tag:theconversation.com,2011:/id/topics/national-immunisation-program-6278/articlesNational immunisation Program – The Conversation2015-05-14T20:01:35Ztag:theconversation.com,2011:article/417642015-05-14T20:01:35Z2015-05-14T20:01:35ZNew register shows importance of vaccination beyond childhood<figure><img src="https://images.theconversation.com/files/81666/original/image-20150514-28586-1tf2v9h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Given the increasing number of vaccines recommended for adolescents and adults in Australia, the newly announced initiatives are a very good idea.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/wellcomeimages/16580160449/">Wellcome Images/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Health was not one of the winners of <a href="http://www.budget.gov.au/">Tuesday night’s big-spending federal budget</a>, but one initiative tucked away in the budget papers is worthy of applause – the establishment of an adult immunisation register and the expansion of the childhood register to include adolescents. </p>
<p>The <a href="http://www.budget.gov.au/2015-16/content/bp2/html/bp2_expense-14.htm">budget papers</a> say immunisation data collection will be expanded to include school-based adolescent vaccinations and that an adult register will be established from September 1, 2016. </p>
<p>The move means that we will soon record all vaccinations delivered to adolescents and adults through the government-funded National Immunisation Program (NIP). The program covers the cost of vaccines, but not all the recommended shots are on the NIP.</p>
<h2>Existing register</h2>
<p>Australia already has an immunisation register for children. The <a href="http://www.humanservices.gov.au/customer/services/medicare/australian-childhood-immunisation-registe">Australian Childhood Immunisation Register (ACIR)</a> is the envy of many countries around the world. It was established in 1996 and, after a shaky start, now provides accurate data on the immunisation status of all registered children under seven years old. </p>
<p>The register also provides data for the regular reporting of immunisation coverage, with data available by state, regions within the states, Indigenous status and age group. This allows gaps in vaccine coverage to be highlighted and, in turn, for targeted interventions to improve uptake. The adult register could perform a similar role.</p>
<p>Recognising how well the ACIR has allowed monitoring of vaccine coverage for children, many clinicians and public health workers have long advocated having the same information available for adolescents and adults. </p>
<p>Adult vaccinations will be recorded, potentially for every Australian adult, and this information could well become part of the new opt-out e-health record.</p>
<h2>Getting the adult register going</h2>
<p>Before the ACIR was established, the call for its establishment was a recurring theme at the immunisation conferences sponsored by the <a href="http://www.phaa.net.au/">Public Health Association of Australia</a>. It’s been exactly the same with the adult immunisation register. </p>
<p>For at least ten years now, one of the resolutions at every immunisation conference has been the establishment of an adult immunisation register. But most of us supporting these resolutions did not think the idea had much traction in Canberra. So, the announcement has been something of a welcome surprise. </p>
<p>Still, it’s probably an idea whose time has come, given the increasing number of vaccines recommended for adolescents and adults in Australia. </p>
<p>The influenza and <a href="http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-pneumococcal">pneumococcal vaccinations</a> have been recommended for adults for a long time. Originally targeted at older people, <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-influenza">influenza vaccines are now recommended much more widely</a> and are funded for people of any age with an existing illness, such as heart or lung disease, that may increase the risk of serious illness. </p>
<p>But data on uptake are sparse and there are unresolved questions about the impact of these vaccines. Knowing precise coverage may help resolve these problems.</p>
<p>A new vaccine against shingles (<em>Herpes zoster</em>) has recently been recommended for older people, as recognition of the burden this virus poses. It has been funded in the budget for adults between 71 to 79 years old, with an opportunity for a catch-up after November 2016.</p>
<h2>Vaccines for adolescents</h2>
<p>Adolescents and young adults are encouraged to receive the <a href="http://hpv.health.gov.au/">human papilloma virus (HPV) vaccine</a> to prevent specific strains of genital warts and reduce the risk of cervical cancer in women. <a href="https://theconversation.com/the-case-for-vaccinating-boys-as-well-as-girls-against-hpv-6">Australia has led the world</a> with the roll-out of this vaccine. Collecting data on the initiative will be critical to understand population coverage and identify coverage gaps.</p>
