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Reviews Press

Why can't the Daily Mail eat humble pie over MMR?

BMJ 2005; 331 doi: (Published 10 November 2005) Cite this as: BMJ 2005;331:1148

Rapid Response:

BBC: MMR not impacting on measles?

The Cochrane Review of 2005 regretted:

“We were disappointed by our inability to identify effectiveness
studies with population or clinical outcomes. Given the existence of
documented elimination of targeted diseases in large population by means
of mass imunisation campaigns, however, we have no reason to doubt the
effectiveness of MMR." [1]

Remarkably the review came up with no scientific evidence that MMR
eliminated measles, so it remains a proper question whether it has? In its
report of a new study by Baird et [2] al last week the BBC carried the
following statement:

"The number of confirmed measles cases has risen from 56 in 1998 in
England and Wales to just under 1,000 in 2007, according to provisional

"However, the impact of MMR on these figures is not clear." [3]

The most prominent instance of a measles outbreak last summer was
reported in Hackney by Michael Fitzpatrick himself in an article in on-
line Guardian "Right jabs: Before rejecting the MMR vaccination for their
children, middle-class parents should think of the risks measles can
present to the wider community" [4]. It was surprising that Fitzpatrick
focussed not on the vaccination status of the cases, but of another: "the
middle classes", omitting to mention that in many cases they would have
had single jabs. The likely conclusion was that this outbreak was occuring
in a vaccinated population. When quizzed about this Fitzpatrick offered
the following elucidation:

"Could I clarify a few points.
"There have been 150 cases of measles in Hackney (population >200, 000)
over the past three months.
"There have been 3 cases of measles in my practice (population >10,
000). These children had not received MMR.
"Though I do not have the data on the other cases, I understand that the
vast majority had not been fully protected against measles (with MMR at 12
-15 months and a pre-school booster).
"As this number of cases exceeds the number expected, this constitutes an
"The decline in middle class uptake of MMR has contributed to a population
coverage well below that required to protect against outbreaks of measles.
"When an outbreak of measles occurs it is more likely to spread rapidly
among socially disadvantaged children.
This is what we have seen in recent weeks." [5]

You cannot, of course, deduce anything from this unless you knew the
ages of those who had not been vaccinated or not received their "pre-
school booster". This was not, however, the original polemical slant of
the article.

I note as a parallel example the study by Harnden et al [6] on
whooping cough in which a one-time deadly disease is presumed eradicated
because of vaccination, but is simply commonly unrecognised.

It is regrettable if both the profession and the public are being
given less than transparent information about the effectiveness and
usefulness of vaccine.


[2] Baird et al, 'Measles vaccination and anti-body response in
autistic spectrum disorders',




[6] Harnden et al, 'Whooping cough in school age children with
persistent cough: prospective cohort study in primary care'

Competing interests:
Autistic son

Competing interests: No competing interests

15 February 2008
John Stone
London N22