problems has the Epidemiology unit in educating the public on immunisation?

A: In Sri Lanka, there are religious groups who do not advocate immunisation and prevent their children from getting it and as such it is important to educate them because if an epidemic erupts their health is at stake. We have worked closely with communities, religious groups and many religious leaders in education and awareness programmes in order to enlighten them on the importance of immunisation. The positives always outweigh the negatives and the case of the two who died in the rubella scandal, was an instance of one in a million allergic reaction which medical science has documented.

In addition, some people have never seen a polio victim or a smallpox patient, so they don’t understand how tragic it is hence a small loophole in the national immunisation program is seen as a death wave.

Q: What are the successes of the ongoing immunisation programs?

A: We have had the successful islandwide coverage of preventable diseases such as smallpox, polio, pertussis, tetanus, neo-natal tetanus, diphtheria and rubella. When we started the islandwide coverage of smallpox when it was formulated in 1886, there were about thousands of smallpox cases around the country, mostly unreported. In 2009, we had a nearly 100 percent coverage in 10 types of vaccinations islandwide.

Sri Lanka provides immunisation against 11 diseases and some of which are on the verge of eradication. However, we need to uplift the National Immunisation Program because people have negative perceptions on the health sector.

Today several diseases are on the verge of extinction-polio was eradicated in 1993 and we didn’t observe pertussis cases last year.

By 2001, diphtheria was barely visible and tetanus and neo-tetanus were eradicated by the 1990s. We have had several able health ministers, good policies in place and several primary healthcare workers like midwives who work night and day to ensure that every child is protected and immunised against the deadliest of diseases.

Q: What are those negative perceptions?

A: There is a negative image about the government healthcare sector. People think that the government hospitals are giving poor quality vaccinations while the private sector medical institutions are noted for high quality vaccinations because you need to pay to get a good healthcare solution.

National Immunisation campaign

This is definitely affecting the people’s reliability in the public health sector and can also affect the national targets in eliminating diseases.

What people should know is that the vaccinations we administer are of high-quality and are kept in special storage facilities at the EPID unit warehouses at the required temperature.

No hospital or company can charge for a vaccination but they can pay for the service. We work with the private healthcare service providers to give them free vaccinations of high quality but they are only charging for the service.

Immunisation is the basic right of every human-being globally so we should think twice before accusing anybody before getting the facts correct.

Q: There is anti-immunisation lobbying around the world. Some say that immunisation causes child autism and others have alleged that the H1N1 vaccination donated to Sri Lanka recently causes child epilepsy, what are your comments on that?

A: For every action, there is an equal but opposite reaction. In the case of immunization, when we reported an islandwide success in the program, there was plenty of anti-immunisation lobbying that it wasn’t good.

Just like the religious groups I mentioned before, anti-immunization lobbying is natural because people don’t know what’s right and what’s wrong. I don’t mean to say that I’m against anything religious but people should weigh the pros and cons before taking any decision.

It isn’t true that child autism or even epilepsy is caused by immunisation but it is important to note that the positives outweigh the negatives all the time. People who have not suffered an illness easily preventable by immunisation will tell you a different story.

Q: What advice would you give the public on immunisation?

A: For any information on immunisation, we at the EPID unit can answer your questions. If you have any problems, talk to a paediatrician, a primary healthcare worker or a family physician because a plenty of information about immunisation can be obtained from them. Also, ensure that you are well-educated and informed about your child’s well-being and do not hesitate to use the government healthcare services. Make sure that you take your child for all the vaccinations as recommended by a qualified medical professional and ensure that it is done properly.

Before believing stories in the media, make sure you do a background check and talk to the experts before deciding what’s good for your child. As a parent, you want to protect your child and as a doctor, we want to have a healthy nation.

Alarming obesity in school children in Colombo - Prof. Sanath Lamabadusuriya

by Edward ARAMBEWALA

Prof. Sanath Lamabadusuriya, the newly elected President of the Sri Lanka Medical Association (SLMA), at his induction in office held last month in Colombo, speaking on - the March towards millennium development goals, referred to the alarming incidence of increase in obesity of the Colombo school children discovered by the Paediatric Department of the Colombo Medical Faculty in a recent study carried out by them on the subject.

He said, “There is a worldwide increase in childhood obesity. Studies carried out by the academic staff of our own department of paediatrics has shown an alarming incidence of obesity in school children in Colombo. Diabetes mellitus is affecting children in large numbers. Up to 20 years ago, I could have counted the number of children with diabetes mellitus, I personally encountered, on the fingers of one hand. There has been an exponential increase during the past 20 years. Our genes have remained the same; therefore it is due to environmental causes such as changes in life-styles and diet. The incidence of substance abuse among children is increasing. There are many disjointed family units due to migration, alcoholism etc. With more children surviving through intensive care in hospitals, the number of disabled children is increasing. There is a threat of emerging infections such as Novel influenza which has hit our shores recently. National disasters such as tsunamis, floods, earthquakes and earth slips continue to have a tremendous impact on populations and especially children.

