Value of vaccines campaign

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VACCINES Personal choice, global responsibility P2

SHOULD Pharmacies offer you a wider range of vaccines?

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HERD EFFECT How disease can spread without vaccines P4

Value of Vaccines I have asthma… Do I need to get a flu jab?

How do I protect my children against measles?

Do my son and daughter need the HPV vaccine?

Should Mam and Dad get the pneumococcal vaccine?

Are vaccines safe?

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IN THIS ISSUE

Low risk; huge benefit Tackling the myths around vaccination.

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P6-7

“I want to protect my daughter” Why this mother opted for the HPV vaccination for her daughter.

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PHOTO: UNSPLASH

Are you at risk?

The surprising and fatal effects of pneumococcal disease.

Vaccination is a personal choice and a global responsibility

L

iving in Europe today, we can easily take for granted that, with the help of vaccines, our families are protected from dangerous diseases that threatened every generation before us. We may also forget that too many children in our own communities and beyond are not protected due to parental choice or health system failure. Any person who is not protected from a highly contagious infection, like measles or human papillomavirus (HPV), is vulnerable, and a potential source of infection to others.

The battle against vaccine-preventable diseases is far from over. The ever-present reality is that these diseases can continue to spread or make a comeback wherever immunisaFollow us

tion gaps exist. Stopping these diseases is a personal choice and a global responsibility.

Major health gains and even greater potential Vaccines have contributed more to improving health and wellbeing than almost any other medical intervention. Immunisation currently averts an estimated two to three million deaths globally every year. Vaccination against polio, measles, mumps, rubella, diphtheria, tetanus, pertussis, hepatitis B and pneumococcal bacteria has drastically reduced the rates of illness, disability and death they have caused. Vaccination against HPV promises to have the same

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Robb Butler Programme Manager of the Vaccine-Preventable Diseases and Immunization programme (VPI), World Health Organization (WHO) Regional Office for Europe

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dramatic effect on rates of cervical cancer and genital warts.

Safe and effective vaccines are a major tool in global efforts to improve the lives of billions through the Sustainable Development Goals (SDGs).

Goal 3, to “ensure healthy lives and promote well-being for all at all ages”, would be unattainable without the basic protection offered by vaccines.

Vaccination also contributes to other SDGs by helping to ensure that children can fully benefit from quality education, that girls have equal opportunity to thrive, and that parents can maintain full employment. Without the burden of vaccine-preventable diseases, children do better at school and families spend less money on medicines or medical care.

Be the change you want to see Achievement of global ambitions starts with individual action. The full potential of vaccines to contribute to health and development both at home and abroad can only be realised if each one of us plays our part: if parents ensure their families are fully vaccinated; if health professionals are well informed and educate their patients about the benefits of immunisation; if politicians prioritise immunisation in healthcare budgets, systems and laws, then together we can ensure that the few individuals who cannot be vaccinated are shielded by the many who are, and that vaccine-preventable diseases have nowhere left to go.

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PHOTO: IRISH PHARMACY UNION

PHOTO: IRISH PHARMACY UNION

Launching the Pharmacy-based Minor Ailment Scheme Pilot 2016, allowing Medical Card holders to receive treatment for common ailments directly from their local community pharmacy rather than their GP.

By Diane Priestley

Sexual Health Awareness campaign to provide a clear message about the dual risk of contracting a Sexually Transmitted Infection (STI) and/or experiencing a Crisis Pregnancy.

Pharmacies injecting health

Currently, pharmacies offer a limited number of vaccines.

Could that offering be expanded to help prevent even more diseases?

Daragh Connolly, a dedicated third generation pharmacist in Dungarvan, County Waterford, cares deeply about the practice and proud heritage of pharmacy.

He wants to make pharmacy a “really good job for the next generation.” To do this he believes there needs to be some developments in what pharmacies provide.

As President of the Irish Pharmacy Union, Mr Connolly wants to challenge and stretch pharmacies to offer new services to their communities, including a wide range of vaccines.

The pharmacist’s role in their community He believes that administering vaccines is a logical extension of the

role of the pharmacist as a healthcare expert in the community.

