Factors that Influence Measles Immunization in the UK - Dissertation Example

?Factors that influence Measles immunization in the UK and Contents Contents 2 Factors that influence Measles immunization in the UK 3 Chapter 1: Introduction 3 Factors that influence Measles immunization in the UK Chapter 1: Introduction This chapter is organized into seven sections intended to introduce the study. The sections in this chapter include: background information, problem statement, purpose of the study, research objectives, research questions, context of the study, the scope of the study, and structure of the study. Section 1.1: Background information Immunization is an experimentally approved instrument for controlling and eradicating life-threatening infectious diseases (such as measles, mumps and rubella). According to the World Health Organization (WHO) (Hill & Cox, 2013), it prevents from 2 to 3 million deaths globally per year. Besides clean water, immunization makes the most effective intervention of public health in the world for promoting good health and saving life. Immunization is credited by the WHO as one of the main cost-effective health investments ever made in the world nowadays (Hill & Cox, 2013). Although measles containing vaccine (MCV) have been there for more than 40 years, measles infections have been one of the major causes of child morbidity and mortality. This trend brings up the need for very high levels of the vaccination coverage to produce sharply decreased measles deaths. As a result, efforts have been directed to achieve sustainable benefits, which require more effective initiatives to increase vaccination coverage. In the United Kingdom, the combined vaccine for measles, mumps, and rubella (MMR) was introduced in 1988. It is recommended for 13 months old children with the second dose just before they join the school. Vaccination coverage reached its climax at 92% in 1995 amongst 2 year olds who live in the UK. This coverage reduced up to 79% in 2003 after the publication of the lancet research in 1998 by Andrew Wakefield and colleagues that suggested the need to research in order to eliminated an MMR vaccine –autism and bowel disease link in a small division of genetically inclined children. The coverage recovered to stand at circa 85% by April 2008 (Bedford, 2008). However, the rate of recovering, cannot measure up to the levels achieved in 1998. The publication called for single antigen for measles, rubella, and mumps vaccines to be given independently at not less than one year intervals. Lack of evidence in support of this, and dismissal of any connection between MMR and autism some, parents decided to look for single vaccines for their children. Since the government department of health was not persuaded to provide for single vaccines they are done at a cost by private health organization. These forces some parents to go for cheaper single vaccines in France or even not do it at all. Estimates national survey providers and local levels show that use of single antigen vaccine range from about 2% to 21% as of April 2008. Before 1998, use of MMR vaccine was lower among larger families and single parent families and in more socially disadvantaged areas. Nonetheless, since 1998, the decline in use of the vaccine has been quicker in more wealthy areas and sluggish in areas with less well educated residents, even though this quicker decline in more wealthy groups has not been enough to eradicate the unequal social distribution of the vaccine use. Reasons why parents opt not to use the MMR vaccination on their children include, negative publicity through media, the potential risks associated with the vaccine overshadowing the risks of getting the disease, issues with safety of the vaccine, and lack of trust in the advice by the government and health officials (Brown, et al., 2010). Research has also been done on the social distribution aspect of single antigen vaccine use and the differences in the explanations given for declining use of MMR vaccine by parents with unimmunized children and those with children who have used single antigen vaccines. Besides, the findings confirming the reasons by parents selecting not to immunize their children with MMR, practical and medical reasons have been found important for parents who chose not immunize their child (Brown, et al., 2011). It was estimated that 88.6% of the children born between 2000 and 2002 had used MMR vaccine by the age of three and an additional 2.7 had used all the three single antigen vaccines. Even though coverage was found to be relatively high, it was still lower than the projected level required to ensure group immunity (above 95%), leaving a significant proportion of children vulnerable to avoidable infection. Data on confirmed case of measles in Wales and England in 2006 went beyond those recorded in any year in the previous decade, and the possibility of bigger outbreaks of measles will go on whilst very many children remain susceptible. Even though the efficacy of MMR vaccine is known, little is known concerning the nature and handling as compared to the unlicensed single antigen vaccines. Moreover, due to the intervals between single antigen vaccines, children remain defenseless for a longer time as compared to when they had used MMR (Jick & Hagberg, 2010). Furthermore, it was established that children whose parents opt for single vaccines do not use all three antigens. Generally, previous research has looked at factors influencing decision concerning immunization of children by their parents. Moreover, it has investigated on the social distribution aspect of single antigen vaccine use and the differences in the explanations given for declining use of the MMR vaccine by parents with unimmunized children and those with children who have used single antigen vaccines. However, none