Rationale
With research on vaccination in pre-school aged children, a broad research question ‘is compulsory vaccination for pre-school aged children necessary to ensure public health’ was developed based on the initial claim. This was further refined to specifically consider the eradication of infectious disease, in particular measles in Australia.
Measles is vaccinated against in a composite vaccination known as MMR that also protects against mumps and rubella (Australian Institute of Health and Welfare, 2018). This vaccine has been available in Australia a government funded program to all states and territories since 1972 for children aged 12-23 months of age (National Centre for Immunisation Research and Surveillance, 2017). Australia was declared free of measles in 2014, meaning that as of that year there was no ongoing transmission of measles within the population (Australian Institute of Health and Welfare, 2018). However, vaccination is still important because the infection can be brought in from overseas. In recent years, areas of Australia with low vaccination rates have experience outbreaks of the disease, caused by a lack of immunity to the disease (Northern Territory Government, 2019). Given that measles is so contagious, most of the population needs to be immune to stop it spreading (Sadarangani, 2016). This is known as herd immunity and will be discussed further in the Background. Historically, the rate of hospitalisation for measles has been highest among young children up to four years of age (Australian Institute of Health and Welfare, 2018). Children in Australian pre-school are aged between 2-4 years old (Bright Horizons, 2019). Therefore, this essay proposes the following research question.
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Background
Measles is a highly contagious viral diseases spread through bodily fluids in which the virus can survive in the air and on surfaces for a number of hours. Symptoms begin with a fever, runny nose, cough, red eyes and sore throat. A rash appears after a few days beginning on the face or neck and spreading to the rest of the body for up to a week. In some cases, there are serious complications including pneumonia and encephalitis (brain inflammation). Young children and adults are the most likely to develop complications. 1 in 15 children with measles develops pneumonia. Encephalitis is much rarer, and only 1 in 1000 children develop it. For every 10 children who develop measles encephalitis, 1 dies and up to 4 have permanent brain damage (Australian Institute of Health and Welfare, 2018).
Herd immunity, mentioned in the Rationale is essential for stopping the spread of diseases within any community. When a large enough number of people are immune to the disease, in this case measles, the infection cannot be transmitted between people. Some people are unable to be vaccinated, including babies which is usually due to a medical condition that results in a weakened immune system or is an allergy to the actual vaccination itself (Sadarangani, 2016). For many diseases like measles children, and in particular those who are young are at the highest risk of contracting an infectious disease and experience the most severe illness (Australian Institute of Health and Welfare, 2018). As mentioned earlier, this is due to their weakened or underdeveloped immune system that is less effective at recovering from a disease than an adult’s immune system. The number of people, especially children required to be vaccinated for herd immunity to work depends on the virility of the disease (how infectious is is). As stated previously, measles is a highly contagious disease and before vaccinations were available each person who contracted it would spread the disease to 10-15 people each, allowing the infection to spread quickly. To achieve herd immunity for measles at least 90-95% of the population needs to be vaccinated (Sadarangani, 2016).
Analysis and Interpretation
As outlined in the Background and Rationale, areas with higher rates of immunisation experience less cases of infectious diseases. Shown below in Figure 1 and Figure 2 are the percentage of children fully vaccinated with the MMR vaccine both Australia-wide and in major capital cities in 2017.
As stated in the Background, measles is a highly infectious disease that requires a vaccination rate of 90-90% in order to successfully prevent the disease. In 2017 Australia had a vaccination percentage of 93.5% (315, 459 children) with the Northern Territory and Western Australia achieving the lowest rates of immunisation at 92.1% and 92.0% respectively (National Centre for Immunisation Research and Surveillance, 2017).
As can be seen in both Figure 1 and Figure 2, the Northern Territory and Darwin have areas with considerably lower rates of vaccination than other areas around Australia. In February 2019, the Northern Territory experienced an outbreak of measles, which at one stage infected 30 people in 40 days (Northern Territory Government, 2019). The outbreak was the largest since 2014 and they experienced a rate of infection 16 times higher than any other state of territory at the time (Woodley, 2019). In order to contain the spread of infection, the most vulnerable individuals were identified and steps were taken to protect them. The most affected were those aged between 20-55 years old, as there had previously only been one measles vaccine offered to them and babies too young to have received any vaccinations. Those who could be vaccinated were advised to take part in a vaccination program to increase the number of people vaccinated against the disease and so achieve her immunity. This proved effective and no new cases of measles have been reported since the 6th of April (Woodley, 2019).
New South Wales brought in legislation in early 2018 that required all children enrolled in child care to be vaccinated. At the time over 93% of children were already vaccinated and in December 2015 only 1.15% of children aged 0-7 were unvaccinated due to conscientious objection in the state (New South Wales Government, 2017). The changes were made in order to prevent disease with the interests of general public health and reduce the risk of transmission of disease within the population. In the 20 months since implementation of the program there have been 43 cases overall of the disease, a number of which were related to international travel.
Historically, children aged 0-4 years of age have experienced significantly higher number of measles cases, hospitalisations and deaths than the rest of the population. This has, however improved drastically since the introduction of the MMR vaccine. In the mid-1990s there were over 900 cases of measles per million in the population but with the introduction of the second MMR dose this decreased rapidly to practically none in 2000 as shown in Figure 3.
Young children are more vulnerable that adults to infectious diseases for a number of reasons. They are constantly growing and breathe, eat and drink more than adults do in proportion to their weight (World Health Organisation, 2019). Their bodies, and immune systems in particular are still developing and disease like measles can lead to irreversible damage later in life. They also behave differently to adults. Pre-school aged children in particular crawl around on the ground, stick objects in their mouths and constantly touch one another. They have poor hygiene and are unaware of the risks of their actions due to their age. All of these factors result in them being more likely to contract infectious diseases, especially those that are more virulent like measles, and suffer from more acute symptoms.