“For more than half a century we’ve known how much good vaccines do for public health. When we (as pharmacists) administer the flu vaccine, patients constantly ask us if there are other vaccinations we offer.”

Since 2016, pharmacies have also administered the pneumococcal and herpes zoster vaccines. Pharmacists even look after 7,000 recovering intravenous drug users who are being treated with opiate replacements and provide needle exchange services to many others. Mr Connolly says: “We are the interface with this at-risk group and we help to prevent the spread of Hepatitis. We would like to be able to offer Hepatitis B vaccines in pharmacies.”

According to Mr Connolly, travel vaccination is also an area that pharmacists could become involved in. “Travel vaccinations are both

Daragh Connolly President, Irish Pharmacy Union (IPU)

safe and effective. Pharmacies have consultation areas where a pharmacist can carry out a pre-travel consultation to determine exactly what vaccinations are needed.”

Reducing pressure on hospitals and schools “The most expensive place to look after people is in an ambulance;

the most cost-effective place is in a pharmacy. Ireland has one of the highest rates of meningococcal infections in Europe, for example, including meningitis and septicaemia,” he says. The MenB vaccine is offered as part of the Primary Childhood Immunisation Programme for all babies born on or after 1 October 2016. “Many parents with children born before this date have expressed an interest in having their children vaccinated as a private service, which community pharmacies could provide,” Mr Connolly continued.

A Government scheme to vaccinate against Human Papillomavirus (HPV) is currently run through secondary schools; however, Mr Connolly believes that if parents had the additional option of bringing their adolescents to a pharmacist instead, the uptake would be even higher.

While some doctors, nurses and other healthcare providers might

be concerned about pharmacies expanding their role to offer vaccines, Mr Connolly is confident they would benefit.

He says: “Medicine and primary healthcare is a team effort. We are not looking to replace what GPs and nurses offer but I would like us to identify the gaps and see how we can get more people vaccinated effectively and safely.”

“It makes sense to free up the burden on secondary and tertiary care and offer timely, cost-effective access to healthcare at the primary level, with a focus on prevention of serious illnesses.

“Pharmacists are trained in administering injections but we need more Government action so we can expand the scope to offer more services. It just makes good sense.”

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Vaccination: not just a personal choice Despite the availability of free and effective vaccines, some people make the personal choice not to vaccinate themselves or their children in the belief that vaccines are unsafe or no longer necessary. Perhaps people may also be unaware of the potentially devastating effects of the diseases vaccines protect against. However, a personal choice not to vaccinate has a wider public impact. Not only is it a decision that may put one’s own life, and that of one’s child, at risk, but it also puts those who come into contact with an unvaccinated person at risk. Such contact is particularly dangerous for people with a reduced immune system, pregnant women or small babies who have not yet completed all their vaccinations.The 2016 measles outbreak in Ireland demonstrates just how rapidly infectious diseases can spread when there are immunity gaps in the population. It highlights the importance of high vaccination uptake rates to protect populations or for “herd protection”.

When no-one is immunised… disease spreads freely through the population

Why vaccination is a must for you, your family and society

By Tony Greenway

Some diseases may have been reduced or consigned to history — but if we don’t continue to protect ourselves with vaccinations, they will return with a vengeance.

When some of the population is immunised… disease spreads to some of the population

When most of the population is immunised… it provides a disease barrier and limits the spread of disease

Immunised and healthy

Not immunised but still healthy

’Vaccines For Life’, Irish Pharmaceutical Healthcare Association (IPHA)

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Not immunised, sick and contagious

“Immunisation is one of the most cost-effective health interventions since the introduction of clean water,” says Dr Brenda Corcoran, Head of the HSE National Immunisation Office. “We’re also fortunate in this country that all vaccines recommended for children are provided free of charge.”

“Year on year there have been huge changes to our immunisation programmes” says Dr Corcoran. Just look at the number of vaccines now available: a total of nine different vaccines were introduced in Ireland across the whole of the 20th century; whereas 12 have been introduced in the last 17 years alone. Naturally, all of these — whenever they were introduced — have had a huge, positive impact on the health of the nation. Rubella, for instance, is a devastating disease, but in the last two years the World Health Organization declared Ireland rubella-free. Then there’s the Men C vaccine, introduced in the year 2000, which has drastically reduced rates of group C meningococcal disease in small babies and young children, to the point where it is rarely seen.

