Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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MMR and Autism: no further delay please.
- Rema Mathew (6 June 2003)
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The MMR story - a time to move on?
- Gautam Kulkarni (7 June 2003)
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Re: MMR and Autism: no further delay please.
- Anthony R Cox (7 June 2003)
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I don't trust you- you're a doctor
- GH Hall (8 June 2003)
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Re: I don't trust you- you're a doctor
- JK Anand (9 June 2003)
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MMR reduces risk of autism shock!
- Matthew L Grove (11 June 2003)
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Rema Mathew, Paediatrician Chennai, India
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I am reminded by your note of caution regarding the possible link between MMR and autism, of the way a section of the scientific community just shrugged aside the suggestion of a link between cigarette smoking and lung cancer! It took several years (decades) and the immeasurable suffering and death of thousands was unsuspecting smokers for them to finally accept this link. Here we are dealing with children, a life long disability & the
untold suffering of parents & siblings of these innocent children.
This, in my opinion, is not a situation where one can wait for a definite
cause & effect to be established beyond doubt!
Competing interests: None declared |
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Gautam Kulkarni, SHO St Marys PICU
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MMR is not the first vaccine that has been involved in a controversy regarding possible complications. There have been discussions about the oral polio vaccine causing vaccine associated poliomyelitis, the old rabies vaccine causing encephalitis, the measles vaccine and SSPE (subacute sclerosing panencephalitis), the pertussis vaccine and other neurological complications. Some of these associations have been proven and the others not.
However none of these have caused so much discussion in the medical world, media and the public as the MMR vaccine. We have still not proven a cause and effect relation between MMR and autism. There is no reason to believe that if there indeed is one, we will shy away from accepting it.
A lot of water has flown under the bridge since this topic grabbed the limelight. There are agencies all over the world working hard to resolve this issue once and for all. However our continuous discussion about the MMR vaccine inadvertently gives it media attention which causes more public insecurity.
Why not move on to another vaccine say the Hib vaccine. We we know there has been an upward trend in the Hib cases in fully immunised children in the United Kingdom(1). This would mean icreased mortality and morbidity from a disease we thought we had under control. Perhaps its time we changed our focus.
1. Trotter CL, Ramsay ME, Slack MPE. Rising incidence of Haemphilus influenzae type b disease in England and Wales indicates a need for a second catch-up vaccination campaign. Commun Dis Public Health 2003; 6: 55-58.
Competing interests: None declared |
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Anthony R Cox, ADR Pharmacist West Midlands Centre for Adverse Drug Reaction Reporting, City Hospital, Birmingham, B18 7BR.
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Vaccines, as with all drugs come with both risks and benefits. In the UK last year there were 310 cases of measles, the highest number since MMR was introduced in 1988. Worldwide 777,000 die from measles each year. On the other hand there are the risks of the MMR vaccine, in particular the suggested link to autism. Yet, no evidence suggests that the vaccine is linked to autism. The comparison with the link between smoking and lung cancer denigrates the groundbreaking work of Sir Richard Doll and Sir Richard Peto. For example, a paper was recently published by Geir and Geir in a journal called International Paediatrics. The authors supposedly found a significant increase in the incidence of serious neurological disorders to MMR when compared to other vaccines by using spontaneous reports to the US Vaccine Adverse Events Reporting System between 1994 and 2000.(1) Neither of the Geirs has any academic or professional expertise in any discipline relevant to immunisation. They are also prominent in the conferences and on the websites anti-immunisation groups in the USA.(2) This paper has been extensively criticised (3) and at a recent Conference at the Royal College of Physicians, Stephen Evans said: "The absolute junk that was published recently in the Journal of International Paediatrics in the June Issue, you can go and look at it on the web, by Geier and Geier on MMR, comparing rates of adverse reactions to MMR and other vaccines in the America spontaneous reporting database is the most scientific nonsense I have ever seen in a particular published paper." (4) In fact, you can no longer read the paper on the web, the PDF seems to have been removed and it no longer appears in the Table of Contents for the Issue of International Paediatrics concerned.