unvaccinated DCs going to Tunisia

[foreverastudent]

My DD (2) has never had any vacciniations and my DS (8) hasn't had any since the 'standard ones at 2,3&4 months.

They are both healthy and have no chronic conditions.

But now we're planning to go on holiday to Tunisia and I don't know whether they should get any for the trip.

Travel websites/health info is unhelpful as it assumes children are vaccinated.

I cant ask my GP because she would just say get them anyway, without differentiating the relative risks of the UK vs abroad.

I dont want them to get any unless the risk of contraction is significantly higher than here.

Polio, tetanus and diptheria seem to be biggest threats.

They will prob be fine although it depends where you are going. If you are going to a resort then I wouldn't worry. The main risk seems to be polio. You can get a single ipv shot if you are worried. Tbh the likelihood of your healthy contracting and becoming disabled from polio is very unlikely. My ds isn't vaccinated either and we are planning a trip to south Africa.

If you are willing to take the risk here, why not abroad? It's probably very slightly higher there (I just came home from Tunisia on Thursday) but not that much. Personally, having travelled pretty widely in the developing world, I will be forever greatful to the NHS for giving me the opportunity to protect my son from disease wherever he is in the world. A family member was crippled by polio, a colleague was crippled by TB, a neighbour lost her son to chicken pox, all in this country. So we, as a family, vaccinate and will continue to do so.

DrSeuss, could you tell more about the polio case in your family? how did it happen? If you don't mind of course...

My husband's grandfather was permanently disabled by contracting polio as a child. Yes, that was a very long time ago but in the developing world it's still happening and would happen again here if we stopped vaccinating. My colleague, now in his sixties, was permanently disabled when TB entered his hip joint. He now walks by pushing the good leg forward then swinging the other one through. Could have been prevented had the BCG jab been available during his childhood. He used to teach in the next room to me at a local secondary school. Kids who didn't want to get their BCG even after their parents had signed the papers would be directed to go and take a look at him! Most horrifying of all was the neighbour's son
who died aged 35, leaving a wife and 2 children, when chickenpox caused renal failure. The chickenpox jab is not available here on the NHS but is in the USA. I have had whooping cough as a child, despite having been vaccinated and the experience left me with no doubts about getting my own child jabbed. My husband told me this morning that his mother had been unsure about getting him jabbed for whopping cough until their elderly GP described a number of experiences he had as a junior hospital doctor dealing with whooping cough cases before the jab became available, where he had been forced to sit with a small child, unable to do anything but watch them die. I do not have blind faith in science. I come from a family of professional scientists and was taught to believe nothing I can't see the evidence for. I have seen the evidence and I believe in vaccinations.

Thanks a lot DrSeuss for your prompt reply and for sharing your/your family's experience.

Just to add, without (hopefully)starting a 'pros and cons of vax' debate, in Russia, where I come from, the BSG has been and is given to everyone at birth. It's compulsory. Russia is (and has been for a long time) among the highest rates of TB in the world though.

Dr Seuss, your experiences are very sad but I'm not sure that they paint an accurate picture of the diseases today. 99% of polio cases are not paralytic and of the 1% that are, a large percent of those cases cause only temporary paralysis. In fact, polio presents frequently with mild flu like symptoms.
THe TB vaccine has been shown to be quite unreliable and is now only offered to people in what are deemed 'high risk' areas. I find it quite shocking that your school attempted to over rule a parent's decision not to vaccinate by using scare tactics.
Chicken pox is usually a mild childhood disease. It is terrible that your neighbours lost a loving father and husband to it in adulthood. It is definitely a more serious disease in adulthood which is why it is important for our children to acquire natural immunity to it when they are young. A chicken pox vaccine may prevent this and increase the risk of contracting it in adulthood. You may not know if your protection has worn off, leaving you at riskwhen you are more vulnerable. I'm not sure that the CP vaccine is the best course of action and any of my medical friends that I have spoken to, agree.

"Chicken pox is usually a mild childhood disease. It is terrible that your neighbours lost a loving father and husband to it in adulthood. It is definitely a more serious disease in adulthood which is why it is important for our children to acquire natural immunity to it when they are young. A chicken pox vaccine may prevent this and increase the risk of contracting it in adulthood. You may not know if your protection has worn off, leaving you at riskwhen you are more vulnerable. I'm not sure that the CP vaccine is the best course of action and any of my medical friends that I have spoken to, agree."

I very much disagree with the reasoning.

The varicella vaccine is not just designed to avoid people getting the usually mild illness commonly known as Chicken Pox, although it does an excellent job of that.

The varicella vaccine is also designed to reduce the risk of herpes simplex relapse (commonly known as Shingles) which occurs as a result of getting Chicken Pox.

It is both effective, cost-effective and safe for both applications.

Which is why an increasing number of countries are introducing it as routine.

However the efficacy of the varicella vaccine, and the anecdotes which it came with are not really relevant to the OP (assuming they are still around).