The importance of continued vaccination These kinds of success stories, however, can generate their

a challenge to keep parents upto-date with the most trusted information, particularly because unscientific opinions are shared on social media.”

Dr Brenda Corcoran Head of the HSE National Immunisation Office

own peculiar problems. Because some diseases have been significantly reduced or even consigned to the past (polio, for example), the public forgets about their terrible consequences, “Which means people also forget about the importance of immunisation,” says Corcoran.

“But the fact is that, if we don’t continue to vaccinate our children — and get uptakes of 95 per cent — these diseases will come back and cause the devastating problems they did in the past.”

Corcoran cites measles as an example, where uptake for MMR (Measles, Mumps, Rubella) is now at 92 per cent and an uptake of 95 per cent has never been reached in Ireland. “In 1999, unscientific evidence provoked fears that the vaccination caused autism, resulting in uptake of the MMR vaccine dropping to 69 per cent,” she says.

“Then, in the year 2000, there was a very large outbreak in the Dublin area, affecting over 1,600 babies and young children, and resulting in three fatalities. It is

The ‘herd effect’ explained High vaccination uptake rates are vital for ‘herd protection’ against infectious disease, and to put a stop to these diseases circulating. “Take the MMR vaccine,” says Corcoran. “This cannot be given to babies under 12 months, or to children receiving cancer treatment.

But, if we achieve a 95 per cent uptake, then everyone who is vaccinated not only protects themselves, but also those who are too young or too ill to be vaccinated.”

There is a robust safety procedure in place for the licensing and monitoring of vaccines. All of those available in Ireland are licensed by the European Medicines Agency (EMA) and the Health Products Regulatory Authority (HPRA). Yet for anyone still procrastinating about having themselves or their children immunised, Corcoran has this message: “The overwhelming scientific evidence is that vaccines are safe and effective,” she says. “We would encourage every single parent to have their child vaccinated — as I did with my own sons. Vaccination is the best protection against these serious diseases”.

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in the ongoing battle against serious childhood diseases.

www.immunisation.ie

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How a ‘universal’ HPV vaccine can prevent cancer in boys and girls

Myths about

By Tony Greenway

In Ireland, the HPV vaccination is available free to girls, but because of its association with head and neck cancers, is there an argument that it should be offered free to boys, too?

Myth: Vaccines cause autism Fact: There is no evidence that links the MMR vaccine and autism In 1998, a paper was published, which suggested there was a link between the MMR vaccine and autism. This claim was later proven to be seriously flawed and misleading and was retracted by the journal that published it. There are now numerous studies that show there is no link between autism and the MMR vaccine.

The human papillomavirus — or HPV — is spread during sexual intercourse and is known to cause cervical cancer. The optimum time to be immunised for HPV is before a person becomes sexually active, which is why a free vaccination programme has been ongoing in Ireland for all adolescent girls since 2010.

But HPV is also linked with other cancers that affect women and men: oropharyngeal cancers (cancers of the mouth and throat), anal cancer, and other genital cancers. So, is there a case that a ‘universal’ vaccine should be made available in order to protect boys from the virus, too?

cervical cancer within the foreseeable future. In that situation I think it will be hard to not offer the vaccine to boys.”

More boys exposed to HPV “Many people believe so’, says Dr. Ann Hogan, President of the Irish Medical Organisation. ‘The HPV vaccination programme was introduced for girls only to protect girls from cancer of the cervix. It was believed that high uptake of the vaccine in girls would reduce the spread of the virus within the community.’ The trouble is, in Ireland, reduced numbers of girls are coming forward to be vaccinated – down from over 80 per cent to around 50 per cent – which means that sexually active boys are less likely to be protected from HPV transmission.”

In some countries, the vaccine is already offered to adolescent boys. In Australia, for example, the HPV programme was extended in 2013.

So can Hogan see Ireland following suit? “I think we probably will,” she says. “It is predicted that oropharyngeal cancer will become as common as

How effective is the vaccine?

