The return of measles

New figures reveal cases at 20-year high in the wake of panic over safety of MMR

Jeremy Laurance
Friday 16 June 2006 00:00 BST

Figures released yesterday revealed a 20-year high in cases of measles after a collapse in MMR immunisation rates.

There were 449 confirmed cases of measles in England and Wales in the first five months of this year, the biggest outbreak since the triple MMR injection was introduced in 1988. Opposition MPs blamed the rise on ministers' refusal to consider single vaccinations and Tony Blair's reluctance to reveal whether or not his son Leo had been vaccinated.

Peter English, a consultant with the Surrey and Sussex Health Protection Agency, disclosed that since January there had been 106 confirmed cases in his region, with 50 more unconfirmed. "We are not surprised to see the outbreak because this is a population with a lot of people now susceptible to the disease due to a low uptake of the MMR injection, and measles is highly contagious," he said. South Yorkshire has also been struck by a large outbreak, with 100 cases in Doncaster, the national Health Protection Agency (HPA) said. A Manchester, boy of 13 died of the disease in April, the first fatality for 14 years.

Andrew Lansley, Tory health spokesman, said: "Measles can have serious complications, as we learnt tragically earlier this year. Where there is a persistent failure to secure sufficient take-up of MMR to provide population-wide protection, we have made it clear the Government should consider whether to investigate protocols for single jabs.

"It would be better, however, if everyone understood the MMR jab was safe and accepted immunisation for their children. Politicians have an absolute right to protect the privacy of their families but we do have a shared responsibility to show that we believe what we say.

"Whatever decision Tony Blair has made about Leo, him keeping that private stands in contrast to what Gordon Brown, David Cameron and I have done. In my own case, both my children have had their MMR jabs and I would urge parents to do likewise."

But some parents remain unconvinced by government assurances that the vaccine is safe. Gabrielle Green and her husband, Charles, chose to give their daughters, Olivia, five, and Scarlett, two, single vaccinations against measles, mumps and rubella. "All parents should be offered a choice on single vaccines," Mrs Green said. " I would not give myself the triple vaccine, so why on earth would I give it to my children? I don't trust it at all. People who do not have the money to give their children single vaccines are in a very, very difficult situation. They are almost being forced not to protect their children against childhood illnesses which puts them at risk. The only solution is for the Government to offer a choice."

Critics of the government policy said one scare was being used to counter another. Fears about a possible link between MMR and autism had deterred parents from getting their children vaccinated. Now, warnings about the danger of measles were being used to bolster immunisation rates.

Rosemary Fox, head of the Vaccine Damage Association, said: "You get some medical experts who exaggerate the figures. The rise in measles cases, though worrying, is still a fraction of what it used to be. Officials should not use the figures to frighten people."

The 449 confirmed cases of measles so far this year compares with 86,000 cases notified in 1987, the year before MMR was introduced. In the 1960s, cases fluctuated between 160,000 and 800,000 a year.

A spokeswoman for the Health Protection Agency (HPA) said: "People think measles is a trivial disease but it is not. Some people unfortunately died and some were debilitated in the past. Our message to parents is to get their children vaccinated to reduce the risk."

The 13-year-old boy who died in Manchester was part of a travelling community. He was already receiving drugs for a lung condition when he contracted measles and his illness affected his ability to combat the virus. He had not received the MMR vaccine and died of an infection caused by a reaction to the measles virus.

The HPA said travelling communities were more likely to contract measles because they had less contact with local health services and were, therefore, less likely to be vaccinated.

Research published in The Lancet in 1998 by Dr Andrew Wakefield led to a decline in MMR immunisation rates from above 90 per cent to 79 per cent in January 2003. The fall was accelerated by the controversy over Tony Blair's refusal to say whether Leo had been vaccinated. Since 2003, rates had risen again to 83 per cent.

Dr Wakefield is to be charged with serious professional misconduct by the General Medical Council. Charges are being prepared accusing him of "inadequately founded" research, obtaining "improper funding" and conducting "unnecessary and invasive investigations" on children.

