A group of Irish doctors has urged health boards to offer parents the option of individual injection vaccinations, instead of the current three-in-one jabs, in a bid to encourage them to have their children vaccinated.
The Association of General Practitioners, which represents 600 family doctors, believes many parents are fearful of having their children immunised with the three-in-one vaccine for measles, mumps and rubella (MMR). These fears are resulting in low take-up rates for these vaccinations.
Medical experts are warning that with just 77 per cent of children having received the MMR vaccination, a measles epidemic is almost inevitable in the Republic within the next two years. The State needs a vaccination rate of 95 per cent to protect against the rapid spread of measles, according to the director of the National Disease Surveillance Centre, Dr Darina O'Flanagan. "I have no doubt that unless we get our uptake rate to 95 per cent within the next few years we would expect a major increase in the number of our cases of measles," says Dr O'Flanagan. "Parents should have their children vaccinated because the benefits dramatically out-weigh any of the side-effects. Many people think these are mild illnesses, but some children do die. Three children died in the last measles epidemic in 1993."
The Association of General Practitioners' spokeswoman, Dr Mary Grehan, says that while many parents are not afraid of the vaccines, they are fearful of the combined effect of their children being injected with three viruses at the one time.
Dr Grehan says the North Eastern Health Board and the Western Health Board are among a number of health boards which had offered three separate injections, instead of the MMR vaccination.
However, this option has been withdrawn in recent months because the health boards say the individual vaccinations are too expensive, according to Dr Grehan. "They claimed they had to get big batches from the pharmaceutical companies and there was a greater chance of these going out of date."
But North Eastern Health Board press officer Ray Mitchell denies this. The board continues to provide single-dose vaccinations in a small number of cases. The cost of such a service is not an issue, he insists.
The normal policy of the North Eastern Health Board is to supply the MMR as a single vaccination, Mitchell explains.
"In a small number (low single figures) of cases, individual doctors have requested separate vaccination and have been facilitated," he says. "Very few doctors do request this, but when they do and when they can make a valid case for a patient, we facilitate them."
Providing children with three separate injections has the same benefit to their immune systems, without the risk of any interaction, Dr Grehan says. From her experience of her practice in Co Louth, all parents completed the course of three injections. Her practice has had a 97 per cent uptake rate for MMR vaccinations, she says.
There are 35 side-effects to the three-in-one vaccination alone, Dr Grehan says, but these are not spelt out to parents because the primary concern of the health boards is public health and ensuring as high a vaccination uptake as possible.
However, there is no evidence that the single shot vaccinations are any safer than the three-in-one vaccination, and there is some evidence to suggest that the separate vaccinations may put children at risk, according to Dr Anthony Staines, a lecturer in epidemiology at UCD's Department of Public Health and Epidemiology.
One of the dangers of the three single doses is that several months have to be left between each shot, and the child runs the risk of contracting the other diseases in this intervening period. "This is one of the key reasons why every country I know does the single dose," says Dr Staines. By giving three separate injections to a child, there is a risk the child may suffer three bouts of fever as a side-effect, compared to a single bout after the MMR, he believes.
"In fact there is no scientific evidence to show that it is either beneficial or harmful to give the vaccines separately," says Dr Staines.
There is concern that in giving three injections instead of one, there is a risk that children may not get all three vaccinations, he says. "The harder you make it to get vaccinated, the lower the compliance rate will be."
The Department of Health warns that if the vaccines are given separately, it would adversely affect the uptake rate and would cause both children and the people they come into contact with to be exposed to these potentially serious diseases for a much longer time.