Nova Scotia children getting their vaccinations

Compared to other Canadians, Nova Scotians appear to be vaccinating their kids enthusiastically.

However, if there are local parents refusing shots for their kids, they are likely to be wealthy and well-educated, according to one study.

"Vaccine completeness was significantly higher in the least-educated communities and in areas of higher unemployment," wrote the authors of a 2012 study looking at 8,250 Nova Scotia children.

The pattern went against previous wisdom that poorer, less educated families neglected vaccination.

The study's "consistent" findings to the contrary showed that lower-income parents can be motivated to follow immunizations "diligently," wrote the authors, who included chief public health officer Dr. Robert Strang.

"Conversely, individuals more educated and affluent may interpret or follow immunization guidelines differently," they wrote.

With a measles scare in Toronto on the heels of an outbreak in the United States, Nova Scotia's lack of immunization data leaves experts guessing at the province's susceptibility.

The children studied, all born in 2006, had "sub-optimal" vaccination rates but poor record-keeping made it impossible to know wider rates, said the paper, published in the Canadian Journal of Public Health.

The province does keep records of older children's vaccinations, since they receive shots in school. Those rates generally increased between 2008 and 2013, meeting or coming close to the 90 per cent target.

Measles vaccines are given to babies, so they are not tracked. "As far as we know, the rates again are holding up there, but we don't have accurate information," says deputy health chief Dr. Frank Atherton.

The strong school numbers are one sign that Nova Scotia tends to do well within Canada, says Atherton.

"We don't tend to have the kind of organized anti-vaccination campaign here, so I guess we're kind of blessed in that way," he said.

One Bedford doctor says she can only remember one family in her 18-year practice that refused all vaccines, and a handful of others who delayed them.

However, Dr. Natasha Deshwal has noticed an increasing suspicion of vaccines in the last two or three years, with talk shows appearing to be an influence, she said. It requires many more conversations with parents about the necessity and safety of the shots, and how dangerous illness like measles can be.

"A lot of times people talk about the herd immunity, like I'm not going to immunize my child'...because everybody else has it, that their child doesn't need to get it," she said.

Vaccine backlash goes back to 1998

She tells them that "if everybody thought that way, we'd no longer have herd immunity," she said. "That's when they stop and think, Oh yeah. Makes sense.'"

The vaccine backlash goes back to a 1998 United Kingdom study that claimed to show a link between vaccines and autism. It was later retracted, and the authors' medical license revoked, when it was revealed that the research was fraudulent. The main author was on the payroll of a group suing a vaccine-maker.

Still, the article helped convince the parents of at least a million British children to avoid shots. Measles has since resurged in the country, and the anti-vaccination trend also showed up in North America.

One 2009 study found that American parents who gave their children no vaccines were likely to use alternative health care, to get information online and to believe their children had low susceptibility to disease. Compared to other families in the study, they tended to be white and higher-income, with a college-educated mother.

The parents who ended up saying no to Deshwal's efforts to vaccinate had moved from another province, she said.

"That was the big trend elsewhere," she said.

"I think sometimes for a lot of parents, we read articles, you Google things...sometimes it's really difficult without having the opportunity to sit down and talk to somebody about why you should vaccinate."

Nova Scotia communities without easy access to family doctors rely more on public health workers, who were effective at getting immunizations done, said the 2012 study.

Atherton said the province intentionally relies on its public health nurses to fight vaccine misconceptions, asking the nurses to talk in depth with worried parents.

Having a top-tier immunology research centre at the IWK also helps, said Atherton, since parents can be put at ease by being referred there for careful oversight.

"It is a lot of work," said Deshwal. "It needs to be a conversation, it can't be a one-way."