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Measles and MMR: the essential guide Measles and MMR: the essential guide
(35 minutes later)
1. The issue at a glance
2. Why is it being talked about now?
3. What is measles?
4. How dangerous is measles?
5. What is MMR?
6. What is the likelihood of a measles outbreak?
7. Where did the idea of a link between the MMR vaccine and autism come from?
8. What happened to this study?
9. What is the evidence that MMR is not linked to autism?		1. The issue at a glance
2. Why is it being talked about now?
3. What is measles?
4. How dangerous is measles?
5. What is MMR?
6. What is the likelihood of a measles outbreak?
7. Where did the idea of a link between the MMR vaccine and autism come from?
8. What happened to this study?
9. What is the evidence that MMR is not linked to autism?
1. The issue at a glance1. The issue at a glance
After doubts over the safety of the MMR vaccine in a now discredited scientific paper in 1998, vaccination rates fell as some parents lost confidence in the vaccine. This reduced the level of "herd immunity" in the population and has led to an increase in measles cases. After doubts over the safety of the MMR vaccine in a now discredited scientific paper in 1998, vaccination rates fell as some parents lost confidence of the vaccine.
This reduced the level of "herd immunity" in the population and has led to an increase in measles cases.
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2. Why is it being talked about now?2. Why is it being talked about now?
There has been an increase in cases in south Wales and the north of England and vaccination rates are still low in some areas, especially among the cohort that were babies when the MMR controversy was at its height between 1998 and 2002. The government has launched a £20m vaccination campaign targeted at school-age children in England who have not been immunised against measles because of misplaced fears over the MMR jab. The intention is to reach 10- to 14-year-olds who either never received the vaccination or did not have the second booster shot. There has been an increase in cases in south Wales and the north of England and vaccination rates are still low in some areas, especially among the cohort that were babies when the MMR controversy was at its height between 1998 and 2002.
The government launched a £20m vaccination campaign on Thursday targeted at school-age children in England who have not been immunised against measles because of misplaced fears over the MMR jab.
The intention is to reach 10 to 14-year-olds who either never received the vaccination or did not have the second booster shot.
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3. What is measles?3. What is measles?
Measles is a highly infectious illness caused by a virus. Anyone can contract the disease if they have not been vaccinated or had it before, although it is most common in children aged between one and four. Initial symptoms include fever, red eyes and sensitivity to light, greyish white spots in the mouth and throat and cold-like symptoms. The measles rash typically appears after two to four days. Measles is a highly infectious illness caused by a virus.
Anyone can contract the disease if they have not been vaccinated or had it before, although it is most common in children aged between one and four.
Initial symptoms include fever, red eyes and sensitivity to light, greyish white spots in the mouth and throat and cold-like symptoms. The measles rash typically appears after two to four days.
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4. How dangerous is measles?4. How dangerous is measles?
The disease can be very debilitating and can last for up to 14 days. Most people recover fully, but it can have very serious complications including blindness and death. During pregnancy it can be particularly serious, leading to damage to the foetus, miscarriage, premature labour and low birthweight. Death occurs in between one in 2,500 and one in 5,000 cases. One death in Swansea is being investigated as potentially caused by measles. The disease can be very debilitating and can last for up to 14 days. Most people recover fully, but it can have very serious complications including blindness and death.
During pregnancy it can be particularly serious, leading to damage to foetus, miscarriage, premature labour and low birthweight.
Death occurs in between one in 2,500 and one in 5,000 cases.
One death in Swansea is being investigated as potentially caused by measles.
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5. What is MMR?5. What is MMR?
It is a multiple vaccine for measles, mumps and rubella. It comes in two instalments, typically given first to children 13 months old. It is a multiple vaccine for measles, mumps and rubella.
It comes given at 13months with a booster at three and half years. The first installment gives 95% immunity.
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6. What is the likelihood of a measles outbreak?6. What is the likelihood of a measles outbreak?
Vaccination levels for measles need to be at around 95% to achieve "herd immunity" to prevent outbreaks of the disease. Wherever vaccination rates are lower an outbreak is possible. The lower the vaccination rate, the more likely it is and the more serious it is likely to be. In most parts of the country, vaccination rates are below 90% and in some parts of London they are as low as 70%. Some vulnerable groups, such as people with a compromised immune system and pregnant women, cannot be immunised. Vaccination levels for measles need to be at around 95% to achieve "herd immunity" to prevent outbreaks of the disease. Wherever vaccination rates are lower an outbreak is possible.
The lower the vaccination rate, the more likely it is and the more serious it is likely to be. In most parts of the country, vaccination rates are below 90% and in some parts of London they are as low as 70%.