'My son got the virus, but I don't regret my decision'

Jack Paterson, 6

Logan Paterson and his partner Lyndy Renwick, from Castle Douglas, Dumfries and Galloway, decided not to give their son, Jack, the MMR vaccine.

The six-year-old suffered a mild form of measles earlier this year after an outbreak at his school, Kells primary in New Galloway.

Mr Paterson said: "We decided not to give Jack the MMR vaccine because of the link with autism and behavioural poblems associated with MMR. He had all his other vaccines, but we were just not prepared to take the risk. Very few families hadn't vaccinated their children, but Jack was in a class with them. He had a very mild form of measles, which I attribute to his strong immune system. It did cross my mind when he was ill as to whether we had done the right thing, but we still weren't persuaded MMR would be a better option. He was slightly off-colour, a wee bit irritable and had about eight spots on his back.

A couple of days later he was fine again. One parent had a measles party so that her three children would get the disease, and then be immune. Some children had a bad time, they were off school for over a week, and displayed the classic measles symptoms. My son's experience certainly hasn't changed my mind and meant that I or Lyndy regretted not giving Jack the MMR vaccine."

The key questions for parents

How serious is measles?

It is a mild disease but complications are not uncommon. They include a severe cough and breathing difficulties (croup), ear infections, pneumonia and eye infections (conjunctivitis). In one in 1,000 cases it can cause encephalitis (swelling of the brain). A quarter of these cases result in permanent damage. In the 1940s and 1950s, 500 children died in the UK each year from measles. In the 1960s there were 100 deaths a year. The death in April of a boy aged 13 was the first in the UK for 14 years.

Who catches measles?

It is still rare in the UK, despite a recent rise. Measles commonly affects the one-to-four age group but can occur at any age.

How infectious is it?

About 90 per cent of people who have not been immunised, or had measles, catch the disease if they live in the same house as someone with measles. It is caught through direct contact or through droplets in the air when an infected person coughs or sneezes. It is most infectious before the rash appears.

When did vaccination start?

Between 1940 and 1970 cases fluctuated between 160,000 and 800,000 a year, with an epidemic every two years. From 1970, when the measles vaccine was introduced, cases fell as coverage hovered at 50 per cent. In 1987, the year before the triple MMR vaccine was introduced, there were 86,000 cases. Coverage continued to rise, to 92 per cent, until 1998.

Why did vaccination rates fall?

In 1998, Andrew Wakefield, a researcher at the Royal Free Hospital, published with colleagues a paper in The Lancet identifying a new inflammatory bowel disease linked with autism and suggested it might be associated with the MMR vaccination. Controversy over the link has continued for eight years. The vaccination rate fell to 79 per cent in 2003 but has since risen to 83 per cent.

Is MMR safe?

More than 500 million doses of MMR have been used worldwide. The World Health Organisation says the vaccine has an outstanding safety record. Last October, a review of 31 studies of MMR published by the authoritative Cochrane Library, a collection of medical databases, concluded there were no credible grounds for questioning the jab's safety. Andrew Wakefield and his colleagues have continued to publish papers which have kept the controversy alive. The most recent study, from North Carolina and presented on a poster at a conference in the US, and which has not been peer-reviewed, reported finding the measles virus in the intestines of children with a form of autism.

Why not give parents the choice of single vaccines?

The Government has refused to provide single vaccines on the grounds that the combined MMR vaccination is given in two doses instead of six, so parents are more likely to complete the course, and there is less chance of children catching the diseases while waiting for the next jab. MMR is given in more than 100 countries and none of them recommends single vaccines. Critics such as Andrew Lansley, the Tories' health spokesman, say this is "flawed thinking".

Why is protection against mumps and rubella important?

Mumps can lead to sterility in boys. Rubella (German measles) is dangerous for pregnant women when it can cause blindness and other deformities in the unborn child. Cases of mumps rose sharply from 1,556 in 2003 to 43,322 in 2005. Cases of rubella have declined since the late 1990s to 28 in 2005.

Jeremy Laurance

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