Hot Topic Is MMR safety confirmed Marian Donegan GPR measles

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					       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 ….. ?

				
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