MMR controversy

Published:

Introduction

MMR is the name of the vaccine against mumps measles and rubella, which can be given in a single dose against all three diseases at ages between 12 and 15 months, with a booster to be given before going to school at around 3 to 5 years of age. This replaced the need to give separate vaccinations in 1988, which would require 6 separate inoculations and therefore making it easier and more likely that uptake of the vaccination would be taken by parents (Politics.co.uk.2010). All of these diseases can cause serious complications and even kill, and in the case of rubella, if it is contracted in the first trimester of pregnancy, there is a chance that this will cause damage to the unborn child resulting in miscarriage and still birth as well as other significant problems for the unborn child if it survives to the full term of the pregnancy.

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This paper will attempt to look at the facts surrounding the MMR scare initialised by Dr Andrew Wakefield et al in 1998 via research he undertook at that time, and the subsequent handling of the issue by the media, scientific journals and reaction by the public.

The Facts and the Timeline

In 1998, a paper was published in the medical journal, the Lancet by a team of doctors and scientist lead by Dr Andrew Wakefield from the Royal Free Hospital in London, describing research carried out which could link the occurrence of autism and bowel disorders (Wakefield et al. 1998).

Meanwhile a study carried out in Helsinki and run by Patja et al (2000) followed 1.8 million individuals over 14 years from 1982-1996, who had received MMR vaccination stated in their report, that in view of the reported adverse reactions and after comprehensive analysis, that the indication that they were causally related to MMR vaccine was rare and would outweigh any risks of natural MMR disease.

April 2000 saw Dr Wakefield and Dr John O'Leary (Coombe Womens Hospital, Dublin) that there is 'compelling evidence' that there is a link. (Times Online.2010)

In January 2001 there were claims made by Dr Wakefield that the MMR vaccine had not been tested properly and after being ostracised by the British medical community he and his family moved to America. (Times Online.2010)

Tony Blair, the current Prime Minister who had previously supported the MMR vaccine refused to say if his son Leo had been given the vaccine in December 2001. (Times Online.2010)

2003 saw a drop in the uptake of the MMR to 79% compared to a previous 91% in 1997 (Times Online.2010)

The Lancet in February 2004 announced that they were retracting the original 1998 paper issuing this statement from 10 of its original 12 authors, one of whom was unable to be contacted. 'We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data were insufficient. However, the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper, according to precedent.'(Murch et al.2004)

Japanese scientists Honda et al published a paper in 2005 stating that Autism Spectrum Disorders (ASD) is most unlikely to have been caused by the MMR vaccination and that withdrawing from the MMR vaccination programme in countries where it is used would be unlikely to reduce the incidence of ASD occurring.

In April 2006 a 13 year old boy dies from the measles, and is the first in 14 years. He had not been vaccinated with MMR. The GMC begins and investigation into Dr Wakefield in July 2007. Figures released in 2009 for 2008 show that in England there were well over 1000 cases of measles confirmed in comparison to 56 in 1998, with 3 more deaths reported. (Times online.2010)

January 2010, the results of the GMC investigation into Dr Wakefield were released, after many delays. According to the GMC, Dr Wakefield abused his position, acted unethically and subjected the children to unnecessary and brought the medical profession into disrepute. (BMJ.2010)

Research, claims and public reaction.

The original research paper was carried out by Dr Andrew Wakefield et al (1998), in which 12 children were investigated via referral. The mean age of the children was 6 (from age 3 - 10) and 11 of those were boys. These children had shown normal development until they showed signs of loss of language and communication skills along with some gastrointestinal symptoms such as abdominal pain, diarrhoea, and some with food intolerance.

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These children were then subjected to intensive invasive investigative procedures including lumbar puncture, venepuncture, biopsy and ileocolonoscopy, as well as barium radiological procedures. Other procedures were performed such as magnetic resonance imaging (MRI), electroencephalography (EEG), as well as psychological, neurological and developmental assessments.

The paper states that the behavioural problems had been noted by the parent to coincide with the administration of MMR Vaccine. All 12 had gastrointestinal problems. Of the behavioural problems, 9 had autism, 1 had disintegrative psychosis and 1 had possible post viral or vaccinal encephalitis. Accounts and records were accessed from parents, health visitors and GP's with regard to assessing the developmental progress of the children.

Clinical examination showed no neurological abnormalities in any of the children.MRI, cerebrospinal fluid (CSF) analysis, EEG and radiological procedures revealed no abnormalities.

Developmentally, all the boys showed normal early development with the one girl in the group reported to have developed on a slower level to her older sister. It was later discovered that she suffered from coarctation of the aorta.

Of the 12 children 8 had had behavioural problems which were associated by the parents of the children or by their doctor to the MMR vaccine. 5 of the 8 had an adverse reaction early on to the vaccine which caused them to suffer from rash, fever and delirium. 3 of those had convulsions. The average time it took to associate the behavioural problems with the vaccine was 6.1 days, between 1-14 days. It was less clear about a time span to link the intestinal problems by the parents as some of the children were not toilet trained.

The study was given ethical approval by the Ethics Approval committee at the Royal Free Hospital NHS Trust, London.

The study was accompanied by a press release and video news coverage. It received enormous attention from the media, as well as further attacks on the vaccine by Dr Wakefield and the media. (Deer.2010)

About the claims, research and public outcry!

Is there a bias in the study?

Are the claims made defendable?

Should Lancet have published it?

Did the press misrepresent the findings?

Was the study ethical?

References:

Journals:

  • Wakefield, A.J., Murch, S.H., Anthony, A., Linnell, J., Casson, D.H., Malik, M., Berelowitz, M., Dhillon, A.P., Thomson, M.A., Harvey, P., Valentine, A., Davies, S.E., Walker-Smith,J. (28 February1998) Ileal-lymphoid-nodular hyperplasia, non specific colitis, and pervasive developmental disorder in children. The Lancet. Vol. 351(9103). Pp.637-641.
  • Murch,S.H.,Anthony,A.,Casson,D.H.,Malik,M.,Berelowitz,M.,Dhillon,A.P.,Thomson,M.A.,Valentine,A.,Davies,S.E.,Walker-Smith,J.(6 March 2004) Retraction of an Interpretation. The Lancet. Vol.363(9411).Pp.750
  • Patja A, Davidkin I, Kurki T, Kallio MJT, Valle M, Peltola H. Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow-up. Pediatric Infectious Diseases Journal. Vol. 19 (12). Pp. 1127-1134.
  • Honda,H., Shimizu,Y.,Rutter,M.,(June 2005) No effect of MMR withdrawal on the incidence of autism: a total population study. Journal of Child Psychology and Psychiatry. Vol. 46(6). Pp.572-579.

Online:

  • MMR (2010).Politics.co.uk [Online]. Available http://www.politics.co.uk/briefings-guides/issue-briefs/health/mmr-$366561.htm (18 March 2010).
  • Timeline: the MMR scandal(2010).TimesOnline[Online].Available http://www.timesonline.co.uk/tol/news/uk/health/article7006306.ece (04 April 2010)
  • Lancet retracts Wakefield's MMR paper,(2010) BMJ [Online]. Available http://www.bmj.com/cgi/content/full/340/feb02_4/c696 (04 April 2010)
  • Nailed: Dr Andrew Wakefield and the MMR - autism fraud. (2010) Summary of Brian Deer's investigation into a threat to children's health [Online]. Available http://briandeer.com/mmr/lancet-summary.htm (04 April 2010)