(5) However, the damage is done. The paper was widely reported in the media, on the BBC as 'Concern over MMR safety study',(6) and has no doubt addded to the fears of parents. Dr Matthews makes a emotive plea to us: 'Here we are dealing with children, a life long disability & the untold suffering of parents & siblings of these innocent children. This, in my opinion, is not a situation where one can wait for a definite cause & effect to be established beyond doubt!'(7) Such thinking endangers the very children we all seek to protect. Western Culture seems to be undergoing a crisis in trust with regard to medicine and technology. We also should be extremely concerned about this fear-mongering being translated to the developing world where the benefits of vaccines are even more overwhelming and there is correspondingly so much more to lose. 1. Geier M, Geier D. Pediatric MMR Vaccination Safety. International Pediatrics 2003, 18: 108-13. 2. http://www.spiked-online.com/Articles/00000006DDBF.htm 3. http://www.immunisation.org.uk/Geier%20and%20Geier%20200503.htm 4. http://www.blacktriangle.org/blogarchive/2003_05_01_archive.html#94777375 5. http://int-pediatrics.org/newip/volumes/volume_18/18_2/18-2toc.htm 6. http://news.bbc.co.uk/1/hi/health/3041225.stm 7. http://bmj.com/cgi/eletters/326/7401/1272#33054 Competing interests: None declared |
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GH Hall, retired physician EX1 2HW
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Or, perhaps, a pharmacist. Those professionals who can't understand why the public have ceased to believe their ex cathedra pronouncements should take the trouble to enquire about the results of safety and efficacy testing on the vaccines they recommend. They may be surprised to find that neither the DoH or the old MCA feel they are able to release such data because of commercial sensitivity. No wonder that fiascos like the Urabe experience or more recently the ineffective HIB batch occur: more worrying is that seldom anyone seems to care enough to challenge the secrecy that surrounds this area. If I were a parent I would go on immunisation strike until the authorities fulfill their promises of openness and honesty: they are a hollow sham at present. Competing interests: None declared |
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JK Anand, Retd Retd
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Dr Hall has a point. A simple suggestion: All immunisation coordinators should publish annually, the numbers of adverse reactions to imm and vacc procedures carried out in their respective authorities. The public can then compare the numbers of reactions reported (by parents/nurses/doctors) in various parts of the country and relate them to the numbers of immunisations of various types carried out. A very crude tool, but better than nothing. The public and the professionals can then also judge how the diligence of the different authorities varies. JK Anand retired Competing interests: None declared |
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Matthew L Grove, Consultant Rheumatologist North Tyneside DGH, NE29 8NH
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What is required to refute the supposed link between MMR and autism is a comprehensive study including all children born in a given country for a period of several years, with an accurate vaccination register to enable all children vaccinated to be compared with those not vaccinated, against an accurate register of cases of autism and autistic spectrum disorder. This has been done. It was published in NEJM last year (1). With over 500,000 children and >2,000,000 person years of follow up, it is as definitive a study as we could ever hope for to solve this question. Overall relative risk of autistic disorder in the group of vaccinated children, as compared with the unvaccinated group, was 0.92 (95 percent confidence interval, 0.68 to 1.24), and the relative risk of another autistic-spectrum disorder was 0.83 (95 percent confidence interval, 0.65 to 1.07). If anything, vaccination would appear to reduce the risk of autism ... This might be expected as neonatal Rubella is a recognised cause of autism, and children from families that don't vaccinate would be more likely to encounter rubella as neonates. Of course, the 95% ci includes 1 - so this isn't significant. And confounding is likely from families who have had one autistic child refusing further vaccination which might lower the apparent risk in vaccinated families. But can anyone actually suggest a better designed study that would have the potential to confirm the supposed link after such a conclusive refutation? Time to move research resources allocated to autism to more fruitful areas of enquiry. (1)Madsen et al. A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism. NEJM 347:1477-1482 Competing interests: My son recently received his MMR. As an educated health professional, this took much soul searching and literature reviewing. I have no idea how parents without access to these sources manage to make up their minds in the face of such a mountain of misinformation. |
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