Monday, 30 August 2010

Madagascar: It's less of a shock the second time around

We've just returned from our two-month vacation in paradise boring France to our home in the dirty, polluted, third-world city of Antananarivo on the paradise island of Madagascar.

Seriously though, last year, when we arrived here for the first time, it was a bit of shock for all of us (even, dare I say it, the Frenchman). This time around, I think we're all happy to be back "home" from vacation. Here are thirteen things I love about living in Madagascar:

13. The vast sky - kind of like in Montana or Saskatchewan. It was the first thing I noticed (after the shacks on the street, that is).

12. We may have the odd case of malaria on the coast but there's no yellow fever here.

11. There's no polio, either, and very little typhoid fever, I daresay.

10. There are some very good restaurants and it's been about eight months since I've felt sick from food I've eaten.

9. Cheap domestic help - we have a nanny, cook and chauffeur.

8. Horseback riding, complete with lessons (English saddle though, which kind of sucks).

7. Lots of neat stuff made out of wood, straw and/or pretty stones.

6. It's close to Mauritius and South Africa, among other great places to visit that are hard to get to from Europe and North America.

5. Did I mention that I have a cook? Who stays until 7PM to clean the kitchen while I get the kids ready for bed?

4. Beautiful, clean, white sand, EMPTY beaches.

3. We might not have parks or playgrounds here but we do have an enormous backyard, as do all our friends who host playgroups every week.

2. Real whales at Isle St. Marie (everything we've heard about it, at least - we're waiting for the Bambino to grow a little before we visit).

1. The size of our house - it's about three times the size of our apartment in Paris.

Monday, 2 August 2010

Vaccines again

Before we moved the Madagascar, under pressure from our pediatrician and the Frenchman, I allowed the Bambino to get the Hexavac shot.  This shot includes vaccines against diptheria, tetanus, pertussis, polio, hiB and hepatitis B.  The Bambino was two and a half months old!

I immediately regretted the decision.

Two days later we moved to Madagascar.  Within the week, Joshua had a horrible upper and lower respiratory infection.  That's pretty unusual for a baby less than three months old who is not in daycare and who is normally still full of antibodies from mama's placenta.  It took him two weeks to recover.

I later read that the hexavac shot had been taken off the market in Europe in 2005, ostensibly owing to the ineffectiveness of the Hepatitis B component of the shot, but more likely because some infants in Germany died after getting the hexavac shot.

I also read this 2000 study, which found that the odds of having a history of asthma was twice as great among children vaccinated with the old diptheria-tetanus-pertussis vaccine than among unvaccinated children and that the odds of having had any allergy-related respiratory symptom in the previous twelve months was 63% greater among vaccinated children than unvaccinated children.  

More recently, a study from Canada found that the risk of asthma was reduced to half in children whose first dose of DPT was delayed by more than 2 months

Both these studies involve the old whole cell pertussis vaccine rather than the newer acellular pertussis vaccine but is there really necessarily a difference?

The Bambino has had no shots since that hexavac shot at two and a half months.  He is now fifteen months old.  Notwithstanding the aforementioned studies, we are prepared to give him the vaccines that are mandatory in France - that is to say, a combined vaccine for diptheria, tetanus and polio  - because the Bambino will not be admitted to a French public school (be it in France or in one of the public French schools abroad) if he has not had been vaccinated against diptheria, tetanus and polio, or a note from the doctor saying he can't have it.

The problem is that the manufacturer, Sanofi Pasteur, took the DT Polio vaccine off the market in 2008 owing to "side effects". They never said what those side effects were.  I do know that the DT Polio vaccine was the only one on the market without no aluminium and no thimerosal.  We are left with the combined pentavac or hexavac shots but both contain more vaccines than the three obligatory ones.  The pentavac contains the vaccine for pertussis and hib and the hexavac has hepatitis B to boot.

So we are left in a situation where we are willing to give are son the obligatory vaccines in France but we have no way of doing this without also giving him vaccines that are not obligatory.  Keep in mind that should we choose to give our son the shots containing non-obligatory vaccines, we have no recourse against the French state should our son suffer any serious side effects from them.

Is this situation the result of joint conspiracy between the French state and drug manufacturers in order to force us to give  our children more vaccines than French law requires?  I don't know but our pediatrician has found a couple of imperfect ways around it.

One way is to have our pediatrician write a letter stating that the Bambino cannot have the DT Polio vaccination because it is no longer available on the market in France and all other shots contain vaccines that are not legally obligatory.  This would be put in the Bambino's health and eventually school records.

Alternatively, we could give the Bambino the adult booster DTP shot, called Revaxis.  This solution has the upside that, since it is a booster shot, the amount of virus in the shot is much lower than the one for children, ironically.  The downside is that the package insert stipulates not to give it to children younger than six years of age.  So if the Bambino received the Revaxis vaccine and then had a severe reaction to it, we would have no recourse against the manufacturer or the French state.

The other downside to the Revaxis shot is that it contains 350 micrograms of aluminium, about 50 micrograms more aluminium than the hexavac shot.

The Bambino is not yet in any kind of collectivity so we're holding off for now.

"But aren't you afraid he'll catch polio?" I hear you asking.  Having looked at the statistics (just check out the vaccine's package insert), I'm just as afraid of side effects from the vaccine.