Immunisation uptake rates in children are on the rise in Ireland, but they are still not up to WHO standards, writes Sylvia Thompson
As 400 health professionals gathered in Croke Park yesterday for the National Immunisation Conference, public health specialists in Ireland will have been pleased to report that immunisation uptake rates in children in Ireland are gradually increasing to levels necessary for so-called "herd immunity".
"The most recent figures show that national uptake rates for the five-in-one (diphtheria, tetanus, whooping cough, polio and Hib) and meningococcal C, were 91 per cent at 24 months. However, they are still lower than in England (93-94 per cent) and Northern Ireland (97 per cent) so there is no room for complacency," says Dr Brenda Corcoran, consultant in public health medicine at the HSE National Immunisation Office.
Uptake rates for the MMR (measles, mumps and rubella) vaccine and Hib booster were 86 per cent at 24 months, according to the Health Protection Surveillance Centre (HPSC) which publishes detailed figures four times a year. Although this figure has increased by 9 per cent since 2003, it is still 9 per below the national target rate of 95 per cent uptake. Uptake rates for all other vaccines at 24 months were 4 per cent below the national target rates.
"We take guidance on our national targets from the World Health Organisation, so we still need to improve our uptake rates and some areas have higher rates than others," says Corcoran. Internationally, it is agreed that to prevent an outbreak of a disease, 95 per cent of the target population must be vaccinated.
The uptake rates for MMR vaccine is the area which still causes the most concern. "Uptake rates for the MMR have always traditionally been lower than other vaccines but they dropped dramatically following the now discredited Andrew Wakefield study linking the MMR to autism," explains Corcoran. Following the drop off - to 69 per cent at one stage - Ireland experienced an outbreak of measles in 2000 (with over 1,600 cases and three children died) and again in 2003 (with over 500 cases).
"There have been a large number of studies since then which have shown that the MMR offers huge protection against the measles without side effects and that there is no link between the MMR and autism and bowel disease," she says.
As part of their participation in European Immunisation Week, which began yesterday, the HSE is driving home the message that the MMR is a safe, effective vaccine which should be given to all children over 12 months old and then again at four or five years old. Ireland is also committed to the WHO initiative to eliminate measles from Europe by 2010.
Tom O'Dowd, professor of general practice at Trinity College Dublin is also a GP in west Tallaght. He says that more sophisticated computer systems are reaching people better than before . He adds that most immunisation programmes are now carried out by practice nurses who do a very good job. "In our GP practice, the doctor is only called in to examine a child if a parent is concerned about the child getting the vaccination."
Corcoran says that new guidelines, to be issued shortly by the HSE National Immunisation Office, state that there are very few reasons why a child shouldn't be vaccinated. "The only contra-indications are if the child has a high temperature or has had a severe allergic reaction to a previous vaccination," she says. She is also keen to point out that researchers haven't found any risks associated with multiple vaccinations and that the single vaccinations, delivered by a small number of doctors in this country, are not licensed by the Irish Medicines Board.
"All our vaccines are manufactured in western Europe and are delivered in temperature controlled conditions which is important. We can't guarantee that such temperature controls are in place for the single vaccinations," she explains.
Dr Niall O'Cleirigh of the Irish College of General Practitioners says that increased numbers of practice nurses has helped to improve immunisation programmes nationally. He says that there may be a concern about non-nationals who move to live in a different area, starting immunisation in one area and not being picked up to continue it in another area. The setting up of a national immunisation database, which was first proposed in 2002 would help GPs track all children, no matter where they lived in Ireland. A proposal for such a database still exists but it appears there are no plans to move it on at present.
Generally speaking, public health specialists and GPs agree that the immigrant population is compliant with immunisation. "In Ireland, we have only folk memories of infectious diseases such as the measles, but people who come from places like Nigeria have seen people suffer with the measles and other infectious diseases, so they have a strong sense of the value of immunisation," says O'Dowd.
