Vaccines - Frequently Asked Questions
I have compiled this list of answers to questions that parents often ask, frequently as a result of issues raised in the media.
The time we allocate to administer a Measles vaccine is fifteen minutes, ten minutes for Rubella and ten minutes for Mumps; the actual time taken for each appointment depends entirely on the amount of time it takes to answer parents’ questions. This can lead to surgeries over running, but we do not want to discourage parents from asking relevant questions, so please do ask any that you have. We understand that most of you have not met us previously and that you are entrusting us with the care of your child. We take great care to preserve that trust.
I hope that the following information will provide answers to most of your questions. If you wish to discuss anything further, now or at a later stage, we will do our best to help and advise you. Please ring the surgery, and if necessary leave a message. We will always return your call.
Our latest Care Quality Commission Inspection was on 15th May 2006 and the Report is available on the CQC website.
Consent
Vaccinations in the UK are NOT compulsory. In law, nobody can give your child ANY vaccination without your consent. Consent must be given before each vaccine is administered. You should not be “forced” or “persuaded” into accepting any vaccine for your child against your wishes, as in law this invalidates consent. NHS Personnel cannot refuse to administer a vaccine to your child if your child is entitled to receive that vaccine.
The fact that you may have signed your child’s “Red Book” does NOT mean you have given your consent to all the vaccines detailed in it. Your consent needs to be “informed”. This means that you must be given as much information about the vaccine as you wish, all your questions should be answered to your satisfaction, and you are given time to discuss any issues arising. You should also be properly informed about the advantages and potential disadvantages of the vaccine, together with any possible side effects and how to treat them, and whether or not an alternative vaccine is available.
I strongly recommend that childhood vaccines are administered into the child’s thigh (not arm) using a paediatric needle (orange) which is far finer than a standard needle (green). Parents have an absolute right to request this.
We are receiving ever increasing numbers of reports from parents who have attended their NHS Practice for their child to receive only the pre-school DPT/Polio booster. PLEASE be very careful to check with the Practice Nurse before any vaccines are given that only the DPT/Polio vaccine is being given. Many parents are reporting that they have had to stop the MMR booster vaccine being given against their wishes and without consent.
The Department of Health have written to all GP’s and Practice Nurses initially on 10th August 2004, to remind them about the consent procedure. Administering a vaccine to a child without consent is a criminal offence.
Return to Top of Page
Measles Vaccines
The fact sheet we give you on the day the vaccine is administered is very important. Please keep it in your “Red Book” as evidence that your child has been vaccinated. Your GP or Health Visitor will want to copy the details of the vaccine that your child has been given. The fact sheet is your record. Many schools and nurseries now require that a child has been immunised against Measles as a condition of entry. This may well become National Policy.
Measles is currently the most important of all the childhood vaccines. Worldwide, nearly 1 million children die each year as a result of Measles. It also causes devastating, untreatable and irreversible brain damage, blindness and deafness. Despite this, many parents in this country are now choosing not to immunise their children against Measles.
Although I have never administered the MMR vaccine, if I had to choose between MMR or “no vaccine”, I would choose MMR. I know how serious Measles can be. It is NOT a trivial childhood illness.
The single Measles vaccine Rouvax (Schwartz strain), is imported from France and manufactured by Aventis Pasteur. This vaccine can be safely used for children with a proven allergy to egg protein.
Return to Top of Page
Mumps Vaccines
Mumpsvax is at present the only vaccine available against Mumps that I believe is both safe and reliable. Mumpsvax contains the “Jeryl Lynn” strain of vaccine and is manufactured solely by Merck in America. Merck also manufacture MMR for the UK.
Other Mumps vaccines do exist but are now not recommended for use in this country, as they may contain either “Urabe” strain, which is known to cause brain damage (as it did when used in the UK as the Mumps component of MMRI from 1988-1993), or “Rubini” strain which provides poor immunity.
We DO NOT have ANY children on a ‘waiting list’ for a mumps vaccine.
The only long term consequence of Mumps is that it may cause male infertility, but only if the infection occurs in a male with fully developed testicles. Mumps infection before puberty does not cause infertility.
Since 2004 there has been an increase each year in the number of confirmed cases of Mumps infections. In 2005 the Dept of Health advised that TWO doses of combined MMR vaccine are needed to provide lasting protection against Mumps, whereas only one dose of Mumpsvax is necessary. Children vaccinated with MMR between 1988 and 1996 received only one dose of Mumps vaccine.
Return to Top of Page
Rubella Vaccines
Single dose Rubella vaccines are no longer available from the NHS.
The single Rubella vaccine (Rudivax) is imported from France and also manufactured by Aventis Pasteur.
In the UK, approximately 40,000 women per year need vaccinating against Rubella after the birth of their first child, as they are found not to be immune against Rubella during pregnancy. These women are now routinely offered the combined MMR instead, as single Rubella vaccines are now only available privately.
Return to Top of Page
Boosters
The only one of the three single “MMR” vaccines which requires a booster is Measles. This is usually given at about the age of 4. Your child will receive a recall from the NHS to receive a “pre-school” MMR booster. Please use that recall as a reminder to contact us to arrange a single Measles vaccine booster instead of the MMR booster. Children who initially had MMR can also have a single Measles vaccine and a single Mumps booster instead of the MMR booster. The vaccines are totally compatible.
We are receiving ever increasing numbers of reports from parents who have attended their NHS Practice for their child to receive only the pre-school DPT/Polio booster. PLEASE be very careful to check with the Practice Nurse before any vaccines are given that only the DPT/Polio vaccine is being given. Many parents are reporting that they have had to stop the MMR booster vaccine being given against their wishes and without consent.
