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The MMR immunisations

There has been a high profile debate about the use of the MMR immunisation, which protects children from measles, mumps and rubella. Parents concerns have led to a decrease in the uptake of the MMR immunisation, which in turn has led to an increased risk of these diseases becoming more prevalent within our society. So what are the risks and advantages of the MMR jab?

What does MMR protect against?

• MMR is a three-in-one combination vaccine which offers children protection against measles, mumps and rubella (German measles).
• Measles can cause pneumonia, fits, encephalitis (inflammation of the brain) and brain abnormality that can lead to mental deterioration, coma and death.
• Mumps can cause meningitis, encephalitis, deafness and, in boys, sterility.
• Rubella is usually a relatively minor illness. However, if a pregnant woman is infected during the early part of pregnancy, it can cause problems in the unborn child including heart damage, blindness, deafness and damage to the brain.
• The reason children are now immunised is that although most children can have these diseases without lasting consequences, each one can be unpleasant and potentially serious.
• Few Irish people under the age of 30 will have seen a case of measles, so won’t realise how unpleasant these illnesses can be.

When is the MMR vaccine given?

MMR is routinely given by the GP between 12-15 months of age. A second dose is usually required as part of the school entry programme at 4-5 years or in 6th class in primary school.

A single dose of the MMR vaccine gives 90% protection against measles and mumps and 95% against rubella. This means that out of 100 people given the vaccine, 90 will then be immune to measles and mumps, and 95 to rubella. Adding a second dose increases the protection to over 99%.

How does the MMR vaccine work?

The combined MMR vaccine protects children against measles, mumps and rubella.

It works by causing the immune system to respond to small amounts of the viruses contained in the vaccination injection, meaning that if the body experiences the disease again it will already have developed immunity.

Can all children receive the MMR vaccination?

• Children who are taking drugs that suppress the immune system, or high dose steroids, or who have illnesses like cancer should not take the MMR vaccine.
• Those with a history of allergic reactions to the drugs neomycin or kanamycin should also avoid the MMR injection.
• It had been thought that children with egg allergies were at risk from the vaccine, but evidence now shows that it is safe to give them the MMR vaccine.
• If your child has received another live vaccine within the previous three weeks or an immunoglobulin injection within the last three months, vaccination should be delayed.
• If your child has a fever, then vaccination should also be delayed.
• If you have any concerns at all about how your child will react to the vaccine talk to your GP or public health nurse, who may consider immunising your child in a hospital under close observation.

Why is the safety of MMR questioned?

A study published by Dr Andrew Wakefield at the Royal Free Hospital, London, in 1996 suggested that there may be a link between the MMR vaccine and the conditions of autism and inflammatory bowel disease in children.

Another concern is whether or not a child’s immune system can cope with three vaccinations given in one injection. Those opposed to the MMR vaccination suggest giving the component vaccinations separately.

What does the evidence now tell us?

An independent review commissioned by the WHO (World Health Organisation) and carried out by the Global Advisory Committee on Vaccine Safety concluded there’s no evidence that the MMR causes either autism or autistic disorders.

Independent and scientific experts agree that there is no proven causal link between the MMR combination vaccine and either autism or inflammatory bowel disease (also known as Crohn’s disease)

Although some people point to the rise in the cases of autism in the past twenty years since the MMR injection has been given, this is probably due to better diagnosis of the condition. Autism tends to become apparent at around one year of age, which is also the time that MMR injections start, again leading some to see a link between the two.

It’s also been found that there’s no evidence to support the suggestion that a child’s immune system cannot cope with three immunisations at once. In fact, MMR appears to be superior to the single vaccines for a number of reasons:

• Using separate vaccines would undoubtedly mean that fewer children would receive all the necessary vaccinations, increasing the risk of these diseases returning.
• Having separate vaccines means that a certain amount of time has to elapse between each dose leaving the child vulnerable to infection while they wait for the next dose.
• Three times as many injections can be unpleasant for the child and inconvenient for parents.

The use of MMR in Southern Ireland

• Recent figures show a relatively low uptake of MMR in Southern Ireland, which has resulted in 1,220 cases of measles and three deaths.
• It’s also worth mentioning that currently thirty three European countries, plus Canada, Australia, New Zealand and the USA, all use the combined MMR vaccine.
• MMR is used in over 90 countries, and more than 500 million doses have been given.
• No country recommends single rather than combined vaccines.

How to obtain the MMR vaccination for your child

The MMR vaccination is available free of charge for children from your GP, as a part of the Republic of Ireland’s Primary Childhood Immunisation Programme. Parents are advised to discuss any concerns they may have with their GP or their public health nurse before making a final decision about their child’s immunisation.