<p>Measles has been eliminated for Australia, which means there’s no strain of this virus circulating for more than a year. But because the virus is circulating elsewhere in the world, <a href="https://theconversation.com/measles-outbreaks-show-the-illness-is-down-but-not-yet-out-19149">it can be imported into the country</a>, often via young adult returning travellers. </p>
<p>The initiatives announced in the budget would allow monitoring of measles vaccine status in young adults, as the current childhood vaccination register allows monitoring in children. Along with other strategies related to measles control, this may well turn out to be important in maintaining Australia’s measles elimination status.</p>
<p>If unexpected disease outbreaks occur, as there have been for whooping cough (pertusis), immunisation registers will help us determine whether it’s due to low vaccine coverage. <a href="http://www.ncirs.edu.au/immunisation/fact-sheets/pertussis-fact-sheet.pdf">Given new recommendations for adult vaccination against whooping cough</a>, it will be just as important to know the proportion of adults who are vaccinated as it is to know how many children are.</p>
<p>It is hard to see a downside for these initiatives. But whether it will be enough of a sweetener to compensate for the cuts that have been flagged for the overall health budget remains to be seen.</p><img src="https://counter.theconversation.com/content/41764/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heath Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tucked away in the budget papers is an intitiative worthy of applause – the establishment of an adult immunisation register and the expansion of the childhood register to include adolescents.Heath Kelly, Professor (Adjunct) in Infectious Diseases Epidemiology, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/400782015-04-14T20:19:13Z2015-04-14T20:19:13Z‘No jab, no pay’ policy has a serious ethical sting<figure><img src="https://images.theconversation.com/files/77879/original/image-20150414-24618-id63tk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The emotional appeals of the opposing views on vaccination are both driven by concern for children.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/worldbank/6358613209">World Bank Photo Collection/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The Coalition government’s <a href="http://www.abc.net.au/news/2015-04-12/parents-who-refuse-to-vaccinate-to-miss-out-on-childcare-rebates/6386448">proposed “no jab, no pay” policy</a> may inject enthusiasm into politics, but policies mandating vaccination are ethically very precarious.</p>
<p>The plan to withhold payments of <a href="http://www.theaustralian.com.au/national-affairs/health/vaccination-to-be-backed-by-welfare-sanctions/story-fn59nokw-1227300267462">child-care and family tax benefits</a> for unvaccinated children could cost non-compliant parents up to A$15,000 a year. But is it ethical to punish parents for what should be an individual decision and is based on concern for their kids?</p>
<p>Parents are naturally concerned for their children. While some of their fears may be unfounded, not all vaccines are 100% safe; while rare, <a href="http://www.cdc.gov/vaccinesafety/Concerns/FebrileSeizures.html">childhood vaccinations can cause febrile seizures</a>. </p>
<p>One of the main reasons for parents’ fears may stem from the controversy about the measles, mumps, rubella (MMR) vaccine. Although this fear was <a href="http://edition.cnn.com/2011/HEALTH/01/05/autism.vaccines/">famously fuelled by false claims</a>, reviews of multiple scientific studies by the Cochrane Collaboration in <a href="http://www.ncbi.nlm.nih.gov/pubmed/16235361">2005</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/16235361">2012</a> show evidence of adverse events associated with that vaccine. Disturbingly, both reviews highlight that the design and reporting of safety outcomes in MMR vaccine studies have been “largely inadequate”.</p>
<p>Here’s what lies at the heart of the problem: the risk of adverse reactions from vaccines is actually very small but families unfortunate enough to suffer a vaccination reaction are unlikely to be consoled by this improbability. They may be little moved by the fact that their loss nonetheless served the common good.</p>
<h2>Unintended consequences</h2>
<p>The “no jab, no pay” policy has harms beyond the physical: it may unfairly deny funds to people who already suffer from hardship. While much attention is given to the half of non-vaccinators who consciously refuse, <a href="https://theconversation.com/why-do-people-not-vaccinate-24882">people have failed to vaccinate for other reasons</a> such as having an ill child, or being caught up in what may be an already difficult separated family situation.</p>