Return to Top of Page
Chicken Pox Vaccines
In America, Government Policy makes Chickenpox vaccination a requirement for all children entering school, along with Measles and Hepatitis B vaccines. It is manufactured by Merck Sharp & Dohme (MSD) and distributed by Sanofi Pasteur as “Varivax”.
Chickenpox is a serious and potentially lethal disease in adults, particularly when it occurs in pregnant women. It is highly contagious, and most people contract the disease during childhood.
The vaccine is not new, but has only been available from the NHS since Summer 2002, and then only for people aged 13 and over who have not previously had Chickenpox.
Varivax is licensed for immunisation of children aged 12 months and over. Not only is it licensed for mass immunisation, but also for preventing Chickenpox in a person who hasn’t had Chickenpox, if given within 72 hours of contact with an infected person . It is a very effective vaccine. It does not contain Thiomersal (mercury) or egg protein. Side effects are very uncommon. A local reaction at the site of the vaccine occurs in less than 1 in 1000 vaccinations.
The vaccine prevents a potentially unpleasant illness, eliminates scarring caused by scratching itchy Chickenpox blisters, and protects against Shingles in later life. It has recently been shown that TWO doses are needed in children, separated by an interval of at least three months. The second dose is needed to provide LONG TERM immunity, as the immunity given by the primary dose appears to decline after about five years. We are currently notifying the parents of all children who have had one dose of Chickenpox vaccine from us, that a second dose is needed to provide long term protection.
Return to Top of Page
How effective are Single Vaccines?
Government sources are constantly stating that the combined MMR is the most “effective” method of vaccinating children against Measles, Mumps and Rubella. The key word is “effective”. Looking at the issue from the Department of Health (DoH) point of view, it is true that when considering the population as a whole, it is more effective to use MMR. This is because more children are vaccinated more quickly and at less cost than if single vaccines were used. However, when considering a child as an individual from a parental point of view, single dose vaccines provide more protection for each child against infection.
Scientific research has repeatedly shown that the greater the time between vaccines being administered, the better the immunity given. Combining different vaccines into one syringe and administering by single injection defeats this principle. It has been clearly demonstrated that the degree of immunity achieved against Measles by a single dose vaccine is greater than that achieved by MMR. This could be of great importance in the event of a Measles epidemic.
The DoH also objects to single vaccines on the grounds that children are left at risk from infection during the time gap left between single vaccines. Providing the Measles vaccine is given first (as is our policy), the DoH objections are groundless as the other two vaccines can safely be left until the child is older.
Healthcare Commission Regulations and Inspections ensure that vaccines are delivered to our Practice in accordance with all Manufacturers’ instructions and Government regulations. The vaccines are immediately placed into one of three LEC pharmaceutical fridges. Each of these fridges has an internal sensor which records the temperature inside on an external gauge, and also shows the highest and lowest temperatures occurring inside the fridge. The readings are recorded daily in a book. Recommended storage temperature is between 2º- 8ºC. Domestic fridges are not of a high enough standard for storage of vaccines.
During each surgery we remove two vaccines from a fridge at a time and prepare them. Every vaccine is administered within a maximum 30 minutes. After preparation each vaccine remains safe and effective for at least one hour.
Return to Top of Page
Side Effects and Fact Sheets
Single vaccines are far better tolerated than MMR. Side effects are uncommon and are generally mild if they do occur. On the day of the vaccine you will be given a fact sheet which outlines possible side effects. The fact sheet also includes the name of the manufacturer, country of origin, batch number and expiry date of the vaccine. Please read the information carefully before your child is seen.
Return to Top of Page
Spacing of Vaccines
We administer the Measles vaccine first as this is by far the most important of the three vaccines. This is followed 10 - 12 weeks later by Rubella. Mumps is administered 10 - 12 weeks following Rubella. (It is the combination of Mumps and Measles together that is implicated in the alleged association of MMR with autism and bowel disorder). These are minimum periods; the vaccines can be more widely spaced if you wish.
The spacing between the administration of other different vaccines should be at least four weeks. This is especially important to remember when your child is also receiving routine vaccinations from your NHS GP Practice.
Return to Top of Page
Vaccine Licences
The single antigen vaccines for Measles, Mumps and Rubella do not have a licence for general use in the UK. However each vaccine has a Manufacturer’s licence for the purpose of vaccinating children.
Each vaccine is imported under permit from the Medicines and Healthcare products Regulatory Agency (MHRA) on a “meet the special needs of an individual” basis.
Permission is obtained to import a vaccine for a named patient to meet the special needs of that patient when an equivalent single vaccine is not available within the UK.
Return to Top of Page
Other Vaccines
There are other vaccines presently available in this country, licensed for use in children over the age of 12 months, but not generally available from the NHS. (Influenza, Hepatitis A & B and Pneumococcal vaccines). Please contact us for further details.
The spacing between the administration of different vaccines should be at least four weeks. This is especially important to remember when your child is also receiving routine vaccinations from your NHS GP Practice.
Return to Top of Page
TB Vaccines
For more information regarding Tuberculosis vaccinations please click here.
Return to Top of Page
Vaccine Administration
We are experiencing an ever increasing number of requests for childhood vaccines, which I could not cope with alone.
I am very lucky and proud to have such a caring and hardworking team: Lynn (my wife and practice administrator who has “put up with me” for over 38 years), Jennie (receptionist / secretary), Sue (receptionist) and Carolyn (receptionist).
All vaccines are administered either by me or by Heather Bratt – Rose (Midwife Practitioner, RM. BSc.(Hons) Midwifery). Heather is very professional, caring, and knowledgeable about vaccines. She is as skilful at administering vaccines as I am.
It is very uncommon for children to cry when we administer a vaccine. The only exception is Mumpsvax where the vaccine solution itself can cause temporary “stinging” for some children.
Return to Top of Page