Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study

Uptake rates for the combined measles, mumps and rubella (MMR) vaccine continue to suffer ten years on from when the alleged link with childhood autism were first raised.1,2 The role of the mass media in generating and sustaining this controversy should not overlooked as their reporting can leave parents confused and concerned.3,4

A local audit was carried out by the paediatric department of a district hospital in South Yorkshire using a simple questionnaire survey of mothers on the postnatal wards between November 18, 2002 and December 20, 2002. The aim of the questionnaire was to examine the sources of information used. There were 78 respondents with an average age of 27.7 years. The respondents were almost all of white ethnicity and native English speakers(76/78). 9% of women had university education, 42% ‘A’ levels and 45% had completed secondary education. The number of first time mothers compared to mothers with older children was roughly equal.

61% of mothers reported using their GP or health visitor as their main sources of information. 56% also used mass media sources such as newspapers, magazines, television and radio for information, but less than 3% used the internet. The mothers were then asked to rank the reliability of their information. 98.5% thought their GP/Health Visitors were a reliable source of information. Interestingly, the mothers regarded newspapers and magazines (67%) and TV and Radio programmes (78%) as reliable information sources too. Although the majority of respondents rated their GP as a more reliable source of information, a quarter of respondents rated the reliability of their GP as sources of information comparable with the media.

Although this was a small survey which probably reflected local awareness and views of immunization issues, it was noteworthy to find that the mass media was used by a large proportion of mothers as an information source and regarded as a reliable source of information. This is worrying in the light of a study by Speers and Lewis conducted in 2002 that found media reporting of the controversy to be biased against the MMR. In particular, they noted that ‘the media’s scrutiny of those supporting MMR was not matched by a rigorous examination of the case against it, and that the public was, as a consequence, often misinformed about the level of risk involved.’3 Information from the media has also been identified in another study as a key factor influencing parents’ decisions.4 The danger of misinformation is very real and parent may lack the health literacy required to critically appraise what is published by the mass media.

Despite government attempts to reassure parents of the safety of the vaccine, some parents remain unconvinced, believing politicians to be ‘untrustworthy’ in health matters.5 Health providers too are not always believed. Some parents question their general practitioners’ objectivity especially as financial motives are seen as a driver for vaccination.4,4 Furthermore, in the early days, more credence was given to Andrew Wakefield who they felt was an ‘important whistle-blower and champion of ordinary parents’. In this survey, of the mothers who had older children immunized with MMR, a large proportion (41%) remained unsure as to the safety of the immunisation.

There remains some persisting parental uncertainty regarding the safety of the MMR vaccine. It is understandably distressing for parents who receive conflicting advice from their health professionals and anecdotal ‘scare stories’ in the media. The role and influence of the media cannot be understated and there is a case for demanding more responsible and accurate media reporting. More work too needs to be done to find ways of counteracting negative media reporting.

References

1. Pearce A, Law C, Elliman D, Cole TJ, Bedford H. Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study. BMJ 2008;336:754-757 (5 April)

2. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lympoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children. Lancet 1998; 351: 637-41.

3. Speers T, Lewis J. Journalists and jabs: media coverage of the MMR vaccine. Commun Med 2004; 1(2): 171-81.

4. Evans M, Stoddart H, Condon L, Freeman E, Grizzell M, Mullen R. Parents’ perspectives on the MMR immunization: a focus group study. Br J Gen Pract 2001; 51(472):904-10.

5. Hilton S, Petticrew M, Hunt K. Parents’ champions vs. vested interests: who do parents belieave about MMR? A qualitative study. BMC Public Health 2007 (epub); 7:42.

Competing interests: None declared

There is a simple way to increase vaccine uptake: identify the cause of regressive autism. When it is found that vaccinations don't cause autism people will flock to the clinics. The biological disorders have been ignored -- except for colitis. Using an anecdotal report on sleep apnea and colitis may suggest a different approach.

On the Internet, anecdotes reported that treating sleep apnea also treated reflux, colitis and irritable bowl syndrome. The obvious conclusion is something about the apnea causes colitis and perhaps Crohn's.

When an apnea occurs the airway is blocked and there is no exchange of of air between the lungs and the atmosphere. The brain needs oxygen to survive intact. During the apnea the diaphragm makes multiple attempts at increased effort to overcome the obstruction. (1) In trying to open the airway the diaphragm "pounds the living daylights" out of the intestines, pancreas, kidneys and who knows what else?

If the handling of the intestines during abdominal surgery causes the digestive tract to malfunction for a few days, one should not be surprised that the nightly self flagellation due to sleep apnea does not allow the the injured organs to recover from the injuries.

The nocturnal aspect of colitis is reinforced by a paper on "Gastrointestinal problems in diabetes" which informs the reader "Diarrhea can occur at any time but often is nocturnal".(2) Nocturnal diarrhea is consistent with the body interpreting the pressure during the apnea as a desire to evacuate the bowels.

Reichmuth concluded that sleep apnea is an independent factor in diabetes. (3) The diaphragm is not selective, all it wants is to eliminate the obstruction. The high levels of uric acid in autistic children suggests the diaphragm injures the kidneys.

The patient profile for sleep apnea is older overweight men and women after menopause the same as the profile for gout. Children should not have gout.

Why do the children have gout and sleep apnea? The environment has changed!! Bottle feeding and vaccinations are the changes.

Bottle feeding changes the shape of the skull Bottle feeding predisposes the child to develop sleep apnea because the muscles used are different from those used in breast feeding altering the skull shape. (4)

Nasal congestion can initiate or exacerbate sleep apnea. Upper respiratory viral infections can cause nasal congestion. (5) Both MMR and DpT vaccines contain upper respiratory viral infections.

MMR and DpT can cause regressive autism. The hypothesis fails.

Recommendations that children should be vaccinated with MMR and DpT are irresponsible.

An Internet search for "more regressive autism" leads to further information.

1 Guilleminault, C (1985) Obstructive sleep apnea: the clinical syndrome and historical perspective. Med Clin North Am 69,1187-1203

2 Camilleri M. Gastrointestinal problems in diabetes. Endocrinol Metab Clin North Am. 1996 Jun;25(2):361-78

3. Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of Sleep Apnea and Type II Diabetes: A Population-based Study. Am J Respir Crit Care Med. 2005 Sep 28

4 Palmer B. Breastfeeding: Reducing the risk for obstructive sleep apnea. Breastfeeding Abstracts, 1999 February; 18(3):19-20. (On Internet) http://www.brianpalmerdds.com/bfing_reduces.htm

5. Corey JP, Houser SM, Ng BA. Nasal congestion: a review of its etiology, evaluation, and treatment. Ear Nose Throat J. 2000 Sep;79(9):690 -3, 696, 698 passim.

Competing interests: None declared