Immunisation

Parents' views of the diseases

The immunisations offered to children in the United Kingdom provide high levels of protection against diphtheria, tetanus, whooping cough, poliomyelitis (polio), haemophilus influenzae type b (Hib) (meningitis and epiglottitis) meningococcal C (meningitis and septicaemia), meningococcal B, pneumococcal disease (pneumonia and meningitis), measles, mumps and rubella (German measles). For this reason few parents of today's babies and young children have any direct personal experience of these once common diseases.

The overwhelming majority of parents believe in immunisation for their children. We have however included here the views of a few parents who do not believe immunisation is right for their own child based on their personal beliefs. Their views represent a small proportion of the population.

Measles causes a rash, cough, runny nose, eye irritation and fever. There can also be diarrhoea, vomiting and abdominal pain. About 1 in 15 children with measles have complications, which include ear infection, pneumonia and fits (NHS 2015). A rare complication (about 1 in 1,000 cases - Encephalitis Society 2014) is inflammation of the brain (encephalitis), which can lead to permanent brain damage and can be fatal in children with a lowered immune system, for example, leukaemia.

Mumps causes a fever, headache and swollen salivary glands in the cheeks and neck. At least 30% of cases in children have no symptoms [1]. Complications of symptomatic mumps include deafness, aseptic meningitis (infection of the membranes around the brain and spinal cord), inflammation of the testicles or ovaries, and inflammation of the pancreas.

Rubella (German measles) is often a mild illness. But if a woman gets it while she is pregnant it could cause a miscarriage or her baby could be born with serious birth defects. (1 in 4 cases if rubella occurs in the first three months of pregnancy). Rubella is given as part of the MMR (measles, mumps and rubella) vaccine to young children rather than in the teens, so that if a child caught the disease they can't pass it on to pregnant women. Once it became clear that immunisation at an early age would protect for many years, it was decided to immunise both girls and boys in order to stop the spread of rubella in children, and so gain herd immunity.

With these diseases, the more people who are not immunised the greater chance there is of both immunised and unimmunised children contracting the disease.

One factor influencing parents' decisions about whether to immunise their child was how serious they perceived these diseases to be.

The vast majority of parents knew these diseases could be serious and didn't want to risk the chance of their child getting a complication, nor did they want their child to be unwell when there were effective vaccines available to prevent this.

It is important to consider the long-term implications of not immunising your children.

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But I mean it's like the mumps. That's more for sort of I think little boys and that, and, and teenage men when they get it, it can cause problems. So you can't just look at yourself, you should look at, at future, what can happen in the future, you know. And German measles, if you have never had, or if you've not been vaccinated and you get, get it, or when you're pregnant, I believe, I don't know, but I believe it can harm the baby in the early stages of pregnancy. So it's not just a now thing, it's later, it's later on. And if she's vaccinated against all of those then as I said before she is, I've done my duty now, she's safe from those things. There's enough in the world that she can get, at least that's three less really.

In her work as a community paediatrician, she has seen children with some of these diseases.

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These conditions, these illnesses certainly are less common than they were but like I said I've certainly seen them and this is in England. It's still happening and yes things like polio are incredibly rare now and hopefully will be eliminated relatively soon but we are still seeing it and the advice is still that they need protecting against. Things like meningitis C we are definitely still seeing and they are serious and they've got a 10% mortality. You know, it's, oh a, I've certainly seen children with meningitis and they've been incredibly unwell. That's certainly not a disease that is disappearing, for example. Hib, haven't seen much of but if we stop vaccinating we'll probably start to see more. It's certainly less common than it was 20 years ago but that's proof, directly related to the fact that the Hib vaccine was introduced then in the 80s. We've seen far, far less since then but that certainly doesn't, doesn't mean that it's eliminated and that we should stop vaccinating because of that.

I understand a lot of parents feel, okay let everyone else immunise I don't want to. That's often a, you know, if most of the population are immunised fine I'll be the one who doesn't. But if everyone has that attitude then you're not going to get uptake levels high enough to actually give herd immunity. And okay if a few don't it's not going to make a major impact but enough people, if enough people decide not to for that reason that will leave it to everyone else then you're still going to get these diseases occurring and your not going to be able to keep the levels down. And for example you're then putting very young babies at risk who haven't got to the stage where they should be immunised yet.

More children in her local area have had measles and mumps, which she believes could have been...

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There was an outbreak at the beginning of the year, with the measles, see it's gone from the measles to the mumps, to chicken pox. So there's a lot of the same children had the same things, and I think that's so, you know those children should have been protected from that, but they weren't. I mean, even if you get chicken pox, or measles, when they've had the injections, you'll find the children are not sick with it. If you haven't had the injections, the immunisations they will, they can be, it can be potentially dangerous, obviously especially to pregnant women as well, which there's a lot of, obviously pregnant women around.

And the children that had measles - have you seen them? How ill have they been?

There's been, there is one case that I did see and it was really quite a bad case. They had measles in their eyes, up their nose, on their tongue, in their ears. All over their body and they were really quite sick with it. But if they'd had the injection it wouldn't have been half as bad. They'd have just had, you know, the itchiness, you know, and a little bit sick but not as bad as what it could have been.

Parents who had heard first hand accounts of problems caused by diseases such as measles and mumps, were in favour of immunisation. Some had relatives who had been affected by the diseases before immunisations were available, and this had influenced their decisions. One mother said her neighbour's one-year-old son had had febrile convulsions from measles. Another said her own mother had gone deaf in one ear as a result of having mumps as a child.

Her relative was seriously ill from mumps which influenced her decision to vaccinate her children.

