Concern at fall-off in childhood vaccinations during pandemic

GPs have expressed concern that some infants are not being brought for early childhood vaccinations due to fears of contracting Covid-19 in surgeries. Reduced levels of vaccination for vaccine-preventable diseases – such as the measles and pertussis (whooping cough) – could result in new outbreaks of these infectious diseases, some of which are more contagious than Covid-19.

"There is a lot of resistance among some parents to bringing their children for early childhood vaccinations," explains Dr Tom O'Dowd who works in Tallaght, Co Dublin. "The practice nurse in our surgery has found only 50 per cent of parents are bringing their infants for their first vaccination appointment."

Dr O’Dowd says there is wide variation between parents who will make immunisation appointments for their babies without being prompted by the practice nurse. “Many eastern Europeans, and some Irish people, are distrustful of vaccines, but the Africans and Asians are very keen to have their children vaccinated because they have seen the spread of infectious diseases such as measles and diphtheria as a result of the lack of vaccination programmes,” he says. He adds that it’s ironic at a time when we are yearning for a vaccine for Covid-19 that there is a fall-off in early childhood vaccinations for vaccine-preventable diseases.

Dr Tony Cox is the medical director of the Irish College of General Practitioners (ICGP) and a GP in Ennis, Co Clare. He says that at the start of the pandemic, parents were staying away from surgeries in fear of getting coronavirus but that once they understand the infection control measures are in place, they will come.

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“We are completely up to date with our early childhood vaccinations now, except one parent who isn’t vaccinating her child,” he said of his practice. “The nurse has chased up parents and the mother checks her and the baby’s temperature before coming into the clinic. There is no waiting room so they don’t meet any other patients and the vaccines are ready to be given straight away.”

Prof Karina Butler, paediatric infectious disease specialist with Children's Health Ireland, says that figures are not yet available from the Health Protection Surveillance Centre (HPSC) to clarify whether there have been fewer early childhood vaccinations during the Covid-19 pandemic compared to the same period in 2019.

“It would be a concern if there is a fall-off as this would lead to an increase in diseases such as measles, mumps and meningitis. We have an overall uptake rate of 90 per cent of childhood vaccinations and we need to have 95 per cent to break the spread of infection,” she says.

For example, measles is a highly infectious disease, infecting 12-18 people for each person with it compared to an infection rate of 2.5/3 people from an individual with Covid-19. Clusters of measles cases can also lead to ear infections, hearing impairments, pneumonia, meningitis and encephalitis.

Arguably, the lockdown has stopped the spread of all infectious diseases but as restrictions are lifted, the combination of reduced herd immunity [due to lower levels of vaccination] for vaccine-preventable infectious diseases has also been highlighted by the World Health Organisation (WHO).

In a statement in advance of the Global Vaccine Summit in London on June 4th, the WHO said that Covid-19 is disrupting life-saving immunisation services around the world, putting 80 million children at risk of diseases like diphtheria, measles and polio.

According to WHO data, routine childhood immunisation services have been disrupted on a global scale that may be unprecedented since immunisation programmes were expanded in the 1970s.

"Disruption to immunisation programmes from the Covid-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles," said Dr Tedros Adhanom Ghebreyesus, WHO director-general. Fears of infection from Covid-19, redeployment of health workers to respond to the pandemic, lack of protective equipment for health workers and transport delays in vaccines due to lockdown measures are among the reasons cited for the disruption.

The HSE has stressed that early childhood vaccinations are essential medical services throughout the Covid-19 pandemic. Dr Lucy Jessop, director of public health at the National Immunisation Office (NIO) advises people to contact their GP practice to make an appointment. "You can ask them about their protocol for giving vaccinations during Covid-19. GPs will be following the current HSE advice on how to keep their patients and staff safe at this time."

In the first 20 weeks of 2020, the HPSC reported 2,660 cases of mumps, 65 cases of rotavirus, 55 cases of whopping cough as well as cases of other vaccine preventable diseases. The NIO is encouraging vaccination through its #KeepVaccinating social media campaigns.

The recommended early childhood vaccinations in Ireland are the 6 in 1 vaccine (diphtheria, tetanus, polio, pertussis, haemophilus influenza type b (Hib), hepatitis B) + Pneumococcal conjugate (PCV), meningcoccal B (MenB) and rotavirus at two months, the 6 in 1 vaccine + meningcoccal B and rotavirus at four months, the 6 in 1 vaccine + PCV and Men C at six months, the measles, mumps and rubella (MMR) + Men B at 12 months and the Hib, Men C and PCV at 13 months.

The vaccine programme in schools – the 4 in 1 vaccine and MMR in junior infants and the human papilloma virus (HPV) and Men C in first year of secondary school – was paused when schools closed in March. However, the NIO has stated that children and teenagers can complete their course of vaccines once schools reopen.