Should childhood vaccination be mandatory? No
Department of Health, London SE1 8UG, UK.BMJ (online) (Impact Factor: 17.45). 05/2012; 344(may15 2):e2435. DOI: 10.1136/bmj.e2435
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ABSTRACT: Adverse effects following immunization to vaccines (AEFI) are considered extremely rare events, the occurrence of which could gain a major role in optimizing allergy diagnosis by cellular tests. The urgent need to eradicate infectious diseases from population, is the main goal of vaccination campaign, therefore its successful outcome should be almost undisputable. Basophil Activation Test (BAT) is commonly used to ascertain a type I hypersensitivity reaction, often replacing reasability tests. Therefore, flow cytometry assay of basophil, as performed in BATs, is employed to test if a particular antigen elicits some activatory response from cells. The allergic subject may undergo an AEFI to vaccine not necessarily by an atopic reaction with an allergen within vaccines but because of the existence of an asymptomatic or not diagnosed inflammatory chronic allergy or other immune-disregulating allergy disorder in the subject. BAT, also in its basilar fashion, might be used from a simple heparinized whole blood specimen, but its application in diagnosing allergy before mandatory of facultative vaccination, must be associated to improve other diagnostic tools, at least in its pivotal application. If the application of BAT can be suggested to improve allergy diagnosis by introducing a cellular test in routinely used tools, such as sIgE and SPT, its use, due to possible expertise-consuming and relatively expensive issues, can be included in a specialized allergy consultancy panel as an exploratory approach of allergy inflammation, for which a subject undergoing immunization by vaccines is suggested to undergo and advised to sign an informed consent for BAT performing. This may extend BAT use in many other forms of chronic allergy and immunity disorders related to AEFI with vaccines.
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ABSTRACT: In Italy, vaccination against diphtheria, tetanus, polio and hepatitis B is compulsory for infants countrywide, except in Veneto region where since 2007 Health Authorities have experimented the suspension of mandatory vaccination. In light of the recent discussion on the potential abrogation in other regions, we explored the opinion of family pediatricians who play a crucial role in promoting immunization programmes in Italy. In November 2009, we interviewed by phone the family pediatricians working in Puglia region using a standardised, ad hoc and piloted questionnaire. Of the 596 contacted, 502 (84.2%) completed the questionnaire (54% female, median age = 52 y). Among the respondents, 72 (14.3%) would agree on the hypothesis of abrogation. This judgment was associated with having a good opinion on the level of awareness of the importance of vaccinations in the general public (OR = 6.6; 95% CI: 3.6-12.1) and having the perception of adequate organization of Vaccination Services in supporting the abrogation (OR = 3.6; 95% CI: 1.7-5.9). Family pediatricians appeared really sceptical about the abrogation of compulsory vaccination that could be hypothesized only increasing public awareness, communication skills and capability of Vaccination Services personnel in offering vaccinations.
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