BMJ  2005;330 (14 May), doi:10.1136/bmj.330.7500.0-f

Editor's choice

Think mumps

Social historians will have a field day with recent vaccine scares. Evidence that a vaccine works and is safe should be universal, but antivaccine campaigns seem to take on a peculiarly local flavour. In the 1970s, concerns that whooping cough vaccine caused neurological damage were largely a British affair. In the 1990s, worries that hepatitis B vaccine caused multiple sclerosis mainly played out in France. The suggested link between MMR, autism, and inflammatory bowel disease echoed in the US but remained most potent in the UK (p 1120). Rather than illustrating cultural peculiarities, these episodes may show that mass vaccination programmes raise people's awareness of potential risks—something governments must take into account when planning future schemes.

WHO's highly successful global polio eradication programme is the latest victim of localised antivaccine activism. Two years ago, Nigerian Muslims boycotted polio vaccination after local imams claimed that the vaccine was part of a US plot to spread AIDS or infertility in the Islamic world. The boycott was followed by a large outbreak of polio in Nigeria and surrounding countries. Now there are reports of the same strain of polio causing paralysis in children in Yemen and Indonesia (p 1106).

A campaign linking autism to vaccines containing the mercury based preservative thiomersal is currently playing out in the US, and Michael Fitzpatrick (p 1154) is in no doubt as to who are its real victims. Firstly, the parent activists themselves, vulnerable to the machinations of legal and medical charlatans peddling hopes of substantial damages and miracle cures. Secondly, parents and doctors who are made to feel uncertain, guilty, and intimidated for vaccinating their own and other people's children. And finally, most importantly, the children and adults suffering the consequences of what are entirely preventable diseases.

Ironically the current epidemic of mumps in the UK is proof, say Emma Savage and colleagues, of the success rather than the failure of the UK's vaccination policy (p 1119). Most cases in 2004 were in 19-23 year olds—young adults who were not exposed to mumps as children (because of the dramatic fall in rates of natural infection after the MMR vaccine was introduced in 1988) and who for various reasons didn't receive the recommended two doses of MMR vaccine.

As a result of the vaccine's success, few UK doctors who qualified in the past 15 years will ever have seen a case of mumps. With nearly 5000 cases reported in January this year alone, this could be about to change, so the clinical review by Gupta and colleagues (p 1132) may prove useful. Its take home messages are that mumps should now be part of the differential diagnosis for a range of conditions, clinical diagnosis is not always possible, specific IgM antibody in saliva is a good diagnostic test, there is no antiviral treatment or post-exposure prophylaxis, infected people should be isolated and susceptible people vaccinated, and all children and young adults should have had two doses of MMR vaccine.