Why did I refuse MMR?

Sophie Radice made a decision not to vaccinate her daughter. But when Ella caught mumps aged 10, she had to face the consequences. And oh, the shame of it...
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Indy Lifestyle Online

Two months ago, my 10-year-old daughter woke up and said that she felt like she had been punched very hard in the jaw. I am of the "let's get up and have breakfast and see how you feel after that" school of parenting, rather than a "you just stay in bed and I will bring you a little something on a tray" type. But when I saw that one side of her face was swollen, giving my daughter the look of a lop-sided hamster, I agreed that it was probably best to get her off to the doctor as soon as possible.

Two months ago, my 10-year-old daughter woke up and said that she felt like she had been punched very hard in the jaw. I am of the "let's get up and have breakfast and see how you feel after that" school of parenting, rather than a "you just stay in bed and I will bring you a little something on a tray" type. But when I saw that one side of her face was swollen, giving my daughter the look of a lop-sided hamster, I agreed that it was probably best to get her off to the doctor as soon as possible.

The GP tried hard not to be judgmental, but I felt a wave of shame when she told me that Ella probably had mumps. She saw from our notes that we had not given her the MMR triple booster and I explained, slightly defensively, that we had taken a decision not to give her the vaccine. Her older brother had contracted a nasty case of measles a couple of weeks after his MMR, and although such a reaction is rare, after extensive debate my partner and I felt that it was best not to risk the same problem with his sister.

Although the vaccination was only introduced in 1988, mumps has already been banished to the past as firmly as whooping cough or rickets. Of course, those of us who decide not to give their child MMR and then don't go on to have all three vaccines separately are relying on the fact that other parents will continue with the vaccine. Now I realise that opting out has consequences.

Our doctor gently reminded me that there was something of a mumps epidemic in Britain, although for the moment it is confined mostly to the university student population who are too old to have had their MMR. However, there is no reason why a 10-year old who has not been protected against the disease should not get it, particularly if she has been in contact with this age group.

We were told to inform the school, which we duly did, and I also felt obliged to ring and confess to the parents of other children in her class before the letter went round telling everyone of my laxity - although thankfully they didn't name and shame. Having been told that mumps is most contagious from two days before symptoms begin to six days after they end, I also thought of Ella's gym class teacher, a pregnant friend and a friend with premature twins whom we had visited the week before. I tried to pre-empt their anger by apologising so profusely that they couldn't get a word in edgeways. My mother, usually so supportive of my parenting, was appalled that I had not given Ella her MMR, something I hoped I wouldn't have to confess to. I had to agree with her when she said: "What parents would give in some parts of the world for the chance of that vaccine."

Mumps is caused by a virus that usually spreads through saliva. The virus can be passed to other people by sneezing, coughing or using the same drinking glass as the infected person. The incubation period for mumps can last between 12 and 25 days, but the average is 16 to 18 days. Mumps can infect many parts of the body, especially the parotid salivary glands, which are found towards the back of each cheek in the area between the ear and jaw. There is no treatment except bed rest and trying to lower the high temperature that results from the illness. The most serious repercussions involve possible infection of other organs. In 20 to 30 per cent of the cases of adult men with mumps, the disease infects the testicles, causing swelling (orchitis) and running the risk of sterility. Serious complications can lead to encephalitis (inflammation of the brain), meningitis (inflammation of the lining of the brain and spinal cord) and deafness. Before the MMR vaccine was introduced, mumps was the commonest cause of viral meningitis. Mumps can also cause women problems with their ovaries and spontaneous abortion early in pregnancy.

My doctor wasn't exaggerating when she described the increase in mumps cases as an epidemic, either, according to Dr Mary Ramsay, who monitors cases of mumps for the Health Protection Agency. "The term 'outbreak' implies that mumps has occurred in localised areas, whereas cases of mumps have risen right across England and Wales," she says. In the first four weeks of 2005 there were 4,891 notifications for mumps; in the same period last year, there were only 358 cases. Suspected cases are at their highest for 15 years - and, after laboratory testing, between 60 and 75 per cent of notifications are being confirmed as genuine cases. While two-thirds of cases are in patients between the ages of 15 and 24, children whose parents have refused the MMR vaccination, often because of fears over the connection with autism, are also vulnerable to infection.

Dr Ramsay explains that teenagers and young adults are getting mumps because these age groups tend to live closely together, particularly in universities. "We believe the number of cases have increased more steeply in recent weeks because many of the young adults born between 1981 and 1989 are now at university. This age group was too old to be offered the MMR vaccine, so many will not have received any mumps-containing vaccine, although some may have received one dose of MMR vaccine. As the susceptible group is quite large, we do not expect the number of cases of mumps to reduce in the near future."

Even those who were young enough to have had the first lot of MMR vaccine may not have followed through with a second. In 1996, it became clear that it wasn't enough for people to have one jab to protect them and that it was important to have two.

As concerns about a possible epidemic grow, vaccination programmes have been set up in some schools and university towns, advising students to have an MMR jab. The response has been good. At Kingston University, where there have been 21 suspected cases of the viral infection, 548 vaccinations have been carried out in the last few weeks.

The daughter of a friend of mine who is in the most susceptible age group asked if I could find out if she could have a separate "mumps" vaccine rather than having the MMR vaccine. After all, her mother paid for separate measles and rubella vaccines for her sister. A spokesperson for the Health Protection Agency said that it was not possible to do this because there isn't a single mumps vaccine licensed for use in the UK.

I received a letter from my daughter's primary school saying that it was going to start an MMR vaccination programme. Was it just because of Ella? As far as I know, there weren't any other cases in our area. I still have no idea how she caught mumps.

She was ill for a week, ate little and drank lots of water. I gave her paracetamol to keep her temperature down. Ella found the school's letter, which her father and I were still considering, and started to fill in the attached form herself. "Please, Mum. Come on, I don't want to get any more of these horrible, old-fashioned illnesses."

That's us decided, then. After a decade of pondering, I think we might have learnt our lesson.

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