All scientific evidence shows that the HPV vaccine is safe, effective and long-lasting. It has been used in Australia since 2007, and the result has been a significant drop in incidents of pre-cancerous lesions of the cervix, and also of incidents of genital warts, which are associated with other strains of HPV. At the moment, in Ireland, adolescent boys can be given the vaccination privately although, says Hogan, this is very much down to individual choice.

“We certainly need to look at a free vaccination programme for boys,” says Hogan, “which is why the Irish government has asked HIQA (the Health Information and Quality Authority) to undertake a health technology assessment on the value of expanding the programme. Many doctors — particularly those involved in the treatment of oropharyngeal cancers —believe it should be extended.”

Dr Ann Hogan President, Irish Medical Organisation (IMO)

Myth: The HPV vaccine causes chronic fatigue Fact: There is no evidence that links the HPV vaccine to chronic fatigue or any other long-term medical condition Some people have expressed concerns that the HPV vaccine causes side effects such as chronic fatigue. These concerns were reviewed by a number of international expert bodies such as the World Health Organization, the Centres for Disease Control and Prevention in the US and the European Medicines Agency ’Vaccines For Life’, Irish Pharmaceutical Healthcare Association (IPHA)

CONTRACT AGAINST CANCER Up to 420 people this year in Ireland will be diagnosed with a cancer caused by the Human Papilloma Virus (HPV).

Vaccination can stop this. Members of the HPV Vaccination Alliance have pledged to: ENDORSE the HPV vaccine as a proven and safe way to protect from cancers which can destroy and end lives.

REALISE our obligation to do all we can to protect health and wellbeing by ensuring the facts prevail when it comes to the HPV vaccine.

PLEDGE to raise awareness of the HPV vaccine and its benefits in preventing cancer and saving lives.

We have the ability to spare our country’s children and adults the devastation of a cancer diagnosis.

We have a duty to act urgently to prevent future hardship and save lives.

For further information and to get the #hpvvaxfacts go to

www.hpvalliance.ie

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vaccines

The global value of vaccines

By Lilian Anekwe

18+ Myth: Vaccines are only for children Fact: Vaccines are important for each life stage While vaccinating infants provides much needed immunity and protection in childhood they are also advised across each life stage from infancy, childhood, adolescence and adulthood. Following recommended vaccination guidelines protects individuals and those around them from developing vaccine-preventable diseases.

Myth: Multiple vaccinations weaken the immune system Fact: Multiple or combined vaccinations do not have an adverse effect on the immune system

Scientific evidence has shown that giving multiple or combined vaccinations does not weaken the immune system or cause increased adverse effects. People are exposed to much higher levels of ingredients through their diet on a daily basis that trigger immune responses. All vaccines used in Ireland are licensed by the HPRA and EMA. These agencies have strict procedures for the licensing and monitoring of all vaccines and their ingredients to ensure their safety and effectiveness.

The IPHA discusses the contribution that vaccines make to society and healthcare systems all over the world.

Disease prevention is one of the most successful and cost-effective public healthcare interventions available, says Vivienne Hough, Commercial Affairs Manager for the IPHA. Vaccines save up to three million lives a year and prevent another three quarters of a million people from developing disabilities as a result of disease. However, she says, because vaccination has been so successful the full benefits are often taken for granted.

How do vaccines benefit society?

Ms Hough says, “the World Health Organization (WHO) state that vaccines provide broad ranging societal and economic gains more easily than any other medical intervention. This is because a healthy population – across all stages of life, regardless of age, gender or social status – increases contributions to society and the economy. For example, childhood vaccination has been linked to better educational performance and higher earnings later in life. Parents and employers also benefit as there is less likelihood of an employee being absent from work to look after a sick child. Healthy populations are productive and better able to contribute to economic development and remain active members of society.”

Why the benefits outweigh the costs A study conducted by researchers at the WHO in 2008, found that “the annual return on investment in vaccination has been calculated to be in the range of 12 to 18 per cent.” Hough states that “successful programmes require support and adequate funding. However, their benefits far outweigh their costs.

