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Immunisation debates

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    Whether we like it or not “the media” are the most powerful influence on public opinion. There have been times when unbalanced reporting has done harm but recently (December 2000–January 2001) there has been evidence of a well-considered approach, at least to the subject of immunisation. The apparent success of group C meningococcal vaccination has been well publicised and MMR vaccination defended. Commenting on a recent fall in MMR acceptance rates, theTimes concluded (January 5, 2001) that parents who refuse the vaccine for their children “shirk, for selfish reasons and on the basis of wholly inconclusive scientific research, a manifest social responsibility”. Strong stuff, and probably unfair to many concerned parents, but at least fighting on the side of the angels.  Whenever questions are raised about immunisation there are fears about vaccine refusal, the great spectre being the example of pertussis in the early 1980s when disease rates soared after fears of vaccine-induced encephalopathy resulted in low acceptance rates. But questions must be asked. It may be irresponsible to endanger vaccination programmes on the basis of inadequate data but it is never irresponsible to ask sensible questions.  There is no doubt that parents do have their own thoughts about immunisation. In a national survey in the USA (Bruce G Gellin and colleagues.Pediatrics2000;106:1097–102) 23% agreed that “children get more immunisations than are good for them”, and 25% agreed, or expressed concern, that “too many immunisations could weaken the child's immune system”. Could such concerns have any rational basis? Immunisation almost certainly has non-specific effects on immune function. Both measles and BCG immunisations probably boost immunity in non-specific as well as specific ways and so may other immunisations. In a randomised study in Germany (S Otto and colleagues.Journal of Infection2000;41:172–5) babies who had their first immunisations at 3 months had more symptoms (cough, snuffles, restlessness, rash, or apparent pain) during their third month than did babies immunised at 2 months. The effects may be different in countries with high infection rates and high mortality. In Guinea-Bissau, West Africa (Ines Kristensen and colleagues. BMJ2000;321:1435–8) measles and BCG immunisation improved non-specific immunity in young children but diphtheria, pertussis, and tetanus (DPT), and poliomyelitis immunisation appeared to impair it. This effect may reduce the effectiveness of DPT and polio immunisation and in this study DPT immunisation was associated with an increase in early childhood mortality. The BMJ published the paper together with a commentary which questioned the reliability of the results and an editorial which strongly defended current immunisation practice and hinted that there were those who thought that the paper should not have been published.  The television science guru Jacob Bronowski once wrote, “ask an impertinent question, and you are on the way to a pertinent answer”. No subject, not even immunisation, is sacrosanct. Scaremongering is silly and irresponsible but questions have to be asked and debated. Evidence resolved the pertussis controversy and evidence has assuaged MMR fears. Parents' concerns must be faced and answered. Recent evidence suggests that the media can be an ally rather than an irritant in this process.

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