Measles cases at highest point since 2006 as outbreaks continue to spread
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5141 (Published 13 August 2019) Cite this as: BMJ 2019;366:l5141
All rapid responses
In my letter just posted [1] I also intended to cite Jacqui Wise's report 'MMR vaccine: Johnson urges new impetus to increase uptake as UK loses measles-free status' [2]. Politicians need to understand the limitations of the data they are shown and they also need to have regard for citizens' legal rights, whether over informed consent or to speak their mind in public over medical treatment. Only last month outside No. 10 after all, if memory serves, Boris Johnson was affirming his government's commitment to free speech!
[1] John Stone, 'Re: Measles cases at highest point since 2006 as outbreaks continue to spread', https://www.bmj.com/content/366/bmj.l5141/rr-1
[2] Jacqui Wise, 'MMR vaccine: Johnson urges new impetus to increase uptake as UK loses measles-free status', BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5219 (Published 20 August 2019)
Competing interests: No competing interests
I read the letter of Jessica Omassoli and her fellow students [1] with interest, but I wonder whether trust in the medical profession is not also dependent on listening to patients or their families if something goes wrong with a prescribed medical product -and despite the assurances of medical professionals manifestly things can go wrong even on the basis of what we can read from package inserts [2], which under the provisions of the Montgomery ruling should be made known before being administered [3]. Given that the Montgomery ruling was only in 2015 I am not sure that concept of informed consent is that outdated. I also wonder about the scientific soundness of extrapolating from the case of Andrew Wakefield - even supposing he had a fair hearing [4].
Meanwhile, I am bemused by the government/media narrative that the United Kingdom has meaningfully lost some pristine status conferred on it by the World Health Organisation [5]. If we look at government data confirmed measles cases in 2017 and 2018 (284, 991) were higher than in 2014 and 15 (122, 92) [6]. In the case of 2018 I detected an anomaly in the data which still has to be explained [7], and I can only repeat my recent criticism of the apparent lack of control in the WHO's global data (which remains undefended) [8].
There is also very considerable doubt whether even 100% uptake could eradicate measles due to waning vaccine effectiveness, well documented [9].
[1] Jessica A Omassoli, Amber Jennifer Sara Moore, Charlotte Rachel Valentine, Katherine Joanne Lewis, 'Re: Measles cases at highest point since 2006 as outbreaks continue to spread', 22 August 2019, https://www.bmj.com/content/366/bmj.l5141/rr-0
[2] John Stone, 'Re: NHS chief attacks anti-vax “fake news” for falling uptake', 2 April 2019, https://www.bmj.com/content/364/bmj.l1000/rr-8
[3] Noel Thomas, 'Re: NHS chief attacks anti-vax “fake news” for falling uptake', 6 March 2019, https://www.bmj.com/content/364/bmj.l1000/rr-0
[4] John Stone, 'Re: A tale of two vaccines and the "spectre of Andrew Wakefield", 22 October 2018, https://www.bmj.com/content/363/bmj.k4152/rr-22
[5] Elisabeth Mahase, 'Measles cases at highest point since 2006 as outbreaks continue to spread'
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5141 (Published 13 August 2019)
[6] 'Research and analysis :Confirmed cases of measles, mumps and rubella in England and Wales: 1996 to 2018
Updated 22 July 2019', Public Health England, https://www.gov.uk/government/publications/measles-confirmed-cases/confi...
[7] John Stone, 'Re: Measles: Europe sees record number of cases and 37 deaths so far this year' 11 September 2018, https://www.bmj.com/content/362/bmj.k3596/rr-29
[8] John Stone, 'What controls are there on this data?', 15 August 2019, https://www.bmj.com/content/366/bmj.l5141/rr
[9] John Stone, 'Measles vaccination has substituted one problem for another', 20 June 2019, https://www.bmj.com/content/365/bmj.l2359/rr-19
Competing interests: No competing interests
Dear Editor,
As a medical student at Imperial College London I have recently undergone my paediatrics rotation. Incidentally this coincided with the most recent measles outbreak in London (April-May) [1]. Throughout my placement the paediatricians emphasised the importance of determining whether the child was ‘up to date with his/her vaccinations’. In cases where the child’s vaccines were not up to date, the main reason given was due to a fear in the side effects of the vaccine.
