Childhood vaccinations are widely given in the UK in the first year of life. How do vaccines work? Are they effective and safe? Are there any ethical considerations?
Vaccinations contain a dead or weakened form of an antigen, which when injected activates the body’s defences. This stimulates the an immune response which in turn, produces antibodies that kill the antigens. The antibodies that are produced are kept in the body as B memory cells, so if an infection occurs in the future, the body can release antibodies upon recognition without the effects of the infection being felt. Within the first year of life a number of vaccines are given, these include; the 5-in-1 vaccination, pneumococcal vaccination, rotavirus vaccine, meningitis B vaccine, Hib/ Meningitis C vaccine and the MMR vaccine (NHS, 2016). In this essay we will explore the different vaccines, whether they are effective and the controversy surrounding them.
Figure 1. Schedule for the UK routine immunisations for under 2’s. It details when the vaccinations are given and where they are given as of September 2016. Source: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/554298/Green_Book_Chapter_11.pdf
The 5-in-1 Vaccine
The 5-in-1 vaccine is one of the first that a child will receive, it protects against diphtheria, tetanus, whooping cough, polio and Haemophilus influenzae type b (Hib). The 5-in-1 vaccine works in a number of ways as it is a variety of different types of vaccination. The Diphtheria and Tetanus part is a toxoid vaccine. Toxoid vaccines contain a weakened form of the toxin which means that when the body is infected with the toxoid, the body learns how to destroy the natural toxin. The whooping cough part is a subunit vaccine, this means that it only contains part of the bacterium which means that less side effects are felt than when the whole bacterium is used. The Hib part of the vaccine is a conjugate vaccine where the vaccine fights a number of different bacteria. The vaccine contains the acellular pertussis vaccine as of 2004, that contains purified components of Bordetella pertussis; the small Gram-negative coccobacillus bacterium (WHO, 2016). The bacteria are covered in polysaccharides therefore they make the antigen unrecognisable. The vaccine ‘conjugates the polysaccharide to the antigens that the immune system responds to very well’ as a child’s immune system is not yet fully developed (CDC, 2013).
The Pneumococcal Conjugate Vaccine
The pneumococcal conjugate vaccine (PCV) protects against 13 different types of pneumococcal bacteria. These thirteen bacteria all cause pneumococcal disease which is an infection that results in pneumonia, bacteremia/sepsis, otitis media or bacterial meningitis. According to the World Health Organisation ‘pneumococcal disease is the world’s number 1 vaccine-preventable cause of death among infants and children <5 years of age’ (medicalnewstoday.com, 2016). It’s a conjugate vaccine and so works as the Hib vaccine works, mentioned above. In terms of the efficacy of the vaccine, a study published in 2000 shows that the PCV is ‘highly effective in preventing invasive disease in young children’ (Black et al, 2000). The study was performed with 37,868 children who either received the PCV vaccine or the meningococcus type C conjugate vaccine. The trial was ran for 2 years and so the results are substantial and reliable.
Rotavirus Vaccine
Rotavirus vaccine, protects against type A rotavirus infections which causes diarrhea. Before the vaccination was made widely available (in 2013), ‘more than 400,000 young children had to see a doctor for illness caused by rotavirus’ (CDC, 2016). The vaccination contains a live human rotavirus, however it has been attenuated, so will not cause infection however it will stimulate an immune response. ‘The vaccine is over 85% effective at protecting against severe rotavirus infection in the first two years of life’ (Oxford Vaccine Group, 2016). A recent study shows that there was a 77% decline in confirmed rotavirus cases in infants from July 2000 to June 2015. This proves that the rotavirus vaccine helps to prevent a child from contracting rotavirus (Atchinson et al, 2015).
Meningits B Vaccine
As of September 2015 in the UK, babies are offered the MenB (meningococcal group B) vaccine. MenB has been the most common cause of bacterial meningitis for years and so vaccines are imperative. The vaccine contains an inactivated form of a strain of a New Zealand outbreak of MenB, and a small amount of an aluminium salt. Interestingly, the aluminium delays the time that the active ingredient takes to be released, therefore meaning that they body has longer to respond to the pathogen. This means that the immune system has a stronger defence against the antigen in future infections and can respond effectively (Oxford Vaccine group, 2016).
