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Largest group of children affected by measles outbreak in Wales is 10-18 year olds

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2545 (Published 19 April 2013) Cite this as: BMJ 2013;346:f2545

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Re: Largest group of children affected by measles outbreak in Wales is 10-18 year olds

The news that a man of 25 has died with (but not necessarily of) measles in Swansea is surprising and of possible public health concern. Fatal measles has been very rare in this country for decades, and when it did occur here or elsewhere it was much more likely be among young children. Lest other young adults become alarmed, it is important that further medical details are released soon. Targetting 10 to 18 year olds for a special immunisation campaign would not have included that unfortunate individual, though he could have been among the first group of British children given MMR. Perhaps he was.
Children given MMR in the later 1980s and early 1990s would have been given a vaccine which had already been withdrawn from Canada; and a similar vaccine had allegedly caused at least one death in Japan. It was introduced in the UK despite this knowledge and some serious scientific concerns, although more expensive products with a better safety profile were already available. The known adverse effects were aseptic meningitis and encephalopathy, usually presenting as febrile convulsions, and in 1992 the DOH replaced it.
Jacqui Wise's article does not say how abrupt the fall in MMR uptake was between 1995 and 2003, but the notorious and ill-advised Wakefield press conference, and the resulting media ballyhoo, which are variously blamed for the disappointing results of the DOH vaccination programme, did not take place until 1998. By then, the adverse reactions to the early MMR vaccine would have been widely known among the parents of young infants, some of whom refused to have their babies immunised, and ever since then the DOH has had an uphill struggle to get its message across.
Hindsight is only useful if lessons are learned. We should not insult the intelligence of the public by covering up mistakes. We should acknowledge that just like other medical agents, all known vaccines, from BCG to Varicella, may have unexpected adverse effects in rare, vulnerable persons. Public health policy balances the risks to the few against the great benefits for the many. However, it is incumbent on public health authorities to ensure that only products with the very highest safety profiles are employed.

Competing interests: No competing interests

21 April 2013
John A. DODGE
Retired Professor of Child health
Queen's University Belfast and Swansea University
Big Wood Barn, Gwehelog, Usk, Monmouthshire NP15 1RD