of the research has focused on measles, which is the most prevalent of the infectious diseases (Baron-Cohen, et al., 2009). Therefore, investigating the factors associated with measles immunization, particularly the use of single antigen vaccine and reported cases of infections and deaths from measles will reveal more insight into the factors. Section 1.2: Problem statement As noted in the background information section, most of the recent research on influencing factors linked to decisions concerning the immunizations of children, has been dealing with MMR vaccines as opposed to dealing with immunization of each infectious disease. The coverage of measles containing vaccines (MCV) has not been able to sharply decrease measles death. Investigation focusing on measles helps in resolving immunization the problem that efforts a substantial proportion of children remain vulnerable to avoidable infection (Goldhaber-Fiebert, et al., 2010). Measles as an infectious disease needs a sustainable solution in terms of vaccine. Any speculations or misrepresentation of facts on the usefulness of the vaccine casts a lot of aspersions on the vaccine. As a result, different perspectives arise among the public, but the managers of such a situation are few. Instead of providing a solution, it leads to an endless debate. Few of the debaters will provide the much needed solution. In the case of UK studies, it is indicated that most trusted source of advice to parents regarding immunization of children is the nurse. However, whoever works in the vaccine and the related information is different. There is the one who makes the vaccines at the industries and laboratories and there is the other who collects process and maintains data on cases of measles. Moreover, different researchers are bound to get different results besides confirmation of the findings in previous research. As much as such cases call for further research on the subject matter, it requires serious management to ensure a solution is reached. Therefore, even with precense of clean water in the UK, coverage of measles containing vaccines or measles single antigen vaccines is suspicious. Section 1.3: Purpose and rationale of the study The study has focused on investigating the factors influencing measles immunization in the UK. In the UK, the fight against measles is being hampered by the insistence on the use of MMR vaccines by government health department and the use single antigen vaccines by some children. The debate about the opposing perspectives has triggered a number of researches on the factors influencing immunization of children by parents. Despite the researches, the debate is alive and a significant proportion of children are still susceptible to avoidable infections. Section 1.4: Research objectives The main objective of this paper is to investigate the factors that influence measles immunization of children by parents in the UK. Specific objectives of the study include: To investigate the factors influencing immunization of children by parents in the UK To establish the reliability of both MMR and single antigen vaccines in the UK To investigate prevalence of measles infection in the UK To investigate effectives of both MMR and single antigen vaccines in the UK To find out the extent of effect the opposing perspectives on the use of MMR have on immunization in UK To establish the extent of coverage of both measles containing vaccines and measles single antigen vaccine in the UK Section 1.5: Research questions The main research question is: What are the factors influencing measles immunization in the UK? Specific questions of the study include: 1. What are the factors influencing decisions regarding immunization of children by parents in the UK? 2. How reliable is both MMR and single antigen vaccines for preventing measles infection in the UK? 3. How prevalent is measles in the UK? 4. How effective is both MMR and single antigen vaccines in preventing measles infection in the UK? 5. How far have the debates on the use of MMR affected immunization efforts in the UK? 6. What is the coverage of both measles containing vaccines and measles single antigen vaccines in the UK? 7. Is there an effective way of carrying out measles immunization in the UK? Section 1.6: The context of the study This study revolves around measles immunization in the UK. The UK has had issues with immunization of measles for over 40 years now, despite being in the league of most developed countries. The most popular measles containing vaccine, MMR vaccine, was introduced in the UK in 1988 and has been increasing in use over the years. It was found to be useful for not only giving three antigen vaccines at the same time, but also cost effective. It was also preferred to single antigen vaccines, because it reduced the time involved in administering the three antigens separately. However, issues arose concerning its connection to autism and its dosage (Campion-Smith, et al., 2008). Despite attempts to quell the worries by dismissing the concerns through subsequent researches the debate has continued. As the debate continues among professionals, the management of the danger of contracting measles amongst children living in the UK becomes ineffective. Parents make their own choices regarding immunization of their children, which leaves a significant proportion of the children vulnerable to infectious diseases (Griffith, 2008). The UK has put in place a well structured childhood immunization programme, which goes on evolving and developing to satisfy the demand to improve and manage preventable infectious disease. The childhood immunization programme is generally aimed at protecting all the children against the avoidable diseases of: pertussis, diphtheria, polio, tetanus, haemophillus influenza type b, mumps, meningococcal serogroup C, rubella, pneumococcus