Should YOU pay to have these jabs?

As anxious parents scramble to get the Meningitis B jab privately, which other vaccines are worth paying for?

There are many more effective vaccines around today compared with even ten years ago — for adults as well as children — thanks to rapid progress in the technology. But the NHS restricts their availability, leaving some people worried they’re not protected against deadly infections.

The Meningitis B vaccine Bexsero is a case in point. It is given only to babies between two and six months old, which means infants outside these ages when the national vaccination programme was introduced in March 2015 have missed out.

however, you can pay to have some of the vaccines the NHS restricts (typically via a private clinic or doctor). here, we talk to the experts about whether it’s worth going private.

SHINGLES

SHINGLES is caused by the varicellazoster virus, which also causes chickenpox. As well as triggering a painful rash and fever, some sufferers can be left with post-herpetic neuralgia (persistent nerve pain) long after the rash has disappeared.

Shingles affects one in four of the over-50s and is fatal for one in 1,000 of the over-70s who develop it.

A single jab of the vaccine Zostavax can reduce the shingles risk by more than 50 per cent in over-50s, and lessens symptoms when the infection does develop. Protection lasts around five years.

Zostavax is what is known as a ‘live’ vaccine. Vaccines work by teaching the body to recognise a disease or bug and attack it; live vaccines, which contain a weaker form of the virus or bacteria, make better teachers, but carry a (very small) risk of triggering the illness.

This doesn’t happen with ‘killed’ or deactivated vaccines (which contain only sugars or proteins from the virus/ bacteria and no living material). WHO GETS THE NHS VACCINE? Since last September, the jab has been offered to those aged either 70 or 78. You become eligible for this on the first day of September after you’ve turned 70 or 78 and remain eligible for a full year. But people who aren’t those ages can’t have the jab on the NHS.

The over-80s miss out because after that age the vaccine is much less effective, according to Andrew Pollard, a professor of paediatric i nfection and immunity at the University of Oxford.

Professor Pollard, who sits on the Joint Committee on Vaccination and Immunisation, which advises the government on vaccinations, says the decision to offer the jab only to 70 and 78-year- olds ‘was made as a result of the need to give the vaccine to those who suffer the highest burden of disease at an age where the vaccine still works well and in the knowledge that protection probably lasts no more than ten years’.

Caroline Abrahams, charity director of Age UK, says vaccines are a ‘vital tool’ in helping older people avoid serious illness: ‘We remain concerned that entitlement to the vaccine is restricted to people aged 70 or 78.’

Dr Martin Scurr, good health’s GP, believes the upper cut-off point is arbitrary: ‘The vaccine is less effective in these people but it does work, and those who do get shingles are much less likely to develop longterm nerve pain.’ he thinks the restrictions are ‘random and unethical — if one in four people over the age of 50 who will get this disease can be protected by a vaccine, they should be given it routinely’.

he adds: ‘It is also nonsense to say that it causes only mild problems in those under 70. I have seen patients in their 30s and 40s who have been really debilitated by shingles.’ SHOULD I PAY FOR IT PRIVATELY? There is a ‘catch-up’ on the NHS scheme for people who were 71, 72 or 79 on September 1, 2015.

If you are between 50 and 70 or over 70 and outside the qualifying ages, or over 80 and are worried about getting shingles, Dr Scurr highly recommends having the jab privately. however, it is in short supply.

COST: Between £100 and £200.

CHICKENPOX

CHICKENPOX is usually a mild illness. however, complications include meningitis and pneumonia.

The live vaccine Varivax — which is given to adults or children in two injections, six to eight weeks apart — is regarded as very safe and effective and can last for up to 20 years.

‘In the U.S., where chickenpox vaccination is routine for children aged 12 to 15 months, with a second dose at age four to six years, the infection has all but disappeared,’ says Professor Pollard. WHO GETS THE NHS VACCINE? ‘It is not routinely offered to children or adults but can be given to patients on the NHS who are considered vulnerable to chickenpox and its complications, or those who come into close contact with them, such as healthcare workers,’ explains Professor Pollard.

Vulnerable people include those with a weakened immune system and pregnant women who’ve not had chickenpox already, as it can lead to birth defects.

‘Based on the last review of the evidence in 2009, it isn’t cost-effective for the NHS to have a nationwide vaccination programme,’ explains Professor Pollard. SHOULD I PAY FOR IT PRIVATELY? When it comes to adults, most people already have immunity, having caught it as a child.

Some experts have suggested the best use of NHS resources would be to give the jab to older teenagers who haven’t yet had the infection, but could be at risk in adulthood, when symptoms tend to be more severe.

Although the vaccine is effective in childhood, it is less effective in the teenage years and adulthood, protecting around 75 per cent of people who’ve had it.

