30/11/01 Private Eye

MMR: The Doctors Reply

Sir,

"More needle over MMR" (1038) criticised our report in Archives of Diseases in
Childhood in which we reviewed the evidence on the purported link between MMR
vaccine and autism for our colleagues in child health.

The intention was not to "rubbish" Andrew Wakefield but to examine the
scientific evidence. Unfortunately, since the research suggesting a link
between MMR, autism and bowel disease has been almost exclusively conducted by
Andrew Wakefield and colleagues, any criticism of the evidence may be
construed
as criticism of the author rather than the science.

You state that we made "great claims" for the "Finnish study". It is
unfortunate that you failed to notice that we were not referring to the recent
much quoted study by Patja, but to two more rigorous studies published in 1986
and 1998. We also cited not only the original 1999 Taylor paper, but a more
recent paper in which the data were re-analysed to allow for the diagnosis of
autism up to three years following MMR vaccine. This re-analysis confirmed no
association between MMR vaccine and autism.

In referring to a regimen of the three single vaccines never having being used
in this age group, we meant exactly that. This fact is fundamentally
important.
Single measles vaccines were indeed used in the UK from 1967 to 1988, and are
still recommended by WHO in some circumstances. Rubella vaccine was commonly
used in secondary school girls. This is entirely different from the regimen
that some professionals are advocating. It is not possible to predict, from
this experience, the safety and efficacy of the proposed regimen ie single
measles, mumps and rubella vaccines at yearly intervals. Following the
introduction of the combined MMR vaccine there was a significant reduction in
these diseases.

We assume that the reference to the outbreak of measles in a highly immunised
population concerns a paper published in the South African Medical journal in
1994 ("The 1992 measles epidemic in Cape Town - a changing epidemiological
pattern" Coetzee et al). The authors concluded not that there was a difference
in efficacy between the combined MMR and the single measles vaccine, but that
the MMR had not been stored properly. This emphasises the importance of
reading
the original scientific research, in full, rather that relying on someone
else's interpretation. This also applies to the 1988 paper by Wakefield et al,
often quoted as the basis for the fears about the safety of MMR vaccine.
However, in the paper the authors themselves said "We did not prove an
association between measles, mumps and rubella vaccine and the syndrome
described".

Our "selective" questioning of the use of two specific strains of mumps
vaccine
was to highlight the problems inherent in the use of unlicensed products. Some
children have been given these vaccines and are now either inadequately
protected or ran the risk of developing meningitis.

The Archives paper reviewed the evidence to date concerning a proported
association between MMR vaccine, autism and bowel disease, it was not intended
to provide a complete review of the safety profile of MMR vaccine. In your
piece you gave the impression that the infrequent associations of idiopathic
thrombocytopenic purpura (ITP) and convulsions and MMR vaccine have only just
been revealed. They have been recognised for many years, albeit at a much
lower
incidence than occurs with natural infection.

We stated in the article that we have received funding from vaccine
manufacturers (none of which has been personal profit). It would be
professional suicide to take a particular stance on an issue for reasons other
than the scientific evidence. We are not alone in concluding that the evidence
does not support an association between MMR vaccine and autism or bowel
disease.

In presenting an unbiased picture, you will of course be reporting the latest
paper by Fombonne in which he reported no association between MMR vaccine and
regressive autism as originally suggested by Dr Wakefield?

We stand by our conclusion that: "While the final decision rests with the
parents, the evidence of the safety and efficacy of MMR vaccine is so
overwhelmingly conclusive that health professionals should have no hesitation
in recommending its use."

Yours sincerely
DAVID ELLIMAN, Consultant in Community Child Health, St George's Hospital,
London

HELEN BEDFORD, Lecturer in the Epidemiology of Child Health, Institute of
Child
Health, London

Sir,

Re: "More Needle over MMR", (3 October 2001.) I am writing to you to correct
several significant factual inaccuracies which appeared in the above
article in
Private Eye earlier this month.

Your report implies that the media coverage of the "Archives of Disease in
Childhood" paper suggested that this was new research, rather than a review of
previous reasearch. No attempt was made by the PHLS to present this as
anything
other than an overview. Indeed, as your own article points out, I described it
as such in my commentary; and the PHLS press office was at pains to point out
to journalists who called us that this was not "new research".

You state that the policy of using separate vaccines is fully sanctioned by
the
WHO - it is not. The WHO fully endorses the use of the triple MMR vaccine as
the best way of protecting children against the disease; it has never endorsed
the use of single measles, mumps and rubella vaccines.

I stand by the view that there is no evidence about the safety and
effectiveness of single vaccines used in place of MMR. You are correct to say
that there are studies of single vaccines used in isolation, such as the 1994
measles vaccine study. However, there is no evidence looking at the safety or
effectiveness of giving single measles, mumps and rubella vaccines, separated
by a time interval, to the same child as part of a routine immunisation
schedule. Parents who have expressed concern about MMR have often cited the
interaction of the three elements as a key concern; the lack of evidence about
how three single doses will interact is therefore likely to be of particular
concern to those parents.

The separate measles and mumps vaccines being imported are not licensed in
this
country; where doctors give such vaccines, they do so on an unlicensed, named
patient basis.

You might like to note that I have done work investigating adverse
reactions to
vaccines; as you mention in your article, I have published (and publicised)
work which looked at the association between MMR and idiopathic
thrombocytopenic purpura (ITP), a rare rash disorder. The study concluded
that
the measles and rubella vaccine components of MMR were associated with an
increased rate of ITP, but that the reaction was rare, and relatively mild
compared with the effect of the diseases measles, mumps and rubella
themselves.

I also led the research work which showed a link between a strain of mumps
vaccine (the Urabe strain) and increased rates of viral meningitis. In this
case the work led to the vaccine being withdrawn altogether. To suggest as you
do that I am not prepared to be critical of vaccines when they are unsafe is
simply not supported by the facts.

Finally, you state that my work on MMR paved the way for its licensing. In
fact, the work I coordinated on MMR was not part of the licence application at
all. The vaccine licence was granted on the basis of work done elsewhere.

I hope this clarifies the situation.

Your sincerely

DR. ELIZABETH MILLER,
Head, PHLS Immunisation Division.