Reluctance or Refusal to Vaccinate one of the 10 Threats to Global Health

This year April 7^th is World Health Day and we should celebrate the achievements in the field of vaccination. However, despite vaccine availability, many refuse or hesitate to be vaccinated despite vaccines being available.

Vaccination is one of the best ways of avoiding disease. It prevents ill-health, death and disability.

With an outbreak of measles across Europe in 2018, it gets us thinking –complacency, inconvenience and lack of patient confidence needs tackling.

This article addresses few of illnesses and vaccinations available.

How do I get immunised?

Immunisation is easily accessible through private or NHS clinics, travel centres and some pharmacies. For national health immunisation programmes you will be receiving invitations that you should not ignore. If in doubt call your local NHS clinic, travel health or private health centre. All will happily provide you with the information you need. Alternatively, a simple web search will provide you with extensive information.

However, when you plan to travel it is your responsibility to ensure you receive the necessary travel advice and vaccinations. The important thing to remember is that vaccines need time to take effect and it is important to make an appointment in plenty of time. Some vaccines need multiple doses. In general, make an appointment 8 weeks before travel.

Measles

Measles is still very active around the globe with 2-3 major outbreaks being reported each year. It is still one of the major causes of child mortality worldwide.

Measles vaccination is combined with mumps and rubella in the MMR. This vaccine became unpopular because of the unsubstantiated link with autism and the number of children being vaccinated fell.

This immunisation is offered as part of the childhood immunisation programme by the NHS. However, is never too late to be immunised and if this was not done as a child it can still be done as an adult.

It is also important to remember that Rubella or German Measles immunisation is advised for ladies who are planning pregnancy who have no immunity as acquiring the infection can have devastating consequences for the expecting baby. You may wish to have a blood test to check for immunity at the pregnancy planning stage.

MMR is also suggested for travel to many countries. An MMR immunity blood test can quickly establish whether you are immune to Measles, Mumps or Rubella or you require immunisation. We often find that adults who have immigrated to UK from other parts of Europe have incomplete immunisation to MMR and require a booster.

You may read more about MMR vaccination here.

Chickenpox

Chickenpox is caused by the Varicella – Zoster Virus and causes an itchy rash, fever and sometime joint pains. It is more common in children but can occur at any age. It is a self-limiting infection that usually needs no treatment but can cause complications such as pneumonia and encephalitis (inflammation of the brain).

Again, this is a viral infection which is preventable with immunisation. Routine immunisation is not offered by the NHS currently in the UK, but is available privately in UK or part of immunisation programmes in other countries across the globe.

Immunisation is available from 9 months of age.

You may read more about chickenpox and vaccinations here and here.

Shingles

One complication of having had chickenpox is the possibility of shingles in later life. Varicella Zoster Virus is unusual in that the immune system does not completely clear it and it can lie dormant in the body, and reactivate many years later. In this case it appears as a similar rash to chickenpox but only in a localised area of the body, as it reactivates in a particular nerve root.

As with chickenpox, the rash settles quickly but as the infection stimulates the nerve this can cause neuralgia, known as post herpetic neuralgia – ‘nerve pain’. This gives a burning pain in the area affected and although this can be short lived it can go on for many months and can be severe in some cases. There are medications to help decrease the irritability of the nerve and help symptoms.

There is a vaccine for shingles prevention which is available on the NHS, namely Zostavax, for people between 70 and 80 years of age, but it can be given privately from age 50. A new vaccine, Shingrix, is available in UK privately, and this has a 91% effectiveness versus the 51% in preventing the rash. You may read more about these vaccines here and here.

Malaria

Between year 2000 and 2017, a total of 30,000 cases of malaria were reported in UK in returning travellers, cases that led to 135 deaths*.

This highlights the importance of pre-travel advice, consultation and preventative treatment. It is always important to seek advice as you may be surprised of the illnesses you are putting yourself at risk when travelling. Malaria is widely distributed throughout tropical regions of the world including in parts of Africa, Asia, Central and South America, the Caribbean, the Middle East and Oceania.

Malaria is a potentially serious parasitic infection transmitted through the bite of an infected mosquito. Malaria is preventable and curable if diagnosed and treated promptly. Prevention is through tablets that in many cases is started within 24 hours of travel, so is never too late to seek advice! Medication however needs to be taken for days or weeks after return from travel.

Our experience tells us that many cases are caused by complacency, belief of self-acquired immunity and the inconvenience of taking tablets when away.

Yellow Fever

Yellow Fever is a severe disease with a high mortality rate and no specific treatment. Although rare, 2017 and 2018 has seen an unusual increase in relation to an increase virus circulation in South America, in particular Brazil.

The Yellow Fever Vaccine is highly efficacious and provides lifelong immunity in travellers. The vaccine may be administered for both reasons of certificate requirements and illness prevention. The vaccine is a live vaccine with associated side effects, some of which are severe and therefore a carful assessment with a trained professional is recommended.

The vaccine provides effective immunity within 10 days for 80-100% of people vaccinated, and within 30 days for more than 99% of people vaccinated.

If you have any questions about vaccinations available against any illnesses do get in touch with our clinics. Our staff will be happy to answer your questions.

Take Home Points

• If planning travel, check if immunisations or other preventative measures are required for the countries you are planning to visit
• Make the appointment in plenty time – at least 8 weeks before travel
• Take precautions for bite prevention and antimalarial tablets if going to a country with Malaria risk
• Remember to take antimalarials after return to the UK
• Don’t forget about Measles!

https://www.gov.uk/government/publications/imported-malaria-in-the-uk-statistics