Talking with parents about immunisation- developing trust and providing information Redbridge 29-09-2011 David Elliman (Whittington Health) with acknowledgements to Helen Bedford
Immunisation process • Research shows:- – Most parents satisfied, even if consented to immunisation – However, a small but significant minority have criticisms Lack of information
Parents’ questions and concerns are predictable Are vaccines safe? Why does my baby need all these vaccines when you don’t hear about the diseases anymore? Why do we need to immunise babies at such a young age? I am breastfeeding won’t that protect my baby against these infections? Don’t all these vaccines overload the immune system? Won’t the other things in vaccines harm my baby? I use homeopathy and do not want my baby to have conventional vaccines I am worried that MMR causes autism • Professionals need to be well informed about specific issues • Many resources available-have them to hand and use them
Are vaccines safe? • Generic answer – What do you mean by safe? - Nothing effective is without side effects. – Extensive trials before licensing – Batch testing before release – Postmarketing surveillance – yellow card, etc. – Specific studies • Specific issues – Particular response
Why does my baby need all these vaccines when you don’t hear about the diseases anymore?
Why does my baby need all these vaccines when you don’t hear about the diseases anymore? • Incidence of diseases reduced BECAUSE of vaccines • When vaccine uptake falls diseases re- emerge • Travel to and from countries where many diseases endemic
Diphtheria • May 2008 – first death for over a decade from C.diphtheriae • Unimmunised school age child • Moved to the UK from Europe in late 2007 • No carriers found • One family member had travelled to Africa earlier that year, returning to UK one month before the child became unwell • Last previous death in UK from C .diphtheriae was in 1994 – an unimmunised school child from the Indian subcontinent
Diphtheria • December 2009 • Teenager presented with a severe sore, pustular tonsils and abdominal pain in the right upper quadrant. • Admitted to hospital and treated with IV antibiotics • Diagnosed as glandular fever • Toxigenic strain of C. diphtheriae identified, – born in the United Kingdom with no recent history of travel or known contact with a case of diphtheria or a carrier – partially vaccinated (no PSB, but booster Jan 2009)
Polio • Eliminated from Western hemisphere • 1349 cases worldwide in 2010 (1659 in 2008) • Remains endemic in four countries: • Nigeria (21) India (42) Pakistan (144) Afghanistan (25) • Total this year (to 6 th July 2011) 401 – was 663 at this point last year http://www.polioeradication.org/casecount.asp
1597 cases 2009
Polio in Tajikistan - 1st importation since Europe certified polio-free (2002) • In 2010, there was an outbreak of disease in Tajikstan, with a total of 458 cases of paralytic polio reported. • The virus was most closely related to virus from Uttar Pradesh, India • Subsequently, the Russian Federation reported 14 cases, Turkmenistan reported three and Kazakhstan one case. The infection was most likely imported from India. • As at the beginning of 2011, the outbreak seemed to have been terminated. • This emphasises the importance of continuing immunisation until the disease has been eradicated.
I think 8 weeks is too early to start giving my baby vaccines. I would prefer to wait until he is 6 months old, after all he was premature. In any case he is breastfed so he will be protected by that.
Age of immunisation • vaccines used to be given-3,5 & 9 months • 1990-changed to 2,3,4 months • early protection is important • whooping cough kills v young babies
Pertussis notifications and deaths with a mention of pertussis in age group >1 year: 1994-2010 (HPA)
Pertussis notifications and deaths with a mention of pertussis in infants: 1994-2010 (HPA)
Age of immunisation • vaccines used to be given-3,5 & 9 months • 1990-changed to 2,3,4 months • early protection is important • whooping cough kills v young babies • peak age for Hib (6-12 months)
Age of immunisation • vaccines used to be given-3,5 & 9 months • 1990-changed to 2,3,4 months • early protection is important • whooping cough kills v young babies • peak age for Hib (6-12 months) • fewer reactions when vaccines given at younger age particularly with whole cell pertussis vaccine, less so with acellular (Ramsay et al . BMJ 1992; Miller et al . Vaccine 1997)
Prematurity - Efficacy • Very premature infants may have a reduced response to some vaccines and need serology to check response at neonatologist’s discretion • Less of a problem now we have boosters of conjugate vaccines at 12 months
Prematurity – Adverse Effects • Mostly not a problem, in fact fewer adverse reactions BUT • Infants born very prematurely (born ≤ 28 weeks of gestation) and with a history of respiratory immaturity are at greater risk of apnoea after primary immunisations • If still in hospital at time of first immunisation should have cardiorepsiratory monitoring for 48-72 hours. • If have cardiorespiratory problems with first set of immunisations, should be readmitted and monitored for second set.
