THE HSE HAS said falling take-up rates for a childhood vaccination against a dangerous type of meningitis are of “critical concern” in internal briefings. 

In some parts of the country, targets for immunisation were over 20% below what they were supposed to be, with serious problems identified in West Cork, Wicklow, and parts of Dublin.

A series of detailed performance reports – which have been released to Noteworthy after a Freedom of Information request – show how “anti-vaccine sentiment” is now having a serious impact.

The reports warn that “herd immunity” against meningitis C is now being compromised based on the number of cases being reported in the community.

Problems in identifying how many children have actually been immunised against meningitis C are also raised in internal HSE records with families moving between areas and “staff shortages” at local level blamed for delays in collecting accurate data and follow-up.

Local Reports

Individual letters to regional offices reveal just how low take-up rates had fallen in certain areas for the meningitis vaccine.

A letter from Dr Kevin Kelleher of the HSE to a colleague in Donegal said: “Uptake for MenC in Cavan/Monaghan dropped 13% to 73%, second lowest rate in the country.

“I request that you review the data inputting and uptakes of 6in1, MMR and booster vaccines in those areas where the target was not achieved to ensure children are protected from these serious infectious diseases.”

In other correspondence, Dr Kelleher asked area chiefs to report back on why vaccination rates appeared to be dropping, especially for booster jabs.

He wrote: “Please review the 12 month vaccine uptake rates and report back whether low vaccine uptakes or recent declines are related to a delay in data entry, delay in GP returns, parents choosing some vaccines over others, increasing anti vaccine sentiment or some other factor.”

The worst rates were found in North Dublin according to another letter with uptake down to 75%, “the lowest level in the country”.

Dr Kelleher was also critical of a lack of accurate data in parts of the country with no reliable figures provided in Cavan/Monaghan for the first quarter of last year.

“Reports on vaccine uptake are vitally important to achieve vaccination targets and ensure children are protected,” he said.

In a separate letter to a senior colleague in February of this year, Dr Kelleher said no data on meningitis vaccination for Louth and Meath had been provided over a nine-month period in 2018.

He wrote: “I cannot emphasise enough that data entry must be a priority in all areas.”

Speaking to Noteworthy, cancer researcher and physicist Dr David Robert Grimes said the take-up levels for MenC vaccination were worrying.

He said: “This seems to be part of a larger picture we’ve seen with other vaccinations, a toxic combination of complacency and misinformation.

“People forget that after clean water, nothing has saved more lives than vaccination, and it gets too readily taken for granted.”

Quarterly Reports

In a series of quarterly reports, officials said they would need to discuss “the impact in some areas of anti-vaccine sentiment, especially in the border counties and the suspected contagion effect this may be having” in take-up rates by parents.

The records said there was anecdotal evidence that some families were now choosing certain vaccines over others, based on scare stories over the side-effects involved with some immunisations.

In the latest report from December of last year, officials said that take-up rates for a variety of childhood vaccinations risked the spread of infectious diseases.

It said: “Uptake levels below target present a risk of increase in infectious diseases, particularly measles in the context of outbreaks across Europe and MenC [meningitis C] cases in the past few years in Ireland suggesting that herd immunity is falling.”

The National Immunisation Office said they would look at providing extra training and guidance for nurses “to improve their confidence in recommending them [newer vaccines] to parents”.

A report from June of last year identified large chunks of the country as being of “critical concern” with take-up rates in North Dublin – or what is officially known as CHO9 – at just 84.6%, well below the 95% target.

In total, six areas – Donegal, West Cork, Wicklow, Dublin South West, Dublin North, and Dublin North Central – were identified in that report as being at least 10% behind the targets set for take-up rates in children at 12 months of age.

For kids aged 24 months who had received two doses of the meningitis C vaccine, there was a “critical under-performance nationally”. Uptake nationally was 87.6%, which was 7.8% below the target.

The report said: “Local area uptake ranges from 93.9% in Roscommon to 77.4% in Wicklow. No data was received from Cavan/Monaghan, South Lee, Louth, and Meath.”

A report from September also identified Wicklow as a place of “critical concern” with take-up rates more than 10% behind target for 12-month olds.

It also identified 11 areas of the country, which were of critical concern based on vaccination of children aged two years.

The MenC vaccine has been a remarkable success since it was first introduced in late 2000 and 90% of children become immune to the disease following the recommended vaccine schedule.

The number of cases of meningitis C had declined dramatically with 139 reported cases in 2000 compared to just six in 2014 – a reduction of 96%.

Serious side effects from the MenC vaccine are extremely rare with HSE advice saying children may have discomfort, redness or swelling around the injection spot.

Their advice says: “Children usually recover from these minor side effects within a day or two. Of the children who are immunised: 1 in 2 will become irritable, 1 in 20 will get discomfort, redness or swelling where the injection was given or will have a fever, 1 in 100 may get a tummy upset or vomit.”

Infection with meningococcal disease however, always results in serious illness with 5% of those infected losing their lives and 10% suffering a major disability such as deafness, brain damage, or loss of limb.

HSE Statement

In a statement, a spokeswoman for the HSE said they offered MenC, MenB, PCV, and Hib vaccines to protect people against meningitis.

She said: “Meningococcal disease is a serious illness caused by the bacteria Neisseria meningitidis. This bacterial infection can cause meningitis (inflammation of the lining around the brain) and septicaemia (blood poisoning.

“Meningitis can be caused by meningococcal disease, pneumococcal disease or Hib. The only way to prevent meningitis is by getting vaccinated. It is important people get their vaccines on time for best protection.”

Overall, national vaccination rates for MenC up to 12 months of age are at 89%, falling to 87% for those aged up to two years. For first year students at second level education, the vaccination rate is 83.9%.

Dr Kevin Kelleher, assistant national director public health in the HSE, said Ireland needed to reach a target of 95% to “fully curtail and control this disease”.

He said: “We would really urge parents of under twos who have not been vaccinated to seriously consider getting the vaccine as soon as possible.”

Dr David Robert Grimes said that anti-vaccine activists were using social media to spread their message “like never before”.

He said: “We’ve seen this in the past with needless panics over the MMR vaccine, and more recently in Ireland over the HPV vaccine, which drove uptake from 87% to 50% within a year based on nothing but scaremongering.

“While that rate is now recovering, it took sustained effort by patients advocates, physicians, and scientists to prompt that recovery, and as this latest data shows, we still have an uphill struggle ahead of us. I’d implore parents to vaccinate their children – their very lives might depend on it.”