MANDA­TORY VAC­CI­NA­TIONS

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SASKA­TOON Four in five Saskatchewan res­i­dents think vac­ci­na­tions for chil­dren and youth un­der the age of 18 should be manda­tory, new pub­lic opin­ion re­search sug­gests.How­ever, Dr. Saqib Sha­hab, Saskatchewan’s chief med­i­cal health of­fi­cer, says such a move wouldn’t be of much value be­cause the ex­ist­ing sys­tem is do­ing a good job of en­sur­ing as many peo­ple as pos­si­ble are vac­ci­nated on time.Eighty-three per cent of the 400 Saskatchewan res­i­dents who par­tic­i­pated in a tele­phone sur­vey this month agreed that im­mu­niza­tions should be manda­tory for chil­dren and youth un­der the age of 18.Four­teen per cent dis­agreed. The re­main­ing re­spon­dents were un­sure or re­fused to an­swer.Men were more likely than women to agree that im­mu­niza­tions should be manda­tory.The re­search was done by the Uni­ver­sity of Saskatchewan’s So­cial Sciences Re­search Lab­o­ra­to­ries (SSRL) as part of the Tak­ing the Pulse ini­tia­tive, which in­volves SSRL re­searchers call­ing a rep­re­sen­ta­tive sam­ple of Saskatchewan res­i­dents four times a year and ask­ing for their views on hot-but­ton top­ics in the prov­ince. The re­sults are pub­lished by Post­media News.On­tario and New Brunswick are the only prov­inces in Canada with leg­is­la­tion in place re­quir­ing chil­dren to be im­mu­nized against dis­eases in­clud­ing diph­the­ria, tetanus, po­lio, measles, mumps, rubella, meningo­coc­cal dis­ease and per­tus­sis (whoop­ing cough) in or­der to at­tend school.How­ever, both prov­inces have ex­emp­tion clauses that al­low par­ents to refuse vac­ci­na­tions for med­i­cal rea­sons or be­cause of con­science or re­li­gious be­liefs.Sha­hab es­ti­mates that fewer than one per cent of par­ents in Saskatchewan ac­tively refuse to have their chil­dren vac­ci­nated.In the ma­jor­ity of cases when chil­dren are not up to date on vac­ci­na­tions it’s be­cause par­ents don’t un­der­stand the im­mu­niza­tion sched­ule, have ques­tions about vac­ci­na­tions they want an­swered be­fore get­ting the shots, or face chal­lenges in mak­ing it to a clinic on time.Cory Neu­dorf, a pro­fes­sor in com­mu­nity health and epi­demi­ol­ogy at the U of S, said he wasn’t sur­prised to see high sup­port for manda­tory im­mu­niza­tion in the sur­vey re­sults.“Peo­ple think that im­mu­niza­tion is very im­por­tant and, not just im­por­tant for them, but they want to make sure that their friends and neigh­bours have their kids im­mu­nized as well,” Neu­dorf said.De­spite the ap­par­ent sup­port for manda­tory vac­ci­na­tions, “we prob­a­bly haven’t met the bar in this prov­ince for need­ing that,” Neu­dorf said.“I think we’re al­ready get­ting the same kind of re­sults here with­out need­ing the leg­is­la­tion … I doubt very much whether there would be a per­ceived need for go­ing that way.”Ac­cord­ing to the Im­mu­niza­tion Cov­er­age Re­port for School Pupils in On­tario, which looked at im­mu­niza­tion rates of sev­enyear-old stu­dents for the 2016-17 school year, cov­er­age was 91 per cent for measles and 85 per cent for per­tus­sis.Re­ports pub­lished by the Saskatchewan Min­istry of Health show that im­mu­niza­tion rates for measles and per­tus­sis were 91 and 76 per cent, re­spec­tively, for the prov­ince’s seven-year-old chil­dren in Sep­tem­ber 2018.The na­tional goal for cov­er­age is 95 per cent.