We have recently been doing a lot of research into this as we decide whether to immunise Molly. I must admit, myself and Victoria are not quite in agreement. I would be happy for Molly to have everything except the MMR, Pneumococcal, fluvax, and varicella (chicken pox). She would prefer Molly to just have tetanus, and possibly a couple of others.

I should note that, while Government literature often states that research has dismissed the link between the MMR and autism, this is not actually the case. It is a common claim and one that really gets up the noses of some of us paediatric health professionals. Studies into the MMR vaccine and autism have thus far failed to prove a link between the MMR and autism, but there is too much anecdotal evidence for any researcher to dismiss, and every recent study I have read has closed by suggesting that mroe research be done. In other words, recent research suggests that there is something, some factor, that causes some children to react to the MMR in this unusual way; what it actually is is not clear.

As many have stated, it is damn nigh impssible to get unbiased information about immunisation. As I have said above, government literature has often stretchwed the truth a little about the link between MMR and autism, but having said that, Vera Schneiber's research is often a little light on facts as well, and some of her claims about the Japanese immunisation schedule changes have been disproved. Both camps are shouting very loudly, and us poor parents in the middle are left to try and make the right choice!

As to why my choices? Tetanus is found in the ground and will never go away, and toddlers, once they start being mobile, are at risk of penetrating and dirty injuries. Until they start to mobilise, I see no need for them to have it. MMR - the dangers are well documented. Rubella is a non-event unless you are in a household with unimmunised women of childbearing age. Mumps is likewise a non-event for girls, although I would consider giving it for boys as there is a risk it can impair their fertility later in life. Measles is the dangerous one, with the risk of measles encephalitis, but this is a remote risk, especially in a healthy, well nourished child.

Diptheria is non-existent in this country and requires a decent exposure (ie. you can;t catch it from walking by someone with it) so unless you are mixing with people from a diptheria-prevalent area, it is really not needed in this country. Pertussis is another one for debate; the pertussis vaccine is only around 60% effective, and you need a high level of exposure to droplets to catch pertussis, some research has found in the order of about four hours of close contact with someone with the cough; I would have it, on the off-chance that Molly goes into care and is unsupervised and playing with another child that is sick for an extended period of time. That said, I would only give it to her now because we have a newborn in the house; after six months, the pertussis would not kill her, although keeping her away from her sister for three-four weeks while she was contagious would be unmanageable.

Pneumococcal disease stops being an issue after the age of two, and I don't believe they even offer it on the schedule after 2.

Meningococcal vaccine protects against the meningococcal germ strains a and c. It is not strongly efefctive against these strains. It is also not efefctive against meningococcal strain B, and it is this strain that most commonly causes life-threatening septicaemia and meningitis. That said, I would consider giving it to Molly, only because meningococcal disease is easy to catch from casual contact, progresses incredibly rapidly, and is consistently under diagnosed by our health system and can be difficult to recognise for parents and carers. Some dubious protection is better than none at all. My DW does not like this one, though, because it is still a relatively new vaccine.

Hib I would give to Molly becuase it is an extremely effective immunisation (almost 100% effective in most children) and Hib can cause a meningitis or epiglottitis (sever inflammation of the vocal cords) that progresses quite rapidly, like meningococcal disease.

As we are not in a high-risk group for HepB, I would not giver Moll`y HepB. And I do think giving it at birth to all babies regardless is poor policy.

this is all complicated because of the availability of multi-dose vaccines. The Infanrix Hexa that is given to babies from 2 months onwards contains diptheria, tetanus, pertussis, hepatitis b, polio, and hib. We won;t use that ebcause we don;t see any need for her to have hep b, or diptheria, or really polio either. There is a four-in-one that is given to older babies that contains diptheria, tetanus, pertussis, and polio vaccine - I'd consider giving this to Molly for the tetanus and pertussis component.

Well, there are my reasons! This turned out to be a long post...