Intended for healthcare professionals

Rapid response to:


Child vaccination rates in England fall across the board, figures show

BMJ 2019; 366 doi: (Published 26 September 2019) Cite this as: BMJ 2019;366:l5773

Rapid Response:

Re: Child vaccination rates in England fall across the board, figures show

I am concerned about the statement of Robert Hendry [1]. As I understand it there is a legal obligation to explain the risks of medical interventions so it would be worrying if these were not explained as well as the benefit. For instance at 8 weeks an infant is scheduled to receive:

Infanrix hexa (DTaP+Polio+HiB+HebB)
Rotarix (Rotavirus vaccine)
Prevnar 13 (13 strain pneumococcal vaccine)
Bexsero (MenB vaccine)

Each one of these products has an extensive range of complications and side effects listed in the Patient Information Leaflets, some of which are both frequent and unpleasant [2-5]. It would beyond the scope of this letter to list them all, but each one could make an infant very ill, and not necessarily uncommonly. Here is the list for Bexsero [5]:-

Infants and children (up to 10 years of age)
Very common (these may affect more than 1 in 10 people)
- fever (≥38ºC)
- loss of appetite
- tenderness at the injection site (including severe injection site tenderness resulting in crying
when injected limb is moved)
- painful joints
- skin rash (children aged 12 to 23 months) (uncommon after booster)
- sleepiness
- feeling irritable
- unusual crying
- vomiting (uncommon after booster)
- diarrhoea
- headache
Common (these may affect up to 1 in 10 people)
- skin rash (infants and children 2 to 10 years of age)
Uncommon (these may affect up to 1 in 100 people)
- high fever (≥40°C)
- seizures (including febrile seizures)
- dry skin
- paleness (rare after booster)
Rare (these may affect up to 1 in 1,000 people)
- Kawasaki disease which may include symptoms such as fever that lasts for more than five days,
associated with a skin rash on the trunk of the body, and sometimes followed by a peeling of the
skin on the hands and fingers, swollen glands in the neck, red eyes, lips, throat and tongue
- Itchy rash, skin rash

Meningitis B, while an horrific disease, is rare, and these are bad effects - and we are talking about giving 1 in 1000 children Kawasaki disease.

Nor is it fair, or reasonable to ask a parent to consider the benefit of society over the well-being of their tiny infant (I do not even know what legal standing that would have). Nor can we know what the long term effects might be when all these products are combined.

It is evident that these matters should be frankly and systematically discussed both ethically and legally. Finally, I am not sure of the standing of Hendry's "meaningful consent" over the traditional legal concept of "informed consent" [6].

[1] Robert A Hendry, 'Re: Child vaccination rates in England fall across the board, figures show', 4 October 2019,

[2] Infanrix hexa PIL,

[3] Rotarix PIL,

[4] Prevnar 13 PIL,

[5] Bexsero PIL,

[6] MDU, 'Montgomery and Informed Consent',

Competing interests: No competing interests

04 October 2019
John Stone
UK Editor
London N22