Breastfeeding • breast milk reduces risk of GI, respiratory and middle ear infections • some protection against Hib, meningococcal and pneumococcal disease • ? Better response to Hib vaccine in breastfed babies • otherwise little if any protection against vaccine preventable infections • breastmilk not an alternative to immunisation
9 Feb 2006
I am worried that giving my baby all these vaccines at the same time will overload my child’s immune system. I would prefer her to have them separately.
Vaccines and “immune overload” • immune system constantly challenged • cells of immune system constantly being replenished
Number of bacteria in human body Part of body Number of bacteria 1,000,000/cm 2 Scalp 1000/cm 2 Surface of skin Saliva 100,000,000/g Nasal mucus 10,000,000/g Faeces Over 100,000,000/g The Human Immune System: Barriers to infection (non-specific immunity) http://www.schoolscience.co.uk/content/4/biology/abpi/immune/immune3.html
Vaccines and “immune overload” • immune system constantly challenged • cells of immune system constantly being replenished • no increase in serious bacterial or viral infections following MMR vaccine (Miller et al . Arch Dis Child 2002; ). • no increase in hospitalisation for infections following other vaccines (Hviid et al. 2005 JAMA) • fewer minor infections following vaccination (Otto et al 2000 J.Infect) • no evidence to support link with atopy or autoimmune diseases
Vaccines and “immune overload” • babies given vaccines against 10 diseases in first 13 months: diphtheria/tetanus/pertussis/polio/Hib/PCV/menC/measles/mumps/rubella • 25 separate injections • ? interval between doses • child older when fully protected • distressing for baby and parent/carer • more local reactions • additives in all vaccines-fewer if given in combination
Number of different immunogenic proteins and polysaccharides in vaccines (from Offit 2002) 1960 1980 • Smallpox ~200 • Diphtheria 1 • Diphtheria 1 • Tetanus 1 • Tetanus 1 • Pertussis (WC) ~3000 • Pertussis (WC) ~3000 • Polio 15 • Polio 15 • Measles 10 Total vaccines 5 Total vaccines 5 Total antigens ~3217 Total antigens ~3027
Number of different immunogenic proteins and polysaccharides in vaccines ( fromOffit 2002) 2004 2011 Diphtheria 1 Diphtheria 1 Tetanus 1 Tetanus 1 Pertussis (ac) 5 Pertussis (ac) 5 Polio 15 Polio 15 Hib 1 Hib 2 Meningococcal C 2 Men C 2 Measles 10 PCV 13 Mumps 9 MMR 24 Rubella 5 Total vaccines 9 Total vaccines 10 Total antigens 49 Total antigens 63
The Sun, August 10, 2004. Page 3 NEWS IN BRIEFS Katie understands parents concerns over the new five-in-one jab. She said: “Tony Blair has done the right thing by publicly reassuring mums and dads. The experts seem to agree that the five-in-one is a positive step so I think most parents will put their faith in the government.”
Won’t the other things in vaccines harm my baby?
Mercury in vaccines (Thiomersal) • Thiomersal is 50% wfw mercury • Small quantity in some vaccines in the past • Studies in UK and US have shown no evidence of harm. • It is wise not to add anything to vaccines that is not needed (precautionary principle) • Therefore thiomersal should be phased out of vaccines, where they are equally safe and effective as thiomersal containing vaccines.
Recommend
More recommend