<p>People who do not vaccinate for <a href="http://www.racgp.org.au/afpbackissues/2004/200407/20040703lawrence.pdf">reasons other than disagreement and concern</a> tend to have lower household incomes (60% have a household income less than A$50,000) and lower education levels (34% have year ten or less education). Single-parent households are also over-represented in this sub-population – 21% versus <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Products/6224.0.55.001%7EJun%202012%7EChapter%7Eone%20Parent%20Families">15% of families nationally</a>.</p>
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<a href="https://images.theconversation.com/files/73031/original/image-20150225-1761-5npbry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/73031/original/image-20150225-1761-5npbry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/73031/original/image-20150225-1761-5npbry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/73031/original/image-20150225-1761-5npbry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/73031/original/image-20150225-1761-5npbry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/73031/original/image-20150225-1761-5npbry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1067&fit=crop&dpr=1 754w, https://images.theconversation.com/files/73031/original/image-20150225-1761-5npbry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1067&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/73031/original/image-20150225-1761-5npbry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1067&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>For such people, a policy that links vaccination to family benefits may simply increase their disadvantage. It may even add fuel to family tensions if the problem arises because of a separated family situation and parents with differing views.</p>
<p>Yet another potential harm resulting from the policy is that mandating vaccinations fails to respect individual autonomy. This tension between <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196023/">individual rights and the public good</a> has been labelled the “<a href="http://www.polity.co.uk/book.asp?ref=9780745662190">central dilemma</a>” in public health. </p>
<p>The counter-argument to these harms is that <a href="http://graphics.wsj.com/infectious-diseases-and-vaccines/">childhood vaccination can and does save lives</a>. But we now know that not all <a href="http://news.sciencemag.org/health/2014/04/measles-outbreak-traced-fully-vaccinated-patient-first-time">vaccinations are 100% effective</a>. If they were, there would fewer emotional appeals along the lines of “<a href="http://paul-offit.com/booksby/deadly-choices/">the anti-vaccine movement threatens us all</a>”.</p>
<h2>The same coin</h2>
<p>The emotional appeals of the opposing views on vaccination are both driven by concern for children. Some parents fear their children may be harmed by vaccines, or harmed by people around them who aren’t vaccinated. Neither wishes to endanger their child. </p>
<p>The ultimate aim of public health is the benefit conferred after taking potential harm into account. In the case of vaccination, the gold standard is achieving herd or <a href="https://theconversation.com/braving-the-jab-for-community-immunity-330">community immunity</a>. But the moral challenge posed by this policy concerns what, if any, additional benefit is conferred by mandating vaccinations.</p>
<p>The <a href="http://www.myhealthycommunities.gov.au/Content/publications/downloads/NHPA_HC_Report_Imm_Rates_March_2014.pdf">National Health Performance Authority reports</a> that Australia already enjoys high immunisation rates. Over 90% of children are classified as “fully immunised” by the age of five.</p>
<p>And we know that complete elimination of risk of exposure to infected people is unrealistic as reflected in the case of the Brisbane woman who reportedly contracted <a href="http://www.couriermail.com.au/news/fatal-return-of-diphtheria/story-e6freomx-1226048663339">diphtheria from a friend who had been travelling abroad</a>. Risks of infection will likely always remain, especially because of our unprecedented mobility across national borders.</p>
<p>Public health in this instance is about the delicate balance between the desired benefits (protection from preventable disease) and possible costs (adverse events, unfair distribution of costs and undermining individual autonomy). </p>
<p>It’s vital that those guiding the community and especially those seeking to impose their view on others are mindful of the complex ethical issues raised by this policy. Indeed, it’s unfortunate that there’s no vaccine against inadvertently engaging in unethical behaviour. If there were, we could administer it to policy makers first of all.</p>
