Tag Archives: Samantha Carlson

Flu is a tragic illness. How can we get more people to vaccinate?

The Conversation

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Most people don’t take flu seriously enough. from http://www.shutterstock.com.au

Julie Leask, University of Sydney and Samantha Carlson, University of Sydney

Flu (influenza) has traditionally been the underdog of vaccine-preventable diseases. People tend not to worry about the flu too much, and there are various myths about its prevention and the vaccine. It’s true most people experience flu as a mild disease, but many don’t recognise it can be more severe.

Each year flu is estimated to kill at least 3,000 Australians aged over 50 years alone. It took more children’s lives than any other vaccine preventable disease in Australia between 2005-2014, and is the most common vaccine preventable disease that sends Australian children to hospital.

The tragic death of eight-year-old Rosie Andersen from flu this week has followed the recent outbreaks in aged care facilities and subsequent deaths of residents in South Australia, Tasmania and Victoria. A 30-year-old father died earlier this month due to complications from the flu, and now Sarah Hawthorn, who was infected late in her pregnancy, remains in a coma, unaware her baby was safely delivered six weeks ago.

This year’s flu season has been a bad one. And it’s not over yet.

Australian studies have shown the flu vaccine can usually reduce the risk of flu in those who are vaccinated by 40-50%, and by 50-60% for children. Early indications are showing the effectiveness of this year’s flu vaccine may be lower.

Experts are calling for a better vaccine, which is needed. But even a more effective vaccine won’t address all the barriers to uptake.


Read more: Flu vaccine won’t definitely stop you from getting the flu, but it’s more important than you think


Who’s most at-risk?

Annual flu vaccination is recommended for any person six months of age or older who wishes to reduce the likelihood of becoming ill with flu. It’s free for certain groups at higher risk of the severe effects of the disease including:

• people over 65 (80% of whom are vaccinated)

• Aboriginal and Torres Strait Islander people from six months to five years (12% of whom are vaccinated)

• Aboriginal and Torres Strait Islander people over 15 (34% of whom are vaccinated)

• pregnant women (45% of whom are vaccinated)

• people aged six months and over with medical conditions such as severe asthma, lung or heart disease, low immunity or diabetes (58% of these adults are vaccinated, and 27% of these children).

Why don’t they vaccinate?

Researchers have looked at why many people in these groups don’t have their yearly flu vaccine. A common theme emerges – health professionals are not recommending it enough, people aren’t aware they need it, they’re not sufficiently motivated, or they don’t have easy access.

These themes come out in studies with parents of young children, pregnant women, Aboriginal and Torres Strait Islander children, adults with other disease, and people over 65.

The flu vaccine isn’t free for all kids. from http://www.shutterstock.com

Our research is now looking at the children who end up in hospital with severe flu. We’re trying to better understand the barriers to flu vaccination, along with vaccine efficacy issues.

We’ve heard that not only are health care workers not recommending it enough, some doctors are even recommending against it, as they don’t believe the child is at risk. This is even though over half of children hospitalised from the flu are those without medical risk factors. Other times it’s simple awareness – parents didn’t know their child can receive a flu vaccine if they’re over the age of six months.

Busy lives can mean making time to go to the clinic for a vaccine falls down the list of priorities. A four-year-old in our study was hospitalised only three days before a visit to the clinic had been booked.

Some of the children in our study were not theoretically at high risk of flu and so not in the group where the vaccine is free. This was a major barrier, as it has been in other studies in children and adults. Parents report to us that their child is up-to-date with their scheduled vaccines, but annual flu vaccination is not being ticked off as it’s not on the schedule.

The challenge with flu vaccine is it’s given yearly. In the UK it’s recommended and funded for all children of primary school age using a school-based delivery program and currently between 53-58% of children have it. When this many children are vaccinated there can be indirect protection of others who are not vaccinated because the virus is not able to spread from person to person as easily.


Read more: I’ve always wondered: why is the flu virus so much worse than the common cold virus?


Misconceptions about the flu vaccine

Misconceptions about flu vaccine are also a barrier: that it causes flu, that it’s not effective, that it’s not needed. People might say they never get the flu, not realising symptoms can be mild or not noticed and they can pass it on to the vulnerable. Others reported their belief was that the flu was not a serious disease. Some believed contracting flu “naturally” was likely to provide greater immunity.

Some parents also have concerns about the safety of the flu vaccine. Australians were spooked by a 2010 incident when there was a temporary suspension of flu vaccine for children under five after reports of an increase in the rate of convulsions in children.

The one vaccine found to be the cause (BioCSL/Sequiris Fluvax™) is no longer approved for use in children younger than five, but there are other seasonal flu vaccines children can have. But public and professional confidence is yet to fully recover, despite having reassuring safety data.

People may say they never get the flu so they don’t need the vaccine, but you can pass on the virus without knowing you have it. from http://www.shutterstock.com

Western Australia has had a free child vaccine program for years which was achieving relatively good coverage, but this dramatically declined after 2010, and coverage languishes at around 15% today. In other words, mud sticks.

How to improve uptake

To improve uptake we first need timely and accurate coverage figures. We now have the capacity to get coverage estimates from the expanded Australian Immunisation Register but these are not yet available.

