Australian Medical Association NSW president Brian Owler said parents who chose not to vaccinate needed to be aware that side effects of vaccinations were ''very low and mild in nature''. ''One of the things we are battling is parents who are worried because they've been influenced by vaccination sceptics. Measles epidemics are springing up in NSW, which is very serious and potentially fatal. Parents should speak to the GP for credible information. I suspect there is a cultural element that has crept into some areas and they are seeking alternatives to vaccination.'' Authority chief executive Diane Watson said that overall immunisation rates across Australia were improving, but there were still about 75,000 children not fully vaccinated, spread unevenly across the country. The report showed 13 catchments where less than 90 per cent of children were fully immunised, compared with 23 last year. ''It's fantastic that more kids are protected this year,'' she said. ''But we still have pockets that are very low. For fully immunised five-year-olds the rate can be as low as about 67 per cent in Byron Bay to as high as 98 per cent in the Illawarra.''

For the first time, the report records the number of parents who have registered as conscientious objectors to vaccination. About 15,000 people have lodged their objection, with 761 objectors clustered in the north coast and fewer than six in far-west NSW. There were 212 objectors in eastern Sydney and more than 350 in the north shore and northern beaches. NSW Health's head of health protection, Dr Jeremy McAnulty, said the high numbers of objectors on the north coast could be swayed by community attitudes and peer pressure. ''If the parents have non-scientific beliefs about vaccines that are wrong then the downside is children won't be protected. We're not sure why there are pockets with certain attitudes, but we are trying and make it as easy as possible to vaccinate because immunisation is one of public health's greatest gifts. We are battling parents worried because they've been influenced by vaccination sceptics. ''Part of the problem is while we see some epidemics of measles and whooping cough, we don't see many kids with tetanus and polio so parents don't have vaccination front of mind.''

Associate professor in the school of public health at the University of Sydney, Julie Leask, said access and acceptance are the two major reasons parents forgo immunisation programs. ''Parents on the north coast are subject to less acceptance because they don't like the idea of children getting so many vaccines so they pick and choose. Many parents are also influenced by their peers.'' She said some low rates could be due to under-recording in transient communities or that parents ''just haven't got around to it''. ''Sometimes life gets in the way and kids are falling through the gaps. Parents need support to be reminded.'' Loading

The report also reveals significant fluctuations in the uptake of the cervical cancer vaccine, which is provided free in schools for children aged 12 and 13. Rates vary between 75 per cent in the central coast to only 59 per cent in the eastern suburbs. ''All schools should be participating in that program,'' said Dr Owler. ''The fact that this will save lives and people are not taking up the chance to vaccinate is very concerning.''