The letter from Twins Ireland is being examined in my Department and a reply will issue shortly. However, I wish to make the following general points. The primary childhood immunisation programme, PCIP, provides for the immunisation of children against a range of potentially serious infectious diseases. The objective of the PCIP is to achieve an uptake level of 95%, which is the rate required to provide population immunity and to protect children and the population generally from the potentially serious diseases concerned. The PCIP provides for the immunisation of children up to two years of age. Under the PCIP parents may have their children immunised free of charge by the general practitioner of their choice. The schedule of immunisation is in accordance with the recommendations of the national immunisation advisory committee of the Royal College of Physicians of Ireland. The schedule was most recently revised in October 2002.
The recommended childhood immunisation schedule is as follows:
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Age
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Immunisation
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Birth-1 month
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BCG
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2 months
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DTaP/IPV/Hib (“5 in 1”) and MenC
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4 months
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DTaP/IPV/Hib (“5 in 1”) and MenC
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6 months
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DTaP/IPV/Hib (“5 in 1”) and MenC
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12-15 months
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MMR, Hib1
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4-5 years
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DTaP/IPV (“4 in 1”) and MMR
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11-12 years
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MMR (omit if 2 previous doses)
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10-14 years
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BCG2
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11-14 years
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Td
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1 A single dose of Hib vaccine is also recommended if the child presents after age 13 months and has had no previous Hib vaccine
2 Only for those who are known to be tuberculin negative and have had no previous BCG.
The immunisation guidelines state that if an immunisation course is interrupted, it should be resumed as soon as possible. Children who are not immunised and are older than the recommended age should be immunised as soon as possible.
The MMR vaccine protects against measles, mumps and rubella and can be administered to children aged between 12 and 15 months. A vaccine uptake rate of 95% is required 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 contracts measles suffers serious complications.
There is concern among parents regarding the MMR vaccine. Negative coverage on this issue has added to the confusion of parents in deciding whether to vaccinate their children. In April 2002, my predecessor 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 about the most common concerns about MMR in a way that will help health professionals and parents to explore these concerns together, review the evidence regarding MMR and provide the basis for making an informed decision.
The information is presented 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 a 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 enables health professionals to respond to the very real concerns of parents.
There are sound public health reasons for not administering the MMR as separate vaccines. First, the scientific evidence does not support a link between MMR and autism or inflammatory bowel disease. There is no evidence that administering the three components of MMR as separate vaccines is safer. The immune system is well capable of responding to the small number of components in the MMR vaccine and there is no evidence that the component parts of the MMR vaccine interfere with each other. In any event, vaccines are designed to strengthen the immune system and not weaken it.
If the vaccines were administered separately, a child would require a total of six injections to complete the course instead of two, which could also result in an increased risk of local reactions at the injection site. The practical aspect of giving six injections means children would be unprotected for a greater time from these diseases and, therefore, would be at significantly greater risk of contracting these conditions. The protracted time involved in administering the vaccines would result in the diseases in question circulating in the community for longer. Unprotected children such as younger children, that is, children below the age of 12 months and children who are immuno-suppressed would, therefore, be at greater risk of catching the diseases concerned.
Most countries implement a two-dose MMR vaccine programme and this policy has been very successful in controlling measles where high uptake of the vaccine has been achieved. My Department's primary concern regarding immunisation is that the vaccines in use are safe and effective. Since the original publication of UK research by 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. 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 and the vaccine is safer than giving the three component vaccines separately. 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 and the American Academy of Paediatrics in the USA as well as the World Health Organisation.
I urge all parents to have their children immunised against the diseases covered by the childhood immunisation programme to ensure both their children and the population generally have maximum protection against the diseases concerned.
