This September, the Mums NI Team chat with Dr Lucy Jessop (Health Protection Consultant) and Dr Jenny Mack (Specialist registrar) from the Public Health Agency about Childhood Immunisations. We are delighted that they were able to take some time out of their busy schedules in order to chat with us on this important topic.
After clean water, vaccination is the most effective public health intervention in the world for saving lives and promoting good health. Before vaccines were introduced hundreds of thousands of people became ill with infectious diseases, which can now be prevented by vaccines. Unfortunately as a consequence of these diseases many people died or were left permanently disabled. For example, parents nowadays may never have met anyone who has been permanently paralysed by polio because the UK and almost all countries in the world are now polio free. This is thanks to the success of vaccination programmes worldwide.
It is important that as many children as possible receive all vaccines in the routine programme. The year before the Measles, Mumps and Rubella (MMR) vaccine was introduced in the UK, 86,000 children caught measles and 16 died. Between May 2017 and May 2018 there were approximately 13000 cases of measles across Europe, including 17 deaths. This underlies how easy it is for vaccine preventable disease to come back if vaccination rates drop, and how parents can’t just rely on herd immunity to protect their children.
In Northern Ireland we have very high uptake of all the vaccines offered in our routine programme, so there is no need for vaccinations to be made mandatory. Parents are given the opportunity to discuss vaccinations with health care professionals and most then decide to protect their children with all the vaccines they are offered.
Herd immunity is a concept used to describe how a small minority of a population can be indirectly protected against an infectious disease if most of the population have been vaccinated against it. Herd immunity is particularly important for people who are too young to be vaccinated or have medical reasons why they can’t receive a vaccine. If most of the population are vaccinated and someone with an infectious disease comes into that population, the vaccinated people cannot become unwell and therefore the disease cannot spread to the few who are unvaccinated. Measles is an extremely infectious disease and spreads very easily, so it is necessary for 95% of people to be vaccinated to prevent its spread in a population. Unfortunately in some countries in Europe, the level of vaccination is much lower than this, which explains why there are so many cases of measles in Europe at the moment.
Vaccines are safe. A vaccine can only be used in people if scientific tests, called clinical trials, show it is safe and effective, and that the benefits provided by the vaccine are greater than any risks. The data from these trials are then looked over by a European Medicines Agency (EMA) group called the Committee for Medicinal Products for Human Use. If the committee is happy the trials show a vaccine is safe, it will grant a licence for use in the UK. It is far more likely that children can become seriously ill from a vaccine-preventable disease than from a vaccine. For example, polio can cause paralysis, measles can cause inflammation of the brain and some vaccine-preventable diseases like meningococcal disease can even result in death. The benefits of vaccination greatly outweigh the risks, and many more illness and deaths would occur without vaccines.
Vaccines are extremely well tested before they are used in national vaccine programmes and there are mechanisms in place to monitor any possible adverse events that occur after vaccination, to ensure that any possible problems can be picked up and investigated. The Vaccine Damages Payment Act was introduced in the late 1970s and is intended to provide additional reassurance that in the extremely unlikely event that a routine vaccine does cause harm, parents are able to claim financial assistance.
In 1998 Andrew Wakefield and his colleagues published a paper looking at the association of gastrointestinal disease, autism and environmental factors in 12 children. In a press conference about the paper Wakefield suggested that MMR vaccine might be associated with autism, even though the paper itself states that they did not prove an association between the MMR vaccine and the syndrome they were describing. The study was later found to be seriously flawed and fraudulent.
Subsequently Andrew Wakefield was found guilty of serious professional misconduct, dishonesty and irresponsibility and was struck off the medical register. There is now overwhelming published evidence that the MMR does not cause autism.
Unfortunately press coverage about Wakefield’s claims led to a decrease in the uptake of MMR vaccine for a time, and measles outbreaks have occurred in the UK as a consequence of this.
In Northern Ireland 95% of children receive the MMR vaccine. Considering that a small percentage of children do not receive the vaccine for medical reasons, this means that there are only a small number of people who do not vaccinate their children and this may or may not be due to the debunked theory. This high uptake demonstrates that it is widely accepted that there is no link between the MMR and autism.
Gelatine is used in a very wide range of medicines including some vaccines. It acts as a stabiliser which helps to make sure that the vaccine remains safe and effective during storage. In the UK routine vaccination schedule the only vaccines that contain gelatine are one of the MMR vaccines, the shingles vaccine, and the children's nasal flu vaccine. Some religious groups may be concerned about using vaccines containing gelatine however many faith group leaders have stated the use of gelatine in vaccines is acceptable. This link provides access to an NHS leaflet which summarises these points: www.pha.site/gelatine
No vaccines included in the UK routine immunisation schedule contain any mercury elements (also called thiomersal).
No vaccines used in the UK vaccine schedule contain fetal cells.
It is important that vaccines are given to people at the right time, to protect them when they need it most. Some vaccines, for example rotavirus, can only be given to young babies. However, any adult who has not had five doses of vaccines that protect against diphtheria, tetanus and polio can get these from their GP. We would also recommend anyone born after 1970 who has not had two MMR vaccines should receive these. This is particularly important for women who want to get pregnant, because rubella disease in pregnancy can have devastating effects on the baby.
Anyone with a medical condition that puts them at greater risk of influenza should have the flu vaccine each year. Pregnant women are also advised to receive the flu and pertussis vaccines to help protect themselves, as well as their babies when they are too young to be vaccinated but are particularly at risk in the first few months of life.
If you are travelling abroad you should also see your GP or travel clinic for advice on any other vaccines that you might need.
There are very few reasons why a child should not be immunised. They should not have a vaccine if they have had a severe allergic reaction, called anaphylaxis, to that vaccine or any of its components. People with some diseases that affect their immune system cannot receive live vaccines like MMR. Occasionally vaccines may need to be postponed for a short time if a child is ill with a fever when they are due to receive them. If this happens, it is important that the child receives their vaccines as soon as possible after they have recovered. Where there is doubt, advice should be sought from an appropriate specialist.
Further information about vaccines can be found at NI direct or the PHA website: