In the second letter it is stated: “There is little evidence of waning immunity.” If that is the case, why is a second MMR being recommended/required? Please go to
http://www.vaccinationnews.com/rally/waning%20immunity%2C%20i.e.%2C%20secondary%20vaccine%20failure.htm for some of the evidence FOR vaccine failure. - SM
http://bmj.com/cgi/content/full/323/7317/869/a
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Letters
MMR immunisation
True
anaphylaxis to MMR vaccine is extremely rare
Health
professionals should strongly recommend this immunisation
True anaphylaxis to MMR vaccine is
extremely rare
In
their concise review of the common issues surrounding MMR (measles, mumps, and
rubella) immunisation Harnden and Shakespeare mentioned that
"special vaccination precautions need to be taken
. . . in children with known anaphylactic reactions to
egg or coexisting chronic severe asthma."1 It is
important that this statement be clarified.
True anaphylaxis to MMR vaccine is extremely rare, and most cases have
occurred in children not allergic to eggs. In a study at our
hospital over 400 children with documented egg allergy received
the vaccine; minor reactions (not requiring treatment) occurred in
four, and no major reactions occurred.2 Since
that time we have immunised hundreds more children with known or
suspected egg allergy at our immunisation clinic and have not seen
any severe reactions. We do not routinely carry out skin tests on
these children for reaction to either egg protein or components of
the MMR vaccine.
Children with egg allergy can safely be given MMR vaccine in a centre where
resuscitation facilities (including adrenaline) are available. These
facilities are required to be present for any immunisation, not just
when MMR vaccine is given.
Jonathan R Carapetis
Nigel Curtis
University of Melbourne, Royal Children's Hospital, Murdoch Children's Research
Institute, Parkville, Victoria, 3052 Australia carapetj@cryptic.rch.unimelb.edu.au
Jenny Royle
Royal Children's Hospital, Parkville
|
1. |
Harnden A, Shakespeare J. 10 minute consultation: MMR immunisation.
BMJ 2001; 323: 32 |
|
2. |
Aickin R, Hill D, Kemp A. Measles immunisation in children
with allergy to egg. BMJ 1994; 309: 223-225 |
Health
professionals should strongly recommend this immunisation
Many
parents have already acquired a lot of (mis)information about measles, mumps,
and rubella (MMR) vaccine and autism, particularly from the
internet, by the time we see them. What is needed is for health
professionals to provide them with information that is supported by
hard data so they can check it for themselves. For this reason
references to medical literature must be provided. Parents are not
going to accept what they are told on the telephone by NHS Direct;
directing people to the Health Promotion England website (www.hpe.org.uk) would be much more helpful as
the information there is well referenced.
We were surprised that the only study that Harnden and Shakespeare mentioned1 in
relation to MMR (measles, mumps, and rubella) immunisation and
autism was a recently reported work from Finland. This is probably
the least robust; it would have been much better to quote the study
by Taylor et al in London.2 Much
more powerful might have been to point out what the researchers from
the Inflammatory Bowel Disease Study Group themselves stated in
their original study: "We did not prove an association between
measles, mumps, and rubella vaccine and the syndrome described."3
Later three of the group emphasised, "We emphatically endorsed
current vaccination policy until further data are available."4
Harnden and Shakespeare set out the reasons behind current policy, but,
unfortunately, some inaccuracies crept in. The first dose of the
vaccine should be given any time after the child's first birthday; there
is no need to wait until 13 months. The reason for the second
dose is that the vaccine has an efficacy of only 85-90% for mumps
and 90-95% for measles, whereas 99% of recipients will be protected
after two doses.
There is little evidence of waning immunity.5
Although measles is highly infectious, a child will only infect 15 others
if they are susceptible, which is now unlikely in most settings. We
would have listed convulsions, rather than deafness, among the
complications of measles disease.
Although we agree that the decision whether to have a child vaccinated is
ultimately the parents', the evidence is so conclusive that health
professionals should make it clear that they strongly recommend MMR
immunisation. Anything else is second best for the child and the
wider community.
David Elliman
St George's Hospital, London SW17 0QT DavidElliman@compuserve.com
Helen Bedford
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child
Health, London WC1N 1EH
|
1. |
Harnden A, Shakespeare J. 10-minute consultation: MMR
immunisation. BMJ 2001; 323: 32 |
|
2. |
Taylor B, Miller E, Farrington CP, Petropoulos M-C,
Favot-Mayaud I, Li J, et al. Autism and measles, mumps and rubella vaccine:
no epidemiological evidence for a causal association. Lancet 1999;
353: 2026-2029 |
|
3. |
Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM,
Malik M, et al. Ileal-lymphoid nodular hyperplasia, non-specific colitis, and
pervasive developmental disorder in children. Lancet 1998; 351:
1327-1328 |
|
4. |
Murch S, Thomson NP, Walker-Smith J. Autism, inflammatory
bowel disease, and MMR vaccine. Lancet 1998; 351: 908 |
|
5. |
Anders JF, Jacobson RM, Poland GA, Jacobsen SJ, Wollan PC.
Secondary failure rates of measles vaccine: a metaanalysis of published
studies. Pediatr Infect Dis J 1996; 15: 62-66 |
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Other related articles in
BMJ:
PRIMARY CARE
10-minute consultation: MMR immunisation.
Anthony Harnden and Judy
Shakespeare
BMJ 2001 323: 32.
EDITOR'S CHOICE
War, normality, and a time for women.
BMJ 2001 323: 0.
EDITOR'S CHOICE [GP]
War, normality, and a time for women.
BMJ 2001 323: 0.
ALL
INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR
GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE
KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED
AS PROVIDING MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO
VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU
ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.