The United Kingdom’s vaccine authorities are playing a sinister game by refusing to reintroduce the single measles, mumps and rubella vaccines. The result is that fewer children are being immunized. Because thousands of foreign travelers from every continent, many of whom are also inadequately immunized, arrive and depart the UK every day, outbreaks of measles will unquestionably occur. When they do, and they will, the popular outcry will reach new heights. The fact is that the single antigens should have never been excluded in the first place, as it is clearly stated in the UK publication “Immunization against Infectious Disease 1988” that, “For children whose parents refuse MMR vaccine, single antigen measles will be available.” (p. 60, 10.2 Recommendations, 10.2.1 Children of both sexes aged 1-2 years)

Parents in the United Kingdom have requested that the single antigen vaccines be made available again, in addition to MMR. Many are so desirous to protect their children that they are crossing the English Channel to France or paying substantial fees to obtain them in a few, supplied clinics in the United Kingdom. The authorities’ argument that these convinced and concerned parents will not return for subsequent jabs is offensive.

Lately, Dr. David Salisbury who is in charge of the immunization program in the UK has vociferously asserted that the MMR vaccine offers better protection against the individual diseases than the single antigen vaccines. Similarly, Professor Brent Taylor, head of the Department of Pediatrics and Child Health at the Royal Free and University College Medical School, stated last Sunday that, “Separate vaccines do not provide good protection for children.”  (January 14, 2001 Sunday Herald) http://www.sundayherald.com/news/newsi.hts?section=News&story_id=13747)

It is certain that the just published article by Drs. Wakefield and Montgomery will be followed by significant fall-out, and that Professor Taylor and Dr. Salisbury will  undoubtedly repeat their argument that single vaccines are somehow not as effective as the combined MMR. This is simply not true and is not supported by a review of published medical literature.

The single mumps, measles, and rubella vaccines available from Merck are exactly the same vaccine products which are combined to make MMR. In fact, before the MMR could be released initially, the manufacturer had to prove convincingly that the efficacy of the single antigens had not been impaired or diminished by combining them. Even today, vaccine developers and manufacturers are still obligated to prove that the vaccine combinations they produce are as effective as their individual components.

Historically the single antigen vaccines were most effective prior to the widespread use of the triple (MMR) vaccine. Quoting the CDC Manual “Epidemiology & Prevention of Vaccine-Preventable Diseases”, 3rd edition, January 1996:

· Following licensure of the (Measles) vaccine in 1963, the incidence of measles decreased by more than 98% and 2-3 year epidemic cycles no longer occurred. p. 92
· Following vaccine licensure (1967), reported mumps decreased rapidly. P. 105
· Following vaccine licensure in 1969, rubella incidence fell rapidly. P. 117

Only a few of these reports will be reviewed. In the specific case of Measles one finds:

Holland
A measles epidemic in an adequately vaccinated middle school population
Van Eijndhoven MJ, et al. ( Ned Tijdschr Geneeskd. 1994 Nov 26;138(48):2396-400. Dutch. PMID: 7990987; UI: 95082975.
“Thirty-three of 37 patients with clinical or laboratory criteria of measles had been vaccinated… Primary failure of the measles vaccine might be the cause of the minor epidemic…”

Finland
Explosive School-based Measles Outbreak. Intense Exposure May Have Resulted in High Risk, Even among Revaccinees
Mikko Paunio, Heikki Peltola, Martti Valle, Irja Davidkin, Martti Virtanen, and Olli P. Heinonen (University of Helsinki, Helsinki, Finland) Am J Epidemiol 1998;148:1103-10
“When siblings shared a bedroom with a measles case, a 78 percent risk (seven out of nine children) was observed among vaccinees. Vaccinated and unvaccinated students were equally able to infect their siblings. Total protection against measles might not be achievable, even among revaccinees, when children are confronted with intense exposure to measles virus.”
NOTE: Merck, the manufacturer of MMR, sponsors H. Peltola’s research

United Kingdom
Reasons for non-uptake of measles, mumps, and rubella catch up immunization in a measles epidemic and side-effects of the vaccine.
Roberts RJ, et al. BMJ. 1995 Jun 24;310(6995):1629-32. PMID: 7795447; UI: 95315783.
“Many of the objections raised by parents could be overcome by emphasizing that primary immunization does not necessarily confer immunity and that diagnosis of measles is unreliable.”

Canada
Major measles epidemic in the region of Quebec despite a 99% vaccine coverage.
Boulianne N, et al. Can J Public Health. 1991 May-Jun; 82(3):189-90. French. PMID: 1884314; UI: 91356447.
“The vaccination coverage among cases was at least 84.5%. Vaccination coverage for the total population was 99.0%. Incomplete vaccination coverage is not a valid explanation for the Quebec City measles outbreak” (1989).

