Vaccinations

A hot topic lately has been vaccinations – during pregnancy, for kids, etc.

Let me preface this entry by saying that its purpose is to neither encourage nor discourage you or your family from being vaccinated – it’s only to discuss some of the issues surrounding this topic.

The influenza vaccination is recommended for most pregnant women – studies have shown that pregnant women with influenza have an increased risk of complications, including hospitalisation, intensive care unit admission, pre term delivery, and sometimes (in severe cases) even death.

Babies born to vaccinated mothers had a reduced risk of contracting influenza in the first six months of life. The latest Australian immunisation handbook recommends that all pregnant women who will be in their second or third trimester during influenza season be vaccinated, although the vaccine can be given in any trimester.

Despite this recommendation, the uptake of influenza vaccine by pregnant women in Australia is low, ranging from 7-40%. It has been proposed that one reason for the low uptake level is due to a lack of direction from healthcare providers to pregnant women to get vaccinated. One recent study showed that women are more likely to have the influenza vaccination when pregnant if it is recommended by their healthcare provider, but in the study sample fewer than 50% of the women had received such a recommendation.

Another reason why pregnant women don’t get their influenza vaccination is that they prefer to use ‘other methods’ to prevent them contracting the disease – eg. Using surgical masks. However, it has been found that influenza can sneak past masks, with one study finding air samples yielding small-particle viral RNA as far as 6 feet from infected patients. So much for that theory…

Regarding the vaccination of kids, there are groups out there who are largely ‘anti-vaccination’ and this is upsetting some in the medical mainstream. Official Australian figures are showing that ~80,000 children are not immunised – this is not only due to parents conscientious objections to vaccination, but also other factors such as changing address, losing track of documentation and losing touch with their family doctor.

Those ‘in charge’ are arguing that low vaccinations rates are in part as a result of lack of education of parents, but when you look at the areas which have the lowest vaccination rates – Manly, Mosman, inner west Sydney, Byron Bay, Lennox Heads, the Blue Mountains, Kempsey and Nambucca – it’s likely that these parents are not only sufficiently educated, but also likely highly informed of the pros and cons of vaccination.

In any event, vaccination supporters are arguing that under- and non-vaccinated children are putting the community at risk. Interestingly, while the Government is unhappy with the low vaccination rate, last year they also axed the funding that used to support GPs in tracking childhood vaccinations They have also linked eligibility for some family payments to vaccination – for instance, to be eligible for the $726 Family Tax Benefit Part A supplement, parents are required to ensure that their children are fully immunised, unless (and correct me if I’m wrong), parents have a ‘conscientious objector’ form signed by a GP or immunisation provider, in which case they’re still eligible for that part of the Family Tax Benefit. This form states that they have chosen not to have their child immunised based on “a personal, philosophical, religious or medical belief involving a conviction that vaccination under the National Immunisation Program should not take place”.

Anyway, the decision is up to you, check out the following websites for some further reading:
The science of immunisation: questions and answers (http://www.science.org.au/policy/immunisation.html)
Australian Vaccination Network (http://avn.org.au/)

REFERENCES
Wiley KE, Massey PD, Cooper SC, Wood NJ, Ho J, Quinn HE, Leask J. Uptake of influenza vaccine by pregnant women: a cross-sectional survey. Med J Aust. 2013 Apr 15;198(7):373-5.
 Neuzil KM, Reed GW, Mitchel EF, et al. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol 1998; 148: 1094-1102.
 ANZIC Influenza Investigators and Australasian Maternity Outcomes Surveillance System. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ 2010; 340: c1279.
 Jamieson DJ, Honein MA, Rasmussen SA, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009; 374: 451-458.
 Tamma PD, Steinhoff MC, Omer SB. Influenza infection and vaccination in pregnant women. Expert Rev Respir Med 2010; 4: 321-328
 Bischoff WE, Swett K, Leng I, Peters TR. Exposure to influenza virus aerosols during routine patient care. J Infect Dis. 2013 Apr;207(7):1037-46. doi: 10.1093/infdis/jis773. Epub 2013 Jan 30.
 Anti-vax parents failing in responsibility to all. Australian Medicine 2013 Apr 22.
 Doshi P. Influenza: marketing vaccine by marketing disease. BMJ. 2013 May 16;346:f3037. doi: 10.1136/bmj.f3037.

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