Tunisia has a better Measles vaccination rate than the UK right now.
Thus measles risk is low.

Tunisia only recently instated a Rubella immunisation programme so risks are higher.

Mumps is not vaccinated for thus risk is higher.

Pertussis risk is also higher.

Probably higher for the various meningitis microbes as well.

And it might be worth remembering that Tunisia is generally considered to have worse healthcare than the UK if you are unlucky.

DB, I thought one of the main reasons we were currently not vaxing against CP in the UK is because there is some concern that the vaccine will increase the incidence of shingles (which is much worse than chicken pox). Iirc, the HPA predicted a 20% increase in shingles cases if a vaccine was introduced - basically because while cp circulates among the population it provides a 'booster' to protect us against shingles. I think it has been said that any benefit of the cp vax would be greatly outweighed by the resulting increase in shingles which is a much worse (and more expensive) illness to treat.

I'm not sure that I would agree
"It is both effective, cost-effective and safe for both applications. "
just yet.

I hadn't heard that from the HPA.
But if it's not a new statement they may be swayed by the current state of the evidence.

The Shingles Prevention Study is a multi-centre, double blind, randomly controlled placebo trial of the varicella vaccine in 38,546 people.

51% lower incidence of HZ.
67% reduction in postherpetic neuralgia.
61% lower burden of illness.
73% reduction in the number of cases of HZ with severe and long-lasting pain.

And similar benefits in quality of life.

It is being extended as we speak but these are excellent results.

As for chicken pox, before vaccination in the US (longest data period) there were:

4 million cases of chicken pox (4-6 days of school/parental work).
Around 10,000 required hospitalisation.
Around 100 deaths.

Cases fell by around 90%.
Hospitalisations fell by 88%.
Deaths fell by 66% (90% in children).

My colleagues and I never tried to overrule the decision of a parent through scare tactics or any other tactics. This is not what I said. Please reread my post. Even though parents have decided to vaccinate and have returned the completed forms, many teenagers are less than enthused with the idea of a needle in their arm, especially one that leaves a scar. We merely suggested to these teenagers that their parents believed that they were doing the best for them and provided an object lesson in why this was so.
I await your apology for the accusation of unprofessionalism and coercion with interest.

Apologies Dr Seuss - I misread your post. I still think it is a case of using scare tactics to persuade a teenager to get a jab against their will but not as unethical as doing it against their parent's wishes.

DBennett, I'm curious about the cost effectiveness of vaccinating an entire population against a disease with a death rate of 0.0025%. The HPA info came from 2008. There doesn't seem to be anything more recent about it.

It's not the death rate that one needs to consider when it comes to cost-effectiveness.

Cold it may sound but death is cheap.

What's expensive for a society is the time off work & school and the hospitalisation.

Which is why I mentioned those numbers.

In fact, the US estimated before they went ahead with the vaccine that for every dollar spent, 90c would be saved by the person but $5.40 by society.

I understand that things have come out a little better than that.

And I had understood that the HPA advice for occupational health pointed out that NHS trusts would save money overall but costs would be higher from OH budgets.

Vaccines in general are some of the most cost-effective interventions.
We've sort of gone beyond references but I'm not sure the numbers are believable otherwise.

There is also a risk of Hepatitis A in Tunisia.

Hmmm, II wouldn't put 'society' before my own child so perhaps that's why I am not swayed by the economic argument. I'm also a SAHM/WAHM who HEs so time off work and school isn't an issue - although I wonder how time off school is expensive for society?
I have heard the argument used in the US of comparing the price of the vaccine to the cost of having to take the time off work to look after your child and I just thought it was very sad :(

Gee, thanks for the apology, I feel so much better now!

I think that it is unlikely that we would ever reach agreement on this topic, particularly given our differing views on education and other matters. So, I'm going to keep on immunising my child since I believe this is the right thing to do as a parent. You should keep doing whatever it is that you feel to be right and I hope that you never have cause to regret your course of action.

The formula does not add a cost for missed school days.
I mentioned it to be sure it was clear that why work days were lost.

But days off work at short notice due to caring for illness is no-ones ideal.
And certainly not why I think of when I think of spending more time with the kids.

And it does cost money.

"I hope that you never have cause to regret your course of action."

arf. See, you say that but in a way that sounds like you actually mean the exact opposite.

see whenever I get lectured about soceital responsibilty I always ponder how incredibly derisory the support is for children who have been vaccine damaged.

I am happy to discuss vaccines with people but tend to shy away from the hectoring, arrogant lecturing types. So perhaps ducking out of this one is a good idea

Thank you, Dr Seuss. I hope you never have cause to regret your course of action either.

Dear Pagwatch,
Thank you so much for the implication that I would wish harm on anyone or on their children.
I'd love to discuss this further with you but I'm too busy drawing my inverted pentangles and working on my hexes!