Immunisation in the spotlight
28 May, 2013
Immunisation is in the news at the moment, prompted by calls in some states to exclude unimmunised children from a range of activities.
To immunise or not has been too often presented as a "you're either with us or against us" issue, no matter which side you're on. But the facts show that less than 2% of parents are genuinely opposed to immunisation.
The vast majority of parents of unimmunised children either just haven't gotten around to it or are uncertain. Reminding a parent should be relatively straightforward (though we need better systems for this) - but what about those who are uncertain? It's become very apparent to me that we need to talk with these parents in a better way.
Firstly, let's acknowledge that every parent wants the best for their child, so those who don't immunise think they are doing the right thing. My task as a health professional is to talk to parents honestly about risks and benefits, giving them reliable information and confidence in me as the expert.
What about risks? While there is no doubt that vaccines save millions of lives, we can't pretend that they come with no risk at all. The issue here is that peoples' perception of the risks can be dramatically overinflated (for example, the risk of a severe reaction to penicillin for a sore throat or an ear infection is much more than after receiving a vaccine, but most wouldn't baulk at getting the antibiotic prescription filled). This is often fuelled by the amount of misinformation out there, particularly in the age of "Dr Google".
What are the benefits? People often forget that we are protecting children from potentially fatal diseases. My own mother was a polio victim as well as a nurse in the 1950s, and had horrific stories to tell. And people need to understand that these diseases are still around - we still have deaths every year from whooping cough for example.
The facts show that the risks of immunising are miniscule compared to the risks of not-immunising. My job is to take parents' concerns seriously, accept that there are very rare problems (such as the influenza vaccine issues of 2010) but point out how we learn from those and end up with an even better, safer system.
It's important we present facts not spin.
For the record, my own children are fully immunised, including their annual influenza vaccine.
Just like them, I want what is best for my kids.
Professor Jonathan Carapetis
Director, Telethon Institute for Child Health Research
- Watch the video of our recent Infectious Disease
& Vaccination Seminar
(recorded 14 May, 2013)
- Read the Australian Academy of Science publication The Science of Immunisation
Scratch and a sniffle just normal part of healthy schooling
25 February, 2013
Published in The Australian newspaper.
We've started another school year. If your family is like mine,
your kids have not only been very happy these past couple of months
but also very healthy. There's been lots of relaxing and playing
over summer and remarkably little sickness.
The usual run of colds, asthma and ear infections seems to take a break at this time of year. Some of this is because of the weather -- some viruses are more common in the cooler months. Kids also tend to be less tired during the holidays (there seems to be a link between fatigue and susceptibility to infections). But a lot of it is because of proximity to other children.
At childcare, kindergarten or school, children spend a lot of time in close contact with each other, and as a result share some of the billions of organisms living on their skin and up their noses. So, today, when you drop your child off at their classroom and see that little Johnny who sits next to your child has a runny nose, you will probably get a sinking feeling that your kid will soon be sick as well. If you are like most parents, you will shrug your shoulders, kiss your child goodbye and walk away. And this is the right way to handle it.
Infections are a normal part of growing up. Our immune systems need to be exposed to lots of infections while we are young so they can develop defences, ready for the next encounter. On the other hand, a virus or bacterium that causes a mild cold in one child might lead to a nasty middle ear infection or pneumonia in another. As with so much in life, there is a balance to be struck, in this case between reducing the risks of severe infections and over-protecting our children.
The recent guidelines for childcare centres released by the National Health and Medical Research Council recommend daily washing of surfaces that kids come into contact with and, controversially, not letting kids blow out the candles on their birthday cake if that cake is to be served to other children. The Australian Medical Association was not happy, accusing the NHMRC of wanting to place kids "in a bubble". I tend to sympathise with the AMA on the birthday cake issue, while still recognising that we can reduce the chance of infections with some sensible measures to improve hygiene.
I have to mention head lice. I don't know a parent who hasn't had several head lice moments during their children's school years. A few facts: first, head lice are democratic -- any child can get them, regardless of where they live or how rich their parents are. They are also nothing to do with hygiene or kids being dirty. And head lice can't jump -- they spread by direct contact of one child's hair with another's. Finally, head lice are irritating but not serious -- at most, they are itchy. The major worries are how difficult they are to get rid of, and the looks from other parents when your child is responsible for the note in schoolbags saying that there are head lice in the classroom.
There are plenty of resources about how to deal with head lice (just enter "head lice" and your state in your search engine to get your local guidelines). They detail the treatment options, but also that your child can return to school the next morning after being treated.
So, as kids settle back into school routine, we know they are going to pick up more than an education. Be reassured that the challenges to their immune system and what it learns are equally important lessons for a healthy life.
Ready for school?
28 January, 2013
Published in The Australian newspaper.
Over the next few weeks children and their parents around Australia will gear up for a new school year. Kids will experience anticipation and trepidation about what awaits them in their new classroom, and mums and dads will be rushing around organising books and uniforms and filling out forms (and for some, large cheques) for the school.
Amid all the hubbub, do any of us consider why we are doing all of this? Sending our kids to school has become such a routine for most of us, we usually don't think twice about it.
School is, of course, about setting our kids up for the future. It develops their skills and knowledge and equips them to enter adulthood ready for work or further education, and hopefully to deal with the ups and downs that will face them over the course of their lives. But there are many more benefits of schooling that most of us don't appreciate.
For example, education is the single most important intervention to improve health. Why?
Because there is a strong and universal link between level of educational attainment and long-term health outcomes, whether they be measured by life expectancy, rates of chronic diseases in adulthood, or just about anything else.
For decades we have known that, in the poorest countries of the world, the chances of a child dying before age 5 are directly linked to how much schooling their mother received.
Indeed, if I could pick one strategy that would have the greatest impact in improving Aboriginal health in this country, I would choose making sure that every Aboriginal child received a good formal education. I am not talking about specific teaching around health. Rather it is education as a whole - reading, writing, arithmetic and the rest - that allows people to take control over their lives, make sensible choices, and acquire the knowledge and tools (including earning an income) to be happy as well as healthy.
Leaders of many developing countries around the world during the mid-20th Century understood this, and some would argue that the current "Asian Century" is largely a result of steadily improving literacy and numeracy levels in these emerging economies over the last 30 years. Countries like China and India are now bearing the fruits of ensuring that, even in settings of poverty, good schooling can be provided to most children, and can be a ticket to health and productivity.
But parents can't kid themselves that all they need to do is send their children to school. Some parents treat school like an interest-earning bank account - all you have to do is deposit your children there and the school will ensure that they grow and develop as they should. It's not that simple.
School is part of an equation that includes family and community. It is parents' responsibility to make sure that kids are ready for school in the first place - that they come from happy environments where education is valued, their child's development is nurtured from day one and they take an interest in their child's schooling.
Some parents worry about whether their kids are at the right school. In fact, the evidence shows that the most important determinant of a child's educational outcome is not the school they attend but the equipment they bring to school - their intelligence, attitude, hunger to learn, etc - which in turn are most influenced by their home and community environment.
If we think of education as a full time pursuit, not one that stops when the school bell rings in the afternoon, then we realise that what happens outside of school is just as important as what happens in the classroom.