Since the introduction of the MMR vaccine, which children can receive at 12 months of age, with a booster at 18 months the number of deaths decreased significantly. In 1912 there were more than 500 reported cases of measles related deaths but between 1996 – 2016 there were only three (Australian Institute of Health and Welfare, 2018). Due to the immunisation program in effect throughout Australia, the vast majority of cases are found in those too young to be vaccinated and young adults partially vaccinated or unvaccinated in childhood. Most cases diagnosed within the country can be traced back to international travellers (Australian Institute of Health and Welfare, 2018). The information presented shows that the introduction of vaccinations from an early age result in significantly fewer measles cases due to herd immunity. Without high rates of vaccination, international travel and unvaccinated people result in a fast-spreading disease and high numbers of cases.
Evaluation
The data analysed in this report comes from a range of sources. They cover a range of sample sizes from states and territories, to nationally and even internationally. Information has been selected from governmental sources, private medical research organisation, universities and international organisations.
Governmental sources include the Australian Institute of Health and Welfare, the New South Wales Government health department and Northern Territory health department. The data analyse from these bodies is all recent, within the last 3-5 years, covers a wide range of people and is carried out under strict guidelines that demands unbiased sampling and research procedures.
The National Centre for Immunisation Research and Surveillance is one of the largest private research organisation within the country and contributes research to the Australian Technical Advisory Group on Immunisation, including the Australian Immunisation Handbook, a government-issued guide on recommended vaccinations in the interests of public health. It is also certified under and meets the criteria for credibility and content under the Global Advisory Committee on Vaccine Safety. The information analysed from this organisation covers a wide range of sample sizes from major cities, to states and territories and Australia-wide. All research used is relevant and concerns vaccinations within the last 3-5 years.
The World Health Organisation is recognised as the leading authority on health around the world, is governed by qualified health professional and works closely with delegations from each of its 149 member states. The information included from their organisation in this essay is supported by their experience all over the world since 1948.
The information analysed from each of these organisation concerns populations relevant to the research question; pre-school aged children and the wider population of Australia. While the main body of data presented ranges over a period of 3 years, it is all recent and concerns the last 3-5 years. Historical data collected from the AIHW is included to demonstrate the effect of introduction of vaccines over time.
Overall the information presented is highly relevant to the research question presented and gives the resounding conclusion that vaccinations should be made compulsory for all pre-school aged children in the interest of public health and the eradication of measles in Australia. This research could be extended by further research in to the uptake of widespread vaccination has on the prevalence of diseases like measles in pre-school aged children and the wider population in Australia. This research will provide further information as to why vaccination is important.
Conclusion
In conclusion, the evidence provided in the essay shows that vaccination against measles should be made compulsory for pre-school aged children in the interest of public health in Australia. The data available shows that both historically and in recent times, higher rates of vaccination against measles has majorly decreased the number of cases, hospitalisation and deaths from the disease in both pre-school aged children and the wider Australia population. As mention in the Evaluation, further information in to why this is the case could strengthen the evidence in favour of vaccinations.
Bibliography
- Australian Institute of Health and Welfare, 2018. Measles in Australia. [Online] Available at: https://www.aihw.gov.au/getmedia/c828baef-75d9-4295-9cc9-b3d50d7153a2/aihw-phe-236_Measles.pdf.aspx[Accessed 25 July 2019].
- Bright Horizons, 2019. Difference Between Preschool and Pre-K. [Online] Available at: https://www.brighthorizons.com/family-resources/preschool-vs-pre-kindergarten-what-is-the-difference[Accessed 30 July 2019].
- National Centre for Immunisation Research and Surveillance, 2017. Significant events in measles, mumps and rubella vaccination practice in Australia. [Online] Available at: http://ncirs.org.au/sites/default/files/2019-07/Measles-mumps-rubella-history-July%202019.pdf[Accessed 26 July 2019].
- New South Wales Government, 2017. Question and answers about vaccination requirements for childcare. [Online] Available at: https://www.health.nsw.gov.au/immunisation/Pages/childcare_qa.aspx[Accessed 31 July 2019].
- New South Wales Government, 2019. Communicable Disease Weekly Report (CDWR). [Online] Available at: https://www.health.nsw.gov.au/Infectious/Reports/Pages/CDWR.aspx[Accessed 30 July 2019].
- Northern Territory Government, 2019. Measles Update - Vaccination Program Extended. [Online] Available at: https://health.nt.gov.au/news/measles-update-vaccination-program-extended[Accessed 27 July 2019].
- Northern Territory Government, 2019. No new measles cases but the risk is not over. [Online] Available at: https://health.nt.gov.au/news/no-new-measles-cases-but-the-risk-is-not-over[Accessed 30 July 2019].
- Sadarangani, M., 2016. Herd Immunity: How does it work?. [Online] Available at: https://www.ovg.ox.ac.uk/news/herd-immunity-how-does-it-work[Accessed 26 July 2019].
- Woodley, M., 2019. Darwin measles outbreak 'over'. [Online] Available at: https://www1.racgp.org.au/newsgp/clinical/darwin-measles-outbreak-%E2%80%98over%E2%80%99[Accessed 31 July 2019].
- World Health Organisation, 2019. Children's Environmental Health. [Online] Available at: https://www.who.int/ceh/risks/en/[Accessed 10 August 2019].
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