The Controversy Surrounding the MMR Vaccine - Essay Example

MMR Vaccine Outline the controversy that occurred surrounding this allegation. MMR is a combined vaccine that offers protection against measles, mumps and rubella. The vaccine was first introduced in the year 1988 and has caused a dramatic reduction in the incidence of these diseases. which account for significant morbidity (NHS, 2009). The first dose of the vaccine is given around 13 months of age and a booster dose is given between 3-5 years of age (NHS, 2009). This vaccine contains inacitivated live viruses of measles, mumps and rubella. (CDC, 2007) Live attenuated forms of the viruses are used for preparation of the vaccine. It is because of MMR vaccine that since 1992, no fatal case of acute measles was reported in the United Kingdom (NHS, 2009). Prior to introduction of the vaccine, the most common cause of meningitis related to virus was mumps (NHS, 2004). Mumps is also in the stage of wiping-out because of the vaccine. Even the impact of rubella on fetuses has drastically decreased due to the vaccine. MMR has always been given as a combination vaccine and separate vaccination programme was never there in the United Kingdom (NHS, 2004). Thus, MMR is a very effective vaccine. However, several concerns have been raised by some experts about the safety of these vaccines because of reports of some studies pointing to the development of various complications like asthma, Guillain-Barre Syndrome, Crohns disease, Autism and Subacute Sclerosing Panencephalitis (Mediinfo, 2004). Of interest is a major study by Wakefiled et al (1998) published in the popular magazine Lancet which linked mumps vaccine to autism. According to this study, MMR vaccine can lead to autism spectrum disorders with associated enterocolitis. In the study, parents of eight out of 12 children who presented with "history of normal development followed by loss of acquired skills, including language, together with diarrhea and abdominal pain" (Wakefiled et al, 1998) reported that the onset of symptoms were after administration of MMR vaccine. This was a major breakthrough study that forced the UK government to discontinue the vaccine until further research. Based on the reports of the study, the rates of vaccination of MMR vaccine dropped dramatically (McIntyre and Leask, 2008), leading to an increase in the incidence of mumps and measles and their associated complications like morbidity and mortality (Pepys, 2007). Following the reports from the study, several research institutes conducted various studies to ascertain the link between MMR vaccine and autism spectrum of disorders. The reports of the study were investigated by a journalist by name Brian Deer who discovered the fact that the main researcher of the study, Andrew Wakefield had some conflicts of interest that were undeclared, because of which he manipulated the evidence from the parents, thus breaking the basic ethical codes of research (Deer, 2008). Based on the reports from the journalist, the Gneral medical Council found Wakefiled guily for professional misconduct in the year May 2010 (Nick, 2010). The doctor lost his place in the medical register and his paper was retracted (Nick, 2010). DOH has opined that there is no link between autism and MMR because, if it were to be the case, regressive autism, a form of autism that manifests at an older age, would be more common in children vaccinated with MMR than those who are not (NHS, 2004). Also, since there is sudden surge of autism after introduction of the vaccine, autism cannot be related to the vaccine. Extensive studies which involved many children, carried out in various parts of the world including the UK and the US have not been able to prove any association between the vaccine and autism (NHS, 2004). CDC (2007) opined that the most common cause of autism is genetic predisposition and that the chances of a child who received MMR is at a similar risk as that who has not taken the vaccine. CDC (2007) recommends combined vaccine against MMR because "in the time gaps between the three vaccines, children would not be protected against the diseases they had not yet been immunized against. So there would be an increase in measles, mumps and rubella leading to illness and possible death. Also, unprotected children can pass on these diseases to other at risk children and pregnant women." 