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Childhood immunisation : a guide for healthcare professionals

British Medical Association
Board of Science and Education
June 2003

The Board of Science and Education, a standing committee of the British Medical Association (BMA), provides an interface between the medical profession, the government and the public. One major aim of the board is to contribute to the improvement of public health, and it has developed a wide range of policies on the health of specific groups such as children and the elderly. Furthermore, the board’s work on infectious diseases has resulted in a number of publications including the BMA guide to rabies (1995), Bloodborne viruses and infection control: a guide for healthcare professionals (1998) and Sexually transmitted infections (2002).

At the BMA’s 2002 annual representative meeting a motion on immunisation against childhood infectious diseases was debated and referred to the board of science and education for further consideration. In addressing this resolution, the board decided to write a report for general practitioners which reviews the principles of vaccination and immunisation in the UK in children aged 0 to five years. Vaccines not included in the UK immunisation programme, but given to children if clinically indicated, are also mentioned.

There have been concerns over vaccination since the introduction of variolation in the 18th century. In the middle of the 19th century and more recently, the need for compulsory immunisation has been widely debated in the public domain. The recent debate has been fuelled by publications suggesting a link between the measles, mumps and rubella (MMR) vaccine and autism or inflammatory bowel disease, although the validity of this research is disputed. The debate surrounding the MMR vaccination is considered in this report along with issues that concern other types of childhood vaccinations such as tetanus and diphtheria. Increased societal concern regarding the safety of vaccines has an impact on the risk tolerance of parents and healthcare professionals. This report is intended to assist general practitioners and other healthcare professionals in discussing the health benefits and potential risks of vaccination with parents so that informed decisions can be made.

Professor Sir David Carter
Chairman, board of science and education
June 2003

Please note that this report is a guide for general practitioners and other healthcare professionals on issues relating to childhood immunisation – it is not intended to be a comprehensive text on immunisation. Where appropriate, the reader is referred to specialist texts for more detailed information.


Erratum: please note that the following amendment has been made to the report. Page 29, appendix IV: the percentage of pertussis complications requiring hospitalisation is 32 and not 0.2 (this error was printed in the source material).

Editorial board
A publication from the BMA science and education department and the Board of Science and Education
Chairman, Board of Science and Education - Professor Sir David Carter
Director of professional activities - Dr Vivienne Nathanson
Head of science and education - Dr Caroline Seddon
Project manager - Nicky Jayesinghe
Research and writing - Angela Sharpe
Editorial secretariat - Carol Chan, Sherri Cooper, Darshna Gohil, Elaine Martyn, Amy Schofield

Board of science and education
This report was prepared under the auspices of the board of science and education of the British Medical Association, whose membership for 2002/2003 was as follows:

Sir Anthony Grabham - President, BMA
Dr George Rae - Chairman, BMA representative body
Dr Ian Bogle - Chairman, BMA council
Dr David Pickersgill - Treasurer, BMA
Professor Sir David Carter - Chairman, board of science and education
Dr P H Dangerfield - Deputy chairman, board of science and education
Dr S J Austin
Dr A Elsharkawy
Dr S Hajioff
Dr G D Lewis
Professor S Lingam
Dr P Maguire
Dr S J Nelson
Dr N D L Olsen
Dr S J Richards
Dr D M B Ward
Dr C McCullough (Deputy)

Approval for publication as a BMA policy report was recommended by BMA Board of Professional Activities on 28 May 2003.

Acknowledgements
The Association is very grateful for the help provided by the BMA committees and many outside experts and organisations. We would particularly like to thank Dr David Elliman (Consultant in Community Child Health, St George’s Hospital), Dr Helen Bedford (Lecturer, Institute of Child Health) and Dr Martin Donaghy (Clinical Director, Scottish Centre for Infection and Environmental Health).

Childhood immunisation is available from the:
BMA Science and Education department
British Medical Association
BMA House
Tavistock Square
London WC1H 9JP
email: info.science@bma.org.uk