Guest blog: Peter Barnett – Revisiting vaccination

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The European Centre for Disease Prevention and control (ECDC) has published its Annual epidemiological surveillance report [1]. The overall picture is of a European Union in which citizens are well protected against infectious diseases via their various vaccination programmes and operation of their surveillance systems.

But despite all these positive developments, some worrying signals remain. The reality, as highlighted by ECDC, is that perhaps we are becoming complacent about immunisation. For example, there were several significant outbreaks of measles, an extremely serious potentially life-threatening disease in adults, in EU countries during 2009. This was a clear marker that Europe was on track to miss its target of eliminating measles by 2010. Outside Europe a quick “Google news” search highlights measles outbreaks in Canada, the United States and New Zealand.

So even in the developed world, let alone the developing world, these diseases are by no means defeated. OECD included influenza in its 2010 Health at a Glance: Europe 2010 report [2] and noted that the highest influenza morbidity and mortality occurs among the elderly and those with chronic conditions (e.g. 85-90% of people who die from influenza in France and Germany are over 65 years of age). In their report, ECDC noted that in the 2008/9 influenza season a severe outcome was associated with increased age and the presence of at least one underlying medical condition. If sustained, these changes in risk patterns for severe influenza may result in a change in thinking about who should be offered immunisation in terms of age and risk profile.

In the USA, vaccination against chickenpox/shingles has become routine and cases have dropped by 80%. US researchers found that the Zoster vaccine reduced the occurrence of shingles by about 50% among persons age 60 years and older. The vaccine is most effective for those age 60–69 years (64%) and effectiveness declines with increasing age. Despite these outcomes this vaccine is not used in the UK to prevent shingles, apart from those at risk in a health work setting. In January 2010, the government advisers on vaccines recommended the vaccine to those aged 70 to 79 [3]. The UK Department of Health calculates that up to four million people might be immunised and further progress with a UK vaccination programme is dependent on negotiating a “fair price”.

Over the last few years, ILC-UK has been studying and developing the case for adult immunisation both in the UK and internationally. In 2009 an ILC Global Alliance paper [4] found there is a gap between recommendations for vaccination among older persons and actual vaccination rates in Europe. At the same time an ILC Global Alliance immunisation policy brief [5] noted that as well as children, older persons require immunisation as well. Vaccines can prevent the onset and/or consequences of serious, often deadly, diseases including influenza; pneumococcal disease; chickenpox and shingles (varicella and herpes zoster); and measles, mumps and rubella (MMR).

In the interim, if anything the pace seems to have slowed in terms of investment in education and immunisation practice for older people and so it may be time to revisit this issue and reinforce the message. It appears that, along with other health programmes, immunisation is suffering from recession-induced health cuts. An important policy question for us here in the UK is if a shingles vaccination programme were in place, has a ‘value’ been calculated for the ensuing reduction in suffering and economic and social cost, which would be borne by those who would otherwise develop symptoms.

Let us know about vaccination policy in your country:
• what is happening with vaccination where you are;
• are you satisfied that not only are the appropriate policies in place;
• that they are being correctly implemented and monitored?

Peter Barnett

[1] Annual epidemiological report – Reporting on 2009 surveillance data and 2010 epidemic intelligence data ECDC Surveillance report 2011
[2] Health at a Glance: Europe 2010 OECD, European Union Dec 2010
[3] BBC News Sunday, 31 January 2010
[4] Life Course Vaccination. Impact of Life Course Vaccination on an Ageing Population. Alliance for Health & the Future at the ILC. Policy Brief Volume 4 Number 1, Nov. 2009
[5] Immunizations—Not Just For Kids, Harrison Bloom, M.D. ILC Global Alliance Policy brief. Oct 2009

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