To immunise or not to immunise? That is the question.

Historically, New Zealand’s statistics of children who were immunised against certain diseases, such as diphtheria, tetanus and pertussis (a) have not improved much.  In some years immunisation statistics have decreased for certain viruses, for example the measles virus (b).

Why are parents choosing not to immunise their children?  The Ministry of Health (MOH, 2007) reported that a main reason prompting parents to be against immunisation were their fears of adverse reactions to immunisations.  Hamilton, Corwin, Gower, and Roger’s (2004) research found that parents who chose not to immunise because of fears of adverse effects were highly educated and had read widely on the issue themselves as they lacked trust in the information that the Government provided.  However, the data sample for their research was taken from Christchurch and therefore is not a nationwide representation. Many examples of this ideology became evident with the recent outbreak of the measles virus.  Gluckman (as cited in Kirk, 2011) states “parents have been taken in by misinformation that immunisations can cause autism, which is a load of rubbish” (para. 4).

In 1992, Dr Andrew Wakefield published two articles relating to the Mumps Measles Rubella (MMR) immunisations and autism, the first in 1998 and the second in 2002.  The Lancet, who published the 1998 article, retracted it after an inquiry into the validity of the research. Opposing research then countered the findings of the second article. The American Medical Association (n.d.) states that “four studies have been performed to refute a causal association between receipt of MMR and autism” (para. 15).  The MOH (2011a) states “there are many examples in the medical literature of negative press coverage, and a subsequent reduction in vaccine uptake, followed by a resurgence of disease” (p. 354).

The Immunisation Awareness Society (IAS) promotes the right to having an informed decision regarding immunisation. Although the society states that it does not advise parents not to immunise, I found their articles to be anti-immunisation, by advising other options to remain healthy.  They advise alternate ways to remain healthy, yet they do not discuss what parents can expect if their child does get infected with the wild form of a virus.  The wild form of a virus is to contract it naturally without being vaccinated.  In a recent reported case of tetanus, parents said “they made what they thought was an informed decision not to vaccinate any of their children because of concerns over adverse reactions, but had since changed their minds” (Akoorie, 2012, December, 22, para. 18).  The IAS has stated their opinion relating to this article.

The Royal New Zealand Plunket Society (1993) states there is a greater risk in developing worse cases of illnesses from the wild form of a virus, such as encephalitis and meningitis, compared to those cases who had been vaccinated.  In addition, the MOH (2011b) reports “the only absolute contraindication to receiving a vaccine is an anaphylactic reaction to a prior dose of, or an ingredient in the vaccine.  However, immune dysfunction can be a contraindication to receiving live vaccines” (p. 349).  So yes there are risks of anaphylactic (allergic) reactions and virus related illnesses associated with immunisation.  However, allergic reactions are rare, and the severity of illness caused by viruses is reduced by being vaccinated (by not being the wild form).

What is now becoming apparent is that many children are not completing their immunisation schedules, which is also a major issue. “Ministry of Health figures showed about 5 per cent of parents object to childhood immunisation” (Kirk, 2011, para. 10).  Therefore, if only a minority are against child immunisation, then it is parents from within the majority, being pro-immunisation, who are not completing the immunisation program.  I found this very surprising as I thought the percentage of parents against immunisation was much greater.  The Herald reported recently that nearly 20 percent of New Zealand parents failed to immunise their children on time.  I was unaware that so many parents were not completing their children's immunisation schedules.  A recent news article concerning the death of a teenager, who contracted the Meningococcal C virus, reiterates the need for parents to know exactly what their children are being immunised for and ensure the vaccines are administered on time.

The MOH (2007) stated that two main risk factors for young children failing to complete their immunisations are missed appointments and frequent address changes.  Missed appointments were due to parents’ identifying their child as being unwell and rescheduling being not followed up (MOH, 2007).  Frequent address changes mobility were identified as an issue for a large percentage of Māori; health providers failed to follow-up on their immunisations (MOH, 2007).  Both of these risk factors seem to suggest that children’s health providers are lacking the necessary processes required to effectively monitor and manage their clients’ immunisations.

