Compulsory MMR Vaccinations

There is currently much debate in the UK on whether MMR vaccinations should be made compulsory with, as in the USA, children not being allowed to start school unless they have had the shot.

Dr Crippen recently wrote about his reservations about this.

I have one further observation - children with immuno-suppresive diseases cannot take "live" vacccinations such as MMR so Kezia would not have been able to start school. If such a measure is indeed introduced, there would have to be exceptions.

Here children just receive the single measles jab - which is why our doctor sees so many cases of mumps.

MMR Vaccine and Leukaemia

In the light of my previous two posts on take-up of the MMR vaccine and Ben Goldacre's Bad Science's spat with Jeni Barnett and the LBC radio station, I have keenly been following the on-going story. I really feel Adrian Sudbury, Josie Grove, Davo, Christian and the many others who have died of immuno-suppresive diseases would be turning in their graves - I truly hope they come back to haunt Jeni Barnett and LBC management. The degree of support Ben is receiving from both the medical and non-medical blogosphere is impressive and again I implore all my UK readers to write to their Members of Parliament to support the EDM 754 in the UK Parliament encouraging up-take of the MMR vaccine. I have already written to mine (and, as an aside, was surprised to read of his vociferous opposition in parliament to the recent Israeli activities in Gaza. but then again, being the cynical sod I am, I have to remember that many of his constituents are infidel sooties). In the light of their support for the late Adrian Sudbury's but on-going campaign to encourage education about Bone Marrow Transplantation in the last years of secondary schools,I am surprised to see that our Prime Minister, Secretary of State for Health Alan Johnson (johnsona@parliament.uk) and Secretary of State for Children, Schools and Families Ed Balls (http://www.edballs.co.uk) (after all they are all MPs - do parliamentary rules not permit cabinet members to sign EDMs?) have not signed the EDM, especially given the Department of Health's memorandum reproduced below. Many thanks to HolfordWatch in a comment on one of Ben's posts on this for bringing this official DoH memo to my attention.

Subject: Public Health Link: MEASLES - PROTECTION OF HEALTH PROFESSIONALS [NONURGENT (cascade within 48 hours)]
Importance: High

To: NHS Trusts - Medical Directors (England)
NHST/FT/007 - NHS FOUNDATION TRUSTS (ENGLAND) - MEDICAL DIRECTOR
Primary Care Trusts - Medical Directors

Cc: NHS Trust Chief Executives
NHST/FT/001 - NHS FOUNDATION TRUSTS (ENGLAND) - CHIEF EXECUTIVE
PCT Chief Executives
Public Health Link
Regional Directors of Public Health
SHA Chief Executives

From: Professor David M Salisbury CB - Immunisation Policy -
Monitoring and Surveillance - Department of Health
Date: 19 May 2008
Reference: CEM/CMO/2008/07

Category: NON URGENT (cascade within 48 hours)

Title: MEASLES - PROTECTION OF HEALTH PROFESSIONALS
-------------------------------------------------------------------------------------------

To: Medical Directors

Cc(for information only): Chief Executives of PCTs, Foundation Trusts, SHA Chief Executives, RDPHs and Public Health Link

Dear Colleague

MEASLES

I am writing to you to let you know about my concerns about protection of health staff and the risks to patients at a time when there are increasing number of cases of measles. I have recently learned of a junior doctor who whilst working on an oncology ward developed measles. The doctor had not been vaccinated.

I cannot emphasise enough the risk that measles presents to immunosuppressed individuals, particularly children. Between 1974 and 1984, of 51 children who died when in the first remission from acute lymphatic leukaemia, 15 of the deaths were due to measles or its complications. While the incidence of measles has declined since then and the coverage of measles-containing vaccine has increased, there have been about 1000 confirmed cases reported in England and Wales in the last 12 months. There are ongoing outbreaks in other European countries.

MMR vaccine cannot be given to immunosuppressed individuals, so their protection is dependent on avoiding exposure to the virus. Protection of healthcare workers, particularly those in contact with immunosuppressed patients, is an essential part of infection control in hospital and other healthcare settings. Under the Health Act 2006, specific duties are required of NHS bodies in England to control respiratory viruses including an alert system for suspect cases, isolation criteria and infection control measures. Occupational Health Services should include relevant immunisations (see http://www.dh.gov.uk/en/Publicationsand ... /DH_081927).

In light of the above incident, I am writing to advise you of the importance of ensuring that staff working with immunosuppressed individuals are protected against measles – for the benefit of their patients and themselves. Advice is available in the chapter on measles in the book “Immunisation against Infectious Disease” (see: http://www.dh.gov.uk/en/Publichealth/He ... DH_4097254).

Unless the relevant staff can provide written evidence of having received two doses of MMR or laboratory evidence of immunity to measles, I strongly recommend you ensure all staff in contact with of immunosuppressed patients or paediatric patients are given MMR vaccine. If a staff member is unable to have the vaccine for any reason, you will need to consider the potential risk to patients.

Yours sincerely

Professor DAVID SALISBURY CB, FRCP, FRCPH, FFPH Director of Immunisation This document has been authorised by the Department of Health: Gateway reference no: 9949

P.S.  ... I forgot to curse another person as well. Dr Andrew Wakefield. 

In the News

Perhaps the most important health news we have come across today is that the vaccine for the human papillomavirus (HPV) that causes cervical cancer has been approved for use in the U.K. by the Joint Committee on Vaccination and Immunisation (JCVI). Department of Health press release here. BBC report here. The Scottish Executive has said it will implement vaccinations of all 12 and 13 year old girls as soon as possible (probably late 2008) but, typically, England is dragging its feet and the government wants an independent cost-effectiveness study before it will (or will not) implement a vaccination programme.

So here are some UK statistics for you culled from the web. I won't vouch for their accuracy but they are approximately correct.

Female population: 30.7 million
Females 12-13 years: c. 380,000
No. of new cases of cervical cancer per annum: 2800
No. of deaths from cervical cancer per annum: 1120
Cost of treatment per case: £2150
Cost of treatment all cases per annum: £6.02 million
Cost of annual pap smear: £12.50
Cost of vaccine: £250
No. of cases prevented by the vaccine: 70% - 1960
Cost of all treatment all cases per annum with a vaccination programme: £1.8 million (saving 4.2 million)

Make up your own mind.

In other news, a reminder that it is not just the high profile tropical diseases that kill in the developing world. An outbreak of measles in northern Nigeria has killed at least 20 children with at least 400 infected.

Staying in Nigeria, its government is suing the multinational pharmaceutical company Pfizer for deaths and disabilities caused by the 1996 trial of the meningitis treatment drug Trovan. The company claims that all participants in the trial gave verbal consent and it was acting according to Nigerian regulations. Even if it was, purely verbal consent would not be considered ethical here. Report here.

We have posted before on the importance of biodiversity to the development of new drugs and treatments. Now the drug Trabectadin, developed from a sea squirt, has been shown to control the cancer myoxid liposarcoma.

And finally, the search for a treatment for river blindness, which is thought to effect 18 million people in Africa, is documented in pictures here.