The vaccine needs to be recommended more often, available more readily, free and recommended as part of the schedule, and myths addressed more effectively.

We need to motivate and support health care workers to implement the recommendations, such as with automated reminders, incentives and performance indicators. Systems need to ensure people can get the vaccine easily – from the GP or other health clinic, the specialist clinic, the antenatal care clinic, or from an Aboriginal or Torres Strait Islander health worker.

The ConversationPromoting flu vaccine to everyone is important, as is providing ease of access, awareness and opportunity. Although the flu vaccine isn’t perfect, it’s far better than no protection at all.

Julie Leask, Associate Professor, University of Sydney and Samantha Carlson, Research Officer for the National Centre for Immunisation Research and Surveillance, University of Sydney

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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‘No Vax, No Visit’? If mum was vaccinated baby is already protected against whooping cough

The Conversation

Samantha Carlson, University of Sydney; Kerrie Wiley, University of Sydney, and Peter Bruce McIntyre, University of Sydney

NO VAX, NO VISIT! Our baby girl is due in four weeks. We can’t wait to meet her! If you would like to meet her, we ask that you ask your doctor for a whooping cough booster this week. Our daughter can’t receive her first vaccination until she’s six weeks old, so relies on us to keep her safe from germs. #NoVaxNoVisit

Have you seen these requests in your social media feeds recently?

No Vax, No Visit is a movement being propagated through social media and social pressure. Expectant parents are demanding that all visitors who wish to visit their newborn are recently vaccinated against whooping cough. If visitors can’t prove they’re vaccinated, they’re refused permission to visit the baby in hospital or at home until after the newborn’s two-month vaccination (which can be given at six weeks).

It is understandable that prospective parents, aware of how devastating whooping cough can be, want to leave no stone unturned to protect their baby. But is it supported by the best evidence?

No Vax, No Visit is an unofficial extension of the “cocooning” strategy, recommended by the Australian Immunisation Handbook since 2003.

The official cocooning recommendation is to vaccinate regular household contacts if they haven’t had a whooping cough booster within the last ten years. This strategy targets parents, siblings, grandparents and anyone who is in regular contact with babies, as they are the most common sources of infection in newborns.

‘Cocooning’ doesn’t mean a baby can’t come into contact with anyone who hasn’t been vaccinated. Tom Leuntjens/Flickr, CC BY

The cocooning recommendation doesn’t mean that anyone who comes through the front door to visit and say a quick hello must be vaccinated. It doesn’t mean regular household contacts need to be vaccinated for every child born within those ten years.

Although the idea of creating a “cocoon” of protection around babies is attractive, this approach has limitations. And eliminating all possible sources of whooping cough this way just isn’t possible.

So, what should parents do?

Evidence became available in 2014 that showed if mums are vaccinated during pregnancy, the vaccine is 91% effective in preventing severe whooping cough in very young infants.

When a mum is vaccinated during pregnancy, the protective antibodies travel across the placenta and into the baby. It’s essentially a baby’s first vaccine, so the baby is born with an army of antibodies ready for defence.

Contrary to the American vaccine insert, many studies, such as this one, have actually tested the vaccine on tens of thousands of pregnant women. The studies demonstrate how effective and safe this is for pregnant mums and their unborn child. Subsequently, in March 2015, the Australian Immunisation Handbook began recommending that women who are between 28 and 32 weeks pregnant receive a whooping cough booster for each pregnancy.

If mums follow this pregnancy recommendation, the vaccination of all visitors (in addition to regular household contacts) could theoretically offer a small amount of additional protection for the baby. However, there’s no evidence to say this is the case. The person more likely to benefit is the one receiving the vaccination, particularly if they are elderly.

Social consequences

Important things to consider with No Vax, No Visit are the unintended social consequences.

While some parents will find their family and friends are happy to be vaccinated, we are also hearing stories of isolation of new parents, division in social groups, and guilt of friends feeling irresponsible. Some new parents are even too scared to take their baby to the “disease-riddled” shopping centre, school or playground.

What seems to be forgotten is the high level of protection the baby already has if mum was vaccinated while pregnant.

While there’s no evidence that No Vax, No Visit will offer any additional protection for the newborn, there is evidence that social isolation can lead to postnatal depression. This is particularly important when we consider one in seven new mothers in Australia experiences postnatal depression.

Support for new parents is most needed during the newborn’s first few weeks of life. If new parents don’t have any visitors and are too scared to go out into the world with their newborn, what effect will this have on the family’s wellbeing?

So, what else can parents do to protect their newborn before the six-week vaccination if mum was vaccinated during pregnancy, and dad, siblings and grandparents are all up to date with their vaccines? Ask visitors to postpone their visit if they are sick, and hand-washing before cuddles is essential.

With all this in place, there’s little or no extra benefit from No Vax, No Visit.

The ConversationSamantha Carlson, Social Science Research Officer for the National Centre for Immunisation Research and Surveillance, University of Sydney; Kerrie Wiley, Research Fellow, National Centre for Immunisation Research & Surveillance, and School of Public Health, University of Sydney, and Peter Bruce McIntyre, Professor and Director for the National Centre for Immunisation Research and Surveillance of Vaccine, University of Sydney

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

 

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