So how is the government addressing these issues?  “Since August 2007, increased immunisation has been a health target.  In July 2009, the Government showed its commitment to immunisation by making it one of six nationwide Health Targets” (MOH, 2011c, para.1).  More research by the MOH (2011a) identified another major reason why parents choose not to immunise: they believed it not necessary due to a low number of vaccine preventable disease outbreaks in 2010.  The MOH (2011c) reports that, while two year-old immunisation rates have recently improved, the low rates prior to this time had enabled the breakthrough of vaccine preventable diseases, such as measles and whooping cough.  Due to these recent outbreaks of diseases, parents’ awareness of immunisation has been brought to the forefront, with the Government recognising the need to increase immunisation rates at earlier ages (MOH, 2012, December, 3) as a priority.  The Health Promotion Advisory (HPA, 2012) has been established by the Government to assist in reaching immunisation targets.  “The HPA’s work is to provide quality resources to promote immunisation and disease prevention, and to support the Ministry of Health with outbreak responses” (p. 17).

References

Akoorie, N. (2012, December, 22). 'It was hideous' - Family's tetanus agony. The New Zealand Hearld. Retrieved from http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10855638

Akoorie, N. (2013, January, 19). Son’s ordeal was our fault, say parents. The New Zealand Hearld. Retrieved from http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10855638

American Medical Association. (n.d.). The relationship between the MMR vaccine and autism. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/public-health/vaccination-resources/pediatric-vaccination/relationship-between-mmr.page

Kelso, J. M. (n.d.). Allergic reactions to vaccines. Retrieved from http://www.uptodate.com/contents/allergic-reactions-to-vaccines

Kirk, S. (2011, April, 18). Vaccination rate ‘dismal’. Retrieved from http://www.stuff.co.nz/national/health/4900007/Vaccination-rate-dismal

Hamilton, M., Corwin, P., Gower, S., & Roger, S. (2004).  Why do parents choose not to immunise their children? Journal of the New Zealand Medical Association. Retrieved from http://journal.nzma.org.nz/journal/117-1189/768/

Health Promotion Advisory. (2012). Statement of intent 2012-2015.  Retrieved from http://www.hpa.org.nz/sites/public_files/documents/FINAL%20SOI%202012-15%20single%20pagesFinal.pdf

Immunisation Awareness Society. (2013, January, 20). Informed choice: More than just ‘yes’ or ‘no’. Retrieved from http://www.ias.org.nz/vaccines/informed-choice-more-than-just-yes-or-no/

Immunisation Awareness Society. (2013, January, 17). Vaccine deaths. Retrieved from http://www.ias.org.nz/vaccination-2/vaccine-deaths/

Immunisation rates must improve – Plunket (2012, April, 27). Retrieved from http://www.3news.co.nz/Immunisation-rates-must-continue-to-improve---Plunket/tabid/423/articleID/252044/Default.aspx

Ministry of Health. (2007). The national childhood immunisation coverage survey 2005. Wellington, New Zealand: Author.

Ministry of Health. (2011a). Immunisation Audience Research. Retrieved from http://www.health.govt.nz/publication/immunisation-audience-research

Ministry of Health. (2011b). Immunisation handbook 2011. Retrieved from http://www.health.govt.nz/publication/immunisation-handbook-2011

Ministry of Health. (2011c). Targeting immunisation: Increased immunisation. Retrieved from http://www.health.govt.nz/publication/targeting-immunisation-increased-immunisation

Ministry of Health. (2012, August, 9). Measles scare prompts immunisation rethink. Retrieved from http://www.health.govt.nz/our-work/diseases-and-conditions/measles/stories-2011-measles-outbreaks/measles-scare-prompts-immunisation-rethink

Ministry of Health. (2012, December, 3). Health targets 2012/13: Increased immunisation. Retrieved from http://www.health.govt.nz/new-zealand-health-system/health-targets/2012-13-health-targets/health-targets-2012-13-increased-immunisation

Organisation for Economic Cooperation and Development. (2012, October, 30a). Immunisation: Diphtheria, tetanus, pertussis percentage of children immunised. Retrieved from http://www.oecd-ilibrary.org/social-issues-migration-health/immunisation-diphtheria-tetanus-pertussis_immu-dtp-table-en

Organisation for Economic Cooperation and Development. (2012, October, 30b). Immunisation: Measles percentage of children immunised. Retrieved from http://www.oecd-ilibrary.org/social-issues-migration-health/immunisation-measles_immu-measle-table-en

Quilliam, R. (2013, April, 17). NZ parents slow to immunise children. The New Zealand Herald. Retrieved from http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10878171

Royal New Zealand Plunket Society. (1993). Immunisation: Questions and answers. Dunedin, New Zealand: Author.

Wakefield, A. J. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet. Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)11096-0/abstract