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Dispatches. MMR: What They Didn't Tell You

BMJ 2004; 329 doi: (Published 25 November 2004) Cite this as: BMJ 2004;329:1293

Rapid Response:

The MMR and Single Measles, Mumps and Rubella Vaccines: The REAL Facts

In her review “Dispatches. MMR: What They Didn't Tell You” and
referring to Andrew Wakefield, Dr. A. Berger, Associate Editor of the
BMJ, stated: “In one fell swoop he had undermined the MMR vaccination
programme in the United Kingdom, and subsequently around the world.”

For the record, here are the REAL facts about the subject:

1. Andrew Wakefield never said that children should not be vaccinated
and protected against measles, mumps and rubella.

2. Andrew Wakefield never said that the MMR vaccine should not be

3. Andrew Wakefield only suggested that the monovalent vaccines
against measles, mumps and rubella be made available alongside the MMR.

4. Wakefield not only notified the Department of Health of the above
in writing but also repeated it at a private meeting that was held in
October 1997 with the then Health Minister, Tessa Jowell and in the
presence of the Chief Medical Officer, Sir Kenneth Calman, Dr. David
Salisbury and others.

5. The UK had a single dose measles vaccine program since 1967. The
single rubella and mumps vaccines became available in the early seventies.
The MMR vaccine was introduced in 1988. When parents started requesting
the monovalent vaccines in increasing numbers, the DOH decided in August
1998 to withdraw their license. Those who could afford it crossed the
Channel to get their children vaccinated or purchased the single vaccines
at private clinics.

6. The single vaccines have always been licensed and available in The
United States and most other countries.

7. If the DOH had agreed to make the MMR and the single vaccines
available in the UK, the vaccination rates and the immunity against all
three diseases would have been remarkably better than they are.

8. The DOH did not have to endorse Wakefield’s recommendation for a
one-year interval between single vaccines and could have opted for the 3
month interval-routine recommended in the US pre-MMR. The argument raised
by the UK Medical Authorities that they could not support such a schedule
“because it had not been offered that way before” is frivolous. In fact
the DOH had previously recommended the administration of an MMR booster
three months after a primary vaccination at 12 months of age.

9. Starting in 1998, if the monovalent measles, mumps and rubella
vaccines had been made available and had been administered a whole year
apart to those children who were not getting the MMR anyway, most if not
all the children in the UK would have been, by now, protected against all
three diseases.

10. In November 1994, because of dropping vaccination rates, the DOH
embarked on a mass vaccination campaign of school-age children and over
seven million doses of Measles-Rubella (MR) vaccine were administered in a
short period of time. Although the DOH had strongly reassured parents that
serious adverse events were unlikely because most children were already
immune by either natural disease or prior vaccination, 530 serious adverse
events were reported and documented.

11. The extensive media coverage that followed those unfortunate
reactions resulted in a significant drop in the measles, mumps and rubella
(MMR) vaccination rates well before the Wakefield Lancet article of
February 1998.

The following information is from “NHS Immunisation Statistics,
England: 1997-98” -

According to NHS “This is the first statistical bulletin to be
published on immunisation since 1987”.

Approximately 19,000 (3.3%) fewer children received 3 doses of
pertussis vaccine in 1997-1998 than in 1993-1994. In comparison, 87,000
(13.6%) fewer children received one dose of MMR vaccine.

Reporting on vaccination rates during the two years preceding
Wakefield’s paper in the Lancet, the DOH stated: “Between 1996-97 and 1997
-98: The highest ever levels of immunisation coverage for diphtheria,
tetanus, polio, pertussis and Haemophilus influenzae B., achieved for
children reaching their second birthday in 1996-97, continued in 1997-98;
coverage for measles, mumps and rubella vaccine in this same age fell by
about 1%.

“In the case of pertussis, coverage rates have regained the ground
lost in the mid-1970’s due to public anxiety about the safety and efficacy
of the vaccine. The recent fall in MMR coverage may be the result of
similar concern over the vaccine”. (End quote)

12. Spokespersons for the Health Department and the Press have stated
that the MMR Vaccine is “more effective” than the monovalent vaccines.

Looking specifically at the Merck products, this is not true.

MMR II contains Attenuevax, Mumpsvax and Meruvax, all registered
trade marks of Merck and Co.

