I am quite happy to respond to Hilary Butler. It is quite appropriate to weigh the risks from measles as well as the risks from MMR when considering the risk/benefit equation of vaccination, and I am glad she raised the topic.
If we take data from the last 10 years, we will have to factor into the risk/benefit equation the information that around a 15 million doses of MMR have been dispensed in this period (assuming 85% vaccine uptake) and around 4000 cases of measles have been notified.
I have been asked for replies to these questions:
1) The number of all deaths from measles since 1998
On a global basis, WHO/Unicef estimate that in 1999 there were estimated to be 873 thousand deaths from measles, reducing to 530 thousand in 2003 as a direct result of vaccination initiatives (1). Assuming this relative reduction has continued, then since 1999 there have been 5.3 million deaths, nearly as many as died in the holocaust. Almost all of these deaths would be preventible through vaccination.
However, I guess you mean UK statistics. I can only report what has been officially recorded by the relevant agencies, and have no personal knowledge of the cases involved. According to the HPA, from 1998 to 2007 there have been 12 cases of “deaths” (2). One of these is provisional, and one has subsequently been revised as “known not to be measles” (implying the remaining cases were known to be measles). However, as I am sure you already know, with the exception of one case, these deaths represent delayed deaths from the neurological complications of measles contracted during the time before vaccination, when measles outbreaks were unfortunately very common, and are probably cases of subacute sclerosing panencephalitis, or SSPE (something we will no doubt see the return of if the current escalation in measles continues). People worry about the BSE time bomb – they should realise that measles carries a similar risk.
One death from acute measles occurred in 2006 in a “13 year old male who had an underlying lung condition and was taking immunosuppressive drugs”. However, earlier this year the HPA reported there has been another acute death, this time a 17 year old male, who was reported to have had some hereditary immunodeficiency.
2) The ages and sex of all those deaths
I have insufficient information on this, bar that concerning the 2 deaths from acute measles.
3) Whether or not the people who died had absolute proof that measles was the direct cause of their deaths, as opposed to, "it was the doctor's understanding..."
I don’t know if the people who died had time to be aware of what was killing them, but the clinicians caring for these cases would have had no doubt. Acute measles is a relatively easy clinical and laboratory diagnosis.
4) How many of the people who died had immunodeficiencies, cancer, or any other underlying condition which would have contributed to their deaths.
Both the deaths from acute measles had underlying immunodeficiency. To pre-empt your next question (which would be to say that “normal” children do not die from measles in the UK), let me say that these deaths demonstrate quite irrefutably the case for universal measles vaccination. These two children would never have been allowed to receive live MMR vaccine; so they depended upon herd immunity to keep them safe from catching measles. In a world where there was no measles vaccine, these two children would have been exposed to measles in infancy, with no doubt the same outcome. Poor vaccination rates lead to lowered herd immunity, and can directly be linked to these unfortunate deaths. It is precisely because some children are more vulnerable (yet cannot be protected through vaccine) that herd immunity is so vital.
5) Whether or not the anecdotal near-death/s mentioned by Peter Flegg also had an immunodeficiency, chronic illness or any other underlying condition that contributed to their near-death/s.
I gave reference to one case of near death from the Blackpool 2008 outbreak. This young, unvaccinated child did not have an underlying immune deficiency or other disorder, and has fortunately returned to full health.
To address Ms Butler’s other comments, I agree with her that it is not at all likely that every child on the face of the earth could die from measles (although 5 million have done exactly that in the last 10 years). The only reason more children do not die of measles in the UK is that herd immunity is still sufficiently high to protect those who cannot or have not been fully immunised. This is changing, as measles outbreaks spread throughout the UK. I have no doubt that another vulnerable group (infants too young to be vaccinated) will see deaths within its ranks before too long. That is not fear mongering, but the simple reality of measles infection.
To return to the risk/benefit equation for MMR versus measles infection, during the last 10 years the case fatality for acute measles in the UK has been in the order of 1 in 2000. To entail a similar degree of risk from MMR, we would need to have seen 7500 deaths from MMR vaccination.