“I would like to highlight 3Ds for its future evolvement. D on dynamism - with a rapidly changing world scenario in all dimensions of illness and health, a formula given 10 years ago is likely to lose its viability. Hence, emerging patterns should be under constant scrutiny and appropriate action taken. D on Dispensation - in policy planning worldwide, the haves dispense for the have nots; powerful to less powerful. My plea is, in this dispensation, equity, lack of personal interest and ethical issues should be closely safeguarded. D on Development - Application of MDGs has mainly been with the developing countries in mind. Hence wider involvement of these countries as stakeholders, greater devolvement of power on decision making, will ensure the correct balance and the resultant sustainability that follows any project.

Earlier touching on why we in the Third world are failing on global health issues he said, As recently as in 2010, 8.8 million under the age of 5 years still died mainly from preventable or readily treatable diseases. Of these, 40 percent of babies were in the neonatal age group. Countless millions of other children will survive with impaired health and development. Approximately two thirds of these deaths are preventable. Nearly all these deaths are among the poor in the developing world. Under - nutrition contributes to one third of the deaths. Most of these children are found in Africa and South East Asia.

“There are several general causes to explain why we are failing in global health issues. Poverty and its concomitants such as poor nutrition, poor hygiene, low literacy and a dirty environment contribute to it. Poor governance, due to rapidly changing governments in third world countries coupled with drastic changes in policy with every change of government is a major factor. In the developed world although governments change, there are no drastic changes in policies. Third World politicians by and large fail to apply evidence based knowledge and therefore follow misguided policies.

In some Third World countries, lip service is paid to preventive health whilst the emphasis is on curative health. There is lack of health equity for children. Sometimes important vaccines that are available for use in the private sector are not found in a country’s National Immunisation Schedule.

There is a sense of despair at times with lack of political and societal will. Underlying moral and ethical malfeasance plays a very important underlying role.

Nanoshell therapy found to be effective against brain cancer

Rice University bioengineers and physician-scientists at Baylor College of Medicine and Texas Children’s Hospital have successfully destroyed tumors of human brain cancer cells in the first animal tests of a minimally invasive treatment that zaps glioma tumors with heat.

The tests involved nanoshells, light-activated nanoparticles that are designed to destroy tumors with heat and avoid the unwanted side effects of drug and radiation therapies.

The results of the new study are available online in the Journal of Neuro-Oncology. The researchers reported that more than half of the animals that received the nanoshell treatment for glioma tumors had no signs of cancer more than three months after treatment.

Option

“This first round of in vivo animal tests suggests that photothermal therapy with nanoshells may one day be a viable option for glioma patients,” said study co-author Jennifer West, the Isabel C. Cameron Professor of Bioengineering at Rice and chair of Rice’s Department of Bioengineering. West cautioned that follow-up work in the laboratory is needed before any human testing of the therapy can begin. She said human clinical trials of nanoshell phototherapy for glioma are likely at least a year away.

Glioma is among the most aggressive and difficult-to-treat of all brain cancers. Fewer than five percent of glioma patients survive beyond five years. The disease is particularly difficult to treat because glioma tumors are often highly invasive and inoperable.

Study co-authors include pediatric oncologist Susan Blaney, deputy director of Texas Children’s Cancer Center and Baylor College of Medicine professor and vice chair for research in the department of pediatrics, and Rebekah Drezek, professor in bioengineering at Rice.

West, Blaney, Drezek and colleagues tested mice with abdominal tumors of human glioma cells. The researchers injected the mice with nanoshells and waited 24 hours for the nanoparticles to accumulate in the tumors. A laser of near-infrared light - which is harmless to healthy tissue - was shined at the tumor for three minutes.

The nanoshells converted the laser light into tumor-killing heat. All seven animals that received the nanoshell treatment responded, but cancer returned in three. The other four remained cancer-free 90 days after treatment.

Glioma

“The results of this study are encouraging, and we are cautiously optimistic that this process may bring us closer to finding a cure for glioma,” said Blaney, also associate director for clinical research at Baylor College of Medicine’s Dan L. Duncan Cancer Center and co-director of The Institute for Clinical and Translational Research.

“This is very exciting, especially given the poor prognosis of the disease and the importance of finding brain tumor treatment alternatives that have minimal side effects.”

Gold nanoshells, which were invented by Rice researcher Naomi Halas in the mid-1990s, are smaller than red blood cells. Nanoshells are like tiny malted milk balls that are coated with gold rather than chocolate. Their core is nonconducting, and by varying the size of the core and thickness of the shell, researchers can tune them to respond to different wavelengths of light.

Houston-based biomedical firm Nanospectra Biosciences, which holds the licence for medical use of Rice’s nanoshell technology, began the first human clinical trial of nanoshell phototherapy in 2008.

