Dáil Éireann Debate, Wednesday - 7 April 2004
78 Ms B. Moynihan-Cronin asked the Minister for Health and Children the level of take-up of the MMR vaccine in each health board area for the latest period for which figures are available; the steps being taken to promote fuller take-up; and if he will make a statement on the matter. [10781/04]
Amharc ar fhreagraData provided by the National Disease Surveillance Centre, NDSC, indicate that MMR uptake rates for children of 24 months of age per health board region for the third quarter of 2003 are as follows:
|
Quarter 3, 2003* |
|
|
% |
|
|
ERHA |
75 |
|
MHB |
88 |
|
MWHB |
82 |
|
NEHB |
83 |
|
NWHB |
85 |
|
SEHB |
84 |
|
SHB |
79 |
|
WHB |
77 |
|
Ireland |
80 |
*The most recent period for which uptake figures are available from the NDSC.
The MMR vaccine protects against measles, mumps and rubella and, in accordance with the recommendations of the immunisation advisory committee of the Royal College of Physicians of Ireland, can be administered to children between 12 and 15 months of age. A vaccine uptake rate of 95% is required in order to protect children from the diseases concerned and to stop the spread of the diseases in the community. Measles, in particular, is a highly infectious and serious disease; approximately one in 15 children who contract measles suffer serious complications.
I am concerned about the unsatisfactory MMR immunisation uptake rates because of the risk of unimmunised children contracting the potentially serious diseases concerned. The outbreak of measles in 2000, which resulted in approximately 2,000 cases and three deaths, is evidence of the consequences of insufficient immunisation uptake.
Based on information available from the National Disease Surveillance Centre, NDSC, there was a significant increase in 2003 in the number of reported measles cases. In 2002, 243 cases of measles were reported but provisional returns for 2003 indicate that there were 586 measles cases during that year. This underlines the importance of raising the immunisation uptake level to the optimal level of 95% against measles and the other potentially serious infectious diseases. However, I am encouraged by the most recent statistics from the NDSC which show that for the third quarter of 2003 MMR uptake for children up to 24 months of age was 80% — this uptake rate had increased from 77% in the previous quarter in 2003 and from 73% in the comparative quarter in 2002.
In 2003, CEOs in all health boards and the ERHA were asked to ensure that specific immunisation measures were prioritised in all regions in order to prevent a serious measles outbreak. A national immunisation steering committee was established to address a wide range of issues relating to the childhood and other immunisation programmes including the identification of issues that are hampering the achievement of uptake targets. I launched the report of the steering committee in April 2002 and a national implementation group was subsequently established to draw up a phased national implementation plan based on the report's recommendations.
Following consideration of proposals in regard to childhood immunisation which were submitted by the national implementation group through the Health Boards Executive, HeBE, on behalf of the health boards, €2.116 million was allocated by my Department in 2003 to fund initiatives to improve childhood immunisation uptake. A further €2.778 million has been allocated for that purpose this year.
There is concern among some parents in regard to the measles, mumps and rubella, MMR, vaccine. Negative coverage on this issue has added to the confusion of parents in deciding whether to vaccinate their children. In April 2002, I launched the MMR vaccine discussion pack — an information guide for health professionals and parents. The pack was produced by the NDSC and the department of public health, Southern Health Board and was published by HeBE on behalf of the health boards. The pack sets out the facts in regard to the most common concerns about MMR in a way that will help health professionals and parents to explore these concerns together, review the evidence in regard to MMR and provide the basis for making an informed decision. The information is presented in such a way as to allow full discussion between health professionals and parents on each issue. The pack also contains an information leaflet for parents. The pack is set out in question and answer format and addresses such issues as the alleged link between MMR and autism and Crohn's disease, the safety and side effects of the vaccine, the purpose of a second dose of vaccine, combined vaccine versus single doses and contraindications to the vaccine. The pack will enable health professionals to respond to the very real concerns of parents.
There is a sound evidence basis for the use of the MMR vaccine. Since the original publication of UK research from Dr. Andrew Wakefield about a possible causal link between MMR vaccine and autism, many researchers have investigated the proposed causal relationship and concluded that there is no link between MMR vaccine and autism or inflammatory bowel disease. My Department's submission to the Oireachtas committee contained further details on the scientific evidence in this regard. In Ireland, this issue has been examined by the immunisation advisory committee of the RCPI and the Irish Medicines Board. The conclusions are: there is no evidence to support the association between MMR vaccines and the development of autism or inflammatory bowel disease; the vaccine is safer than giving the three component vaccines separately; and the Oireachtas committee has also endorsed the safety of the MMR vaccine.
The international consensus from professional bodies and international organisations is that the MMR is a safe and effective vaccine. The institutions include the Medical Research Council expert committee and the British committee on safety of medicines in the UK, the Centres for Disease Control and Prevention, CDC, and the American Academy of Paediatrics in the USA as well as the World Health Organisation. Studies by the United States Institute of Medicine concluded that there is no link between the vaccine and autism or inflammatory bowel disease. A large Finnish study involving 1.8 million individuals demonstrated that no case of inflammatory bowel disease or autism was linked to the MMR vaccine. A recent UK study where researchers analysed 2,000 studies from 180 countries found no evidence of a causal link between MMR vaccine and autism or inflammatory bowel disease. A similar Swedish study found no increase in cases of autism in the ten years during which MMR vaccine was introduced. In late 2002, the New England Journal of Medicine published details of a study of more than 500,000 children born in Denmark between January 1991 and December 1998 which indicated that the risk of autism was the same for children regardless of whether they were vaccinated with MMR. The World Health Organisation, WHO, strongly endorses the use of MMR vaccine on the grounds of its convincing record of safety and efficacy.
Dr Simon Murch of the Centre for Paediatric Gastroenterology, Royal Free and University College Medical School, London, who had originally questioned the safety of the MMR vaccine, categorically supports use of the MMR vaccine; in the November 2003 edition of the Lancet he states that “..by any rational standards of risk/benefit calculation, it is an illogical and potentially dangerous mistake for parents to be prepared to take their children in a car on the motorway or in an aeroplane on holiday, but not to protect them with the MMR vaccine. An unprotected child is not only at personal danger, but represents a potential hazard to others, including unborn children”.
I am aware that the editor of the Lancet has said recently that the journal had learned of a “fatal conflict of interest” concerning the research carried out by Dr. Wakefield. I understand that the British General Medical Council is to examine this matter.
I understand that some health boards have undertaken measures in their regions to improve vaccine uptake which include: information sessions for professionals, for example, doctors and nurses in the area; information sessions for parents; distribution of information to the public, for example, leaflets on MMR available in public areas; advertisements taken out in local papers; advertisements on local radio stations; advice regarding immunisation, including MMR, which forms part of every public health nurse consultation with parents; information leaflets displayed prominently in all health centres; information given to schools regarding the booster MMR; follow up of parents by letter and telephone where children have not been vaccinated; follow up with GPs and nurses regarding children in their area who have not been vaccinated; and information sessions for staff. Discussions are ongoing between my Department and HeBE in regard to targeted and focused local/regional initiatives to bring about improvements in MMR uptake levels.
I take this opportunity to again urge all parents to have their children immunised against the diseases covered by the childhood immunisation programme in order to ensure that both their children and the population generally have maximum protection against the diseases concerned. This is particularly important at present in light of the increase in reported measles cases.
