Wednesday, 16 November 2011

Are we becoming complacent about immunisaton

Posted at on
Front page news in today’s Brighton Argus makes very worrying if depressingly predictable reading (Measles Sweeps Through Brighton and Hove (1)). The newspaper reports that “Nine children at two Hove schools have been diagnosed with the potentially fatal infectious disease in the past couple of weeks – more than the entire number of cases in the whole of Sussex last year.” It goes on to point out that some babies too young to be vaccinated have contracted the condition from other children.

What this issue isn’t however, is a just local problem for the people of Brighton. France has seen a very severe outbreak this year and a quick “google news” search highlights measles outbreaks in Canada, the United States (2), and New Zealand.

Just last week, the European Centre for Disease Prevention and Control (ECDC), highlighted “worrying signals” on epidemics of measles. Marc Sprenger, ECDC director argued that “The biggest threat we face is complacency about infectious diseases. The attitude that the battle against infectious diseases has been won must be continuously challenged,” (3)

In Brighton, authorities are responding by vaccinating children in schools. This is of course vital. Earlier this year the Health Protection Agency (HPA) urged parents to ensure that their children were vaccinated after a “tenfold increase in measles cases in the first four months of the year” (4)

It is easy to say after the event that children should have been vaccinated earlier. But what this outbreak does highlight is that despite warnings from the HPA, we may have taken our eye of the ball.

Over the last few years, ILC-UK has been studying and developing the case for adult immunisation. Through the ILC global alliance we have published reports (5) on the case for a life-course approach to vaccination. ILC-UK has developed thinking on how we could better deliver the flu vaccination to adults (6). ILC-UK also presented our thoughts on adult immunisation at European Health Forum Gastein earlier this year. (7) (8)

So, how does the measles outbreak among children fit in with our concerns about adult immunisation? At one level, it is important to note that measles occurs in adulthood as well as in children. It is also worth mentioning the importance of herd immunity (9).

But there are much bigger issues at play here and they are extremely worrying. The reality, as highlighted by ECDC, is that perhaps we are becoming complacent about immunisation.

Vaccination has a very positive story to tell, having controlled 12 major diseases (in many parts of the world). Other than clean water, it has probably had the biggest impact on mortality reduction and population growth.

Historically, we have “done” child immunisation very well in the UK. But we must ensure that as a result complacency doesn’t undermine progress. And we need to work across all vaccine preventable diseases to ensure that we not only continue to do child immunisation well, but that we improve it.

Alongside this, we must improve the way we deliver vaccination across the lifecourse. When the HPA made their warnings in May, their spokesperson, Dr Mary Ramsay, said “You’re never too old to get vaccinated” (4). Let’s hope we can find a way to better get this message out.

David Sinclair

2.There have been 220 cases of measles in the United States this year, the most since 1996
5.See: and
7.Our slides from the European Health Forum Gastein can be found at
8.ILC-UK receives some (unrestricted) support from Amgen, Sanofi Pasteur MSD and Pfizer