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<p><em>Do you have a question about vaccination? Contact The Conversation on <a href="https://twitter.com/ConversationEDU">Twitter</a>, our <a href="https://www.facebook.com/ConversationEDU">Facebook page</a> or leave a comment below and we will try to answer it with an article we’ve already published or by getting one of our expert authors to write an article about it.</em></p><img src="https://counter.theconversation.com/content/40078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen S Holden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The plan to withhold payments of child-care and family tax benefits for unvaccinated children could cost non-compliant parents up to A$15,000 a year. But is it ethical to punish parents?Stephen S Holden, Associate professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/278542014-09-22T04:34:02Z2014-09-22T04:34:02ZHealth Check: can sex affect your risk of getting cancer?<figure><img src="https://images.theconversation.com/files/59643/original/tnsrvmcd-1411346790.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As with most matters health, how sex and cancer risk are linked is complicated and dependent on several factors.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/lucasfrasca/10036159755">Lucas Frasca/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>The <a href="http://www.nhs.uk/Livewell/Goodsex/Pages/ValentinesDay.aspx">sex act has many health benefits</a> from reducing stress and tension, to boosting your immune system. It may even affect your risk of developing certain cancers.</p>
<p>But as with most matters health, how sex and cancer risk are linked is complicated and dependent on several factors. Your age, gender, and how often you practice safe sex will all influence your potential cancer risk. </p>
<p>To date, the only clear literature linking sex and cancer is that concerning the human papillomavirus (HPV). There are over 200 strains of HPV, but some are more cancer-causing than others. The good news is that we <a href="https://theconversation.com/four-things-you-should-know-about-hpv-vaccinations-15178">now have a vaccine</a> against the most common cancer-causing strains of the virus.</p>
<p>Most commonly, HPV is linked to cervical cancer. But both men and women can increase their risk of developing cancer through sexual activities that pass on the virus. </p>
<h2>HPV infection</h2>
<p>A lot has been written about HPV and cervical cancer. So much, in fact, that most people don’t even realise men can also get HPV, and that they can get HPV-related cancers too. Indeed, men have largely been ignored in the <a href="http://www.tandfonline.com/doi/abs/10.1080/10810730.2011.585700">media and promotion of the HPV vaccine</a>.</p>
<p>Boys have been included in the Australian school-based HPV vaccination program <a href="http://hpv.health.gov.au/the-program/">since 2013</a>. But preliminary results of research with male adolescents and their parents suggest there’s low awareness and understanding about the vaccine. </p>
<p>Adolescent boys aren’t sure what the vaccine is for, nor why they need to get it; parents think their sons are not at risk of HPV-related cancers. But HPV can cause a range of cancers in both men and women, in sites other than the cervix. These include cancers of the anus and genitals, as well as cancers of the head, neck, and throat. </p>
<p>Indeed, HPV infections are now a proportionally significant cause of <a href="http://www.ncbi.nlm.nih.gov/pubmed/21816661">oropharyngeal (head, neck, and throat) cancer diagnoses</a>. And epidemiological modelling suggests that by 2020, HPV will cause <a href="http://www.ncbi.nlm.nih.gov/pubmed/21969503">more oropharyngeal cancers</a> than cervical cancers in the United States. </p>
<p>In 2013, news reports of Hollywood veteran (and self-confessed ladies’ man) Michael Douglas <a href="http://www.bostonglobe.com/lifestyle/health-wellness/2013/06/09/michael-douglas-blames-throat-cancer-oral-sex-what-are-risks/Akb38cr5CCvj2HUKXJ5SCP/story.html">identified HPV as the cause of his throat cancer</a>, creating public interest in the relationship between sexual activity and cancer risk. </p>
<p>Unfortunately, some interpretations of this news were incorrect, leading people to believe that oral sex could also “cure” cancer after Douglas <a href="http://www.ibtimes.com/michael-douglas-says-oral-sex-both-cause-cure-throat-cancer-not-quite-1288941">also made that claim</a>. In fact, the only “cure” in the case of HPV-related cancers is prevention. </p>
<h2>HPV vaccination</h2>