2. Using a range of literature sources, compare and contrast media coverage The CDC (2007) reported that "carefully performed scientific studies have found no relationship between MMR vaccine and autism." CDC continues to recommend 2 doses of the vaccine for children. The cochrane library which is the highest evidence for practice opined that there is no relationship between administartion of MMR vaccine and development of autism (Demichelli et al, 2004). The review justified the use of the vaccine which is against disease associated with significant mortality and morbidity. In Febraury, 2008, the British medical Journal published the study by Baird et al in which the researchers evaluated many children who received MMR vaccination and found that measles antibody respose was not linked to autistic spectrum of diseases. While these scientific bodies of evidence have ascertained the absence of role of MMR in autism, several news papers and news articles reported the implications of the famous study. On Febraury 5th, 2008, Gaurdian reported that "In the biggest review conducted to date, scientists from Guys Hospital in London, Manchester University and the Health Protection Agency, analysed the blood from 250 children and concluded that the vaccine could not be responsible." The news was mainly reported to the study which refuted the implications of MMR on autism disorders. On the same day, the Daily telegraph reported "The measles, mumps and rubella vaccine is safe and does not cause autism, the most comprehensive study carried out on the jab has concluded." This news was mainly oriented towards the vaccine benefits. Daily Express reported on that day that "parents were last night urged to keep having their children vaccinated after research showed the controversial MMR jab does not trigger autism." The news reported concerns of the parents who did not provide the vaccine becuase of fear of development of autism. 3.In light of the evidence you have found, discuss whether you support the use of a combined vaccine or giving the components separately. MMR vaccination was first introduced in 1988 and caused significant decrease in the number of cases of measles, mumps and rubella (NHS, 2009). However, the 1998 lancet study raised a debate as to whether MMR causes autism. Though all the health organisations like CDC, NHS and others have justified the use of MMR and lack of evidence for association between MMR and autism, some researchers proved that measles vaccine can be associated with risk of autism. Pauls study proved that the risk of autism with MMR is 1 in 10 cases (Ho, 2007). But many other studies have refuted this link. Researchers like Singh and Jensen proved that increased levels of antibodies against measles increase the risk of autism and that autism is associated with presence of an unusual measles protein (Ho, 2007). If at all there is a risk, then, the risk is because of measles vaccine. This makes it advisable to administer vaccines separately. However, most countries in the world administer the vaccines as a combination. If given separate, it increases the number of vaccinations to 6 which can be distressing for the child and can also lead to poor compliance. Single vaccines are also expensive. Thus a debate arises as to whether to administer MMR vaccine or not. According to Schwarz and Thompson framework analysis, four different views can arise in the debate "egalitarian – we should stop using MMR even if there is the slight risk of it causing autism, individualists – the risks associated with MMR is minimal compared to others, hierarchists – the government is giving us the best option and the fatalists – the cause might be genetic, so its lose-lose anyway " (Ho, 2007). Despite years of debate, there still seems to be no solution to this problem (Ho, 2007). However, following reports of evidence against lack of association between measles and autism by Bair et al (2008), many experts opined it is likely that measles does not cause autism. 