Immunisation - there has been quite a bit of discussion in the forums regarding its safety and whether it causes significant side-effects.

It can be an emotive subject. But, what are the facts? I did a literature search on immunsiation/vaccination to find some evidence to support the concerns I read about in the forums.

And, I found that in the past 150 years, the world's wealthy nations have successfully controlled - and in some cases, even eliminated - infectious diseases such as cholera and typhoid by ensuring a clean water supply; tuberculosis by good nutrition and pasturisation; and diptheria, polio, measles and rubella by immunisation. The success of infancy and childhood vaccination programs is one of the most effective health interventions of the 20th Century and is credited with helping increase our life expectancy. So, it can't be all bad!

Immunisation has eradicated smallpox; eliminated polio in wealthy nations and reduced the number of measles, mumps, rubella and congenital rubella, diptheria and haemophilus influenza type B (HIB) cases.

Unfortunately, as the incidence of vaccine preventable diseases has declined, concern about the safety of vaccines has increased. It seems that we have forgotten how terrible and fatal many of these illnesses are. Our collective memory has forgotten the high infant mortality rates and disabilities for survivors of these illnesses.

A more recent example of "disease fear" is the terror over Haemophilus Influenza B in the early 1990s. Parents were terrified that their infant would be the 1 in 600 who would contract either HIB menigitis or HIB epiglottitis. Why? Because 1 in 20 of those children would die quickly and suddenly, despite antibiotic treatment. On top of that, 1 in 10 survivors were left deaf and/or neurologically impaired. I remember the fear of parents and the rush to find a vaccination. It was a major public health issue. Consequently, we have now reduced the mortality and morbidity to HIB and become complacent once again.

Fortunately, Australia has a high immunisation rate with approximately 94% of children being vaccinated by 12 months, with only 2 - 3% of parents actively disagreeing or expressing concern about vaccination.

To keep our population safe and eliminate vaccine preventable diseases, we need to have 95% of the population vaccinated - this is called "herd immunity". We vaccinate children to keep those individuals safe as our primary reason, but the bigger picture is the elimination of these diseases in the population. Vaccination is also about the greater good and that's why we continue to actively promote and encourage immunisation to all families in the community as well as try to provide the same good public health measures in developing countries. After all, these people have a right to the same good health as we currently enjoy.

Autism and bowel diseases have been cited as adverse outcomes for some children after being given the Measles, Mumps and Rubella (MMR) vaccine. This myth arose from a 1993 study done by a Dr. Wakefield in the UK. The study made a spurious connection between immunisation and the development of autism and Inflammatory Bowel Disease (IBD). Over 20 subsequent studies and expert reviews have shown that there is no association between the MMR vaccine and autism or IBD .

In 2004, 10 of the original 13 authors of the study published a statement retracting the original's papers interpretation, stating that the data was insufficient to establish a causal link between MMR vaccine and autism.

Another concern people raise is that immunisations contain aluminium and mercury. To address these fears the mercury has now been removed from vaccines. But, unfortunately for those of us who enjoy seafood, we now get plenty of mercury through global pollutants in the oceans. As for aluminium, if you cook in aluminium pots every day, you are also consuming it through your diet. Aluminuim has been linked with Alzheimers disease, but this is also a tenuous link and has never been proven.

Several of the studies I read discussed reasons for the low uptake of vaccinations in some Australian rural areas and other developed nations. What came through was the attitudes of health professionals including nurses was a factor in why parents decide not to vaccinate. I find this disturbing. We nurses have a duty of care to our clients to be very well informed about these debates for and against vaccination so we can discuss our patients concerns knowledgably and without bias. Parents have a right to make informed decisions.

Having said that, we must also consider the rights of the child. Should a parent have the right to deny their child something that may prevent an illness that causes death or lifelong disability? The child's right to be protected until old enough to choose for themselves is a complex issue, but one I think must be considered in this debate. As a child health nurse, I must advocate for the right of the child and the evidence tells me that a child is at more risk of death or disability than any side effects of immunisation.

To finish - I'd like to offer some comparative risk stats for the MMR vaccine and the natural diseases the MMR immunisation protects against.

• Convulsions 1:200 for natural disease and 1:1000 for Immunistion
• Menigitis/encepahalitis 1:200 to 1:5000 for natural disease and 1:1,000,000 for immunisation
• Thrombocytopenia 1:3000 for natural disease and 1:24,000 for immunisation
• Death 1:8,000 to 1:10,000 for natural disease and 0 for immunisation.

For much more information, research and links about vaccination and immunisation go to the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases. http://www.ncirs.usyd.edu.au.

If you have access to a medical database, your search terms are of course: immunisation and vaccination.