Interestingly this is supported by a recent report from the Royal Society for Public Health (RSPH) [2], which consistently found the fear of vaccine side effects to be the primary reason for choosing not to vaccinate. It revealed that social media is the main factor propagating all these negative connotations about vaccines, with 41% of parents being exposed to negative messages concerning vaccination [2]. More worryingly, a lot of the information being spread on social media is inaccurate. For example, it is 21 years since Andrew Wakefield published his infamous and now widely discredited paper on the alleged link between the MMR vaccine and autism, and yet the ramifications of this are ongoing in Europe. The above report on vaccine uptake also showed that the trust in healthcare professionals remains very high, with doctors and nurses consistently identified to be a valued source of information about vaccinations [2].
Therefore, the findings of the above report together with my personal experience in hospitals, suggest that the main barrier towards vaccinations is social media spread of misinformation as opposed to ‘incredulity and hostility towards doctors’. The increasing popularity of social media may make this issue more problematic in the future, thus emphasising the importance of focussing efforts to stem false information.
References
[1] Matthews-King A. Measles outbreak: Public health warning over ‘significant increase’ in cases at schools in central and west London. Independent. [Online] 2019.
Available from: https://www.independent.co.uk/news/health/measles-outbreak-london-vaccin...
[2] RSPH. Moving the needle. [Online] 2019.
Available from: https://www.rsph.org.uk/uploads/assets/uploaded/3b82db00-a7ef-494c-85451...
Competing interests: No competing interests
Under an earlier report [1] I posed questions about how the World Health Organisation compiles its measles data [2,3]. Of what we were being told how many cases were merely reported, how many confirmed, how many just projections, how much of the trend was an artefact of looking for cases?
It may be noted that no one replied to me apart from a further polite enquiry from Dr Anand [4]. And now we have another report of what the WHO says [5] but it is information which is currently impossible to assess for the reasons already outlined, and coincidentally in the same year as the WHO named "vaccine hesitancy" as a "threat" to global health [6].
[1] Elisabeth Mahase, 'Measles cases rise 300% globally in first few months of 2019',
BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1810 (Published 16 April 2019)
[2] John Stone, 'Re: Measles cases rise 300% globally in first few months of 2019 - how long is a piece of string?', 17 April 2019, https://www.bmj.com/content/365/bmj.l1810/rr
[3] John Stone, 'Re: Measles cases rise 300% globally in first few months of 2019', 23 April 2019,
https://www.bmj.com/content/365/bmj.l1810/rr-3
[4] JK Anand, 'Re: Measles cases rise 300% globally in first few months of 2019. Ms Mahase’s report', 17 April 2019, https://www.bmj.com/content/365/bmj.l1810/rr-1
[5] Elisabeth Mahase, 'Measles cases at highest point since 2006 as outbreaks continue to spread'
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5141 (Published 13 August 2019)
[6] https://www.who.int/emergencies/ten-threats-to-global-health-in-2019
Competing interests: No competing interests
Government publishes two sets of measles data
Following my recent letters [1] I have been comparing two sets of measles data published by Public Health England: the data in the table published under the title "Measles notifications and confirmed cases by oral fluid testing 2013 to 2019" and those published in separate documents under the title "Measles, mumps and rubella: laboratory confirmed cases in England". Here are the figures for comparison from the respective sources for the four quarters of the five years 2014 to 2018:
2014
Q1 69/70
Q2 11/16
Q3 8/11
Q4 5/4
2015
Q1 18/20
Q2 16/33
Q3 13/15
Q4 12/23
2016
Q1: 36/67
Q2: 117/167
Q3 137/243
Q4 28/37
2017
Q1 18/17
Q2 42/64
Q3 22/36
Q4 42/149
2018
Q1 91/265
Q2 359/421
Q3 67/143
Q4 94/97
These figures are sometimes close, but sometimes vary wildly and there are 700 more cases in one set of data than the other (approx 1900 cases versus 1200), mostly in the last three years. Some clarification would be welcome.
[1] John Stone, 'Re: Measles cases at highest point since 2006 as outbreaks continue to spread', 23 August 2019, https://www.bmj.com/content/366/bmj.l5141/rr-1
[2] https://www.gov.uk/government/publications/measles-confirmed-cases/measl...
{3] https://www.gov.uk/government/publications/measles-mumps-and-rubella-lab...
[4] https://www.gov.uk/government/publications/measles-mumps-and-rubella-lab...
[5] https://www.gov.uk/government/publications/measles-mumps-and-rubella-lab...
[6] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
[7] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
[8] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
[9] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
[10] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
[11] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
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[18] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
[19] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
[20] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
[21] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
[22] https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
Competing interests: No competing interests