http://bmj.bmjjournals.com/cgi/eletters/329/7477/1293#92190

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Re: The MMR and Single Measles, Mumps and Rubella Vaccines: The REAL Facts

In her review “Dispatches. MMR: What They Didn't Tell You” and referring to Andrew Wakefield, Dr. A. Berger, Associate Editor of the BMJ, stated: “In one fell swoop he had undermined the MMR vaccination programme in the United Kingdom, and subsequently around the world.”

For the record, here are the REAL facts about the subject:

1. Andrew Wakefield never said that children should not be vaccinated and protected against measles, mumps and rubella.

2. Andrew Wakefield never said that the MMR vaccine should not be used.

3. Andrew Wakefield only suggested that the monovalent vaccines against measles, mumps and rubella be made available alongside the MMR.

4. Wakefield not only notified the Department of Health of the above in writing but also repeated it at a private meeting that was held in October 1997 with the then Health Minister, Tessa Jowell and in the presence of the Chief Medical Officer, Sir Kenneth Calman, Dr. David Salisbury and others.

5. The UK had a single dose measles vaccine program since 1967. The single rubella and mumps vaccines became available in the early seventies. The MMR vaccine was introduced in 1988. When parents started requesting the monovalent vaccines in increasing numbers, the DOH decided in August 1998 to withdraw their license. Those who could afford it crossed the Channel to get their children vaccinated or purchased the single vaccines at private clinics.

6. The single vaccines have always been licensed and available in The United States and most other countries.

7. If the DOH had agreed to make the MMR and the single vaccines available in the UK, the vaccination rates and the immunity against all three diseases would have been remarkably better than they are.

8. The DOH did not have to endorse Wakefield’s recommendation for a one-year interval between single vaccines and could have opted for the 3 month interval-routine recommended in the US pre-MMR. The argument raised by the UK Medical Authorities that they could not support such a schedule “because it had not been offered that way before” is frivolous. In fact the DOH had previously recommended the administration of an MMR booster three months after a primary vaccination at 12 months of age.

9. Starting in 1998, if the monovalent measles, mumps and rubella vaccines had been made available and had been administered a whole year apart to those children who were not getting the MMR anyway, most if not all the children in the UK would have been, by now, protected against all three diseases.

10. In November 1994, because of dropping vaccination rates, the DOH embarked on a mass vaccination campaign of school-age children and over seven million doses of Measles-Rubella (MR) vaccine were administered in a short period of time. Although the DOH had strongly reassured parents that serious adverse events were unlikely because most children were already immune by either natural disease or prior vaccination, 530 serious adverse events were reported and documented.

11. The extensive media coverage that followed those unfortunate reactions resulted in a significant drop in the measles, mumps and rubella (MMR) vaccination rates well before the Wakefield Lancet article of February 1998.

The following information is from “NHS Immunisation Statistics, England: 1997-98” - http://www.publications.doh.gov.uk/public/imunstat.htm -.

According to NHS “This is the first statistical bulletin to be published on immunisation since 1987”.

Approximately 19,000 (3.3%) fewer children received 3 doses of pertussis vaccine in 1997-1998 than in 1993-1994. In comparison, 87,000 (13.6%) fewer children received one dose of MMR vaccine.

Reporting on vaccination rates during the two years preceding Wakefield’s paper in the Lancet, the DOH stated: “Between 1996-97 and 1997 -98: The highest ever levels of immunisation coverage for diphtheria, tetanus, polio, pertussis and Haemophilus influenzae B., achieved for children reaching their second birthday in 1996-97, continued in 1997-98; coverage for measles, mumps and rubella vaccine in this same age fell by about 1%.

“In the case of pertussis, coverage rates have regained the ground lost in the mid-1970’s due to public anxiety about the safety and efficacy of the vaccine. The recent fall in MMR coverage may be the result of similar concern over the vaccine”. (End quote)

12. Spokespersons for the Health Department and the Press have stated that the MMR Vaccine is “more effective” than the monovalent vaccines.

Looking specifically at the Merck products, this is not true.

MMR II contains Attenuevax, Mumpsvax and Meruvax, all registered trade marks of Merck and Co.