4. What ethical considerations or arguments could be applied when considering whether or not to vaccinate a child (under 16 years)? MMR vaccine is definitely associated with drop in the infections which this vaccine has be targeted against and those diseases are associated with significant morbidity and morbidity (refer to table-1). However, confusion occurs as to whether the vaccine must be administered because of doubts about links to measles vaccine and autism. So the option is to give separate vaccines which again is associated with poor compliance, increased distress and increased cost. While major public health organisations, politicians and government policies support the use of combination vaccination, some experts in medical field and elsewhere question the need for it in the wake of the MMR controversy. According to Clemenst and Ratzan (2003), "Ultimately, the public must decide whether to follow the lead of the antivaccine lobby and the media that encourages rejection of government vaccination policy, or to follow the official voice that encourages vaccination. But if confidence falters, vaccine coverage dips, and an outbreak of measles, mumps, or rubella ensues, with cases and deaths from measles, or babies born with congenital rubella syndrome, who, if anyone, will be responsible?" Research has proven that vaccination is the most important strategy to prevent infectious diseases. According to Fry (2002), the debate on MMR vaccine is open and it is upto the parents to decide whether their child needs to be vaccinated or not. Thus, one cannot decide as to whether combination vaccine or individual vaccines must be given to the child and it is upto the parents to decide what is best for their child. Complication Risk after natural disease† Risk after vaccination‡ †Risks after natural measles are calculated in terms of events per number of cases. ‡Risks after vaccination are calculated in terms of events per number of doses. SSPE = subacute sclerosing panencephalitis. Otitis media 7–9% 0 Pneumonia 1–6% 0 Diarrhoea 6% 0 Postinfectious ecephalomyelitis 0.5–1 per 1000 1 per 1 000 000 SSPE 1 per 100 000 0 Anaphylaxis 0 1 per 100 000–1 000 000 Death 0.1–1 per 1000 in industrialised countries up to 5–15% in developing countries 0 Table-1: “Risk of complications from natural measles infection compared to known risks of vaccination with a live attenuated virus in immunocompetent individuals” (Clements and Ratzan, 2003). References Baird, G., Pickles, A., Simonoff, E., et al. (2008). Measles vaccination and antibody response in autism spectrum disorders. BMJ, 49, 23- 44. CDC. (2007). Measles, Mumps, and Rubella (MMR) Vaccine and Autism Fact Sheet. Department of health and Human Services. Retrieved on 20th November, 2010 from http://web.archive.org/web/20080407015528/http://www.cdc.gov/vaccinesafety/concerns/mmr_autism_factsheet.htm Clements, C.J., and Ratzan, S. (2003). Misled and confused? Telling the public about MMR vaccine safety. J Med Ethics, 29, 22-26. Demicheli, V., Jefferson, T., Rivetti, A., and Price, D. (2008). Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004407. DOI: 10.1002/14651858.CD004407.pub2. Daily telegraphy (5-2-2008). MMR vaccine doesnt cause autism, says study. Retrieved on 20th November, 2010 from http://www.telegraph.co.uk/news/uknews/1577644/MMR-vaccine-doesnt-cause-autism-says-study.html Daily Express. (5-2-2008). Parents Anger over new evidence that the MMR Jab is safe. Retrieved on 20th November, 2010 from http://www.express.co.uk/posts/view/33885/Parents-anger-over-new-evidence-that-the-MMR-jab-is-safe Deer, B. (2009-02-08). MMR doctor Andrew Wakefield fixed data on autism. Sunday Times (London). Retrieved on 20th November, 2010 from http://www.timesonline.co.uk/tol/life_and_style/health/article5683671.ece. Fry, R. (2002). MMR vaccine Debate. BMJ, 324(7339), 733. Gaurdian. (5-2-2008). MMR links to autism dismissed by huge study. Retrieved on 20th November, 2010 from http://www.guardian.co.uk/society/2008/feb/05/health.children Ho, K. (2007). The MMR vaccination debate – Analysis through the Schwarz and Thompson framework. Retrieved on 20th November, 2010 from http://homepages.inf.ed.ac.uk/s9904132/MMR.pdf Mediinfo. (2004). MMR vaccination. Retrieved on 20th November, 2010 from http://www.medinfo.co.uk/immunisations/mmr.html McIntyre, P., and Leask, J. (2008). Improving uptake of MMR vaccine. BMJ, 336 (7647), 729–30. NHS. (2009). MMR. NHS Choices. Retrieved on 20th November, 2010 from http://www.nhs.uk/conditions/MMR/Pages/Introduction.aspx NHS (2010). MMR vaccine ‘does not cause autism’. Retrieved on 20th November, 2010 from http://www.nhs.uk/news/2007/january08/pages/mmrvaccinedoesnotcauseautism.aspx NHS. (2004). MMR: the facts. Retrieved on 20th November, 2010 from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_105189.pdf Nick, T. (24-5-2010). MMR doctor struck off register. BBC Online. Retrieved on 20th November, 2010 from http://news.bbc.co.uk/1/hi/health/8695267.stm. Pepys, M.B. (2007). Science and serendipity. Clin Med., 7 (6), 562–78. Wake, A.J., Murch, S.H., Anthony, A., et al. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet, 351, 637- 641. Read More