Measles—a minor childhood illness?BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7317.875 (Published 13 October 2001) Cite this as: BMJ 2001;323:875
Several weeks ago, the BBC Radio 4 phone-in programme You and Yours tackled the subject of the MMR (measles, mumps, and rubella) vaccine. David Elliman, consultant in community child health at St George's Hospital, London, and author of a BMJ editorial on MMR (BMJ 2001;322:183-4), was in the studio. There were calls from parents saying that their children had developed autism after having the MMR vaccine, and others from parents who firmly believed that the single vaccine was the way forward. Then a woman rang in to say that she had had measles at the age of 5 and it wasn't such an innocuous disease. She had been deaf ever since. Finally, there was the mother who called to say that her child, who had had the MMR vaccine, was autistic; she believed that the two were completely unconnected.
Measles is not a trivial illness. If you're unlucky, like Adam, it may take away your life
I tried to get through to tell them about Adam, but the lines were engaged. Adam was 1 year old when he contracted measles. He had been due to have his MMR two months later. He was very ill with measles, but he seemed to recover. He went on to be a normal, happy little boy. He was the second child in a family of four children. Suddenly, when he was 12, his schoolwork deteriorated, he became uncoordinated, and it was clear that something was wrong. He was referred to the paediatrician. Did he have a brain tumour? The scans were done, then the EEG. He didn't have a brain tumour, he had subacute sclerosing panencephalitis (SSPE). One in a million children in the United Kingdom develop SSPE. It's a revolting sequela of measles. The measles virus invades the neurological system and its effects are manifest several years later. The child's motor and intellectual functions degenerate, and he or she needs to be fed, becomes confined to a wheelchair, and finally enters a permanent vegetative state from which he or she never recovers.
This is what happened to Adam, my nephew. He's now 20, he's cared for at home by my sister and her family, and his condition, after the initial rapid decline, is stable. He can probably smell, he probably recognises the voices of his immediate family, and that's just about it.
He's also a well built young man, six feet tall. Too heavy now, of course, to be lifted around by my sister and brother in law. A hoist helps when he has to be moved, but it is hard physical work to care for him. He is fed via a gastrostomy. He wears the clothes that his peers wear. The illness did not affect his puberty. He needs to be shaved and he's had acne. His need for personal privacy and dignity is even greater. Because of the quality of the care he has received, he has been free of the intercurrent infections that his complete immobility might have brought. He has already outlived the original prognosis and his life expectancy may now extend further than was ever imagined. His elder sister graduated from university in July and his younger sister has just started at university. His younger brother, who was 11/2 years old when Adam got sick, has no memory of him well. He sometimes refers to him as “my brother who sleeps all the time.”
When my sister and brother in law first received the diagnosis, they said that the challenge they had set themselves was that, despite Adam's illness, the family was going to remain a happy one, that Adam's illness was, in some way, going to contribute to it. They have met that challenge. When you walk into the family home, Adam is there, lying on his bed in the heart of the home, being acknowledged by everyone who walks by. Everyone who meets him learns something about themselves, about living.
Measles is not a trivial illness. It's not just something that gives you a fever and spots. It may be. Or, if you're unlucky, like Adam, it may take away your life.
Patients have the right, of course to all the facts available about any procedure that is being offered to their child, including MMR. My sister acknowledges that, if she were being offered the vaccination for another child now, she would still want to be given up to date information on which to base her decision. That information should, however, include the rare, but real, risk of a sinister complication like SSPE.
When, as a general practitioner, I discuss with patients the pros and cons of MMR immunisation, it sometimes occurs to me to tell them about Adam. I don't, of course, because it's too personal. But when I listened to some of the callers to You and Yours suggesting that MMR was a dangerous immunisation being forced on them by insensitive doctors, I wanted to say, “Walk into my sister's house, say hello to Adam, and then make your decision.”
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