In the 2003 Physician’s Desk Reference (PDR), the manufacturer states that a single injection of MMR vaccine induced measles hemagglutination- inhibition (HI) antibodies in 95 %, mumps neutralizing antibodies in 96% and rubella HI antibodies in 99% of susceptible individuals (p. 2022). Referring to the monovalent vaccines, the manufacturer states that a single dose of Attenuevax has been shown to induce measles HI antibodies in 97% or more of susceptible individuals (p. 1946). Similarly, one dose of Mumpsvax resulted in 97% immunity in susceptible children (p.2046) and one dose of Meruvax II resulted in immunity in 97% or more of susceptible individuals (p. 2035).

Pre-MMR licensure, the manufacturers had to conduct safety and efficacy studies. It is well known that the safety studies were few, small and of short duration.

On the other hand, there were many efficacy studies performed because of fear that combining the three live attenuated vaccines would result in decreased effectiveness of one or more of the components. (End quote)

One must note that no synergistic effect was ever claimed or detected by the manufacturer.

The problem of decreased efficacy when vaccines are combined was demonstrated recently when the DOH ordered the revaccination of thousands of UK children because of vaccine failure and a high incidence of invasive Hemophylus Influenzae B illness in children who had received a combination vaccine containing HIB, tetanus, diphtheria and whooping cough vaccines.

13. The DOH claims that a vaccination rate of over 90 % is needed to provide “Herd Immunity” and effectively eliminate disease.

That is often true but not always so.

Toronto, Canada: “Eighty-seven laboratory-confirmed or clinically confirmed cases of measles were identified (for an attack rate of 7.7%). The measles vaccination rate was 94.2%” Sutcliffe PA, et al. CMAJ. 1996 Nov 15;155(10):1407-13. PMID: 8943928

Anchorage, Alaska: “The 33 case-patients ranged in age from 2 to 28 years (median: 16 years). Twenty-nine case-patients had received at least one dose of measles-containing vaccine (MCV) at or after age 12 months; one person with laboratory-confirmed measles had received two appropriately spaced doses of measles-mumps-rubella vaccine (MMR). At the high school where 17 cases occurred, based on school records, only one of 2186 students had not received at least one dose of MCV before the outbreak. 49% of the students had received one dose of MCV, and 51% had received two or more doses. CDC, MMWR: January 08, 1999 / 47(51); 1109- 1111

Cape Town, South Africa “Immunisation coverage (at least one dose of any measles vaccine) was 91% and vaccine efficacy was estimated to be 79% (95% CI 55-90); it was highest for monovalent measles (100%) and lowest for measles-mumps-rubella (74%) Coetzee N, et al. S Afr Med J. 1994 Mar; 84(3):145-9. PMID: 7740350

West Switzerland: “Since 1991, 6 years after the recommendation of universal childhood vaccination against measles, mumps, and rubella (MMR triple vaccine), Switzerland is confronted with a large number of mumps cases affecting both vaccinated and unvaccinated children. Up to 80% of the children suffering from mumps between 1991 and 1995 had previously been vaccinated …”Ströhle A, et al. Schweiz Med Wochenschr, 1997 Jun, 127:26, 1124-33

Switzeralnd: In evaluating the impact of the MMR mass vaccination program begun in Switzerland in 1985: “We conclude that MMR mass vaccination has not interrupted the circulation of rubella virus in Switzerland, and that improvements in the implementation and surveillance of the MMR vaccination campaign are necessary in order to avoid [the] untoward effects of it.”European Journal of Epidemiology, vol. 11, no. 3, June 1995, pp. 305-10)

14. To prevent a measles epidemic the Afghan Government embarked in a massive campaign in 2002. Some twelve million children aged 6 months to 12 years were given the monovalent measles vaccine under the auspices of WHO and UNICEF. The Minister of Health estimated that 35,000 lives may have been saved by the campaign. (1)

15. It was estimated that there were 350,000 cases of measles in Madagascar in 2002. Between September 13 and October 8, 2004 a massive campaign was carried out with the help of the UNICEF. Over 7,000 vaccinators and 15,000 community workers administered the monovalent measles vaccine to over 7 million children aged 9 months to 14 years in the Country’s 111 districts. (2, 3)

16. Without a doubt, the WHO and UNESCO will be using the single (monovalent) measles vaccine and NOT THE MMR, to vaccinate thousands and prevent outbreaks of measles in the areas of the Far East that were devastated by the Tsumanis of December 2004.

The above are the facts, the REAL facts.

They are well worth remembering.

References

1.http://www.unicef.org/publications/files/WHO_UNICEF_Measles_Emergencies.pdf  

2. http://www.unicef.org/media/media_23437.html  

3. http://www.medscape.com/viewarticle/490996  

Competing interests: Grandfather of a child with regressive autism