Hib/Meningitis C Vaccine
The Hib/Men C vaccination is one that protects against Haemophilus influenzae type b and meningitis C, which ultimately lead to septicaemia and meningitis (NHS, 2016). So why do you need to give a vaccine against Hib when it is part of the 5-in-1 vaccination? The answer is not yet known, it is believed to be associated with how long a pathogen takes to leave the body. Previously, the Men C vaccine was given as a booster at 4 months as well as part of the 5-in-1 vaccine at 3 months. This changed as of 2013 as there was sufficient evidence to suggest that the single dose at 3 months was enough to protect a child for the first year of life (Public Health England, 2014). A study published in the Clinical and Vaccine Immunology in 2009 investigated the ‘kinetics of antibody persistence following administration of a combination Meningococcal Serogroup C and Haemophilus influenzae Type b Conjugate Vaccine in healthy infants in the United Kingdom primed with a Monovalent Meningococcal Serogroup C vaccine’ and found that boost doses maybe required later on in life, however after the second dose of Men C is injected, there is no immediate need for a booster in teenage years (Borrow, R et al, 2009).
MMR Vaccine
MMR stands for Mumps, Measles and Rubella. In developing countries where there is a lack of resources, Measles is still a major contributor to infant death and in 2011, 158000 people died of Measles (University of Oxford, 2016). However the vaccination has saved approximately 17.1 million lives since 2000 (WHO, 2015). Contrary to this, in 2016 there has been an increase in the reported cases of measles, having increased by 4 times since the year before (University of Oxford, 2016). Mumps is a viral infection that is preventable with the vaccine, it causes swelling under the face (NHS, 2015). Prior to the introduction of the vaccination in 1988, over 8 in 10 people (mainly children) developed mumps in the UK (University of Oxford, 2015). However, there were 2224 confirmed cases of mumps in England and Wales in 2014 (NHS, 2015). Rubella is caused by a virus, and is not normally serious however for pregnant women it can cause a miscarriage or abnormalities in the baby. The Rubella vaccination was introduced in the 1970s and prior to that, most people contracted Rubella. After the MMR vaccination came about in 1988, there has been a dramatic reduction in cases (University of Oxford, 2016).
Figure 1. All laboratory confirmed cases of measles, mumps and rubella between 2012 and 2015: England and Wales (England only). Source: Centre for Infectious Disease Surveillance and Control (CIDSC). *provisional data.
So are vaccinations safe and effective?
There has been great debate surrounding use of these vaccinations, especially as they are given to children that are so young. There is an argument that in fact nutrition and diet can be better substitutions for vaccinations (REF), as seen in an article in Vactruth in 2016. One of the arguments raised is that ‘Vitamin A reduces Complications of Measles’ and it also talks about the MMR vaccine being linked to serious health consequences (Goldstein, M. 2016). According to the BBC, 10-15 years ago ‘barely a day went by without a newspaper story about the MMR’ as at the time, there were links between the MMR vaccine and autism. This therefore scared parents and so there was a reduction in the number of children vaccinated. Since then, it has been proven that there is no link between the vaccine and autism (Barford, V. 2013) . Yet in 1993 Japan banned the MMR vaccine from its immunisation programme, due to its links with non-viral meningitis (McNeill, D. 2016). The MenB, PCV and the 5-in-1 vaccines contain an amount of aluminium, aluminium has evidence that links it to Alzheimers Disease and so reduced exposure is important (Tomljenovic, L. 2011). However, due to the small amount present in the vaccine, this would not lead to Alzheimers. All of these arguments are plausible and have a degree of science related to them, there is not as much evidence as that associated with the benefits of vaccination. Vaccination has allowed us to eradicate smallpox and soon polio, because we immunise the majority of the population and so transmission of diseases is less likely this is known as herd immunity.
...(download the rest of the essay above)