Healthcare professionals have long understood the importance of vaccination, but amongst a small proportion of the population, there is scepticism surrounding their use. The aim of this report is to explain to a parent why they should have their child vaccinated but also to explore the reasons behind the reduction in the uptake of routine childhood immunisations.
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Vaccination ultimately protects your child’s life. As of autumn 2019, there are a total of 19 vaccinations to be a given before a child is 14 years old as shown in Table 1 (NHS, 2019a). As a new parent, this can seem daunting and as healthcare professionals, it is our role to support and guide parents through this process. What must be stressed is the diseases vaccines protect against are life threatening, with vaccination preventing up to 3 million deaths worldwide annually (NHS, 2019b). Many in 2019 are quick to disregard the significance of infectious disease as a health threat due to its infrequency, but to assume infectious disease has been eradicated indefinitely would be premature. Where vaccination levels have seen a reduction, a correlated increase in outbreaks of such infectious diseases has been experienced. Namely, the 2013 measles outbreak in Wales which led to the infection of 1,202 patients, 88 hospital admissions and one death (NHS Wales, 2013). In the region, there was an unusually low uptake of the MMR vaccine attributed to concerns around its safety. If the area had been sufficiently vaccinated to the appropriate level, the measles virus would have been unable to spread.
Vaccination is paramount not only for the safety of the individual, but the safety of society. In order to be effective, the childhood vaccination programme requires high levels of participation. This allows for what is known as the ‘herd effect’, a decrease in the prevalence of a disease in the unimmunised population as a result of protection given by those that are immunised (John and Samuel, 2000). There is no one standard level of immunisation required for the ‘herd effect’ to be achieved, as this varies across diseases. In the case of measles, at the least 93-95% of the population need to the vaccinated (Funk, 2017). For a variety of reasons, including allergy to excipients, a small proportion of the population cannot be vaccinated (WHO, 2019a). These people rely on those able to be vaccinated to comply with the recommended programme otherwise their protection offered by the ‘herd effect’ is compromised leaving them vulnerable. The concept of herd immunity can seem abstract, but its importance is highlighted by the aforementioned 2013 measles outbreak in Wales. In November 2012, 1 in 6 children of age 11 within the Swansea area had failed to take up the MMR vaccine (NHS Wales, 2013). This level of immunity is considerably lower than the recommended for the ‘herd effect’ to offer protection. Low levels of vaccine uptake leave those already susceptible to infectious disease vulnerable, along with your unvaccinated child.
Vaccines are safe. Problems resulting from vaccination are highly infrequent and where reported, are often exaggerated or as we will explore, entirely false. In 1988, the triple vaccine for mumps, measles and rubella (MMR) was added to the childhood schedule (McBain and Allison, 2011). This became a controversial addition after an academic paper was published by Wakefield, A.J. et al. (1998) linking the vaccine to the development of autism and digestive problems. The paper has since been retracted, but the impact it had on MMR vaccination levels was considerable. This is visible in figure 1 (NHS, 2018), where a drop in uptake can be seen around the same time the paper was published. The problem is that many people only see the headlines linking MMR and autism, they rarely see the retraction notice or the waves of peer-reviewed scientific papers completely disproving Wakefield’s claims (Andrews et al, 2002). The spreading of false information in this way is highly dangerous, as of those not vaccinated against mumps, more than 90% will have contracted the infection by age 15 (McBain and Allison, 2011).
The safety of Human Papilloma Virus (HPV) vaccine, added to the schedule in 2008 and then in 2019 universally, has also been questioned. The vaccine is used to protect against high-risk strains of the virus that can cause cancers such as cervical, anal, genital and cancers of the head and neck (Martin, 2015). Adverse side effects following administration of the vaccine have been reported, which include sympathetic nervous system dysfunction (Martinez-Lavin, 2015) and pain syndromes (Martinez-Lavin et al., 2015). As with any medical procedure, side effects will always be reported but it is important to look at such side effects in context and in contrast to the alternative of life threatening infectious disease. Guillain-Barré syndrome (GBS) is an immune system disorder (Porta and Last, 2018) many studies claim was brought on by the HPV virus. Data by the World Health Organisation (WHO), which looks at a large number of studies concluded that risk of development was less than 1 for every 1 million people vaccinated (WHO, 2017). For comparison, in those countries that have implemented the vaccine, a 50% reduction in uterine cervix precancerous lesions has been seen (WHO, 2017), demonstrating how the selection of facts in isolation is dangerous. No healthcare professional denies that vaccines come with risks, but accurate reporting of these risks is vital in ensuring patients can make an informed and ultimately life saving decision.