West, a co-founder and director of Nanospectra Biosciences, said the new glioma study is part of a larger ongoing effort within the Texas Medical Center to adapt nanoshell phototherapy for use against a variety of cancers. Researchers at Rice, Texas Children’s Hospital, M.D. Anderson Cancer Center, Baylor College of Medicine and other institutions are working to develop nanoshell-based treatments for prostate cancer and pancreatic cancer.

The glioma study was funded by the National Science Foundation, the National Institutes of Health and Hope Street Kids.

Source: Jade Boyd,

Rice U

Growing dental problem not a thing to smile about!

by Nilma DOLE

It was surprising to note that the facts and figures of the last National Oral Health Survey done by the Ministry of Healthcare and Nutrition does not give us a reason to smile about.

“Compared to other countries, Sri Lanka’s dental problems are not that bad but there is still a demand for more dentists and dental therapists to address the issue of bad teeth,” said Dr. Jayasundera Bandara, President of the Sri Lanka Dental Association (SLDA) and Deputy Director General of Dental Services, Ministry of Health.

The doctor said, “There are only 1600 dentists and 350 dental therapists in Sri Lanka at present.” According to him, it was found that nearly 90 percent of those in the 35-44 year age group have dental caries. “In Sri Lanka, about 65 percent of toddlers (having deciduous teeth or milk teeth) have dental caries which is an improvement when compared to 85 percent in 1984.” Dental caries, is also known as tooth decay or a cavity which is a disease in which bacteria damages the tooth structure including the enamel, dentin, and cementum. Dr. Jayasundera said, “Dental caries is one of the most common diseases in the world. There are two types of bacteria namely Streptococcus mutans and Lactobacillus that react with sugar producing acids that dissolve the teeth.” If untreated, the disease can lead to pain, tooth loss, infection, and, in severe cases, the death.

“However, Mother Nature has been kind to us having blessed us with saliva that has anti-bacterial properties that break down food caught in the teeth. So long as we don’t consume anything sweet within three hours of our next meal, saliva saves our teeth,” said Dr.Jayasundera.

Another stark revelation was that the gum disease was prevalent in every age group. The doctor said, “According to the survey, only 23 percent of 12 year olds in Sri Lanka had a good gum while, the rest suffered from some sort of gum disease.” Gingivitis or inflammation of the gum tissue occurs when plaque (white substance that settles on teeth called bacterial biofilm) gets deposited in the gum. “The gum starts receding leading to bleeding if it is not treated soon,” said the doctor.

Hence, many do not even know if they have the disease because they hardly go for dental checks.

In a bid to boost interest in good teeth, the SLDA is conducting an island-wide campaign titled, The Health Master Plan. The doctor said that from a very young age, there should be discipline to take care of one’s teeth. Mothers should take care in oral health techniques for their children,” said Dr. Jayasundera, emphasising the importance of a mother’s influence on her children’s health. “If a calf can drink cow’s milk without any artificial sugars and be healthy, why can’t our children manage without it?” he asked.

Of course, this doesn’t mean that sugar and sweets should be discouraged but a child shouldn’t be an addict to sweets all the time.

The doctor said, “There are at least 28 million problematic teeth in Sri Lanka for all age groups. There are at least seven million problematic teeth needed to be treated in the Under-15 age group.”

Sri Lankans have a severe sweet tooth but it should be brought under control in the interest oral health.

“Overall, Sri Lanka is a low prevalence country when it comes to oral health problems but, we can easily overcome this problem by training more dentists and focusing more on our teeth,” Dr. Jayasundera cautioned.

So from today, make sure you brush your teeth in the morning and at night before you go to bed to maintain that dazzling white smile!

For more information about the Sri Lanka Dental Association, free dental health check-ups and advice on proper oral hygiene, attend Medicare 2011, a National Healthcare Exhibition organised by the Sunday Observer to be held from 4-6, March.

Breast biopsies and microbubble ultrasound

Scientists have discovered a way to kill cancer cells.

Using “microbubbles” and ultrasound can mean more targeted breast biopsies for patients with early breast cancer, helping to determine treatment and possibly saving those patients from undergoing a second breast cancer surgery, a new study shows.

Patients with early breast cancer undergo a sentinel lymph node biopsy to determine if their cancer has spread, said Dr. Ali Sever, lead author of the study. Ultrasound, on its own, can’t distinguish the sentinel lymph node from other lymph nodes, Dr. Sever said. However, “our study found that microbubble contrast- enhanced ultrasound accurately identified the sentinel lymph node in 89% of the 80 patients in our study.”

As many as 35% of patients who undergo sentinel lymph node excision biopsy will require additional surgery because cancer has spread,” Dr. Sever said. Using microbubble contrast-enhanced ultrasound preoperatively means that the cancer and cancer spread can be removed during one operation.Currently blue dye and radioisotopes are used to identify sentinel lymph nodes at the time of surgical excision. While this technique is accurate, there are side effects for some patients, including an allergic reaction. In addition, the disposal of the radioisotopes (radioactive waste) poses an issue.