'Where can we find out more about the MMR vaccination?'

our online advisors reply:

Hi Marc. Thanks for writing in.

The MMR vaccination has been the cause of much soul-searching on the part of parents since 1998 whenThe Lancet published Dr Andrew Wakefield's controversial research. The research claimed to find evidence for a link between the MMR vaccination and both autism and bowel disease.

Recognised independent authorities have subsequently carried out many studies into MMR and the opposite picture has emerged. Subsequent research has concluded that there is no link between MMR and autism and or bowel disease. The research actually suggests that MMR has one of the best worldwide safety records of all vaccines.

It really is necessary to take vaccination seriously. We have benefited from the protection of a national vaccine programme for so long that we have forgotten what it is to live with the effects of serious childhood disease.

It is true that any vaccination could potentially cause a reaction in a minute percentage of children. Reactions are usually very minor, such as localised swelling or short-term low-grade fever. A more serious reaction does occur in extremely rare cases but your child is far more likely to be seriously damaged by the disease than the associated vaccination. That is why vaccination was developed.

The potential for a measles epidemic exists when the take up rate of vaccination falls below 95%. Coverage in many areas of the UK now remains consistently below this rate, leaving us vulnerable to outbreaks.

To understand the implications of an outbreak it is worth exploring the infant mortality and damage rates. A child is far more likely to be damaged by measles, mumps or rubella than by MMR. The following table shows the damage that measles can do in relation to the likelihood of damage from an MMR vaccination:

condition	children affected after measles	children affected after the first dose of MMR
Febrile convulsions (temperature fits)	1 in 200	1 in 1000
Meningitis/encephalitis	1 in 1000	Less than 1 in a million
Conditions affecting blood clotting (ITP)	1 in 6000	1 in 22,000
Severe allergic response (anaphylaxis)	-	1 in 100,000
SSPE (a delayed complication of measles that causes brain damage and death)	1 in 8000 (children under 2)	0
Death	1 in 2500 to 1 in 5000 (depending on age)	0

Source: Health Education Board Scotland

There are some children for whom the MMR vaccine is not suitable (see http://hcd2.bupa.co.uk/fact_sheets/html/mmr.html or www.mmrthefacts.nhs.uk/basics/reasons.php) and parents of these children should discuss alternatives with their doctor.

For research purposes the NHS sites and scientific journals are your best starting point. They are duty bound to be impartial and provide evidence based on the best available research. At the end of this article, we've listed a range of websites and organisations that should provide a useful starting point for your research. Beware the statistics and information on many non-medical Internet sites. Advice can be misrepresentative of the genuine big picture and results are often poorly understood and interpreted, even when the author has the best intentions.

It can be difficult to assess which studies are responsible and which aren't but a good starting point is to ask the following questions:

• Is the research source listed?
• Is the research drawn from a recognised, responsible organisation or research team?
• Does it give the sample sizes and control methods from which the conclusions were drawn?
• Look out for provocative rhetoric backed up with 'figures' from research that sounds official and impressive but which offers no traceable credentials.

If your research leads you to conclude that MMR is not an option for your child, single vaccination may be an acceptable alternative.

Key points worth considering are:

1. Whether you will be able to keep appointments if the single vaccine clinic isn't available locally
2. How you feel about your child having six vaccinations instead of two
3. How you feel about your child being exposed to the diseases for longer than 13 months due to the delay between vaccinations.
4. How you will fund the single vaccine route, which costs around £250 to £300 for the first course at 13 months. Additional initial consultation fees are usually deducted from the cost of the vaccination package.
5. How to avoid the exposure of your child to pregnant women if s/he contracts rubella before completing the rubella course. Rubella damage to an unborn foetus can be serious.

It is worth noting that a child who receives the single vaccines at 13 months can still have the combined MMR at the pre-school vaccination and that it is never too late to be vaccinated – it can be done at any time.

Good luck in your research, Marc.

help and info

websites

Channel 4 is not responsible for the content of third party sites.

Childhood Illnesses
www.askbaby.com/childhood-illnesses.htm
The symptoms, diagnosis and treatment of a variety of childhood diseases, including mumps, measles and german measles (rubella).

Health Protection Agency: Why is MMR preferable to single vaccines?
www.hpa.org.uk/…
Article from 2002 making the case for the combined MMR vaccination over single vaccines.

The Informed Parent
www.informedparent.co.uk
The aims of this site include informing parents of the alternatives to vaccinations and accumulating information about vaccination to make it available to subscribers and interested parties. They offer a 20-page factsheet about MMR for £1.50 and you can also subscribe to a quarterly newsletter.

Institute for Vaccine Safety
www.vaccinesafety.edu/cc-mmr.htm
US site who claim their mission is to "provide an independent assessment of vaccines and vaccine safety to help guide decision makers and educate physicians, the public and the media about key issues surrounding the safety of vaccines."

JABS (Justice, Awareness and Basic Support)
www.jabs.org.uk
A parent-led organisation, campaigning for the parental right to informed choice on vaccines. It describes itself as not anti-vaccines but anti-damage. They will send you an up-to-date list of clinics that provide the single vaccines if you e-mail them on info@jabs.org.uk

National Autistic Society: Is there a link between MMR and autism?
www.nas.org.uk/nas/jsp/polopoly.jsp?d=255&a=3343
Article from 2003 examining the research that has been carried out into MMR and autism.

The New Scientist
www.newscientist.com/…
Recent articles from the New Scientist on the subject of MMR.

NHS Immunisation Information
www.mmrthefacts.nhs.uk
National advice and information service. The website contains a facility where you can e-mail experts with your questions about MMR.

(November 2004)