MMR vaccine
From Ganfyd
This article is a work in progress. Please feel free to contribute to it.
MMR is a mixture of three live viral vaccines. They protect against measles, mumps, and rubella.
People born in the UK prior to 1980 are likely to have natural immunity to these three diseases. All those born since should be offered two doses of MMR, separated by at least four weeks, with the first dose given after the age of 12 months, and the second dose after the age of 18 months.
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Early Immunisation
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Immunocompromised people, non-immune pregnant women, and infants under the age of 9 months who are exposed to measles cases may also be offered immunoglobulin - see measles article for more detail.
There is a cohort of people who may only have been offered a single dose, but who may have received a measles and rubella vaccine (without mumps) - more details are available in the "Questions and answers about mumps and MMR" article.
Useful websites about MMR include:
- Health Protection Agency mumps information
- MMR The Facts
- NHS Immunisation Information
- Brian Deer's pages
- Spiked Online MMR index
- Bandolier "Extra" on MMR and autism
MMR was introduced into the standard UK immunisation schedule in 1988.
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Epidemiology
Measles fell sharply after immunisation was introduced and now affects no more than one percent of people under the age of 30 in countries with routine childhood vaccination.
The CDC report on the effect of vaccination against measles in African countries in 1996-2002 shows that vaccination markedly reduces the mortality rate due to measles.[4]
The MMR vaccine was introduced to induce immunity less painfully than three separate injections at the same time, sooner than at three separate encounters, and more efficiently than either.
By increasing the time until immunised, spacing the components inevitably increases opportunities for infection with at least two of the diseases for the individual and their contacts.
A survey of 1000 patients in the northwest UK by Durham University found 7% of parents had opted for single vaccines, but only 19 out of 72 children had received them all. The overall uptake of MMR there was 85%.[5]
Dose and schedule
The routine schedule in most parts of the UK is to give the first dose of MMR at the age of 12 or 13 months, and a second dose as part of the pre-school booster. In some parts of the UK, where the risk of measles is higher, the second dose is given three months after the first dose.
Each individual should be offered two doses of MMR that meet the following criteria to count (“qualifying doses”):
- The first qualifying dose must be given after the age (from birth, regardless of gestational age at birth) of 1 year;
- The second qualifying dose must be given at least 3 months (90 days) after the first qualifying dose, if given before the age of 18 months; or at least 28 days after the first qualifying dose, if given after the age of 18 months.
- Additional doses of MMR (e.g. before the age of one year, or a second dose too soon to count as the second qualifying dose) will do no harm, and may even be recommended in the event, e.g., of an outbreak; but do they do not count towards the recommended total of two (“qualifying”) doses.
MMR scare
If I were to suggest that between the Earth and Mars there is a china teapot revolving about the sun in an elliptical orbit, nobody would be able to disprove my assertion provided I were careful to add that the teapot is too small to be revealed even by our most powerful telescopes. But if I were to go on to say that, since my assertion cannot be disproved, it is intolerable presumption on the part of human reason to doubt it, I should rightly be thought to be talking nonsense. If, however, the existence of such a teapot were affirmed in ancient books, taught as the sacred truth every Sunday, and instilled into the minds of children at school, hesitation to believe in its existence would become a mark of eccentricity and entitle the doubter to the attentions of the psychiatrist in an enlightened age or of the Inquisitor in an earlier time. 
- Bertrand Russell[6]
There was an unfounded scare about MMR in the late 90s. It took 12 years for the research article that started the scare to be retracted by the Lancet, partially because some relevant information only came out after formal investigation by a regulatory body despite other attempts at investigation[7]. The media continued to report this as a controversy, giving anti-vaccinationists a lot of air time and column-inches, incorrectly implying that the profession was split about this issue - whereas in fact the overwhelming majority of those that had studied the issues (and possibly all informed professionals who didn't have an ulterior motive) believed that MMR is very safe indeed. A significant proportion of parents made a conscious decision not to have their children vaccinated.[8]
Evidence from large, well-peformed studies, shows that:[9][10][11]
- People with autism and bowel disease are no more likely to have received MMR than controls.
- People who are given MMR are no more likely to go on to develop autism or bowel disease than controls.
- There is no association between changes in the incidence of autism or bowel disease and MMR uptake - indeed, in countries such as Japan, where MMR useage stopped because of problems with vaccine supply, autism rates have continued to rise.
Many people who believe that MMR (and other vaccines) are excessively dangerous, in the face of evidence to the contrary, have a near religious belief, as implied by Brian Deer,[12] citing Russell's teapot. [13]
See also
References
- ↑ De Serres G, Boulianne N, Meyer F, Ward BJ. Measles vaccine efficacy during an outbreak in a highly vaccinated population: incremental increase in protection with age at vaccination up to 18 months. Epidemiol Infect 1995;115(2):315-23
- ↑ van den Hof S, Wallinga J, Widdowson MA, Conyn-van Spaendonck MA. Options for improvement of the Dutch measles vaccination schedule. Vaccine 2003;21(7-8):721-4
- ↑ Redd SC, King GE, Heath JL, Forghani B, Bellini WJ, Markowitz LE. Comparison of vaccination with measles-mumps-rubella vaccine at 9, 12, and 15 months of age. J Infect Dis 2004;189 Suppl 1:S116-22
- ↑ MMWR Weekly 2004 53(02);28-30 (January 23)
- ↑ R Casiday, T Cresswell, D Wilson, C Panter-Brick. A survey of UK parental attitudes to the MMR vaccine and trust in medical authority. Vaccine 2006;24:177-84
- ↑ Russell B. Is There a God? (Article commissioned, but not published by Illustrated magazine in 1952.) Text of article available at [1] and at [2].
- ↑ [Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children The Lancet, 2 February 2010 doi:10.1016/S0140-6736(10)60175-7]
- ↑ Pearce A, Law C, Elliman D, Cole TJ, Bedford H, the Millennium Cohort Study Child Health G. Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study. Br Med J "Online First" 2008:bmj.39489.590671.25
- ↑ Social Market Foundation. Science, Risk and the Media: Do the front pages reflect reality?. 5th March 2006. ISBN Number: 1-904899-40-4
- ↑ Eric Fombonne, Rita Zakarian, Andrew Bennett, Linyan Meng, and Diane McLean-Heywood. Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links With Immunizations. Pediatrics 118: e139-e150. (Full text available as pdf here
- ↑ Ray P et al. Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study. Pediatr Infect Dis J 2006 Sep 25:768-73
- ↑ B Deer. Andrew Wakefield: surgeon paid to attack MMR shots faces medical council hearing. Last viewed January 12, 2007
- ↑ Russell B. Is There a God? (Article commissioned, but not published by Illustrated magazine in 1952.) Text of article available at [3] and at [4].
