Health wise

Parents advised on immunisation program

Have no second thoughts

Sajitha PREMATUNGE

Following the report submitted to the President last Tuesday, by the three-member WHO team, new light was shed on the incident surrounding the death of 12 year old Peshala Hansanee, Director Epidemiology Unit, Ministry of Healthcare and Nutrition. Dr. (Mrs.) Paba Palihawadana says that parents should not be put off by the recent turn of events and emphasised that Rubella is not to be taken lightly.

Rubella is a viral disease which may cause miscarriage or still birth if contracted by a pregnant woman. If contracted in the first trimester of pregnancy 85 per cent of infants will be born with Congenital Rubella Syndrome (CRS), which would result in many complications like blindness, deafness, cardiac malformations, microcephaly (small brain) mental retardation and behavioural problems. "Those who survive the neonatal phase may face serious developmental disabilities and have an increased sense of developmental delays including autism, diabetes mellitus and thyroiditis" explained Dr. Palihawadana.

"The decision of the Advisory Committee to include rubella vaccine in the National Immunization Program was due to a CRS outbreak in 1944 and 1945." During the first phase of the program females from age 11 to 44 were given the rubella vaccine. In 2001 all children - both males and females - were given the vaccine at the age of eight, to reduce the immunization gap. Male children were immunized in the hope of stopping the disease transfer. In 2006 the double dose was introduced. The first dose was administered at the age of three and the second at 13. "Between 2007 and 2008 not a single case of CRS had been reported" said Dr. Palihawadana.

"No new cases of polio, diphtheria, neonatal tetanus and very few cases of whooping cough have been reported. And all immunization practices concerning these diseases have been carried out by public health midwives, inspectors, and MOHs. This has been going on for a few decades without any mishaps."

Dr. Palihawadana claimed that the vaccine was of requisite quality, which the WHO report corroborates. The National Immunization Program is currently uses seven different types of vaccines - namely BCG, DT, rubella, DPT, measles, measles rubella and aTd - produced by the same company, Serum Institute of India, that produced the batch of vaccines in question.

This particular batch - a total of 300,000 doses - was well within the safe margin from the date of expiry as it was manufactured in December 2007 and was to expire in November 2009. "250,000 doses have been used already without any complications", said Dr. Palihawadana.

She explained that usually on administration of the rubella vaccine some complain of fever, joint pains and a mild rash, which is very rare, but what Peshala had suffered from a severe attack of anaphylactic shock, a severe allergic reaction, which happens only in cases of one in ten million.

"It was totally unexpected. Only a particular person can develop an allergy to certain qualities of the vaccine." She further explained that people have died of allergic reactions even in medically advanced hospitals elsewhere. She explained that screening is essential before administering any vaccine. During this process allergies to previous vaccines and any contra indications are to be taken very seriously.

Dr. Palihawadana stressed the importance of making full use of available resources to provide practical solutions. There have never been previous complaints about the vaccine and with the National Immunization Program on rubella to be expected to recommence shortly Dr. Palihawadana reiterates that parents should not be reluctant to get their children immunized.

"The quality and the safety of the vaccines are guaranteed by the Epidemiology Unit and the Ministry of Healthcare and Nutrition."

Quality and safety of the vaccines are assured...

**WHO has its own system for quality assurance of vaccines purchased by UN organizations. Such vaccines are referred to as WHO pre-qualified vaccines.

** Since 1997, as a departmental policy, all vaccines including rubella are procured from WHO pre-qualified sources.

** The particular company that supplied the vaccines in question - Serum Institute of India - has supplied vaccines for the National Immunization Program since 1998 and the rubella vaccine since 2001, supplying over five million doses.

** Only vaccines registered with the Drug Control Authority of Sri Lanka are permitted to be used in the National Immunization Program, according to the Cosmetics, Devices and Drugs Act of 27/1980 Sri Lanka.

** The particular batch of vaccines, after procurement, before being used was subject to what is referred to as 'lot release' by Drug Control Authority, conducted under the supervision of Dr. Omala Wimalarathne, consultant vaccinologist.

