Send letter to journal:
Re: "I do not want my baby vaccinated"

Dear Editor:

How many times do general practitioners here parents say "I do not want my baby vaccinated"? Quite often, I guess. As vaccine uptake rates are maintained at high levels, notifications of the diseases prevented by them have fallen. As the incidence of these diseases have fallen from the public consciousness, public attention has deviated from these nasty diseases to its side effects. The paper from Gold M et al[1] is a reminder to health professionals that vaccination schedules can be safely carried on in spite of most adverse reactions.

Some districts, including ours, run immunisation helplines for primary healthcare teams.[2] The most common query we get is from the practice nurse when a mother presents with the child for the next dose of DPT, Hib, and meningitis C vaccine and reports a severe local reaction or prolonged crying after the previous dose. What we find time and time again is that parents seldom go to their general practitioner immediately. An opportunity to check the reaction out and make clear and careful decisions about the future is lost. It is debatable how reliable or vivid parental accounts of a swelling or length and quality of crying could be a month later. We did not find any reference as to how well the yellow card system of reporting adverse immunisation reactions is used in the UK.

A report from the US[3] does suggest that their counterpart to the yellow card (VAERS) may not be reliable. In light of the paper by Gold et al[1] and our experience we have the following suggestions to make:

1. Practice nurses and general practioners should encourage parents to bring the child back if they are worried about side effects
2. The yellow card system of reporting adverse drug reactions should be used appropriately
3. Health professionals should seek expert advice before not recommending any vaccine
4. There are very few true vaccine side effects. The Green Book[4] in the UK should reflect the increasing evidence of vaccine safety. This can help boost professional and parental confidence in vaccination programmes.

Dr Ashok Nathwani
Consultant Paediatrician
Portsmouth, UK

References

(1) Gold M, Goodwin H, Botham S, Burgess M, Nash, Kempe A. Re-vaccination of 421 children with past history of an adverse vaccine reaction in a special immunisation service. Arch Dis Child 2000;83:128-31.

(2) Finlay F, McKechnie L, Pearce A, Lenton S. Immunisation telephone hotline audit. Ambulatory Child Health 1999;5:295-302.

(3) Braun MM, et al. Report of a US Public Service workshop on Hypotonic Hyporesponsive Episode (HHE) after pertussis immunisation. Pediatrics 1998;102:e52.