MMR vaccination rate still stable despite controversy

The number of children being vaccinated against measles, mumps and rubella has remained steady in Malta, despite a raging controversy in the UK over alleged links between autism and the MMR triple vaccination.

Primary Health Care director Andrew Amato-Gauci said the coverage rate of the MMR vaccination has remained stable at over 90 per cent of the population.

"We have seen no evidence that would lead us to believe that parents are avoiding giving the jab to their children. We had a few individual queries from concerned parents but once the situation was explained most put their mind at rest," he said.

"MMR is one of the safest vaccinations we have and is also the most tested and most widely used across the globe," Dr Amato-Gauci said.

Maltese doctors have been closely following the heated debate over MMR in the UK, which has been reverberating since 1998 when Andrew Wakefield published a paper in the reputable medical journal The Lancet.

In it he identified an inflammatory bowel disease linked with autism and suggested it might be associated with MMR vaccination. He even recommended that parents should ask for the MMR to be split into three single vaccines to reduce the impact on the child's developing immune system.

Parents lost confidence in the vaccine, which has saved millions of children's lives, and in the UK the latest figures show the take-up of the MMR jab fell to a record low between last July and September, with a coverage rate of just 84.2 per cent. This has resulted in nasty outbreaks of measles in London.

Dr Amato-Gauci said the World Health Organisation conducted intensive investigations into Dr Wakefield's claims and found absolutely no evidence linking MMR to autism.

Parents' fears in the UK were not alleviated because some believed it was a conspiracy theory and Dr Wakefield persisted in his claims, which were getting international coverage.

The debate took on a different twist last February when it was revealed that Dr Wakefield was, at the time of his research, being paid to carry out investigations for lawyers who were hoping to sue over vaccine damage.

"We followed all that was happening in the UK very closely and we saw no reason to change our policy on the vaccine or to provide single vaccines as the triple vaccine has been proven to be safe," Dr Amato-Gauci said.

"Unfortunately, the subject of immunisation suffers from the paradox of prevention in the sense that the more you manage to eradicate the disease the harder it is to persuade people to get the jab because they do not witness its horrid effects," he said.

The mission of the department was to prevent measles, mumps and rubella from circulating and everyone had to contribute and be inoculated to ensure they remained contained.

"Even if you let up a little bit you risk an epidemic. It's a collective effort," he said.

The facts

So what are the facts? Dr Amato-Gauci explains:

¤ In 1983 a single measles vaccine was introduced in Malta for parents to inoculate their children on a voluntary basis. It was slow to pick up since most people did not understand the cause of concern and did not consider it to be a life-threatening disease.

¤ The combined measles, mumps and rubella vaccine was first introduced in 1989. It was never obligatory to vaccinate the child but doctors strongly encouraged parents, in line with WHO guidelines, to eliminate the diseases in Europe.

¤ Malta will have to attain a coverage target of 95 per cent of the population to ensure the virus is eradicated.

¤ Measles is mostly a mild disease but also one of the most transmissible. In severe cases it can cause encephalitis (swelling of the brain) leading to brain damage. Mumps cause swelling of the glands and can damage the testicles in boys. Rubella (German measles) is dangerous if caught by pregnant women and can cause blindness and other deformities in the unborn child.

¤ In 1992 there had been a reported problem with the mumps strain in the vaccine so WHO ordered that children would be given just an MR jab to protect against measles and rubella. A completely new and safe version of MMR was re-introduced in 1995 and has been used in Malta since.

¤ The first dose of the MMR vaccination is given at the age of about 15 months. After the first dose there are about five to 10 per cent who remain unprotected, so a second dose is given at the age of about seven years and over. This second dose will ensure that everybody is covered.

¤ MMR is used in 90 countries. No country recommends giving MMR as three single vaccines. There is also no evidence that individual injections are safer.

¤ Some parents' decision to leave their healthy child next to another one who is sick with measles to contract it and provide immunity is the principle of an old wives' tale. This has never been encouraged by doctors because there is always a risk involved. This practice is best avoided.

¤ The government's priority is to reach a coverage rate of 95 per cent and each dose of the vaccination is offered free of charge at any of the health centres.

¤ The Primary Health Care is taking part in a European study, ESEN 2, to determine the island's susceptibility to a future epidemic of measles. Together with the Virology Department at St Luke's Hospital, the department is currently in the process of collecting blood from different age groups to determine who is immune to the disease.

¤ It is also taking part in another programme, EUVAC Net, which is a network of all member states and acceding countries to share information and research on routine immunisations.