**From the time of receipt until its distribution it was undisturbed. The 'Cold chain' of the vaccine uninterrupted at the Central Cold Stores.

** The cold chain of the vaccines, during storage at the Regional Medical Supplies Division, Matara and later at the MOH Office Matara has also been maintained uninterrupted.

Symptoms of allergy

** Difficulty in breathing

** Swelling around the face and neck

**Drop in pulse rate and blood pressure

What should be done

** Since there is no way to test the effect a certain vaccine could have on a person...

** In case of a severe allergic reaction the patient should be immediately transferred to a hospital

** Cardio pulmonary resuscitation should be conducted

** Proper drugs administered

Processed vegetable oils

D.P. Atukorale

Many of the foods you buy in super-markets and restaurants are prepared with or cooked in hydrogenated oil. Hydrogenated oils are used in preparing French fries, biscuits, cookies, crackers, chips, frozen pies, pizzas, peanut butter, cake frosting and ice cream substitutes.

The processed vegetable oils you buy in the boutiques and super-markets are not much better. The heat used in the extraction and refining process also creates trans fats. So that bottle of corn oil or soya oil or sunflower oil you have in your kitchen shelf contains trans fats even though it has not been hydrogenated.

Whenever mono-unsaturated and polyunsaturated oils are used in cooking, especially at high temperatures, trans fats are formed. The purpose of buying the `so called healthy' unsaturated oil is defeated if you cook it. Any unsaturated oil becomes toxic when heated. Even a small amount of unsaturated oil if eaten frequently over time will affect your health.Trans fats are very much worse than saturated fats. Trans fats cause significant lowering of your HDL (good) cholesterol and cause significant increase in your LDL (bad) cholesterol.

Trans fats makes the arteries more rigid, cause major clogging of arteries cause insulin resistance, causes or contributes to type 11 diabetes. To limit or reduce the amount of trans fats in food, limit intake of cheese, yogurt, whole milk, limit fatty meals, limit fast foods such as fried or deep fried meat such as chicken beef and mutton, limit consumption of pizzas, limit consumption of vegetable oils, avoid use of vegetable oils for frying purposes especially for deep frying (repeated frying).

Saturated fats from any source are much more tolerant to temperatures used in cooking and do not form trans fats and therefore make much better cooking oils. Saturated fats are the only fats that are safe to heat and cook with. Coconut oil has no trans fats (even when you use this oil for repeated frying) and is resistant to heat and does not cause elevation of your LDL cholesterol or lowering your HDL cholesterol when you use it for cooking purposes.

As I mentioned earlier low HDL cholesterol produced when you use unsaturated oils for cooking purposes, increase the incidence of cardiovascular diseases especially your tendency to get strokes and heart attacks. Low HDL is a worse risk factor for cardiovascular diseases than high LDL cholesterol.

Safest oil for cooking purposes is coconut oil.If you have been advised to take vegetable oils for cooking purposes by your family physician or your dietician, limit the intake of the vegetable oil to the minimum. Never use vegetable oils for repeated frying.

Out of all the vegetable oils, olive oil is the best and store your olive oil bottle in the refrigerator to prevent oxidation of the oil (and to prevent free radical formation).

All vegetable oils should ideally be sealed in air tight opaque containers and stored in the refrigerator as this will slow down the process of free-radical formation.

The one distinct advantage that all saturated fats have over unsaturated fats is that they are not vulnerable to oxidation and free radical formation like unsaturated (mono and polyunsaturated) fats.

Rubella controversy

The tragic death of a schoolgirl following the injection of rubella vaccine could have been prevented if the medical officer or the nurse did not ignore the letter written by the victim's mother to the officer concerned. Whenever parents do inform the doctor (or nurse) that the patient is allergic to certain drugs and items of food it is gross negligence on the part of the doctor (or the nurse) to have administered the injection.

During the 23 years I served at the Institute of Cardiology of the National Hospital we had a significant number of patients getting severe allergic reactions and also a few deaths following Benzathine penicillin injection even when the sensitivity test showed negative.