Outbreak of measles in a highly vaccinated secondary school population. (Toronto)
Sutcliffe PA, et al. CMAJ. 1996 Nov 15;155(10):1407-13. PMID: 8943928; UI: 97099351.
“Eighty-seven laboratory-confirmed or clinically confirmed cases of measles were identified (for an attack rate of 7.7%). The measles vaccination rate was 94.2%”

United States
Measles outbreak in a fully immunized secondary-school population.
Gustafson TL, (1987) Lievens AW, Brunell PA, Moellenberg RG, Buttery CM, Sehulster LM. N Engl J Med 1987 Mar 26; 316(13):771-4
“We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.”

Measles Outbreak among Vaccinated High School Students-- Illinois
MMWR: June 22, 1984 / 33 (24); 349
“The outbreak involved 16 high school students, all of whom had histories of measles vaccination after 15 months of age documented in their school health records”

Measles in an Immunized School-Aged Population -- New Mexico
MMWR: February 01, 1985 / 34 (04); 052
“The school system reported that 98% of students were vaccinated against measles before the outbreak began…”

Transmission of Measles Among a Highly Vaccinated School Population -- Anchorage, Alaska, 1998
MMWR: January 08, 1999 / 47(51); 1109-1111
The 33 case-patients ranged in age from 2 to 28 years (median: 16 years). Twenty-nine case-patients had received at least one dose of measles-containing vaccine (MCV) at or after age 12 months; one person with laboratory-confirmed measles had received two appropriately spaced doses of measles-mumps-rubella vaccine (MMR). At the high school where 17 cases occurred, based on school records, only one of 2186 students had not received at least one dose of MCV before the outbreak. 49% of the students had received one dose of MCV, and 51% had received two or more doses.

Egypt
Sero-epidemiological study of measles after 15 years of compulsory vaccination in Alexandria, Egypt.
Tayil SE, et al. East Mediterr Health J. 1998 Dec;4(3):437-47. [MEDLINE record in process] PMID: 10415952; UI: 99344441.
“Approximately 80% of the children with measles had been vaccinated.”

South Africa
The 1992 measles epidemic in Cape Town – a changing epidemiological pattern.
Coetzee N, et al. S Afr Med J. 1994 Mar; 84(3):145-9. PMID: 7740350; UI: 95258851
“Immunisation coverage (at least one dose of any measles vaccine) was 91% and vaccine efficacy was estimated to be 79% (95% CI 55-90); it was highest for monovalent measles (100%) and lowest for measles-mumps-rubella (74%).”

West Africa
Measles incidence, vaccine efficacy, and mortality in two urban African areas with high vaccination coverage.
Aaby P, et al. J Infect Dis. 1990 Nov;162(5):1043-8. PMID: 2230232; UI: 91037153.
“Even though 95% of the children had measles antibodies after vaccination, vaccine efficacy was not more than 68% (95% confidence interval [CI] 39%-84%) and was unrelated to age at vaccination.”

Singapore
Resurgence of mumps in Singapore caused by the Rubini mumps virus vaccine strain
Goh, K T. Lancet Volume 354, Number 9187 16 October 1999.
”The measles, mumps, and rubella vaccine containing the highly attenuated Rubini mumps virus strain conferred no protection against acute parotitis in vaccinated children in Singapore. Its introduction into the national childhood immunisation programme has resulted in a reduction in the seroprevalence of mumps to pre-vaccination levels. Epidemiological investigations pointed to primary vaccine failure as the most likely cause for the resurgence of mumps. The seroprevalence of mumps in children less than 5 years of age was 22% in 1989, before the introduction of the MMR vaccine. It increased to 72·4% in 1993 after mumps vaccination (with the Urabe strain and Jeryl-Lynn strain) was introduced. In 1998, the seroprevalence of mumps again fell to 25·6%.”

Switzerland
Mumps epidemic in vaccinated children in West Switzerland.
Ströhle A; (1997) Eggenberger K; Steiner CA; Matter L; Germann D.
Schweiz Med Wochenschr, 1997 Jun, 127:26, 1124-33
“Since 1991, 6 years after the recommendation of universal childhood vaccination against measles, mumps, and rubella (MMR triple vaccine), Switzerland is confronted with a large number of mumps cases affecting both vaccinated and unvaccinated children. Up to 80% of the children suffering from mumps between 1991 and 1995 had previously been vaccinated …”

The incidence of rubella virus infections in Switzerland after the introduction of the MMR mass vaccination programme
European Journal of Epidemiology, vol. 11, no. 3, June 1995, pp. 305-10):
In evaluating the impact of the MMR mass vaccination program begun in Switzerland in 1985, "We conclude that MMR mass vaccination has not interrupted the circulation of rubella virus in Switzerland, and that improvements in the implementation and surveillance of the MMR vaccination campaign are necessary in order to avoid [the] untoward effects of it."

Recent scientifically based revelations, decreased national immunization rates, and the threat of measles epidemics make any further stonewalling utterly irresponsible.
More than ever before, there is an urgent need to make the single antigen measles, mumps and rubella vaccines available.

Yielding to this reasonable and popular request would represent a win-win situation. Parents may decide what is best for their child, and the reintroduction of single antigen vaccines is certain to increase vaccination uptake levels. The result will be better protection against measles, mumps and rubella.

This must be the Government’s goal.
 

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