<p>Vaccination is the primary method of preventing HPV-related cancers. But as mentioned above, some parents still question why males need the vaccine if girls are receiving it through the school-based program. </p>
<p>The reason is twofold. </p>
<p>Among heterosexual couples, HPV is transmitted between males and females (either partner could be infected first and transmit it to the other). So, vaccinating women provides some benefits to men, but full protection of heterosexual men only occurs if most women receive the vaccine. </p>
<p>While the school-based program in Australia has reached quite <a href="http://www.hpvregister.org.au/research/coverage-data/vaccination-2012">high coverage of girls</a>, it isn’t high enough to fully protect all heterosexual boys. What’s more, men who are vaccinated will help protect future partners who are not vaccinated. </p>
<p>The second reason is that adolescent boys who do or will eventually identify as bisexual or homosexual are not protected. It’s unrealistic, impractical, and stigmatising to try to single out this population at the age of 12, when school children receive the HPV vaccine. </p>
<p>By vaccinating adolescent boys in a school-based program, we can protect the homosexual community from developing HPV-related cancers as well. And this is very important given the <a href="http://www.ncbi.nlm.nih.gov/pubmed/19342375?dopt=Abstract">higher prevalence of HPV infection and related disease </a> in this population. </p>
<p>HPV is a real risk for developing cancer in both men and women, and it is transmitted through sex. But, reducing this cancer risk is easily done through vaccination. After HPV vaccination, the only real cancer worries are those not directly related to sexual behaviours. </p>
<p>So get vaccinated against HPV, eat your veggies, exercise, and watch out for those other carcinogens in your life. But you won’t have to worry about contracting cancer from your sexual partners.</p><img src="https://counter.theconversation.com/content/27854/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible and the Scottish Universities Life Sciences Alliance for research into anticancer drugs. </span></em></p><p class="fine-print"><em><span>Hayden Fletcher and Spring Chenoa Cooper do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The sex act has many health benefits from reducing stress and tension, to boosting your immune system. It may even affect your risk of developing certain cancers. But as with most matters health, how sex…Spring Chenoa Cooper, Senior Lecturer, University of SydneyHayden Fletcher, PhD Candidate (Paediatrics and Child Health) , University of SydneyNial Wheate, Senior Lecturer in Pharmaceutical Chemistry, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/156142013-06-30T21:06:04Z2013-06-30T21:06:04ZVaccine program changes protect kids, but with fewer ouches<figure><img src="https://images.theconversation.com/files/26418/original/5c7wt6b2-1372397559.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The new vaccine scheme sees children receiving their jabs at an earlier age.</span> <span class="attribution"><span class="source">Jovan Mandic/ Shutterstock</span></span></figcaption></figure><p>Changes to the National Immunisation Program <a href="http://www.health.gov.au/internet/immunise/publishing.nsf/Content/nips-2/$file/NIPS2.pdf">schedule</a> coming into effect today (July 1, 2013) will see two fewer injections given to young children. The changes represent a more efficient way of delivering protection against disease through the use of new combination vaccines.</p>
<p>This is good news for parents and carers (and incidentally, health-care providers) who don’t relish the transient discomfort children experience when given an injection, despite knowing the importance of immunisation. </p>
<p>Children will still be protected against 16 diseases through the national program, but fewer injections will be needed because of two relatively new combination vaccines replacing four previously recommended ones.</p>
<h2>The new combination vaccines</h2>
<p>One of these new combination vaccines is called <a href="http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-MMRV-Vaccine">MMRV</a> and provides protection against measles, mumps, rubella and varicella (chickenpox). Protection against measles, mumps and rubella requires two shots, while chickenpox requires only one shot for children.</p>
<p>The MMRV vaccine (to be offered at 18 months of age) replaces two shots that were previously given separately – the varicella vaccine that was already at 18 months of age and the second dose of the combination vaccine against measles, mumps and rubella vaccine (MMR) that was given to four-year-olds. </p>
<p>The change means that, at four years of age – when they’re a lot more aware of how many plasters they’re sporting – children will only be given one injection (the diphtheria-tetanus-pertussis-polio booster, known as DTPa-IPV vaccine). The first dose of MMR will still be given at the age of one. </p>
