Vaccination

This page deals with routine immunisations. We also provide a travel vaccination service but do not yet have a web page for this. Please contact the surgery if you require travel vaccination.

One of the first dilemmas faced by new parents is often the question of vaccination. We are advised that we should have our precious child vaccinated and then we are told that to do so is not compulsory, indeed we have a genuine choice in the matter.

It is hardly surprising then, when faced with so much conflicting advice that some parents find vaccination difficult and confusing. Most parents find it frightening, and we have never met any who enjoys having their children vaccinated.

At this point, it is important to stress that there is no substitute for discussing your child's health with your family doctor or practice nurse. At Sumner Health Centre, we pride ourselves on taking as impartial a view as possible in trying to answer your questions and guide you in discovering the right way for you to proceed. We try very hard not to place you under any pressure and we do not see it as our role to persuade, simply to present the evidence and to help you make a truly informed decision.

In response to many requests, we have listed some possible answers to our most frequently asked questions. For the sake of readability, many have been kept simple and it would be more valuable if you were to choose to discuss all these issues at greater length during a consultation.

Q1: What are the New Zealand Immunisations?

Full information is available from the Ministry of Health Website. This schedule is updated every two years and is based upon expert opinion as to which vaccines will provide the best protection for the population.

The current (2008/9) national immunisation schedule is set out below. PCV7 is available from 1st June 2008.

DTaP-IPV-HepB/Hib

Diphteria, Tetanus, acellular Pertussis, Polio,Hepatitis B, Haemophilus Influenzae type B

PCV7

Multiple strains of Pneumococcus.

Hib

Haemophilus Influenzae type B

MMR

Measles, Mumps, Rubella

DTaP-IPV

Diphteria, Tetanus, acellular Pertussis, Polio

dTap

Diphteria, Tetanus, acellular Pertussis

HPV

Human Papilloma Virus

Td

Tetanus and Diptheria

Influenza vaccine must be given annually and is available free of charge to those over 65 and to all patients with certain chronic diseases (heart disease, kidney disease, diabetes, cancer and asthma) with very few exceptions.

Q2: My child had some vaccines overseas, what should I do?

Please come and discuss this with us. Most countries have broadly similar schedules but there are a few variations.

Q3: Is it safe to give immunisation against so many conditions at once? Surely it isn't right? Why not split them up?

As far as it is possible to say there is no risk posed by using multiple vaccines at once. This is supported by examination of the outcomes of tens of thousands of individual vaccinations over many years of vaccination in all countries in the world. In all cases to date where concern has been raised by scientists, doctors or patients, robust, open re-examination of the data has failed to demonstrate any risk.

If you think about it, your baby is dealing with hundreds, if not thousands of immune stimulants at once. Immunogenic materiel is present in the air, food, water, upon our clothes and within our bodies. Your immune system takes all of this in its stride, dealing with multiple stimuli simultaneously. It does this by having millions of individual immune cells all working together and all capable of working independently.

There are a number of reasons why vaccines are not split up. Mainly it is because overall the acceptance of vaccines is better when fewer injections are used. An incomplete course of vaccination is possibly worse than none at all as you expose your child to risks (see below) without necessarily gaining any benefit. Also, the cost, both of the vaccine and of the time involved in giving them is a lot lower when many vaccines are combined. Some have questioned the influence of large drug companies in the choice of vaccines. They are right to do so as economic considerations are important in healthcare today. The issue is complex and nowhere near as Machiavellian as some seem to think - please do not hesitate to ask us about it if you have concerns.

Q4: I would like to split the vaccines up for my child anyway. Can this be done?

Difficult. It is almost impossible to obtain vaccines which are not on the New Zealand Schedule as the demand is so low that they are not imported. Importing vaccine for you is also difficult due to the need for them to be maintained in a narrow temperature range. There are often legal difficulties to be overcome too. If you are still keen to explore this option, please make an appointment to discuss your child with Rob.

Q5: You mentioned risks...

Vaccines are, like any medical procedure, not without risk. All injections may result in localised infection and all vaccines may cause some localised redness (especially MeNZB), swelling or pain (Tetanus may cause a sore arm for a few days). All vaccines may cause a mild fever or lethargy for a day or two and a few may cause a rash a few days later (MMR) Some older children and a few adults feel queasy because of the injection itself and may need to lie down for a few moments. Some people even faint.

