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Contemporary Issues - Immunisations

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Kento Hagino

on 5 October 2014

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Transcript of Contemporary Issues - Immunisations


Contemporary Issues - Immunisations
Don't be judgemental or angry
Show you understand the parents' view
Ask if they would LIKE to know more about the issue from a doctor's perspective
Minimise 'forcing' of opinion
Ultimately parent's chocie
Explaining to reluctant parents
- Coverage
- Herd immunity
- Anti-immunisation lobby
- Compulsory vaccinations
The Anti-Immunisation Lobby
Approximate herd immunity values
- Diphtheria 85%
- Measles 83-94%
- Mumps 75-86%
- Pertussis 92-94%
- Polio 80-86%
- Rubella 83-85%
- Smallpox 80-85% (13)

Herd Immunity
Introducing antigenic material into the body to stimulate an adaptive immunity.
Four types:
- Inactivated
- Attenuated
- Virus-like particle/conjugate/subunit
- Toxoid (1)
What are vaccinations?
- Since 1996
- Included if <7yo and enrolled in Medicare
- Used for:
- Ease of obtaining records
- Measuring coverage and penetrance in communities
- Recording performance of individual centres. (3)
National Immunisation Register
Main: HB Vax, Infanrix, Prevenar 13, RotaTeq (2)
Immunisation Schedule
Reasons against vaccinations
- Unnatural
- Invasive and distressing to child
- Religious/cultural
- Cost
- Negative publicity
Feared side-effects of vaccination
Contracting the illness to be immunised against
Other idiopathic illness (ADHD, MS etc)
History of problems
RSV vaccine
Rotavirus vaccine and intussusception
- Study by Andrew Wakefield linking the MMR vaccine and autism
- Study published in 1998 since retracted, and Wakefield banned from practice
- Much new evidence refuting a link
Compulsory Vaccinations
- Parental autonomy as surrogate for child
- Not vaccinating places other children at risk
- "Free-riders"
- Parental autonomy vs paternalism (3)
Future Implications
New Diseases
Increasing coverage
New techniques
New Diseases:
New Infectious Diseases
Alzhiemer's Disease
Increasing coverage:
90% immunisation coverage.
Polio eradicated and measles mortality reduced to 90% of that in 2000.
New Vaccines:
Vaccine modalities:
DNA vaccines
Recombinant virus vaccines
Heterologous Vaccination
Autologous Vaccination

“There are natural alternatives for both the prevention and treatment of all infectious diseases which have not been approved by the government but which have stood the test of time. Check them out to balance against medical vaccination. It’s your right.”

Vaccination coverage in Australia
1 The College of Physicians of Philadelphia. Different types of vaccines [Internet]. Philadelphia: The College of Physicians of Philadelphia; 2014 [updated 31 July 2014, cited 1 September 2014]. Available: http://www.historyofvaccines.org/content/articles/different-types-vaccines
2 Department of Health Victoria (AU). Immunisation schedule Victoria. Melbourne (AU): Victorian Government; 2014 Feb. 2 p.
3 Australian Government: Department of Human Services [Internet]. Canberra: Australian Government; 2014. Australian childhood immunisation register; 2013 Sep 26 [cited 2014 Sep 3]. Available from: http://www.medicareaustralia.gov.au/provider/patients/acir/index.jsp
4 Lyren A, Leonard E. Vaccine refusal: Issues for the Primary Care Physician. Clin Pediatr. 2006;45:399-404
6 Australian Government. Australian Current Immunisation Records. Website on the internet: (12 June 2014) Available from: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/acir-curr-data.htm
7 Davies P, Chapman S, Leak J. Anti-vaccination activists on the world wide web. Arch Dis Child. 2002;87:22-25
8 Taylor B, Miller E, Farrington CP, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. The Lancet. 1999;353: 2026-2029
9 Dales L, Hammer SJ, Smith NJ. Time trends in Autism and in MMR immunization coverage in California. JAMA. 2001;285(9):1183-1185
10 Kaye JA, del Mar Meloro-Montes M, Kick H. Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ. 2001;322:460-463
11 Taylor B, Miller E, Lingam R, et al. Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ. 2002; 324:393-396
12 Institute of Medicine. Immunization safety review: Measles-Mumps-Rubella Vaccine and Autism. Washington DC: National Academis Press; 2001
13 Fine PE. Herd Immunity: History, Theory, Practice. Epidemiologic Reviews. 15(2):265-302, 1914
14 Nossal GJ. Vaccines of the future. Vaccine. 2011 Dec 30; 29 Suppl 4.
15 WHO, UNICEF, World Bank. State of the world’s vaccines and immunization, 3rd ed. Geneva, World Health Organization,
16 The College of Physicians of Philadelphia. The Future of Immunisation. [internet]. 2014 [updated 2014 July 31; cited 2014
September 14]. Available from: http://www.historyofvaccines.org/content/articles/future-immunization
17 Lu S. Heterologous Prime-boost vaccination. Current opinion in Immunology. 2009 June; 21(3):346-351
18 WHO. Immunisation, Vaccines and Biologicals. [internet] 2009 [updated 2009 January 8; cited 2014 September 14].
Available from: http://www.who.int/immunization/givs/goals/en/
19 Finnegan G. The Future of Vaccines. [internet]. 2014 March 27 [updated 2014 March 27; cited 2014 September 14].
Available from: http://www.vaccinestoday.eu/diseases/the-future-of-vaccines-2/
20 Gilbert N. First ASU students receive swine flu vaccine. [internet]. 2009 November 20 [cited 2014 September 14]. Photo credits: Matt Pavelek, state press. Available from: http://www.statepress.com/archive/node/9428
22. Toon J. Disappearing needles. Vaccine-delivery patch with dissolving microneedles eliminates "sharps" waste and improves protection. 2010 July 18 [cited 2014 September 14]. Photo credits: Jeong Woo Lee, Georgia tech. Available from: http://www.gtresearchnews.gatech.edu/dissolving-microneedles-patch/
22 The College of Physicians of Philadelphia. Cancer Vaccines and Immunotherapy. [internet] 2014 [updated 2014 August 12;
cited 2014 September 14]. Available from:
- Vaccinations
- Immunisation schedule
- National Register
- Benefits
- Australian Vaccination Network
- Flow on effects
- Other factors
- Not readily available
- "Those diseases aren't around any more"
- "Overloading the immune system"
- Fear of side-effects (3)
- Name change from Australian Vaccination Network
- Loss of charity status
- Commission:

"Does not provide reliable information regarding vaccination.....disseminating, misleading, incorrect......engendering fear or alarm, and detrimentally affecting clinical care" (5)
GIVS Goals:
- Australian Vaccination-skeptics Network
- Arguments from the lobby
- Autism
- Side-effects of vaccinations
Matt Pavelek, StatePress
Jeong Woo Lee, Georgia Tech
Actual Side Effects
Low-grade fever, swelling, injection site pain, headache
Anaphylaxis (<1 in 1,000,000)
Vaccine-specific effects (eg rotavirus and intussusception) (3)
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