Vaccinations

It's hard to know who feels the greatest pain when it comes to vaccinations - the baby who gets the jab or the parent who holds her. Most parents dread taking their children to be vaccinated and that includes doctors, however much they talk about how lucky we are to be able to protect our children from infectious diseases. The dread is linked to a natural fear that by vaccinating your healthy baby, you will harm her.

First, it feels unnatural to inject your baby with a cocktail of vaccines to kick-start her immune system. How can a tiny baby cope with such an assault? Surely it's more natural to expose your baby to the disease itself?

Secondly there are frequent media reports on the risks of vaccinations, most recently linking the measles, mumps, rubella vaccine to autism and inflammatory bowel disease. The government has also announced it is increasing its compensation for children who have been brain damaged by vaccines, thereby reminding us that such devastating side effects can happen.

Thirdly no one seems to get these infectious diseases any more, anyway and weren't they fairly harmless? No one died from them did they? And now that we're so well nourished and healthy, a dose of whooping cough would surely be no match for a strapping toddler.

These arguments appear persuasive and I'll address then in turn later, but having read the research, I believe the scientific evidence is firmly on the side of vaccination. For a start, children are very, very rarely damaged by vaccines (although to be fair, proving a vaccine caused a child to become brain damaged is not easy.)

The trouble with any successful immunisation programme that has largely eradicated childhood infectious diseases is that we have all forgotten the harm these diseases can do. We think of them almost affectionately - dear old measles, funny old mumps (even the names are cute). Our generation can't recall the iron lungs that people with polio spent their lives in.

My mother nearly died of diphtheria as a child and she'll never forget the little girl in the bed opposite who did die from the disease. When I was a baby she fairly skipped down to the surgery to get me a measles jab. She had no doubt she was insuring my life. In India there is a saying, "Don't count your children until after the measles". Measles is one of the biggest killers of children in the world. And it doesn't just kill malnourished foreign babies.

There are risks and benefits to anything in life and especially in medicine. Because vaccinations have worked and so few people get the diseases any more we only see the risks. Parents must be informed about all that doctors know about the risks as well as the benefits. Any doctor who doesn't have the time to discuss a parent's worries had better get out their old textbooks and start learning what these infectious diseases look like. Because it doesn't take much of a fall in immunisation levels for epidemics to start up.

FAQs about vaccination

1. The infectious diseases of childhood have been largely wiped out so why do we need to be vaccinated?
Improvements in socio-economic conditions have helped reduce the rate of transmission of infections and made it more likely that children will survive any infections they do get. But the real falls in rates of infections occurred when vaccines were introduced. Meningococcal C vaccine, introduced in November 1999, which immunises against a form of meningitis common in babies under 1 year and teenagers between 15 to 17 has already reduced infection rates by 75 percent.

When immunisation rates fell after a scare about whooping cough vaccine in Britain in 1974, the effect was devastating - 100 000 children caught whooping cough and 36 died within the next four years. In the Soviet Union diphtheria is re emerging after vaccination rates fell - in 1994 there were 1,7000 deaths.

Immunisation rates have to be high - sometimes over 90 percent - to avoid epidemics of these diseases. Given half a chance these infections would take hold most effectively. Before vaccinations against diphtheria, one child died every five hours from the disease.

Also remember that your child might like to go abroad for holidays - where rates of infectious diseases are often higher than in the United Kingdom. Beware of bringing back a rash with the suntan.

2. Vaccinations don't always work so why have them?
They don't always work but most have over 90 percent success rates, with many over 95 percent. What's more, if you have been vaccinated and get the infection you generally have a less serious form of the illness.

3. Isn't it safer to have the natural form of the infection than a vaccine?
No. Rates of complications from all the diseases in their natural forms are far higher than those from vaccinations. For example the risk of inflammation of the brain (acute encephalopathy) after measles, mumps and rubella is 1 in a million - for mumps infection it is 1 in 300. One in 2000 children who catch measles will have inflammation of the brain - 25 percent of those will have brain damage and 1 in 3000 children who get measles will die. One in 20 children who catch whooping cough may get inflammation of the brain compared with 5 in a million with the vaccine.

Mumps can cause sterility in men in later life. German measles can cause deafness. You don't have to be unhealthy to start with to suffer the complications of these diseases. For example measles is sometimes said to be a harmless disease that naturally encourages the immune system. But between 1970-1983 270 people died from measles, of whom 144 were healthy children with no known illnesses apart from measles.