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The other thing that really affected me was when I looked at what it said about the downsides of not having the, following the MMR programme and the fact that the whole, all the problems that had come about as a result of this whole this report were people in their hundreds refusing to have, follow the programme through. And I mean the three diseases that it's talking about mumps, measles, rubella are really serious diseases.

A relative of mine basically had [mumps] when he was very young and starting convulsing and I think he was very seriously ill. Yes his mother said it was not a joking matter at all and she really thought at one point that she might lose him. So she's, you know, very much for the immunisation programme, definitely.

Her relative was very unwell with measles when he was a child and she feels that her own children...

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I know from my mother-in-law, she's, always spoken, well, she spoke about it before we had children, I was aware that, that, that he'd been very, very unwell with [measles]. And, and I think it impacted quite a lot on her really having such a, a sick tiny child, with two other small children around as well. I think it, it really frightened her and, and worried her. And I don't think it had a particular impact on my decision to, or our decision to have our children immunised. But certainly it's something that you hear about people being very sick with, with diseases now that we don't really think a great deal about. But it, it's, I guess it's, just because it's not so common you don't, you don't really think so much about it. You just think it's something that's just not too, not too difficult and you get over if you have it. But he was really very poorly with it.

A few parents questioned why measles and mumps were considered to be such serious diseases now, when they themselves had them as a child and do not remember them as serious. One couple personally thought the government was suggesting that the diseases were more serious than they actually are to encourage parents to have the MMR vaccine.

Another parent thought it was important not to scare parents in to having the immunisations but it was also important not to underestimate how serious these diseases could be. Before immunisations fortunately, most people had measles and mumps without serious complications. However, 1 in 15 children with measles had complications including earache, pneumonia and fits. 1 in 1000 had inflammation of the brain (encephalitis). When these rates are applied to the whole population, the complications of measles and mumps caused a serious number of hospital admissions and long-term disability.

Thought it was important not to scare parents in to having the immunisations but it was also...

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The immunisation authorities are always accused of exaggerating the seriousness of some of these diseases. And I think it's understandable that if people look back you will see that diseases like measles for example were in the last twenty or thirty years not regarded as terribly serious diseases in this country. But it's interesting also how times change in, or in the way seriousness is regarded. You see it wasn't regarded as a serious problem thirty, forty, fifty years ago for a handful of children to die every year from measles. That was regarded as, because, compared with thirty years previous to that it was really impressive progress. I think that in modern society people would think to have a handful of children dying every year from measles was an unacceptable thing. And I quite agree that it's unacceptable.

But when people look back with rather rose-tinted spectacles and think, you know, 'Oh, well, you know, we all had a few days off school and granny looked after us, and it was great'. No doubt for the majority of children that was how it was and it wasn't so serious. But if a thousand children get measles, one or two will die from it and three or four will have more serious complications of encephalitis or pneumonia or other problems. And it's interesting in retrospect of course that children and parents only remember the ones that all got better. Doctors remember the ones that didn't. And that sticks very strongly in our memory because we remember those children that died or got serious complications. And we're still seeing some of the children that got serious complications.

For example rubella now is not taken very seriously. But I've got two patients whose mothers had the congenital rubella or got rubella in pregnancy in the 60s, and they were born with congenital rubella syndrome and are very profoundly handicapped as a result. And that's an enduring legacy. And so when you've seen those cases you become a real enthusiast for anything which will prevent them. And that's how I look at this comparison. I don't think it helps to try and scare parents into getting immunisations. On the other hand I don't think it helps to underestimate or to play down the seriousness of these conditions.

A very small number of parents held a personal belief that if their child had a strong immune system, there was less chance of them being very ill or developing complications from these diseases. There is no evidence that a strong immune system in any way substitutes for the protection given by immunisations. While it is true that a child with an underlying health condition is more likely to have complications and/or die from measles, healthy children can be very ill too. Allowing them to catch the diseases means that they run the risk of complications.

She preferred to nurse her children through any of the diseases and chose not to immunise her...

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I also spoke to as many people as possible. And my mother was quite a good source because I have elder brothers and sisters and the immunisations weren't available when they were children, and she nursed them both through measles and mumps. And she felt that whilst it was distressing in some ways and they were very poorly, you know, she managed, she managed to keep it under control and she was able to nurse them through. And I felt confident that I give my children a good diet, we eat organic food when we can and we have lots of fresh air. And also we use homeopathic remedies and I felt confident that my homeopath would be able to help us prevent and perhaps nurse through any of these illnesses should they arise. So that's how I assessed the risk in the end.

Believe the diseases can have unpleasant symptoms and dangerous complications but feel that the...

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Mother' I want anybody, who consults DIPEx to be aware of is that we've not made this decision in a trite way. We are fully aware that the illnesses that our children were offered vaccinations against, are dangerous illness, with unpleasant side effects and complications. But it's necessary to keep a balance and I think the trouble is, when the health authorities are promoting these vaccinations, they really wheel on the big guns and really try to frighten the daylights out of you.

And what are your views on the childhood diseases, like mumps and measles?

Father' Well, they're at the very worse end they are killers. But unfortunately the government that's in place at present, and for the next four years, takes figures from Asia, Japan and such like, and says that they're just as much a bad killer over here as they're over there, which anybody who looks into it in any depth, will realise that a lot of these nations are deficient in certain foods, which keep disease away, such as maybe carrots or whatever.

Mother' Well Vitamin A

Father' Vitamin A, specifically.

Mother' If I agree with [my husband] on that. We accept that these diseases potentially for some children can be very, very serious. But there is an awful lot that we're not told about these illnesses and then the scare tactics are really, really hyped up.

Last reviewed October 2015.
Last updated October 2015.

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