The case for having younger children vaccinated privately may be stronger.

Dr Dionysius Alexandrou, a consultant paediatrician and neonatologist at the Portland hospital and Moorfields eye hospital in london, says: ‘There is an argument that chickenpox is relatively mild in childhood and most children will get it anyway before they reach adulthood, when it becomes more serious. however, in rare cases, chickenpox in children can be devastating.’

Professor Adam Finn, a consultant paediatrician at Bristol Children’s hospital, says: ‘For people who can afford it, it is certainly worth considering, since the vaccine is licensed, available, safe and effective.’

‘Sometimes chickenpox is far from mild, and because nearly all children get it sooner or later, we frequently see children who need hospital care, most of whom were previously perfectly well.

‘On my hospital ward rounds I am more likely to see a child with serious complications of chickenpox than a child with meningococcal disease — a disease which parents are quite rightly very concerned about.

‘In my opinion, there are very good reasons to consider offering the chickenpox vaccine to all children, as is now being done in a growing number of countries in europe, including germany, greece, Italy and Spain.’

COST: Around £250.

MENINGITIS W

THIS form of meningitis is more likely to prove fatal than other strains of the disease. As Mark hunt, of the charity Meningitis Now, explains: ‘It is very virulent — the death rate is around 12 per cent of all people who contract the infection.’

Meningitis W, although still rare, has made a resurgence in the UK: there were 22 cases in 2009, but numbers

nasal spray for a child who falls outside the school scheme,’ says professor Oxford. ‘Flu is very much underestimated as a health problem. it’s treated very casually, when the fact is that it could kill you. For every 1,000 people who get flu, one person will die, which is high.’

However, some experts say there is no evidence that the jab reduces hospitalisations and death in adults; the evidence is that it works best in healthy people. COST: Around £10 from a private clinic or pharmacy.

HUMAN PAPILLOMAVIRUS (HPV)

THe virus is linked to genital warts, cervical cancer, penile cancer and oral cancer.

in Britain, the number of mouth and throat cancers has increased by 40 per cent in just a decade, to 6,200 cases a year. it’s thought Hpv may be largely to blame.

WHO GETS THE NHS VACCINE? girls aged 12 and 13 in t he uK are offered a (deactivated) vaccine known as gardasil. so, too, are men who have sex with men aged 40 and below.

Charities and gps want boys to be given the same protection.

‘We really need every child — every boy, every girl — to be immune to this viral disease that we have a vaccine for,’ says dr george Kassianos, immunisation lead at the royal College of general practitioners.

However, the Joint Committee on vaccination and immunisation has said that it will not complete a review into this until 2017. it has previously suggested that boys will get benefits due to herd protection. SHOULD I PAY FOR IT PRIVATELY? dr Kassianos recommends getting your son vaccinated privately, i deally before he becomes sexually active, although gardasil is approved in people up to the age 26.

The same might apply to girls too old to have qualified for it under the national vaccination programme. COST: each dose (three are required) costs around £130.

TUBERCULOSIS

THis is a disease often thought to have been consigned to history.

in the Fifties, there were 50,000 new cases each year in Britain, but this dropped to around 5,500 in the early nineties.

However, the numbers have since risen to 7,000. it’s thought this has been driven by people coming from countries such as india and russia, where levels of TB are higher.

The vaccine contains a deactivated form of the bacteria that causes TB. Among children who are exposed to TB, it prevents infection in 60-80 per cent of cases. WHO GETS THE NHS VACCINE? Known as Bacillus Calmette-guerin (BCg), the vaccine used to be given to all school-age children, but is now available only to anyone under the age of 35 thought to be at particular risk of catching TB (the vaccine is not thought to be effective in anyone over this age).

This group includes children under 16 who’ve been in close contact with someone with TB or who come from an area where TB is widespread, which can mean some areas of the uK. ‘it is given to infants born in areas where the incidence of TB is more than 40 cases per 100,000 people per year, so in many London boroughs, including Lambeth and ealing,’ says paediatrician dr Alexandrou.

Also, people who are at risk because of their work in healthcare or refugee centres can have the vaccine.

‘However it currently is in very short supply,’ adds dr Kassianos. SHOULD I PAY FOR IT PRIVATELY? dr Alexandrou says he is ‘strongly in favour’ of parents getting the BCg for their children, even if they’re not considered high risk.

‘if young children pick up TB, they cannot contain it in the lungs like adults, and it can quickly invade the other organs and the brain. in some cases, children can die.’

it is also vital if you are planning to travel to places abroad where there is a high incidence of TB, such as China, Cambodia, indonesia and the russian Federation. COST: up to £100, although there is currently a global shortage and most private clinics are not able to offer it.