There were 39 admissions for vaccine preventable conditions to the 23-bed university-affiliated Paediatric Intensive Care Unit in Our Lady’s Children’s Hospital, Crumlin, (3.7 per cent of total PICU admissions) over the four year period 2011-2015, according to a study published in the official journal of the Irish Medical Organisation.
The study showed that 34 children survived to discharge. Death occurred in four children infected with pneumococcus, and one infant with pertussis. There were no deaths in the varicella or meningococcal patients. Serious morbidity occurred in 19 of 39 admissions, and varied from skin loss requiring grafting, limb and digit loss, seizures, acute kidney injury and haemorrhagic cerebral infarction. Children who did not receive immunisation remain vulnerable to life-threatening infection from a number of different bacterial and viral pathogens. There are several additional vaccines available through general practitioners (GP), with parents paying for the vaccine and its administration.
The authors of the study note that there were many reasons why children did not receive their scheduled immunisation, including illness. Children are screened for fever, rash and malaise before vaccination and this may result in planned vaccination being deferred. Parents may choose not to have their child immunised following the routine schedule because of concerns over the effects of vaccine medications . There were no cases of vaccine failure resulting in serious illness. Eight younger infants who presented with severe pneumococcal infection less than six weeks of age had not commenced their schedule of vaccines.
One infant was admitted to PICU with pertussis infection, at corrected age of two weeks. The infection occurred four weeks before the anticipated age for administration, and this child did not survive. Neonates rely on herd immunity to protect them against infection.
Children with varicella infection, presented with secondary bacterial infection. Organisms isolated included invasive Group A Streptococcus and Staphylococcus aureus and these super-infections led to systemic sepsis, cellulitis and empyema. Varicella infection may be avoided with an organism-specific vaccine, which is not funded by the Irish health service . Parents may ask their GP to administer this two dose vaccine at an average cost of 300 euro.
Meningococcal B sepsis was the largest diagnostic group, with 10 patients experiencing serious morbidity. There were no deaths in this group, reflecting improvements in early recognition and critical care management. The vaccine for meningococcal B infection is commercially available since 2014, at a cost of approximately 300 euro. Routine administration as part of the primary schedule is planned. Families who cannot afford to pay would not be offered these vaccines routinely.
There were no admissions with hepatitis B, diphtheria, measles, mumps, rubella, polio and meningococcal C infections. Streptococcus pneumoniae infection accounted for 9 admissions, meningococcus B infection precipitated 17 admissions, varicella 8 admissions, haemophilus influenza 4 admissions, and there was one admission due to pertussis infection.
In Ireland, children are offered vaccinations as part of the State-funded scheduled immunisation programme and include diphtheria, pertussis, tetanus, pneumococcus, hepatitis B, meningococcus C, haemophilus B, polio, measles, rubella and mumps.
The study in the May edition of the Irish Medical Journal by Crowe et al revealed that bacterial and viral infections continued to result in significant morbidity and mortality in a small number of Irish children.
The authors conclude by stating that critical care admission was costly in terms of physical, psychological and family support required, and in socio-economic terms. Although overall numbers were small, each case represented a child and family who had had a traumatic and avoidable experience, some with serious long-term consequences.