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<span class="caption">The new vaccine program targets children before they reach school playground.</span>
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<p>The second of the new combination vaccines (the Hib-MenC vaccine) replaces two vaccines also recommended at the time of a baby’s first birthday – the vaccine for <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda-cdi34suppl.htm%7Ecda-cdi34suppl-3-vpd.htm%7Ecda-cdi34suppl-3-vpd2.htm">haemophilus influenza type b (Hib)</a> and the one for <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda-cdi34suppl.htm%7Ecda-cdi34suppl-3-vpd.htm%7Ecda-cdi34suppl-3-vpd7.htm">meningococcal C</a> (both bacteria cause meningitis, septicaemia and other serious infections). </p>
<p>The Hib-MenC vaccine provides protection against both diseases with one injection, which means, at 12 months of age, two rather than three injections are needed for most children (you’ll recall the other one is the first dose of the MMR vaccine).</p>
<h2>The benefits of combining</h2>
<p>The obvious benefit of combination vaccines is that they provide protection against the same number of diseases with fewer injections. But there are other advantages to incorporating the new combination vaccines into the immunisation schedule. </p>
<p>Adding the MMRV vaccine to those given at 18 months means that children will now receive the second dose of their measles vaccine two-and-half years earlier. Although Australia is free from measles circulating in the community, large outbreaks can occur when travellers reintroduce the virus, particularly into pockets of the population where there is sub-optimal vaccine coverage. </p>
<p>This happened in <a href="http://www.theaustralian.com.au/news/unvaccinated-travellers-spreading-measles-outbreak/story-e6frg6o6-1226031688435">2011</a> and again in New South Wales <a href="http://www.abc.net.au/news/2012-08-15/measles-outbreak/4200376">2012</a>. Having the majority of the community immune to measles by receiving two doses of the vaccine is essential for preventing outbreaks.</p>
<p>The use of MMRV at 18 months is also expected to improve protection against chickenpox. Previously, this vaccine was the only one given at 18 months, and was sometimes forgotten. As a result, coverage against chickenpox has been lower than for other childhood vaccines, with around 84% of children immunised by the age of two.</p>
<p>Chickenpox vaccine was only introduced in 2005, and there has already been a 75% reduction in hospitalisations for chickenpox in children younger than five years old. We can expect further benefits with the increase in the number of vaccinated children.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/26408/original/t6d63h8c-1372395037.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/26408/original/t6d63h8c-1372395037.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/26408/original/t6d63h8c-1372395037.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/26408/original/t6d63h8c-1372395037.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/26408/original/t6d63h8c-1372395037.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/26408/original/t6d63h8c-1372395037.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/26408/original/t6d63h8c-1372395037.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Parents have two fewer jabs to worry about.</span>
<span class="attribution"><span class="source">Marcin Banaszek/Flickr </span></span>
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<p>This change should also see more children get the second dose of the MMR vaccine in a timely way than when it was recommended at the age of four.</p>
<p>Similarly, the convenience of the combination Hib-MenC vaccine at 12 months, rather than two separate injections, will no doubt contribute to more children being vaccinated. This should maintain or improve upon the low rates of both diseases that we have already seen since these vaccines were included on the national immunisation program over a decade ago.</p>
<h2>The immune system and combination vaccines</h2>
<p>The role of the immune system is to survey all the foreign particles (often referred to as antigens) that you come into contact with and, if necessary, make an immune response to them. </p>
<p>There’s a common myth that vaccines, particularly combination vaccines, overwhelm or weaken a child’s immune system. But like all myths, this is <a href="http://www.health.gov.au/internet/immunise/publishing.nsf/Content/1FC63A2886238E6CCA2575BD001C80DC/$File/full-publication-myths-and-realities-5th-ed-2013.pdf">not true</a>. </p>
