Hot Topic Is MMR safety confirmed Marian Donegan GPR

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Hot TopicIs MMR safety confirmed ?Marian
Donegan GPR
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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

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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 URTIs
  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

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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

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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 vaccinealso
  their childs risk of developing the
  diseases..the overall public confidence in the
  government ..and parental choice

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The MMR debate -their childs 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
• Kopliks spots are diagnostic
• Complications 30 cases

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The MMR debate - their childs 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

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The MMR debate-their childs 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

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The MMR debate - whether to give the vaccine ?
Measles
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The MMR debate - whether to give the vaccine ?
Mumps
Measles
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The MMR debate - whether to give the vaccine ?
Rubella
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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

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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

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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.

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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 .. ?