In the 2003 Physician’s Desk Reference (PDR), the manufacturer states
that a single injection of MMR vaccine induced measles hemagglutination-
inhibition (HI) antibodies in 95 %, mumps neutralizing antibodies in 96%
and rubella HI antibodies in 99% of susceptible individuals (p. 2022).
Referring to the monovalent vaccines, the manufacturer states that a
single dose of Attenuevax has been shown to induce measles HI antibodies
in 97% or more of susceptible individuals (p. 1946). Similarly, one dose
of Mumpsvax resulted in 97% immunity in susceptible children (p.2046) and
one dose of Meruvax II resulted in immunity in 97% or more of susceptible
individuals (p. 2035).

Pre-MMR licensure, the manufacturers had to conduct safety and
efficacy studies. It is well known that the safety studies were few, small
and of short duration.

On the other hand, there were many efficacy studies performed because
of fear that combining the three live attenuated vaccines would result in
decreased effectiveness of one or more of the components. (End quote)

One must note that no synergistic effect was ever claimed or detected
by the manufacturer.

The problem of decreased efficacy when vaccines are combined was
demonstrated recently when the DOH ordered the revaccination of thousands
of UK children because of vaccine failure and a high incidence of invasive
Hemophylus Influenzae B illness in children who had received a combination
vaccine containing HIB, tetanus, diphtheria and whooping cough vaccines.

13. The DOH claims that a vaccination rate of over 90 % is needed to
provide “Herd Immunity” and effectively eliminate disease.

That is often true but not always so.

Toronto, Canada: “Eighty-seven laboratory-confirmed or clinically
confirmed cases of measles were identified (for an attack rate of 7.7%).
The measles vaccination rate was 94.2%” Sutcliffe PA, et al. CMAJ. 1996
Nov 15;155(10):1407-13. PMID: 8943928

Anchorage, Alaska: “The 33 case-patients ranged in age from 2 to 28
years (median: 16 years). Twenty-nine case-patients had received at least
one dose of measles-containing vaccine (MCV) at or after age 12 months;
one person with laboratory-confirmed measles had received two
appropriately spaced doses of measles-mumps-rubella vaccine (MMR). At the
high school where 17 cases occurred, based on school records, only one of
2186 students had not received at least one dose of MCV before the
outbreak. 49% of the students had received one dose of MCV, and 51% had
received two or more doses. CDC, MMWR: January 08, 1999 / 47(51); 1109-

Cape Town, South Africa “Immunisation coverage (at least one dose of
any measles vaccine) was 91% and vaccine efficacy was estimated to be 79%
(95% CI 55-90); it was highest for monovalent measles (100%) and lowest
for measles-mumps-rubella (74%) Coetzee N, et al. S Afr Med J. 1994 Mar;
84(3):145-9. PMID: 7740350

West Switzerland: “Since 1991, 6 years after the recommendation of
universal childhood vaccination against measles, mumps, and rubella (MMR
triple vaccine), Switzerland is confronted with a large number of mumps
cases affecting both vaccinated and unvaccinated children. Up to 80% of
the children suffering from mumps between 1991 and 1995 had previously
been vaccinated …”Ströhle A, et al. Schweiz Med Wochenschr, 1997 Jun,
127:26, 1124-33

Switzeralnd: In evaluating the impact of the MMR mass vaccination
program begun in Switzerland in 1985: “We conclude that MMR mass
vaccination has not interrupted the circulation of rubella virus in
Switzerland, and that improvements in the implementation and surveillance
of the MMR vaccination campaign are necessary in order to avoid [the]
untoward effects of it.”European Journal of Epidemiology, vol. 11, no. 3,
June 1995, pp. 305-10)

14. To prevent a measles epidemic the Afghan Government embarked in a
massive campaign in 2002. Some twelve million children aged 6 months to 12
years were given the monovalent measles vaccine under the auspices of WHO
and UNICEF. The Minister of Health estimated that 35,000 lives may have
been saved by the campaign. (1)

15. It was estimated that there were 350,000 cases of measles in
Madagascar in 2002. Between September 13 and October 8, 2004 a massive
campaign was carried out with the help of the UNICEF. Over 7,000
vaccinators and 15,000 community workers administered the monovalent
measles vaccine to over 7 million children aged 9 months to 14 years in
the Country’s 111 districts. (2, 3)

16. Without a doubt, the WHO and UNESCO will be using the single
(monovalent) measles vaccine and NOT THE MMR, to vaccinate thousands and
prevent outbreaks of measles in the areas of the Far East that were
devastated by the Tsumanis of December 2004.

The above are the facts, the REAL facts.

They are well worth remembering.





Competing interests:
Grandfather of a child with regressive autism

Competing interests: No competing interests

11 January 2005
F. Edward Yazbak
Pediatrician, Director
T L Autism Research, Falmouth, Massachusetts 02540 USA