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Dáil Éireann debate -
Thursday, 25 Oct 2001

Vol. 543 No. 1

Other Questions. - Vaccination Programme.

Jim Higgins

Question:

8 Mr. Higgins (Mayo) asked the Minister for Health and Children if vaccinations are being given to school children without a thorough knowledge of their family medical history; and if he will make a statement on the matter. [25514/01]

Booster immunisations are provided in the school setting by health board teams in relation to a number of vaccines. These boosters are required for certain vaccines already given by GPs under the primary childhood immunisation programme in order to further boost immunity. The administration of the school booster programme is the responsibility of individual health boards in the first instance and vaccinations are provided in the school setting by health board teams. Schools are considered the most practical location for the administration of these vaccines as they provide access to a large proportion of the target group.

I have made inquiries of the health boards in relation to the procedures used in their areas. The boards have advised me that consent forms are sent to parents of children due for vaccination prior to the vaccination date. Relevant questions relating to the medical history of the child, including whether the child has suffered any serious illness and whether the child in question has had a reaction to a previous vaccine, are asked. An information sheet providing detailed information in relation to the vaccination in question is also circulated at the same time to parents. In addition, parents are invited to attend the vaccination session with their child.

Health board medical personnel are aware of the contra-indications to the recommended childhood immunisations and review these in respect of each child prior to the administration of any vaccine. I am advised by the health boards that the personal medical history of the child is the relevant issue. The immunisation advisory committee of the Royal College of Physicians of Ireland provides expert advice in relation to the contra-indications to various vaccines and the medical practitioner concerned is aware of this advice.

As one who has had my own children vaccinated, I do not want to say anything that would indicate anything but my support for vaccination in general. However, from the Mini ster's reply, can I take it there is an effort in every case to ascertain a family history?

Yes. As I said in my reply, relevant questions relating to the medical history of the child, including whether the child has suffered any serious illness and whether the child in question has had a reaction to a previous vaccine, are asked. Prior to the vaccination, consent forms are sent to parents asking the relevant questions on the medical history of the child.

Seán Ryan

Question:

9 Mr. S. Ryan asked the Minister for Health and Children the rate of uptake of the MMR vaccine among children in each health board area to the end of March 2001 as compared to March 2000; and if he will make a statement on the matter. [25620/01]

The MMR uptake rate for the first quarter of 2001 was 79.4% compared to 76.1% in the same period in 2000. I am circulating the information broken down by health board area as requested by the Deputy with this reply. The information circulated shows the MMR uptake rate for children aged 24 months in the first quarter of 2000 and 2001 by health board area.

With the exception of one region, MMR uptake rates have improved in all health board areas. The National Disease Surveillance Centre has advised me that the overall improvement in MMR uptake rates seen in the first quarter of 2001 may in part be attributed to a greater number of parents having their children vaccinated in response to concerns about the measles outbreak which occurred in 2000.

Although MMR uptake rates have improved in the first quarter of 2001, they still fall short of the national target rate of 95%. The national immunisation steering committee was established earlier this year to examine a wide range of issues relating to the childhood and other immunisation programmes including the identification of issues which are hampering the achievement of uptake targets. I understand that work is at an advanced stage and the committee is expected to report later this year.

I take this opportunity to urge parents to have their children immunised with the MMR vaccine in accordance with current recommendations. This will ensure that individual children and the population generally have maximum protection against the diseases concerned. General practitioners are aware of the contra-indications to the recommended childhood immunisations and parents should discuss any concerns they may have with their GP before making a decision about their child's immunisation.

I thank the Minister for his reply. I am sure he would agree that, however welcome, the increase in only marginal. Does he not accept that when the desired level is 95%, a level of well under 80% represents a very serious shortfall? In 2000, there were almost 1,600 cases of measles nationally. Will the Minister comment on this and would he agree that it amounts almost to a dangerous epidemic, especially when, in some cases, children's lives were lost? Would he respond to the concerns expressed by the National Disease Surveillance Centre? It has called for an initiative to encourage parents to have their children immunised and proposes a coalition for immunisation.

We will work with the National Disease Surveillance Centre in terms of progressing any of their ideas. Last year I established an immunisation steering committee to consider a number of issues, not only the up-take rates but out of date vaccines and so on, which arose as a result of the oral polio vaccination last year. A number of factors pertaining to MMR have resulted in decreases. There has been much debate in the press and the Deputy will be aware that the Oireachtas Joint Committee on Health and Children conducted hearings on this issue in terms of alleged links between it and autism and so on. That has had an impact and we would bury our heads in the sands if we tried to pretend otherwise.

Equally, there is room for improvement and for more focused and targeted programmes in areas where there are lower than average up-takes of MMR, especially in parts of Dublin. The National Disease Surveillance Centre takes the view that the outbreak of measles in 2000 in the Dublin area was perhaps primarily responsible for the increase in up-take in the Dublin area this year because of the attendant publicity it received. We will work with the centre to try to further improve the rates.

Does the Minister not accept that the health boards need to do more in terms of ensuring that immunisation levels are increased significantly? Does he consider that they should work more closely with general practitioners so that they will ensure children within their practices are given the option and encouraged to be immunised? It is dispiriting if it takes an epidemic of such large proportions to convince parents that their children need to be immunised. Will the Minister comment on the role of health boards and their apparent lack of a relationship with general practitioners in terms of dealing with this issue successfully?

Health boards should have a very strong relationship with general practitioners. Some of the GP units within health boards were established in the first instance to try and develop a proper, structured relationship with general practitioners. I also agree that health boards need to be strategic in their approach to this issue. Last year and in 2000, I asked the Eastern Regional Health Authority to implement a specific programme of targeting in areas that are well below the average, as is the case in Dublin where imple mentation is even well below the rate of 79% to which I referred.

As low as Old Calcutta.

Very low. In such areas there should be a specific targeted programme, either through the schools or in tandem with the GPs, to increase the uptake. The health boards should move quickly in that direction in terms of a more targeted response. In terms of vaccination uptake, some areas are high but some are exceptionally low. As the statutory authorities, the health boards have a responsibility and obligation to take a more targeted approach.

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