This week is World Immunisation Awareness week so it is obligatory to mention NZ have now achieved pretty good immunisation coverage of its infants and the gap between ethnic groups and rich and poor is all but shut.
In December 2012 NZ European and Maori had 90%, Pacific 93% and Asian 95%. The gap between rich and poor is almost non-existent (2 percentage points). More importantly, for a short time last year we appeared to be ahead of Australia who have been pretty smug about their excellent performance in this area.
In the BMJ this week appears the latest Australian data on the impact of the HPV programme on genital warts. The progress is quite astounding and I admit to particular excitement over figures 1 and 2, Which are very pretty indeed. The study reports:
The significant declines in the proportion of young women found to have genital warts and the absence of genital warts in vaccinated women in 2011 suggests that the human papillomavirus vaccine has a high efficacy outside of the trial setting. Large declines in diagnoses of genital warts in heterosexual men are probably due to herd immunity.
Essentially the data indicate that the basic reproduction rate of HPV 6 and 11 has fallen below one. That’s the end of the line for genital warts. Auckland (and NZ) have shown a similar pattern but the particularly dramatic progress in Melbourne is likely attributable to the very high uptake of vaccine along with the relatively large age band eligible for funded vaccine (up to 26 years).
It came to my attention recently that some new mums turning up for their Ponsonby antenatal classes were being provided with a pamphlet along with, but not included in, their Bounty packs (Bounty packs have all sorts of evidence based parenting information and are given to women who have babies in NZ).
Not sure that Bounty were very pleased to know that this was being provided along with their information party bag. The Pamphlet, called “After the Birth, Your Choice” is produced by the Maternity Services Consumer Council with the intention of explaining the various tests and procedures that may occur after birth and what the patient rights, provider obligations are and (I understand) distributed by Parent Centre. The section called vaccinations is appalling.
“In New Zealand it is recommended that your baby have their first vaccinations when s/he is six weeks old. Every year new vaccinations are added to the infant vaccination schedule. While your LMC and other health professionals must recommend that your baby has all of them, vaccinations are not compulsory. It is important that you find out as much information as you can about each vaccine so that you can make an informed choice about which vaccines (if any) you want your baby to receive and at what age you want your baby to start receiving vaccinations. “It is worth noting that although babies are currently vaccinated against up to seven diseases at a time, almost no research has been done on the side effects and risks of having several different vaccinations at the same time.”
For a start there are not new vaccines added to the schedule each year. It’s a bit inflammatory about the health professionals too. Suggesting that a good parent should assess the data themselves and decide on a schedule for their child is bizarre. The NZ Immunisation Schedule has been developed based on more than 200 years of empirical global data collected and assessed by generations of scientists. The NZ recommendations are made by panels of experts in infectious diseases, paediatrics, epidemiology, public health and immunology. I am sure new parents have better things to do than become vaccine experts. By and large when one gets sick one visits their doctor rather than going to medical school to figure out what the problem is.
However it is the final sentence about safety that is a real clanger. This is a shameful lie. All infant vaccines are assessed for concomitant administration. This is a requirement for licensure if they are to be added to a schedule. There is a mindboggling amount of data on the safety of co-administering infant vaccines. For example, take pneumococcal vaccine, added in 2008. The safety of Synflorix (the pneumococcal vaccine we use) aka PCV-10 was initially evaluated in five pivotal studies conducted between 2005 and 2008, in which it was co-administered with a variety of DTaP-based and meningococcal vaccines. Findings are summarised in a paper titled
Another, more recent, example is the Finnish Invasive Pneumococcal disease (FinIP) vaccine trial which enrolled 47,369 children and co-administered the study vaccines with other childhood vaccines (published recently in the Lancet.
And, of course, post marketing safety surveillance all over the world.