But all those who developed severe allergies were promptly admitted to the wards and treated for allergy with drugs such as adrenaline, parenteral antihistamines and hydrocortisones.

As soon as a major allergic reaction occur our instructions were that the nurses to stop the culprit injection and inform the Director of the National Hospital, who would ban the culprit injection and treat the patients using other alternative antibiotics.

We did not waste time informing the Ministry of Health or the President's Office. In such an emergency, the medical officer should use his or her discretion and stop the culprit vaccine immediately, with a view to stop mortality and morbidity.

I wonder whether a sensitivity test could have prevented death of the child.

Dr. D. P. Atukorale, Colombo 7.

Readers' health queries

We were expecting to carry this week answers to nearly 15 questions on personal health matters that were sent to us by our readers, by the SLMA medical advisory panel who requested us to join with them in having a question and answer column for them in the Sunday Observer under their health education program.

However, owing to the SLMA annual sessions held last week and the work involved in it, they were not able to keep to their schedule as anticipated.

Last week we carried in this page an apology by the SLMA Secretary Dr. Ruvaiz Hannifa to our readers who sent in their questions with regard to the unavoidable delay in answering.

This week too Dr. Hannifa says it has not been possible for the committee to meet together and reply to the queries sent. Once again while apologising very much to the readers who have been awaiting the answers for nearly three weeks now, Dr. Hannifa promises to have the answers in this page on Sunday 12th.

Readers who may wish to speak to Dr. Hannifa on this or on any urgent issue they had written and awaiting an answer can do so by calling him on Tel. 2693324.

SLMA is considering having an open session for readers' queries from the media, at the SLMA auditorium shortly.

Young vegetarians and eating disorders

The practice of vegetarianism involves eating a diet that excludes meat, fish, and poultry, while a variation of the vegetarian diet, known as the vegan diet, also excludes eggs, dairy products, and honey. Following a properly planned vegetarian diet can fulfil the nutritional needs of people of any age and can even significantly lower risks of cancer and ischaemic heart disease, as well as other diseases. However, vegetarianism has become increasingly popular among teens for various reasons and may put them at greater risk for the development of serious eating disorders.

A new study published in the April issue of the Journal of the American Dietetic Association revealed that although young adult vegetarians were less likely to be overweight or obese than were those who'd never been vegetarians, about 20 to 25 percent of current and former vegetarians demonstrated unhealthy behaviours for weight control.

These health-endangering practices include the use of diet pills, regurgitation, laxatives, and diuretics, as well as binge eating.According to lead researcher, Ramona Robinson-O'Brien, an assistant professor in the Nutrition Department at the College of Saint Benedict and Saint John's University in St. Joseph, Minnesota, "The majority of adolescents and young adults today would benefit from improvements in dietary intake.

However, current vegetarians may be at increased risk for binge eating, while former vegetarians may be at increased risk for extreme unhealthful weight-control behaviours."She also advised, "Clinicians and nutrition professionals providing guidance to young vegetarians might consider the potential benefits associated with a healthful vegetarian diet, [but also] recognize the possibility of increased risk of disordered eating behaviours."

The participants were questioned about whether or not they had experienced binge eating, loss of control of eating habits, or extreme weight-control behaviours. Around 21 percent of former vegetarian teens admitted to having used unhealthy weight-control behaviours, compared to only 10 percent of non-vegetarian teens.

Among the young adults, extreme weight control measures had been used by 27 percent of former vegetarians, 16 percent of current vegetarians, and 15 percent of those never having been vegetarians.The study also showed that binge eating and loss of control over eating habits were reported by 21 percent of the teen vegetarians as well as 16 percent of former vegetarians, compared to only 4 percent non-vegetarians.

For the young adults, 18 percent of vegetarians reported binge eating and loss of control compared to 9 percent of former vegetarians and only 5 percent of non-vegetarians.Robinson-O'Brien said that although teens may view vegetarianism as a healthy option, they could also be motivated by potential weight loss.She explained, "Adolescents often experience a heightened sensitivity about their appearance and pressure to conform to a cultural ideal, resulting in body dissatisfaction and experimentation with various weight loss methods." -Health News