The Use of Triple MMR Vaccine - Essay Example

The Use of Triple MMR vaccine Mumps, Measles and Rubella when uncontrolled lead to serious health consequences in the population. Makela et al (2002,p.957) quotes that in unimmunized population, Acute Measles Encephalitis was seen in 35 to 100 per 100 000 Measles patients and 10 to 20 die or 25% of survivors develop Neurological diseases. Mumps Encephalitis develops in 260 per 100 000 patients and 0.1 to 15% suffer from Meningitis. In Rubella, Encephalitis develops in 13 out of 100 000 patients. Hence, it is of utmost public health importance that these diseases are prevented by Immunization thereby reducing Mortality and Morbidity. The introduction of Polyvalent Mumps-Measles-Rubella (MMR) vaccination in several countries has shown predictably good results. Wakefield et al (1998,p.637) published a sensational report in the journal Lancet linking MMR vaccine, Pervasive Developmental disorder and bowel disease. The group examined 12 children with loss of acquired skills and presenting with bowel symptoms like diarrhea, abdominal pain, bloating of stomach and food intolerance. Details of History, Immunizations administered, the time of administration of immunizations, examination by neurologists, Psychiatrists and Gastroenterologist apart from Ileanocolonoscopy, MRI Brain, EEG, Evoked Potentials, Urinary methylmalonic acid and other tests, ileal and colonic biopsies were done. Progressive developmental delay (Autism) was diagnosed in 10 cases and in 8, history of MMR vaccination 1 to 14 days before the onset of behavioral symptoms was noticed. Post vaccinial encephalitis in 2 other cases was diagnosed. 9 children had lymphoid nodular hyperplasia of colon and rectum. Crohn's disease was diagnosed in 4 cases. The authors opined that there was evidence of Anaemia and IgA deficiency, which may be the consequences of, inflamed or dysfunctional intestines, which are in turn related to, behavioral changes in Autistic disorder. The fall out of this stunning paper had far reaching consequences on the acceptance of MMR vaccine in the public. Walling (2005,p.517) report that MMR coverage in U.K fell from 92% in 1996 to 82% in 2003 and outbreaks of measles followed this reduced acceptance and fear by the public. This issue was debated in U.S congressional meetings too. There were series of papers rebutting the claims by Wakefield group between 1999 and 2002. Some of them are presented here. Kaye et al (2001,p.460) did a time series analysis for yearly trends looking for MMR vaccination and relation with autism between 1988 and 1999 among children aged 12 years or younger from the UK general practice database. They could identify 305 cases with Autism during that period. An increase of seven fold, 0.3 per 10 000 person years in 1988 to 2.1 per 10 000 person years was observed in the incidence of Autism. The median age of first recorded case was 4.6 years, which remained fairly, stable over the decade. All these years more than 95% of the population had been vaccinated with MMR vaccine, meaning it was fairly constant. The risk of Autism was seen to have raised four fold in a subset of 110 boys aged 2 to 5 years. The distribution of age when the first MMR vaccination administered was same as in the general population. It has been observed that the MMR vaccination was given around 15 months of age and the cases of Autism were first reported at 2 years of age denoting a large time lag in the onset of Autism if it was due to the vaccine. There did not appear any relation between MMR vaccine and the rising incidence of cases of Autism for it should have fairly remained stable over years if that was the cause. The increase in the incidence of Autism was opined as increase in the awareness in general public about the signs and symptoms due to public health education. The study only lacks in inability to obtain full details of the disease from the general practitioners. Black et al (2002,p.325) examined the relation between gastrointestinal disorder (chronic inflammation of gastrointestinal tract, celiac disease, food intolerance and other symptoms of G.I tract) and Autism in a matched case control study from the UK general practitioners research database in children born after 1988 and registered within 6 months after birth. In all 211 480 cases were examined. Evidence for both Autism and Gastrointestinal disorder was examined from the possible sources of information. 9 out of 96 cases of Autism and in matched controls without Autism 41 out of 449 suffered from G.I disorders. This comes to be 9% in each of the groups and the Odds ratio was 1 with a 95% confidence interval between 0.5 to 2.2 suggesting that there is no increase of cases in either of the groups. No child was reported to be having crohn's disease or ulcerative colitis. None of the cases developed G.I disturbances within one month of MMR vaccination. Recall taking information from records and medical practitioners reduced bias, however the authors themselves comment that structured interviews of diagnosis of Autism was lacking. DeStefano (2004,p.259) under the aegis of Centre for Disease control and Prevention, Atlanta, US conducted a matched case control study in metropolitan Atlanta comparing age of MMR vaccination between group with Autism and group without in the total population. Screening the cases and obtaining information from hospital records, clinics, schools and special providers identified the Autism cases. Cases were diagnosed using DSM IV manual for Mental Disorders. Immunization status was assessed from the school records and other sources. The matching was for one case three controls.624 cases and 1824 controls were included in the analysis. In both the groups MMR vaccination was between 12 to 17 months of age i.e. nearly 70% of the population assessed. When a cutoff of 36 months of age was applied 93.4% of cases and 90.6% of the controls were vaccinated, the odds ratio was 1.49, which was not statistically significant. The authors contradict observations of increase in incidence of Autism with MMR vaccination. Current scenario suggests that the rise in cases of Autism are due to better awareness in public and thereby seeking medical opinion and no association between use of MMR vaccination and Autism and Gastrointestinal disturbance. References Black.C, Kaye JA, Jick H (2002), Relation of childhood gastrointestinal disorder to autism: nested case control study using data from the UK general practice research database, British Medical Journal, 325:419-421. DeStefano F, Bhasin TK, Thomson NW, Yeargin-Allsop H, Boyle C (2004), Age at first Measles-Mumps- Rubella vaccination in children with Autism and school matched control subjects: A population based study in Metropolitan Atlanta, Pediatrics; 113:259-266 Kaye.J.A, Mariadel Mar MM, Jick H (2001), Mumps, measles and rubella vaccine and the incidence of Autism recorded by general practitioner: a time trend analysis. British Medical Journal: 322, 460-463 Makela.A, Pekka Nuorti J, Heikki Peltola (2002), Neurologic disease after Measles-Mumps-Rubella vaccination, Pediatrics, 170:957-963. Wakefield A.S, Murch S.H, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentin A, Davis SE, Smith JAW (1998), Ileal-Lymphoid-nodular hyperplasia, nonspecific colitis, and pervasive developmental disorder in children, The Lancet, 351: 637-641. Walling AD, (2005), MMR vaccine unrelated to developmental disorders, American Family Physician, 72,3:517-518 Read More