Babies miss out on TB immunization

Thousands of infants born in remote northern parts of Kenya in the past six weeks risk contracting tuberculosis (TB) due to a vaccine shortage, with medics warning that the effects could be severe in areas where there is already little access to maternity and vaccination services.

In the north-central Isiolo region, for example, stocks of the TB Bacillus Camille Guérin (BCG) vaccine ran out at the main Isiolo District Hospital in early April, leaving hundreds of babies unimmunized. The hospital also serves residents from the northern districts of Garissa, Marsabit, Samburu and Wajir. 

A nurse working at the hospital said so far three deaths of infants under one month old had been reported.

"I know and can only confirm the deaths of three children - one from Isiolo and two others from [neighbouring] Meru [County]. The latter two, who were HIV positive, died at our ward while being treated for tuberculosis and the other had serious respiratory complications. These deaths could have been prevented if they had been immunized," said the nurse. IRIN was unable to confirm the deaths from other sources.

Parents of newborn babies in Isiolo are being urged to travel to towns such as Nanyuki and Meru, further south, for the vaccine. 

"I hired a taxi to Meru, it's very expensive. I was concerned [by the] many visitors, some of whom might be having TB [who] were visiting to see the baby. They were many because he is a boy," said Aadan Malicha, whose son was born two weeks ago.

The birth of boy children is marked by celebrations in some northern Kenyan communities.

The Ministry of Health confirmed the BCG vaccine shortage, saying this was due to manufacturing delays but fresh stocks were expected.

TB, a bacterial disease which most commonly affects the lungs and is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease, remains one of the world's top infectious killers and the UN World Health Organization (WHO) recommends that new-born babies are immunized against it within two weeks of birth.

Poor maternity services

In Isiolo, only 23 percent of women access maternity services, according to the Ministry of Medical Services. Women avoid public maternity health services there partly due to ignorance, traditional beliefs and the absence of female doctors, and they miss out on vaccination for their children in the process.

"We all know that immunization against all diseases is very poor [here]. The few parents who have understood the importance of these vaccines are now very disappointed. This adds to the high number of children who miss immunizations. It will lead to more deaths, more health complications," Jirma Duba, an official with the Marsabit Community Health Support Initiative, told IRIN.

Duba urged the government to declare the vaccine shortage a disaster, to allow for urgent intervention by aid agencies.

According to the North-eastern Provincial Director of Medical Services, Mohamed Abdikadir Sheikh, contingency plans are in place to ensure that all children under four are protected against TB.

"We have scaled up vaccination awareness campaigns targeting families displaced by drought [and] insecurity in areas close to the border. Our mobile teams are more active in the field now than before," said Sheikh.

"All our health workers serving different facilities and mobile units are observing a new set of vaccination rules. They only conduct the exercise one day in a week. This is to make sure that the 20 units in one vial [of the BCG vaccine] are utilized well. The moment you open it and fail to use it on 20 children then it's wasted." 

Handwritten note

Meanwhile, at health facilities in Isiolo, mothers are continuing to be discharged after delivery without having their children vaccinated against TB. A handwritten note on the children’s antenatal cards indicates that the children are expected back for vaccination but a date is not given, meaning that mothers have to keep visiting the health facilities daily until successful.

“I delivered twins two weeks ago. It was not my first delivery. I know from previous experience that I was only allowed to leave the maternity ward after all my three children got the [BCG] injection on the arm and swallowed a liquid,” said a mother.

In interviews with some parents, IRIN noted that most were not aware of the risk of missing the vaccine, while for the rest the long and expensive journey to neighbouring districts in search of the vaccine is a problem.

According to WHO, about half a million children under 14 contracted TB in 2010, with 58,000-71 000 of them dying; no country has ever eliminated TB.

Kenya is one of 22 countries which collectively account for about 80 percent of the world's TB cases