Do you need to vaccinate your child? The arguments for and against vaccination
With two new additions to the child mmunisation schedule this month, it's harder than ever for parents to know what's best for your child's health. Our reporter looks at the arguments for and against vaccination
I was worrying about the fact my son had never got his BCG vaccination when a doctor friend came out with a surprise revelation: "Oh, I wouldn't worry about that," she said. "It doesn't protect against all the strains and most other countries don't even give it to babies."
My confusion was compounded by the fact that I knew I'd had my own BCG jab at the age of 11, so surely there was no immediate rush to get my, then six-months-old son inoculated? Then another friend said she was desperate to get her infant son immunised, but everywhere had run out of the drug. The evident desirability of the tuberculosis vaccination had me worried again: Is this a must-have immunisation, or something my child can easily, and healthily live without?
Because that's the most important question in every parent's mind, isn't it? What is the healthiest, safest and best option for my son or daughter's well-being? Unfortunately, when it comes to vaccinations, it's not always clear what the right answer is.
One problem is that the choice of vaccinations is always changing. This month sees two new additions to Ireland's childhood immunisation schedule. Babies, born on or after October 1, will now receive vaccines for Meningitis B and rotavirus at two and four months.
For decades, MenB has been the most common cause of bacterial meningitis in the UK and Ireland, and a leading infectious cause of death for children under five. The new vaccine was introduced in the UK last year and covers about 85pc of the MenB strains, and has so far proved effective in reducing the number of cases.
Trials have also shown it to have a good safety profile. "The only issue is that when we give MenB with the other vaccines, babies are more likely to get a temperature," explains Dr Brenda Corcoran, consultant in public health medicine at the National Immunisation Office. "Because of this, we will be recommending that babies are given paracetamol at and after the first dose at two months and at four months."
The additions mean the vaccine schedule for children born this month now looks like this. Birth: BCG/ Tuberculosis Vaccine. At two months, the six-in-one vaccine (diphtheria, tetanus, whooping cough/pertussis, Hib (Haemophilus influenza) Polio, Hepatitis B), PCV (Pneumococcal conjugate vaccine) MenB and rotavirus. Four months; six in one, MenB, rotavirus. At six months, six in one, PCV, MenC vaccine. At one year, the MMR (measles, mumps, rubella), MenB vaccine and only a month later, Hib/MenC and PCV.
Then when a child is in junior infants, it's recommended to get a booster against diphtheria, polio, tetanus and whooping cough, as well as a second dose of MMR vaccine. In secondary school there's a tetanus, low-dose diphtheria and pertussis booster, MenC booster and, for girls, the HPV vaccine to protect against cervical cancer (see panel).
Some diseases need multiple doses to make the vaccine effective (which is why you'll see the same names creep up) and you need to talk to your GP if your child has missed one because dosage can change with age.
But what about children on the old schedule - are they missing out? The Meningitis Research Foundation feels passionately that the new vaccine should be made freely available to more people.
"Introducing the MenB vaccine for babies is a major step forward, but restricting the vaccine to only this narrow highest risk age group can never prevent the majority of cases," says Vinny Smith, chief executive of the Meningitis Research Foundation. "We believe vaccinating teenagers could be key to greater protection, as it may stop them picking up and passing on the bacteria to others."
Parents can, depending on availability, buy the vaccine. On average one dose costs between €130 and €180 and children need between two and four doses to be fully protected (depending on their age).
"The schedule has to start at some point. We don't have enough funding and there was no catch-up programme recommended by the expert group," explains Dr Corcoran. "The hope is that once as many of the newer group are covered, that will help protect the older babies as well because there will be less of the germ around."
The second new vaccination is rotavirus, given orally, to protect against vomiting and diarrhoea bugs that hospitalise around 1,000 babies every year. It's a vaccine that has been introduced in most European countries and proved effective. The WHO has been recommending it since 2009 but, until now, it wasn't deemed cost effective in Ireland.
Since rotavirus is expected to affect every child in Ireland before they hit five, you might feel it's one worth paying the €140 for the required two doses. But, not necessarily says pharmacist at Milltown totalhealth and wonderbaba.ie, Sheena Mitchell. "After 24 weeks, it's not on the licence of the manufacturer as there is no safety data for use in older children," she reveals. "Time is of the essence and ideally it should be done before 16 weeks." The first dose can only be given from six weeks and doses must be four weeks apart.
The other two main discretionary vaccines are chicken pox and flu. If you or your child is in an 'at risk' category - suffering diabetes, liver or renal disease, severe asthma, Down syndrome - the flu jab is recommended. It's seasonal - this year's vaccine is to guard against the three main strains of flu for 2016/17 - so it only lasts the year and is only between 40-90pc effective. But for €20 it has an excellent safety profile and could reduce the risk of having your child off sick for a week.
Chickenpox has been on the vaccine schedule in the USA for over two decades. In Ireland parents have to pay around €55 per dose. Children must be over 12 months, need two doses, one month apart and at least one month after other live vaccines, like MMR. It's safe and has about a 90pc rate of success but it's not clear what its long-term success is.