“The herd ef­fect re­ally starts kick­ing in above 80 per cent, and the herd ef­fect of com­mu­nity im­mu­nity is bet­ter the higher the im­mu­niza­tion rate,” Sha­hab said. “Aspi­ra­tionally, we would want to go to 95 per cent.”The herd ef­fect refers to the fact that, when a sig­nif­i­cant por­tion of a pop­u­la­tion is im­mune to a dis­ease, it re­duces the like­li­hood of dis­ease out­break and also pro­vides a mea­sure of pro­tec­tion for those who are not im­mune to it.The most re­cent out­break of a vac­cine-preventable dis­ease in Saskatchewan hap­pened this fall when at least two-dozen cases of whoop­ing cough were re­ported in chil­dren and youth in Ros­th­ern, Hague, Wakaw, Hep­burn and Wald­heim. The ma­jor­ity of the chil­dren were not up to date on their whoop­ing-cough im­mu­niza­tions.While whoop­ing cough causes a bad cough in most peo­ple, the dis­ease can be fa­tal for in­fants.Chil­dren need six doses of per­tus­sis vac­cine by the time they reach Grade 8 to be fully im­mu­nized. The first three doses are done at ages two, four and six months.Sha­hab says it can be easy for par­ents to fall be­hind this sched­ule.A big mis­con­cep­tion is that par­ents think they should de­lay vac­ci­na­tions for pre­ma­ture ba­bies — but they shouldn’t, he says.The health re­gion has re­cently started rec­om­mend­ing per­tus­sis vac­ci­na­tions in preg­nant women to pro­tect their new­borns be­fore they are old enough to be im­mu­nized, and the health re­gion con­tin­ues to do pub­lic ed­u­ca­tion around the need for vac­ci­na­tions, Sha­hab says.In Saskatchewan, pub­lic health nurses work with preg­nant women to en­sure they un­der­stand the prov­ince’s vac­ci­na­tion sched­ule be­fore their chil­dren are born.As of Feb­ru­ary 2015, no mat­ter where a child is im­mu­nized in Saskatchewan, their in­for­ma­tion is en­tered into a com­mon data­base so their im­mu­niza­tion records are eas­ily ac­ces­si­ble by other pub­lic health pro­fes­sion­als, even if they move.Sha­hab says this has helped im­prove im­mu­niza­tion rates in cen­tres such as Prince Al­bert and North Bat­tle­ford — where peo­ple of­ten move around — be­cause fam­i­lies can now get the ap­pro­pri­ate im­mu­niza­tions, re­gard­less of where in the prov­ince they go to gain ac­cess to health-care ser­vices.Pub­lic health nurses do vac­ci­na­tion checks in Saskatchewan schools at grades 1, 6 and 8. If chil­dren are not up to date on vac­ci­na­tions, ar­range­ments are made to catch them up.Sha­hab says im­mu­niza­tion rates tend to lag the most in cen­tres with large new­comer pop­u­la­tions, be­cause par­ents may not un­der­stand the Saskatchewan im­mu­niza­tion sched­ule.A decade ago, Neu­dorf was part of ef­forts to nar­row the im­mu­niza­tion rate gap be­tween dif­fer­ent ar­eas of Saska­toon.When he started his work, some neigh­bour­hoods had 100 per cent im­mu­niza­tion rates while other neigh­bour­hoods had rates below 50 per cent.Neu­dorf and his team worked to un­der­stand why, and they learned that some fam­i­lies were strug­gling to get to clin­ics for ap­point­ments on time.The for­mer Saska­toon Health Re­gion then made changes to drive num­bers up in neigh­bour­hoods where im­mu­niza­tion rates were lower, in­clud­ing chang­ing where clin­ics were lo­cated and when they were open.The health re­gion has cred­ited his work for bring­ing measles im­mu­niza­tion rates in two-year-old in­ner-city chil­dren to 80 per cent in 2016 from just 46 per cent in 2007.Neu­dorf said it’s ef­forts like this — not laws on manda­tory im­mu­niza­tion — that make the most dif­fer­ence in im­mu­niza­tion rates.“Es­sen­tially, it’s not an is­sue with the par­ents’ level of sup­port. It’s a ques­tion of the rest of the de­liv­ery sys­tem: Are we able to re­spond ac­cord­ing to those pa­tients’ needs?” Neu­dorf said.Each it­er­a­tion of Tak­ing the Pulse has an over­all mar­gin of er­ror of plus or mi­nus 4.9 per cent, 19 times out of 20, which means re­searchers ex­pect their re­sults to re­flect the opin­ions of Saskatchewan adults to within 4.9 per cent, 95 times out of 100.

A Post­media poll sug­gests that more than 80 per cent of Saskatchewan res­i­dents favour manda­tory vac­ci­na­tions for chil­dren and youth.

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