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OPINION

Measles and the MMR: where are we now?

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‘The numbers of susceptible unvaccinated children are mounting and as they get older, it’s forgotten that they still need protection’

My earliest childhood memory is of having measles.

Confined to bed with the lights dimmed, I felt really ill. My measles bout was before the UK introduced a vaccine, when 2-3 yearly epidemics affected literally hundreds of thousands of children. Measles has been preventable for nearly 45 years in UK, first with a single measles vaccine and, since 1988, with the combined measles, mumps, rubella vaccine (MMR). So it is disappointing, though not wholly surprising, that numbers of cases in the first quarter of this year are ten times higher (334 cases) than in the same period in 2010 (33 cases).

“It was this statement, unsupported by evidence at the time or subsequently, that attracted media interest”

When MMR came in, vaccine uptake rose quickly; parents liked being able to protect their kids against three diseases with one jab and in the 1990s measles became uncommon.

Then, in 1998 a paper was published in the highly respected journal The Lancet. This now discredited paper described twelve children with autism and bowel conditions, eight of whom were reported to have developed symptoms after MMR vaccine.  Although the paper stated clearly that a link between MMR and autism and bowel disease had not been proved, the lead author announced at a press conference that he felt children should have the vaccines separately with a year between each dose. It was this statement, unsupported by evidence at the time or subsequently, that attracted media interest.

“The numbers of susceptible children mounted and as they got older, it was either forgotten that they still needed the vaccine or mistakenly thought they were too old”

And what interest!

For some periods there were articles about MMR vaccine in the papers every single day. Initially coverage focused on the dangers of the vaccine with much made of the Department of Health’s refusal to provide single vaccines on the NHS.  Many richer parents paid to have single vaccines. C-list celebrities waded in with their usually negative opinions on MMR vaccine safety. A TV film starred Juliet Stevenson and dishy Hugh Bonneville as the mother of an autistic child and the doctor at the heart of the controversy respectively.

Hardly surprising then that many parents chose not to have MMR and children whose parents couldn’t afford single vaccines remained totally unprotected. Over the years, the numbers of susceptible children mounted and as they got older, it was either forgotten that they still needed the vaccine or mistakenly it was thought they were too old for it.

So, they remain at risk and ironically as measles, mumps and rubella are potentially more harmful in adults, are at even greater risk of the consequences of the infections than they were as children. Now of course, the whole MMR vaccine-autism story is history with sound evidence of no link.  

“The solution for all unprotected children and young adults is vaccination.”

Outbreaks of measles in Europe, mainly France, Spain, Italy, Germany and Switzerland are partly to blame for the English cases among largely unvaccinated older children and young adults who have had contact with travellers to these countries.

The solution for all unprotected children and young adults is vaccination.

Two doses of MMR are recommended as about 1 in 10 people don’t mount protection against measles with one dose.  Although usually given at 12 months and 3 years 4 months of age, they can be given with as little as a four week gap between doses in children older than 18 months. So, for those going abroad for their summer holidays, there is still time to have two doses before they go.  

Nurses are often identified as being ideally placed to do all manner of things. In this case they really are. Hospital and community nurses should check the immunisation status of their patients and either vaccinate or remind the unprotected to get the vaccine. It’s simple, vaccination works and is safe. Measles on the other hand is bad news and it’s about time it was a thing of the past.    

Dr Helen Bedford is a senior lecturer in children’s health.

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Readers' comments (1)

  • It is vital that nurses, as professionals as well as informal advisors to friends and family, remain clear, consistent and accurate in the information they give about MMR, (as well as the rest of the routine immunisation programme or infants, children, young people and adults).

    We have such an important public health role to play in this area. Make sure you are well informed whatever your role!


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