and measles (Hill & Cox, 2013). Many of these vaccines come in a combination. Measles, mumps and rubella or MMR vaccine is an example of these combination vaccines. It is recommended to be given to children at age of 13 months and a second dose at circa 4 years of age (before school age). Achievement of any immunization programme is judged by meeting ‘herd/group immunity’ levels to avoid local epidemics and outbreaks of the diseases it is aiming at. The recommended group/herd immunity is 95% of the aimed at population. Therefore, in order to avoid disease outbreaks of mumps, measles and rubella, it is critical that herd immunity is met. As an industrialized country, the UK is expected to provide solutions through manufacturing and distribution of both medicines and vaccines. Through the department of health, the UK has made strides not only in the manufacture of medicine, but also in vaccines. The manufacture of vaccines such as MMR to protect children from measles, mumps and rubella infection is a big step towards achieving the goals of the immunization programme. However, these efforts are hampered by improper introduction of the vaccines and inability to forestall rumors that negate the product. The child immunization programme in the UK is still some miles away from achieving its intended goal. Managing perceptions and removing doubt on a situation concern an infectious disease is very delicate. People (the public) take any negative information concerning vaccines seriously because they do not want to be victims of circumstances. Thus, mere banning of importing single antigen vaccines to enforce the use MMR vaccines may have been one causes of alarm. Measles is a serious infectious disease, which has been a disaster severally in the UK. Although the number of notified and confirmed cases of measles may indicate that measles is not a major problem anymore in the UK, the real situation is speculative. This implies that prevention of measles by achieving herd immunity in the UK is still speculative (Baron-Cohen, et al., 2009). The issues concerning the coverage of measles containing vaccine remains a topic to be researched. Hence, the research revolved around the UK to give answers that helps in managing the outstanding issues in immunization of children and suggests areas of research. Section 1.7: Scope of the study The study covers the investigation of factors influencing measles immunization in the UK. This makes the research relevant to areas within the UK territory and the whole of Europe by extension. This is very important, because European countries share borders and an outbreak of measles in one country can easily spread to the other. Moreover, after banning the use of single antigen vaccine in the UK, parents who trust it would go as far as France to get their children immunized. In France, the single antigen vaccine is available at lower price as compared to private sources in the UK (Bedford, 2008). The study seeks to bring into perspective the really situation of measles prevention in the UK. This includes the extent of coverage of measles containing vaccines and notifications as well as confirmations of cases of measles in the UK. In doing this, some is also shone on the effect of the lancet paper and subsequent paper on shaping the measles situation the UK. Section 1.8: Structure of the study This study has been divided into six chapters. The chapters are further organized into sections according to the coverage requirements of each chapter. The first chapter is for the introduction and is further organized into: background information regarding the study, the problem statement, purpose of study/justification, research objectives, research context, scope of study and the structure of the study. The second chapter is for the literature review that discusses gaps that are filled by this study (Hackett, 2008). The third chapter is for the methodology chapter, which outlines the way research was undertaken from methods to design. The fourth chapter is for the findings and analysis of data collected in the study. Chapter five is for the discussion of the findings of the study. The last but not least is the conclusion and recommendation chapter where the researcher has summarized the results of the study and suggested areas for future research. References Baron-Cohen, S. et al., 2009. Prevalence of autism-spectrum conditions: UK school-based population study. Br J Psychiatry, 194(6), pp. 500-9. Bedford, H., 2008. Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study. BMJ 2008, 336 (12), pp. 754-96. Brown, K. F. et al., 2010. Factors underlying parental decisions about commbination childhood vaccinations including MMR: A systematic review. Vaccine, 28(1), pp. 4235-4248. Brown, K. F. et al., 2011. Attitudinal and demographic predictors of measles, mumps, and rubella (MMR) vaccine acceptance: Development and Validation of an evidence-based measurement instrument. Vaccine, in press. Campion-Smith, H. A., C, T. S. & Ward, W., 2008. Parents' difficulties with decisions about childhood immunisation.. Community Practitioner, 81(10), pp. 32-35. Goldhaber-Fiebert, D. J. et al., 2010. Quantifying Child Mortality Reductions Related to Measles Vaccination. PLoS ONE, 5(11), pp. 2-16. Griffith, R., 2008. Consent and Children: The law for children under sixteen.. British Journal of School Nursing, 3(6), pp. 281-284. Hackett, A. J., 2008. Risk, its perception and the media: the MMR controversy. Community Practicioner, 81(7), pp. 22-25. Hill, C. M. & Cox, L. C., 2013. Influencing factors in MMR immunization decision making. 1st Annual International Interdisciplinary Conference, AIIC 2013, 10(2), pp. 582-592. Jick, H. & Hagberg, K. W., 2010. measles in the United Kingdom 1990-2008 and the effectiveness of measles vaccines.. Vaccine , 28(29), pp. 4588-92. Read More