"With chickenpox, the question of whether to vaccinate or not is difficult because the symptoms can be quite mild or severe," says Sheena, also a pharmacist expert for mummypages.ie. "And we don't know if it gives long-term immunity."
Most people who have had chickenpox develop lifelong immunity, whereas its unsure whether the vaccine will do the same, potentially leaving adults susceptible to the disease (which is more severe as an adult). There's also a possibility that reducing the incidence of childhood chickenpox could increase the level of adult shingles.
The reason Ireland has some vaccines on its schedule and not others, compared to other Western countries, is because vaccinations are both area and time specific. The BCG is not given in most other Western European countries and was only advised in Ireland in recent years because we had high rates of TB. Now rates are down, it looks likely that routine BCG will no longer be advised. We have MenB and MenC because those illnesses are common here. Even though diseases like polio aren't commonplace in Ireland, we still need the vaccine because they are common elsewhere in the world.
"Even though you don't see the diseases, they may only be a plane ride away, so you have to make sure you get the vaccines and keep our rates up, otherwise we may be vulnerable," explains Dr Corcoran. "This is the issue, parents don't see the diseases because the vaccine rate is so high but if we drop the vaccine rates, the diseases come back."
While some parents might be keen to fork out for additional vaccines, others worry about accessing the existing recommended jabs. One of the largest ever global surveys of attitudes of people on vaccines recently revealed that Europeans are the most sceptical of vaccine safety.
Despite Andrew Wakefield's 1998 report - linking MMR and autism - being widely disproved, a 2014 survey by the National Consumers League found that one third of parents with children under 18 still believe vaccines can cause autism. Currently many countries, including Ireland, are facing controversy around the HPV vaccine.
"I think parents are questioning the timing and the sheer number of vaccines currently on the schedule," says Catherine Weitbrecht from Irish Vaccination Awareness (IVA). "In Ireland a baby will receive 27 doses of 13 diseases by the time they are 13-months-old (excluding BCG at birth). Some parents question a baby's ability to develop sufficient antibodies at such a young age, especially given the combination given at any one time. They also are questioning the ingredients for such small babies."
The uptake for infant vaccines in Ireland is high, standing at 96pc; MMR is 93pc (up from 70pc at the height of the autism scare) but HPV has dropped from 87pc to 70pc.
Catherine reports that parents feel "brushed off" when they voice concerns to their doctor about vaccine ingredients, multiple vaccines and whether a one-size fits all is the best approach to childhood immunisation.
"Healthy scepticism and a need to know exactly what they are injecting into their babies brings parents to IVA," she says. "There appears to be too many, too soon in most people's minds."
There's also confusion about the efficacy of some vaccines. For example, it was recently revealed that the whooping cough vaccine has no long lasting protection.
"But whooping cough as an adult is annoying, in small babies it can result in hospitalisation and even death," says Dr Corcoran. "That's why it's important to get the vaccine at the recommended age."
She worries that parents reading online about vaccines don't get the full story. "No medicine is without risk, so it's important to get scientifically accurate information. Our website, immunisation.ie, is accredited by the World Health Organisation as providing factual, accurate information."
For more information, see www.immunisation.ie or call 01-867 6108
HPV vaccine: is it safe or Not?
Since September 2011, the HPV (human papillomavirus) vaccine has been offered to girls in their first year of second-level school. The vaccine protects against over 100 viruses including the two types causing seven of all 10 diagnosed cervical cancers.
The two main HPV vaccines are Gardasil (used by the HSE) and Cervarix. But in recent years Gardasil has received negative press with girls — more than 300 in Ireland and many more in other countries — claiming a link between receiving the vaccine and developing severe long-term conditions, including chronic fatigue and fibromyalgia.
“The vaccine most parents worry about is the HPV vaccine,” says Catherine Weitbrecht, from Irish Vaccination Awareness. “Parents are mostly questioning the ingredients in Gardasil and the affect they might have on pre-pubescent girls.”
Fuelling the belief that Gardasil might be dangerous is the fact that Denmark recently replaced using the drug with Cervarix.
But Dr Corcoran says there was another reason for this. “The reason Denmark changed was because they did a tender process and, based on finance, on a cost basis, they chose Cervarix. It was nothing to do with the safety of the vaccine, it was a commercial decision.”
She says parents need to look at the science before making a decision on HPV. “All scientific evidence shows there is no link between the HPV vaccine and the development of these long-term conditions,” she says.
“The scientific evidence is that these conditions occur in teenagers and have done so for many, many years. There is no change in the numbers of girls who are getting these conditions in girls who have been vaccinated compared to girls who are not being vaccinated.”
Every year 90 women in Ireland die from cervical cancer. “You want to do what’s best for your child, you want to protect them from terrible diseases and we know that last year 5,000 girls were not protected from HPV who would have been protected in the previous year,” says Dr Corcoran.
“And we know that unfortunately some of those girls will develop cervical cancer, they may have to have quite invasive treatment, surgery, chemotherapy. They may end up having actual cervical cancer and some of them will unfortunately die. What we’re trying to do is prevent that. We don’t want to scaremonger, we want to give parents the facts.”
– Chrissie Russell