This lack of direct experience of infectious diseases may have been a factor in a recent study which found that some Irish parents were not having their children vaccinated. The study, which was carried out by a surveillance scientist in the HSE North West area, found that parents who delay or refuse vaccines were more likely to have a high income and high standard of education.
"Both groups of parents exist," says Corcoran. "Some parents can have problems finding suitable times to go to immunisation clinics and there have been other issues around parents using websites which might not be totally accurate as their sources of information." To combat the latter scenario, the HSE launched its own website in October 2005 (www.immunisation.ie) which is the only Irish website on immunisation which has been accredited by the WHO.
Experts in the WHO state, unequivocally, that if immunisation loses priority, we will see highly contagious diseases such as diphtheria, measles or even polio re-emerge - causing death and disability. And while there are no plans to make vaccination mandatory in this country, public health specialists are keen to point out that information on the benefits of vaccination needs to be reinforced at every opportunity.
EARLY YEARS:A childhood vaccination timetable
At birth: BCGis a vaccine that protects against tuberculosis. It is usually given to newborn babies while they are still in hospital. The vaccine contains a weakened form of a bacteria related to the one that causes tuberculosis. Most people will get a blister and scarring on the arm where the BCG injection was given. One in 100 may get small swollen glands under the arm. One in a 1,000 may get an infection which responds to treatment.
At two months, four months and six months:A five in one vaccine for diphtheria, tetanus, whooping cough, polio and Hib. A meningococcal C vaccine is also given.
Diphtheriais a disease caused by bacteria called Cornebacterium diphtheriae. Of the people who get diphtheria, one in 15 will die. The diphtheria vaccine is safe. One in 10 who receive the vaccine will have redness and swelling where the injection was given or have a fever. Serious side effects are very rare.
Tetanusis a painful, often fatal disease. Of the people who get tetanus, one in 10 will die. The risk is greatest for the very young or those aged over 60. The tetanus vaccine is safe. Of the people who are immunised, one in 10 have redness and swelling where the injection was given. Serious side effects are very rare.
Whooping coughcan last up to three months. It is most serious in babies under 12 months of age, often requiring admission to hospital and it may be fatal. Of the people who are immunised, one in 10 will have redness and swelling where the injection was given or have a fever. About 1 in 2,500 may cry for more than three hours after immunisation. More serious side effects, such as fitting, may occur in 1 in 12,500 children vaccinated. Most of these events have no long-term consequences. Very rarely, severe nervous system problems have been reported.
Poliocan cause paralysis the breathing and swallowing muscles, leading to death. Inactivated (killed) polio vaccine (IPV) is a very safe vaccine. No serious side effects have been recorded for inactivated polio vaccine which has been used for over 40 years. Haemophilius influenzae B (Hib)can cause serious diseases including meningitis, septicaemia, epiglottitis and osteomyelitis. Some children may have discomfort, redness or swelling where the injection was given.
Meningococcaldisease is a life threatening illness. This bacterial infection can cause meningitis and septicaemia. Meningococcal C (Men C) can be prevented by immunisation. Of those immunised, one in 20 babies will get redness or swelling where the injection was given and/or get a fever. One in 100 may get a tummy upset or vomit.
At 12-15 months: MMR(measles, mumps and rubella) and Hib booster. The MMR is a live vaccine which contains a weakened form of the measles, mumps and rubella viruses. The vaccine gives protection against the disease with no illness at all or a very mild non-infectious version of the illness. See www.hpse.ie for extensive information on the MMR vaccine. All children reaching 12 months of age are now offered the Hib booster at the same time as MMR vaccine to give extra protection against Hib infection.
At four to five years:Children are given a four-in-one vaccine for diphtheria, tetanus, whooping cough and polio. They are also given an MMR booster vaccine.
All information is adapted from the www.immunisation.ie and www.hpsc.iewebsites.