In 1994, 8 million school children were vaccinated against measles - 1202 children were reported by the yellow card reporting system to have had reactions to the vaccine of which just under half were classed as serious. Virtually all the children recovered fully.

Of course all this is no comfort to the mother of the child that is the one in a million that is damaged by a vaccine. We would wish that vaccines could all be 100 percent safe and certainly that is being worked towards, or that the disease could be fully eradicated such as smallpox so that vaccines weren't needed, but this isn't the case.

Millions and millions of children worldwide have been vaccinated and followed up for side effects. Medical opinion is that the benefits outweigh the risks many hundreds of thousands time over - but no one can decide for you.

4. Can't you overload the immune system?
It's an understandable concern but the vaccines work to the same principle as when your baby is exposed to any infection - it makes antibodies to destroy the enemy. When the enemy comes round again it has learnt to recognise that particular enemy and can make antibodies so quickly that the infectious agent is defeated at the doorstep. Babies are exposed to many foreign agents each day - an ordinary cold may expose your baby to between 4-10 of them.

Vaccines are made to act by exposing your baby to a tiny proportion of the foreign agent so she can learn how to fight off the disease without having to suffer it. We're talking tiny bits of the foreign agent, some of which have been killed, others which have been modified to make them harmless. Babies can cope. It worth saying that homeopathy cannot immunise children against infectious diseases. Many homeopaths are happy to admit this and support immunisation.

5. Why can't my children be let off being vaccinated if everyone else is having their children vaccinated?
Herd immunity as its attractively called means that it's right to some extent to think "I'm alright Jack - everyone else is making sure my child's safe by getting their children immunised." Most parents do get their children immunised, but there will be some children who cannot be immunised because they have no immune systems to speak of and couldn't cope with the vaccination. There will always be people who won't have had vaccinations or will have had them but they might not have worked completely. No one would want to give a pregnant woman (your neighbour for instance) who wasn't for some reason immune to German measles, a dose of this infection which would damage or even kill her unborn child.

Also if you travel to some countries you can't be sure they have herd immunity anyway.

6. What about the links with autism and inflammatory bowel disease?
There was lots of media interest in some research published in the Lancet linking autism and inflammatory bowel disease with measles, mumps and rubella vaccine.

Government groups in the UK and US both found no evidence for these assumptions, criticising the way the studies were carried out and citing bigger studies which did not show a link.

Autism is often diagnosed at a time when babies will have recently been immunised and therefore it is understandable that parents should link the two events. But this does not mean that one caused the other. Finland has very thorough records of immunisations and for inflammatory bowel disease and has found no link between the two after studying hundreds of records. Other studies from Sweden and North London have shown no risk of autism. (For more information see British Medical Journal volume 316 1998 June 6^th page 1745 and BMJ 22 January 2000 pages 240-3). The Lancet study suggested that people might separate out the vaccines and give them separately, thus meaning more visits and more jabs and more risk of catching the diseases in between. Most doctors don't think this is a good idea.

7. What should my baby have and when?
If you have been convinced or even slightly reassured by reading the above you are obviously a very reasonable person and will visit your GP (your health visitor will tell you anyway) for a vaccination schedule.

Generally it's diphtheria, tetanus, pertussis (against whooping cough) polio and hib (against a form of meningitis) at 2, 3, and 4 months.
Then you have a rest until measles, mumps, rubella (MMR) at a year.
The pre school booster comes between 3 to 5. It is diphtheria, tetanus, polio and a booster of MMR (as not everyone is immune after one dose). Be honest with your child without freaking them out - say what it involves, that it hurts like a bee sting but is soon over - try to be calm yourself.

8.What will happen to my baby after her jab?
I always expect my children to have sore lumps on their legs from the jabs and to be fractious and a bit warm. I sometimes squirt a tiny bit of a syringe of paracetamol (Calpol) into their mouths which usually comes straight out but makes me feel like I am doing something. Some children are completely fine. Mine usually cry pitifully and won't sleep so I put them in a papoose and walk around with them and then breast feed them continuously because they are often comforted by skin to skin contact.

The reaction, if there is one, mimics the onset time for the disease, so for measles for example, it will take about 10 days for symptoms to develop and again these may mimic the disease, with a fever and cough. When they get older it is easier for them to take paracetamol but don't overdose them. Never ever give them aspirin as it can cause brain damage in children. If you are worried about your child phone your GP.

The author, Luisa Dilner, is a qualified doctor, mother of three and former health editor of The Guardian. She is currently assistant editor at the BMJ.