<p>Vaccines actually have the opposite effect, and work to strengthen the immune system, as they stimulate it to recognise and protect against a virus (or other antigen) whenever the body comes in contact with it in the future. </p>
<p>Importantly, the amount of virus antigen in a vaccine is much less than the amount you would naturally encounter and it is modified to give an immune response which protects, but without making you sick (which is what the natural infection does). To be sure that combination vaccines have no untoward effects, vaccines <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/1-5">studies assessing immune responses</a> to new vacines and others routinely used at the same time are carried out before a vaccine is registered for use.</p>
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<img alt="" src="https://images.theconversation.com/files/26425/original/7wyqcg6c-1372400940.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/26425/original/7wyqcg6c-1372400940.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/26425/original/7wyqcg6c-1372400940.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/26425/original/7wyqcg6c-1372400940.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/26425/original/7wyqcg6c-1372400940.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/26425/original/7wyqcg6c-1372400940.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/26425/original/7wyqcg6c-1372400940.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Children will now have better protection against chickenpox .</span>
<span class="attribution"><span class="source">Aaron Anderer/Flickr</span></span>
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<p><a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-4-9">Clinical studies</a> comparing MMRV on its own, with MMR and chickenpox vaccines given at the same time at different sites, have found that the immune response to all four viruses is similar. </p>
<p>Combination vaccines have successfully been used in Australia for many years to protect against multiple diseases with only one injection. We have been using the six-in-one vaccine recommended at two, four and six months of age since 2005. This vaccine protects against diphtheria, tetanus, pertussis (whooping cough), polio, Hib disease and hepatitis B. </p>
<p>Although vaccines against these diseases had been in use for many years prior to 2005, having a six-in-one vaccine has made immunising easier for all.</p>
<h2>Benefits outweigh risks</h2>
<p>Part of the decision-making process around the introduction of new vaccines is the assessment of the benefit and risks of vaccination.</p>
<p>Recall that the measles, mumps, rubella vaccine has to be given in two shots. Clinical trial and post-marketing surveillance <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-4-9">data have identified</a> a small increased risk of fever, and in turn, a small added risk of febrile seizures in children when the MMRV vaccine is given as the first dose of the MMR-containing vaccine, compared to when the MMR (with or without chickenpox vaccine at the same time in another injection) is given. </p>
<p>This risk of fever is greatly reduced when the MMRV vaccine is used as the second dose of the MMR-containing vaccine. This is why MMRV is to be given at 18 months of age after just MMR as the first vaccine dose.</p>
<p>Vaccine safety is continually monitored after a new vaccine is introduced into the population. This occurs through passive national surveillance mechanisms such the Therapeutic Goods Administration’s <a href="https://www.ebs.tga.gov.au/ebs/ADRS/ADRSRepo.nsf">Adverse Drug Reaction Reporting System</a>, as well as smaller specific active surveillance systems like the <a href="http://www.apsu.org.au/surveillance-systems/paeds/">Paediatric Active Enhanced Disease Surveillance</a>. </p>
<p>You can rest assured that the changes to the national immunisation program result from a close examination of what we have been doing and ways to improve it. The changes provide children with greater protection while giving them fewer shots.</p><img src="https://counter.theconversation.com/content/15614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristine Macartney receives funding from the NHMRC.</span></em></p><p class="fine-print"><em><span>Melina Georgousakis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Changes to the National Immunisation Program schedule coming into effect today (July 1, 2013) will see two fewer injections given to young children. The changes represent a more efficient way of delivering…Kristine Macartney, Associate Professor, Discipline of Paediatrics and Child Health, University of SydneyMelina Georgousakis, Senior Research Officer, National Centre for Immunisation Research and Surveillance, University of SydneyLicensed as Creative Commons – attribution, no derivatives.