The world health organisation now considers ‘vaccine hesitancy’ to be one of the top 10 threats to global health (WHO, 2019b). Vaccines protect your child from serious, life endangering conditions and through their provision, the lives of those unable to be vaccinated are also protected. Vaccines are safe, and can ultimately mean the difference between life and death. The rise in vaccine hesitancy is a complex phenomenon, but where we as healthcare professionals can have the most influence is in the education of our patients.
- Andrews, N., et al. (2002) ‘Recall bias, MMR and autism’, Archives of Disease in Childhood, 87, pp. 493-494, [Online]. Available at: https://adc.bmj.com/content/archdischild/87/6/493.full.pdf (Accessed: 1 November 2019)
- Funk, S (2017). Critical immunity thresholds for measles elimination [PowerPoint presentation]. Available at: https://www.who.int/immunization/sage/meetings/2017/october/2._target_immunity_levels_FUNK.pdf (Accessed: 31 October 2019)
- John, T.J. and Samuel, R. (2000) ‘Herd immunity and herd effect: new insights and definitions’, European Journal of Epidemiology, 16(7), pp. 601-602, [Online]. Available at: https://link.springer.com/article/10.1023%2FA%3A1007626510002 (Accessed: 31 October 2019)
- Martin, E. (2015). Concise Medical Dictionary. 9th edn. Oxford Reference. [Online]. Available at: https://www-oxfordreference-com.manchester.idm.oclc.org/view/10.1093/acref/9780199687817.001.0001/acref-9780199687817-e-4608#
- Martinez-Lavin, M. (2015). ‘Hypothesis: Human papillomavirus vaccination syndrome—small fiber neuropathy and dysautonomia could be its underlying pathogenesis’, Clinical Rheumatology, 34(7), pp. 1165-1169, [Online]. Available at: https://link.springer.com/article/10.1007%2Fs10067-015-2969-z#citeas (Accessed: 31 October 2019)
- Martinez-Lavin, M., Martinez-Martinez, L.A. and Reyes-Loyola, P. (2015) ‘HPV vaccination syndrome. A questionnaire based study’, Clinical Rheumatology, 34(11), pp. 1981-1983, [Online]. Available at: https://link-springer-com.manchester.idm.oclc.org/article/10.1007/s10067-015-3070-3 (Accessed: 31 October 2019)
- McBain, A. and Allison, D. (2011). ‘Vaccination and immunization’, in Denver, S.P., Hodges, N., Gorman, S.P. and Gilmore, B.F. (eds.) Hugo and Russell’s Pharmaceutical Microbiology. New Jersey: John Wiley & Sons, pp. 151-165.
- NHS Wales. (2013) Report into measles outbreak published. Available at: http://www.wales.nhs.uk/sitesplus/888/news/29688 (Accessed: 31 October 2019)
- NHS. (2018). Childhood vaccination coverage statistics. Pp. 14, [Figure]. Available at: https://files.digital.nhs.uk/55/D9C4C2/child-vacc-stat-eng-2017-18-report.pdf (Accessed: 1 Novemeber 2019)
- NHS. (2018). Childhood vaccination coverage statistics, England, excel data tables. Tables 2, 7. Available at: http://digital.nhs.uk/pubs/childvaccstats1718(Accessed: 1 Novemeber 2019)
- NHS. (2019a). Routine childhood immunisations. [Table] Available at: https://www.gov.uk/government/publications/routine-childhood-immunisation-schedule (Accessed: 1 November 2019)
- NHS. (2019b) Why vaccination is safe and important. Available at: https://www.nhs.uk/conditions/vaccinations/why-vaccination-is-safe-and-important/ (Accessed: 31 October 2019)
- Porta, M. and Last, M.J. (2018) A Dictionary of Public Health. 2nd edn. Oxford Reference. [Online]. Available at: https://www-oxfordreference-com.manchester.idm.oclc.org/view/10.1093/acref/9780191844386.001.0001/acref-9780191844386-e-1822
- Wakefield, A.J. et al. (1998). ‘Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children’,The Lancet, 351(February 1998), [Online]. Available at: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2897%2911096-0 (Accessed: 31 October 2019)
- WHO (2019a). Six common misconceptions about immunization. Available at: https://www.who.int/vaccine_safety/initiative/detection/immunization_misconceptions/en/index2.html (Accessed: 31 October 2019)
- WHO. (2017). ‘Meeting of the Global Advisory Committee on Vaccine Safety, 7–8 June 2017’, Weekly epidemiological record, 28(92), pp. 393-401, [Online]. Available at: https://apps.who.int/iris/bitstream/handle/10665/255870/WER9228.pdf;jsessionid=239149ED8CF12BF853D472F58F0C9061?sequence=1 (Accessed: 1 November 2019)
- WHO. (2019b). Ten threats to global health in 2019. Available at: https://www.who.int/emergencies/ten-threats-to-global-health-in-2019 (Accessed: 1 November)
Table1: Routine childhood immunisations (Source: NHS, 2019a)
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