Vaccination programmes contribute to long-term cost savings, increased productivity and economic

Vivienne Hough Commercial Affairs Manager, Irish Pharmaceutical Healthcare Association (IPHA)

growth. It is crucial that these programmes are continuously updated to ensure the public have access to the best vaccines available”

How vaccines ease the strain on health systems The 2016 measles outbreak in Ireland provides a good example of the impact a vaccine preventable disease can have on a health system. Hough says, “during the outbreak there were 40 confirmed cases, 19 of which were treated in hospital for up to eight days. The remaining patients either attended an emergency department or their GP. This put significant and avoidable pressure on the Irish health system in terms of human, financial and other resources.”

Successful vaccination programmes can help free up healthcare resources, which can then be focused on other areas within the health system.

“Without vaccination, there would be significant additional cost and strain on healthcare systems worldwide,” Hough adds.

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of the public trust the advice and patient care they receive from the pharmacist

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*Behaviour & Attitudes market research, April 2017

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Are you at risk of pneumococcal disease?

By Tony Greenway

If you are at risk of pneumococcal infection — which can cause fatal diseases such as sepsis and meningitis — you should make sure that you are protected by the pneumococcal vaccination.

“Not enough people understand the dangers of pneumococcal disease”, says Kevin Kelly, Advocacy and Communications Manager at the Asthma Society of Ireland. Yet it’s essential they do because Streptococcus pneumoniae bacteria (pneumococcus) can cause potentially fatal diseases, including meningitis, sepsis, pneumonia and inflammation of the heart, and is a leading cause of death worldwide.

Statistics from the HSE Immunisation Office show that quite a lot of people carry the bug in their nose and throat, and while this does not do harm, some can become actively infected in the lungs and go on to develop pneumonia or meningitis. For some, the infection can be so severe that it causes death.

In Ireland, it’s estimated that 37 people a year lose their life because of invasive pneumococcal disease (IPD). “Unfortunately we haven’t seen any data to suggest that public awareness of pneumococcal infection is increasing,” says Kelly. “In fact only one in seven people who are eligible for the pneumococcal vaccine have actually had it. That’s a low figure.”

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Free to ‘at risk’ groups The pneumococcal PPV23 vaccine is recommended for those with a known weakened immune system and can be given from two

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who have a Medical Card.

Pneumococcal PPV23 is an effective prevention too: figures from the HSE show that PCV protects against up to 80 per cent of pneumococcal bacteria that cause IPD, while one study noted that PPV23 was 85 per cent to 90 per cent effective in preventing IPD in adults.

Kevin Kelly Advocacy and Communications Manager, the Asthma Society of Ireland

“Ireland has the fourth highest prevalence of asthma in the world” years of age.

Everyone aged 65 years or older, or defined as being in an ‘at risk’ group for pneumococcal disease, is eligible for the pneumococcal vaccine PPV23. Adults in ‘at risk’ groups include those with long-term health conditions, such as diabetes, chronic heart, lung, kidney or liver disease, and people who have occupational exposure to metal fumes, such a welders. Other ‘at risk’ groups include those with cochlear implants, people with Down’s syndrome and those without a spleen or with a non-functioning spleen.

The HSE provides the pneumococcal PPV23 vaccine for free for all those in the recommended groups through their GP. There is no vaccine administration charge for those in the recommended groups

Asthma and pneumococcal vaccine Ireland has the fourth highest prevalence of asthma in the world: 470,000 people have the condition and more than 60 per cent do not have it under control. The Asthma Society of Ireland recommends that people with asthma should consult their healthcare professionals and receive the pneumococcal vaccine if it is felt appropriate. “That’s particularly true of those who have asthma and who are over 65 and/or those who have moderate to severe asthma and who may be hospitalised regularly as a result of their condition,” says Kelly.

Confusion between the flu vaccine and the pneumococcal vaccine may be the reason that PPV take up is low. “It’s important to understand that pneumococcal vaccine doesn’t prevent seasonal flu and that the flu vaccine doesn’t prevent pneumococcal infection,” says Kelly. “While it won’t be necessarily appropriate for all people with asthma to receive the flu injection and the pneumococcal vaccine, you should consult your GP about the possibility of receiving both, because of the potential for flu to develop into pneumonia.”