More information about text formats
I have provided an opportunity for a large number of children (approx 2000) to have their MMR vaccination using Monovalent vaccines. These vaccines are of THE SAME dose and strain that the recipients of combined MMR get in the UK.
There are existing import regulations supervised by the
Medicines Control Agency (MCA) which allow importation to meet "special needs". If this did not exist then it would be a...
There are existing import regulations supervised by the
Medicines Control Agency (MCA) which allow importation to meet "special needs". If this did not exist then it would be almost impossible for parents to access this option without drifting abroad. They would have no problem getting Schwarz strain Measles in France. However, if they did return for any of the other two, they would almost certainly end up with Urabe strain Mumps. Urabe is still produced by a number of maufacturers worldwide and although perhaps more antigenic, it is associated with a risk of Mumps-related Aseptic Meningitis (1 in 10000).
At least the current MCA legislation makes it a lot easier to achieve uptake of all three components if a child would otherwise remain unvaccinated. The vast majority of children we have dealt with have had dose intervals of 6 to 8 weeks and nearly all have completed the whole course. The need for a second MMR exposure is also highlighted at the last visit.
Elliman and Bedford refer to their concern about Urabe. Surely the simplest way to allay this would be to remove MCA approval for this strain? (As they have already done for Rubini). We ONLY use Jeryl-Lynn strain Mumps from Merck in
the USA. I was supplied with some Urabe strain from Pasteur-Merieux in France when I first started doing this 18 months ago.
Many of the parents we see have existing
children/friends/relatives/neighbours with reported Autism and other disorders. They are alarmed to hear that the incidence of Autism appears to be rising and may now affect more than 1 in 200 children. GPs and Health Visitors up and down the country are unable to tell them why this is so. Some of the other children we see were Premature/assisted
conception/or have other ongoing problems eg. recurrent febrile convulsions. Therefore, media stories or not, "comprehensive overviews" or not, there are a growing number of worried parents in the UK and "shouting" at them will not generate the desired response (as with parenting).
Only a small number of these parents can afford to go to Private GPs. Therefore, it is hardly surprising that we are faced with an increasing number of unprotected children in the community. They are the children we should be reaching out to. Scapegoating the parents and doctors who dabble
in the fringes is misplaced (as long as identical doses and strains are used, the option is a last resort, and "informed consent/informed choice" is ensured as far as is practically possible). How should we deal with the mother who is utterly convinced that an existing child was harmed by a previous vaccination and she refuses combined MMR for her new baby?
If she agrees to single vaccines - as long as she is informed that there is
no evidence to support that this option will reduce any risk (even if it did exist) - how can this be regarded as unreasonable care for that child?
parents of Autistic children have already had an uneasy relationship with
doctors and other professionals during the distressing journey of
diagnosis and getting appropriate learning and psychological support for
In my opinion, we should applaude their desire to come forward, despite
A solution? One step forward would be to tighten up the MCA regulations to
ensure that imported vaccines are of the standard described. In addition,
changes should be introduced IMMEDIATELY which make it easier for NHS GPs
to access this option for resistant parents, without treading uncertain
water in terms of licensing/medical defence indemnity issues etc. It takes
8-10 weeks for a parent to get their first vaccination if they send for
our information pack (largely due to MCA importation controls). The pack
contains detailed advice about the benefits of vaccination and much of it
is from the Department of Health (DOH). I would also like to include a copy of the
excellent report by Elliman and Bedford.
These parents are determined and
they are more likely to perceive each "barrier" as being another tool in
some kind of "cover up". The decision of some areas to block NHS GP access
to licensed Rubella Vaccine is a good example of antagonism. The lack of
public confidence in authority is well and truly with us (it's not our
fault) and I would urge the DOH/Public Health services to reconsider their
approach to this complex problem before innocent children suffer in a
Measles outbreak. The NHS GP should be able to access selected monovalent
vaccines for certain children. Parents should not have to feel that
paying money or doing nothing are their best options. Combined with
another push to confirm the overwhelming balance of medical and scientific
opinion in favour of combined MMR, this more pragmatic approach would be
most welcome. A sound understanding of the changing epidemiology of
Autistic Disorder would also do much to win back consumer confidence.
Nevertheless, this knowledge is probably not forthcoming and so
strengthens the case for other interim action.
The worries may be "not justified", but they remain. Solving this problem
demands listening to people as much as it does preaching the evidence-
base. This concept is all to familiar with GPs. Why can't their Public
Health colleagues offer them some respite or support?
Dr Peter Copp