Reactions other than those stated above are extremely rare.

A very small minority of children will suffer an allergic reaction which is usually very mild but may occasionally be severe or life threatening. We are trained to manage these conditions and stock all the necessary medications and drugs. It is for this reason that you are asked to remain in the surgery for 20 minutes after a vaccination is given.

Guillain-Barre syndrome is a very very rare complication of any immune stimulation (including catching a cold) which results in paralysis which is usually temporary but always requires hospital treatment. This can also occur after vaccination.

There are many sites listing vaccination complications, some more accurate than others. If you have any concerns about the risks, please make an appointment to discuss the issues with us.

The following information about disease risks has been taken from CDC (the USA Centre for Diseases Control)

DISEASE

Measles

Pneumonia: 6 in 100
Encephalitis: 1 in 1,000
Death: 2 in 1,000

Rubella

Congenital Rubella Syndrome: 1 in 4 (if woman becomes infected early in pregnancy)

VACCINES

MMR

Encephalitis or severe allergic reaction: 1 in 1,000,000

Diphtheria, Tetanus, and Pertussis vs. DTap Vaccine

DISEASE

Diphtheria

Death: 1 in 20

Tetanus

Death: 2 in 10

Pertussis

Pneumonia: 1 in 8
Encephalitis: 1 in 20
Death: 1 in 1,500

VACCINES

DTaP

Continuous crying, then full recovery: 1 in 1000
Convulsions or shock, then full recovery: 1 in 14,000
Acute encephalopathy: 0-10.5 in 1,000,000
Death: None proven

As you can see - with a 1 in 500 risk of death from Measles infection, even if everything everyone ever said about vaccine risks was true, including those so far dismissed by scientific analysis and those yet pending assessment you would still be safer being vaccinated.

It is important to note that 'none proven' in terms of vaccine related deaths for DTaP is not the same as 'proven to be competely safe' however the risk is very small. Examination of the 2006 vaccination monitoring results for the USA reveals 10 deaths in under 2 year olds of which 6 could conceivably be vaccine linked. We should point out that in all but 2 cases (where the cause of death is not determinable) expert opinion and the weight of evidence suggests other causes are more likely. Advanced statistical analysis has shown that a child is no more likely to die after vaccination than at any other time. This would put any risk in the less than 1 in ten million category, although of course you can never say never.

A more thorough explanation of risk is found Here

Other Vaccinations

Varicella vaccine

This single dose vaccine can prevent chickenpox, even if given up to 3 days after exposure to the virus.

Chicken pox is often considered a minor disease but even young children can suffer distress, scarring and all exposed persons run the risk of developing shingles later in life as a result of exposure to this virus.

The vaccine reduces the risk of infection by 80% and if infection occurs, the disease is usually much less severe.

This vaccine has an excellent safety record and is now part of the US immunisation schedule. It will soon be included in the UK schedule.

The price for this vaccination is $70 and requires only one injection.

Gardasil

Over the last few years it has become increasingly clear that almost all cervical cancer is caused by Human Papilloma Virus (HPV) infection. This is transmitted by sexual contact. Gardasil is a new vaccine that reduces the risk of infection with HPV. It is licenced for use in women (and men) aged 9 to 25.

The risk of infection with HPV infection rises with the number of sexual contacts so gardasil will be more effective if given to younger patients.

Gardasil can prevent infection by the four types of HPV most commonly implicated in cervical cancer. In controlled studies, it was shown to be 95% effective in preventing infection with these four types of HPV and reduced the risk of developing of CIN (the changes in the cervix detected on a smear) dramatically.

In addition, Gardasil protects against the two strains of HPV which are responsible for 80% of genital warts.

There are other types of HPV which cause cervical cancer and so Gardasil will not replace the need for smear tests and will not prevent all cases of genital warts, CIN or cervical cancer. The issues surrounding the degree of protection afforded are highly complex and depend to some extent upon the individual involved.

Gardasil is given as a course of three injections at a cost of $155 each. (ie $465 for a complete course).

From 2008 Gardasil will be funded for most young women who are likely to benefit. We will continue to make the vaccine available at cost price to others who feel they may benefit from it.

If you are wondering whether Gardasil might be suitable for you, or for your child, please make an appointment to discuss the vaccine with one of our doctors. You may also wish to examine the Gardasil website.