Hot Topic Is MMR safety confirmed ? Marian Donegan GPR Is MMR safety confirmed ? • Recent Cochrane systematic review 19th Oct 2005 – provides strongest backing yet – concluding no credible evidence behind claims that the vaccine is harmful • The most thorough survey of data to date • Review of 139 studies of which 31 met inclusion criteria - 5RCT, 1CCT, 14 Cohort, 5 Case – control, 3 time – series trials, 1 case – crossover, 1 ecological, 1 self – controlled case series Is MMR safety confirmed ? • Low risk of bias evidence did not support a causal association with Inflammatory Bowel Disease or Autism • The studies least likely to be affected by error pointed to a likely association of fewer URTI`s increased febrile convulsions in first 2weeks post- vaccination and no increased incidence of aseptic meningitis • No reason to doubt the effectiveness of MMR, given the existence of documented elimination of targeted diseases in large populations by vaccination Will this information change our current MMR uptake ? • England 80% MMR uptake 2004 • England 81% MMR uptake 2005 • England 92% MMR uptake 1996 • Tayside 89% MMR uptake 2004 • Tayside 91% MMR uptake 2005 Will this information change our current MMR uptake ? • Difficult to change these statistics overnight • The MMR debate will go on ……in parents mind not just about whether to give the vaccine…………also their child`s risk of developing the diseases…..the overall public confidence in the government …..and parental choice The MMR debate - their child`s risk of developing the diseases ? Measles • caused by paramyxovirus • notifiable & contagious • spread by respiratory droplets • incubation 7-14days • symptoms – fever malaise red eyes cough cold – later high fever and red nonitchy maculopapular rash starting at neck & spreading to face & trunk •Koplik`s spots are diagnostic •Complications 30% cases The MMR debate - their child`s risk of developing the diseases ? Mumps • caused by paramyxovirus • notifiable • incubation 14-21 days • symptoms include fever, headache,pain &swelling in salivary glands usually the parotids • swelling unilateral or bilateral • complications incl. deafness meningitis – other glands can also be affected gonads, thyroid & pancreas The MMR debate-their child`s risk of developing the diseases ? Rubella •notifiable • normally mild in children •Caused by togavirus •Spread by respiratory tract •Incubation 14-21days •Symptoms include low grade fever, malaise, sore inflammed throat, coryza, pink maculo-papular rash in face spreading to neck trunk & extremities •Enlargement of posterior auricular and suboccipital glands •Complications esp in pregnancy The MMR debate - whether to give the vaccine ? Measles The MMR debate - whether to give the vaccine ? Mumps Measles The MMR debate - whether to give the vaccine ? Rubella The MMR debate - whether to give the vaccine ? • Claims by Dr.Andrew Wakefield ..Lancet 1998 • Measles virus can be found in the gut tissue of children with inflammatory bowel disease • There is a defined condition of autistic enterocolitis caused by MMR immunisation • The rise in autism is linked to the introduction of MMR vaccine in the UK The MMR debate - the overall public confidence in the government ? • Claims: • MMR was introduced by the government as a cheaper alternative to the three vaccines separately • There is a government cover-up about MMR vaccine. We saw this before with BSE • Only UK parents are not given a choice of single vaccines The MMR debate - parental choice ? • Claims by Dr. Wakefield • Adverse effects of immunisation are specific to MMR rather than single antigen measles vaccine because of biological interference between the different viral components - leading to IBD & Autism • Channel 4 poll 2003 85% said parents should be allowed choice of separate vaccines. Hot Topic - MMR • Is MMR safety confirmed ? • Will this Cochrane systematic review 2005 finally change our current MMR uptake ? • Or will the MMR debate go on ….. ?