Rapid Response:
More on the risk/benefit for MMR
I am quite happy to respond to Hilary Butler. It is quite appropriate to weigh the risks from measles as well as the risks from MMR when considering the risk/benefit equation of vaccination, and I am glad she raised the topic.
If we take data from the last 10 years, we will have to factor into the risk/benefit equation the information that around a 15 million doses of MMR have been dispensed in this period (assuming 85% vaccine uptake) and around 4000 cases of measles have been notified.
I have been asked for replies to these questions:
1) The number of all deaths from measles since 1998
On a global basis, WHO/Unicef estimate that in 1999 there were estimated to be 873 thousand deaths from measles, reducing to 530 thousand in 2003 as a direct result of vaccination initiatives (1). Assuming this relative reduction has continued, then since 1999 there have been 5.3 million deaths, nearly as many as died in the holocaust. Almost all of these deaths would be preventible through vaccination.
However, I guess you mean UK statistics. I can only report what has been officially recorded by the relevant agencies, and have no personal knowledge of the cases involved. According to the HPA, from 1998 to 2007 there have been 12 cases of “deaths” (2). One of these is provisional, and one has subsequently been revised as “known not to be measles” (implying the remaining cases were known to be measles). However, as I am sure you already know, with the exception of one case, these deaths represent delayed deaths from the neurological complications of measles contracted during the time before vaccination, when measles outbreaks were unfortunately very common, and are probably cases of subacute sclerosing panencephalitis, or SSPE (something we will no doubt see the return of if the current escalation in measles continues). People worry about the BSE time bomb – they should realise that measles carries a similar risk.
One death from acute measles occurred in 2006 in a “13 year old male who had an underlying lung condition and was taking immunosuppressive drugs”. However, earlier this year the HPA reported there has been another acute death, this time a 17 year old male, who was reported to have had some hereditary immunodeficiency.
2) The ages and sex of all those deaths
I have insufficient information on this, bar that concerning the 2 deaths from acute measles.
3) Whether or not the people who died had absolute proof that measles was the direct cause of their deaths, as opposed to, "it was the doctor's understanding..."
I don’t know if the people who died had time to be aware of what was killing them, but the clinicians caring for these cases would have had no doubt. Acute measles is a relatively easy clinical and laboratory diagnosis.
4) How many of the people who died had immunodeficiencies, cancer, or any other underlying condition which would have contributed to their deaths.
Both the deaths from acute measles had underlying immunodeficiency. To pre-empt your next question (which would be to say that “normal” children do not die from measles in the UK), let me say that these deaths demonstrate quite irrefutably the case for universal measles vaccination. These two children would never have been allowed to receive live MMR vaccine; so they depended upon herd immunity to keep them safe from catching measles. In a world where there was no measles vaccine, these two children would have been exposed to measles in infancy, with no doubt the same outcome. Poor vaccination rates lead to lowered herd immunity, and can directly be linked to these unfortunate deaths. It is precisely because some children are more vulnerable (yet cannot be protected through vaccine) that herd immunity is so vital.
5) Whether or not the anecdotal near-death/s mentioned by Peter Flegg also had an immunodeficiency, chronic illness or any other underlying condition that contributed to their near-death/s.
I gave reference to one case of near death from the Blackpool 2008 outbreak. This young, unvaccinated child did not have an underlying immune deficiency or other disorder, and has fortunately returned to full health.
To address Ms Butler’s other comments, I agree with her that it is not at all likely that every child on the face of the earth could die from measles (although 5 million have done exactly that in the last 10 years). The only reason more children do not die of measles in the UK is that herd immunity is still sufficiently high to protect those who cannot or have not been fully immunised. This is changing, as measles outbreaks spread throughout the UK. I have no doubt that another vulnerable group (infants too young to be vaccinated) will see deaths within its ranks before too long. That is not fear mongering, but the simple reality of measles infection.
To return to the risk/benefit equation for MMR versus measles infection, during the last 10 years the case fatality for acute measles in the UK has been in the order of 1 in 2000. To entail a similar degree of risk from MMR, we would need to have seen 7500 deaths from MMR vaccination.
1. http://www.unicef.org/progressforchildren/2005n3/measles.php
2. http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733835814
Competing interests:
None declared
Competing interests: No competing interests