Some vulnerable groups, such as people with a compromised immune system and pregnant women cannot be immunised.
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7. Where did the idea of a link between the MMR vaccine and autism come from?7. Where did the idea of a link between the MMR vaccine and autism come from?
The link was proposed in a now discredited paper published in the medical journal the Lancet in February 1998 by a team of researchers led by Andrew Wakefield. In it the team looked at 12 children with autism-like symptoms and reported that the onset of these symptoms was associated in eight cases by the kids' parents with the MMR vaccine. Wakefield was subsequently struck off the medical register for offences relating to dishonesty and failing to act in the best interests of vulnerable child patients. The link was proposed in a now discredited paper published in the medical journal the Lancet in February 1998 by a team of researchers led by Andrew Wakefield. In it the team looked at 12 children with bowel disease who had autism-like symptoms and reported that the onset of these symptoms was associated in eight cases by the kids' parents with the MMR vaccine.
Wakefield was subsequently struck off the medical register for offences relating to dishonesty and failing to act in the best interests of vulnerable child patients.
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8. What happened to this study?8. What happened to this study?
The paper was subsequently retracted by the journal. The journal's editor Richard Horton told the Guardian: "It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false." Wakefield had received legal aid funding to carry out his study, through lawyers acting for children whose parents believed their autism was caused by the MMR jab and wanted to sue the manufacturers. It was alleged he did not reveal this financial conflict of interest to the journal. The paper was subsequently retracted by the journal. The journal's editor, Richard Horton, told the Guardian: "It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false."
The GMC investigation into Wakefield centred around inadequate ethical approval for the study. He was charged with putting children through invasive and uncomfortable tests, including colonoscopies and brain scans, which they did not need in order to try to prove his theory. Wakefield had received legal aid funding to carry out his study, through lawyers acting for children whose parents believed their autism was caused by the MMR jab and wanted to sue the manufacturers. It was alleged he did not reveal this financial conflict of interest to the journal.
The GMC investigation into Wakefield centred around inadequate ethical approval for the study. He was charged with putting children through invasive and uncomfortable tests, including colonoscopies and brain scans, which they did not need, in order to try to prove his theory.
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9. What is the evidence that MMR is not linked to autism?9. What is the evidence that MMR is not linked to autism?
The evidence of no link between MMR and autism is now extremely strong. In February 2012, the Cochrane Collaboration – which compiles gold-standard reviews of medical evidence – conducted a huge study into the safety of MMR. This mega-review brought together evidence from 54 difference scientific studies using a variety of methodologies and involving 14.7 million children from around the world. The study found "no association" between MMR and autism or a range of other conditions (asthma, leukaemia, hay fever, type 1 diabetes, gait disturbance, Crohn's disease, demyelinating diseases, or bacterial or viral infections).
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/>A separate study published in 2005 looked at the withdrawal of the MMR vaccine in Japan between 1988 and 1992. It found that the increase in autism spectrum disorders (ASD) in children aged up to seven continued to increase as MMR was withdrawn and afterwards. The researchers concluded that the MMR vaccine "cannot explain the rise over time" of ASD, and that withdrawing it "cannot be expected to lead to a reduction in the incidence of ASD". 		The evidence of no link between MMR and autism is now extremely strong. In February 2012, the Cochrane Collaboration - which compiles gold-standard reviews of medical evidence - conducted a huge study into the safety of MMR. This mega-review brought together evidence from 54 difference scientific studies using a variety of methodologies and involving 14.7 million children from around the world.
The study found "no association" between MMR and autism or a range of other conditions (asthma, leukaemia, hay fever, type 1 diabetes, gait disturbance, Crohn's disease, demyelinating diseases, or bacterial or viral infections).
A separate study published in 2005 looked at the withdrawal of the MMR vaccine in Japan between 1988 and 1992. It found that the increase in autism spectrum disorders (ASD) in children aged up to seven continued to increase as MMR was withdrawn and afterwards.
The researchers concluded that the MMR vaccine "cannot explain the rise over time" of ASD, and that withdrawing it "cannot be expected to lead to a reduction in the incidence of ASD".
The World Health Organisation's Global Advisory Committee on Vaccine Safety has examined the evidence on MMR safety and concluded that "no evidence exists of a causal association between MMR vaccine and autism or autistic disorders".The World Health Organisation's Global Advisory Committee on Vaccine Safety has examined the evidence on MMR safety and concluded that "no evidence exists of a causal association between MMR vaccine and autism or autistic disorders".
After doubts over the safety of the MMR vaccine in a now discredited scientific paper in 1998, vaccination rates fell as some parents lost confidence in the vaccine. This reduced the level of "herd immunity" in the population and has led to an increase in measles cases.