Intended for healthcare professionals

Rapid response to:


Day care in infancy and risk of childhood acute lymphoblastic leukaemia: findings from UK case-control study

BMJ 2005; 330 doi: (Published 02 June 2005) Cite this as: BMJ 2005;330:1294

Rapid Response:

Vaccinations and immunity.

Gilham et al’s findings should not come as a surprise, however they
have stopped short of questioning the possible benefits to the immune
system of what were once called “normal childhood infections” and now, are
extremly rare.

Prevention of infectious diseases is seen universally as beneficial
to the health of society. However few have considered the possibility that
natural selection and these diseases, played a role in the development of
the immune system to fight more deadly diseases.

Alm, Swartz, Lilja, Scheynius and Pershagen (1999) found that
children who took fewer antibiotics had a lower rate of immunisation and
also had a lower prevalence of asthma , eczema and hay fever than the

Bodner, Anderson, Reid and Godden (2000) reported that children who
contracted measles are less likely to go on and develop asthma, a disease
that was rare thirty years ago and now kills 2000 people per year in the
UK. Hurwitz and Morgenstern concluded that DPT vaccination increased the
risk of allergy.

Shaheen, Aaby and Hall (1996) found a specific inverse relationship
between contracting measles and atopic diseases. Kemp, Pearce and
Fitzharris (1997) found that a small sample of children who did not have
DPT or polio immunisation did not suffer from asthma or other allergic
illnesses compared with 23 per cent. of the main sample who suffered
asthma episodes and 30 per cent. who suffered other allergic illnesses.

Kramer, Heinrich, Wjst and Wichmann (1999) supported the hypothesis
that early infection may protect against allergies later in life. Gibbon,
Smith, Egger, Betts and Phillips (1997) found that children who suffered
infections in the first year of life were less likely to develop insulin
dependent diabetes. Classen and Classen (1999) found that immunised
children had twice the incidence of diabetes type 1.

There is no doubt that the introduction of mass vaccination
programmes in Cuba after the revolution reduced the incidence of death
from measles and other childhood diseases, at a time when sanitation,
nutrition and housing was poor. Cuba now has achieved life expectancy and
infant mortality rates similar to developed countries. However, it also
has a high prevalence of asthma similar to North America and Europe
(MacDonald,1999) and other autoimmune disorders.

Alm, J S, Swartz, J, Lilja, G, Scheynius A, Pershagen G (1999), Atopy
in children of families with an anthroposophic lifestyle, Lancet, 353,1485

Bodner, C, Anderson, W J, Reid, T S and Godden, D J (2000),
Childhood Exposure To Infection And Risk Of Adult Onset Wheeze And Atopy,
Thorax, 55, 383-387

Gibbon, C, Smith, T, Egger, P, Betts, P and Phillips D (1997), Early
infection and subsequent insulin dependent diabetes, Arch Dis Child, 77,
5, 384-5

Hurwitz E L and Morgenstern H, (2000), Effects of diphtheria-tetanus-
pertussis or tetanus vaccination on allergies and allergy-related
respiratory symptoms among children and adolescents in the United States,
Journal of Manipulative and Physiological Therapeutics, 23(2), 81-90

Johnston, S. and Openshaw, P. (2001), The Protective Effect of
Childhood Infections, BMJ, 322, 376-377

Kramer, U, Heinrich, J, Wjst, M and Wichmann, H E (1999), Age Of
Entry To Day Nursey And Allergy In Later Childhood, Lancet, 353, 450-454

Macdonald, T H (1999), A Development Analysis Of Cuba’s Health Care
System Since 1959, The Edwin Mellen Press

Shaheen, S O, Aaby, P, Hall, A J, Barker, D J, Heyes, C B, Shiell, A
W and Goudiaby A (1996), Measles and atopy in Guinea-Bissau, Lancet, 347,

Competing interests:
None declared

Competing interests: No competing interests

24 April 2005
Richard Lanigan
The Park Clinic, Kingston, KT2 6DQ