Anyone have advice on MMR issue???

[opinionsrus]

I know that this is an "old" topic, but I am a first time mum and TBH do not know a great deal on the topic.

Please can anyone tell me? Which is the greater "risk"? The MMR jab given at 15 mths, or the booster at age 4?

Don't really know if it works like that at all so apologies in advance if that sounds a bit dumb. If your child was going to have a reaction,would it be after the inital jab, if at all?

Any comments are greatly appreciated so many thanks in advance to those of you who answer....

I'd just like to add my own pov if I may.

I usually try to stay off health threads and I always namechange if I'm revealing my profession but I just wanted to post on this thread.

I'm a paediatrican, well a Specialist registrar, got another 4 years to go before consultancy.

I agree with several of the posts on this thread, including both flumpytina and jimjams. I would particularly agree with jimjams in that there is no evidence that MMR is a problem for the very very vast majority of children but that for a very small number of children it may trigger autism, autism that may have been triggered by another environmental hit even if the child hadn't had MMR.

This clearly makes it difficult for parents; is my child susceptible? is the new question. Unfortunately the answer is that no one knows for certain although jimjams gives some possible risk factors that parents may well want to consider. This must be balanced out with the knowledge that every child is susceptible to measles, mumps and rubella and the horrendous complications that these diseases can cause. Only each parent can decide what is best for their children. I know that I will be immunising my dd and that if any parents I meet at work ask me then I will be happy to tell them this, explaining why.

I think that the whole MMR debate in itself raises a lot of interesting points:

Giving something to your child that carries a tiny risk of harm is probably harder than not doing something, even though the ommission carries a higher risk of harm.

The media present scientific information very, very badly. If I feel angry with Andrew Wakefield et al. for anything it is the way that they presented their research findings at a press conference. First the media whoop up the controversy around MMR, then once the tide of information begins to turn, they demonise anyone who's child hasn't had the vaccine and cry about outbreaks of disease.

The public in general understand risk very badly. Risk is presented very badly, people expect medical intervention to be entirely risk free when it can never be yet they expect to win the lottery when they buy a ticket. I've had a job where I've had to explain to parents that their premature baby stood an approximate 90% chance of survival but I know (from speaking to many parents later) that for them the risk feels like 50:50. Their baby will either live or die. Similarly, though not with the same figures, for parents despite consciously "knowing" that the risk of MMR to their child may be very tiny it is likely to feel 50:50 as their child will either have autism or not, develop one of MMR or not. You can't get 2% of measles or autism although obviously you an be affected to varying degrees. I'm not sure if I'm expressing myself very well here but I hope tyhat I'm not upsetting anyone .

Although we all understand that large scale research, properly conducted, that truly answers the questions that it sets out to answer, is likely to give us the most robust information we cannot discount personal experience and how it informs our decision making. Personal experience brings home to us the possiblities of what could happen and what those consequences might really mean for us. At best they make us more able to make the right decision for our own individual circumstances.

Sorry about the length of this post but I've kind of let it all out iyswim . Not sure that I've helped the op though .

Oh and another thing!

Nothing annoys me more than the suggestion sometimes made, though not on this thread, that there is some sort of conspiracy whereby doctors are all so desperate to get their uptake levels up that they give MMR despite believing/knowing that they are causing autism by doing so.

The government badly handle any sort of public health crisis so it's no surprise to me that the public distrust what the government say with regard to MMR but this does not mean that your GP/HV/Paed should not be trusted.

My experience of doctors and consultants etc is one mainly consisting a string of misdiagnosis, lazy diagnosis and general apathy to get to the root caue of problem. I distrust doctors not because I think they have a secret agenda, but because they have stuffed up so many times for me and my family. I actually rather think their secret agenda might be to give themelves as easy a life as possible and fob people off who come in with more interesting/difficult medical dilemas.
This is particularly true of older male conultants.

Can I say that this is the most informative thread I've ever seen on this subject with some excellent and very thoughtful contributions - thanks esp namedchangedagain and jimjams.
I wholly agree with the media creating a climate of fear and preventing a proper understanding of risk. I feel like sending this to all my friends who are considering the MMR question (mine have both been done but in a kind of fingers crossed sort of way)Thanks - and thanks to flumpytina too for speaking her mind and asking direct questions

namechanged I do agree with (almost) everything you have written. The only thing I would say is that we haven't vaccinated ds2 and ds3 at all because we think in our case that the risk from the vaccine is greater than the risk from the disease (whe you take into account the likelihood of catching it as well) during the early years of development. That risk will change as they get older, (presumably the risk of autism will decrease once you're out of a vulnerable age, and the risk from diseases such as measles increases dramatically on leaving childhood). I recognise that for the majority though the risk from the diseases will probably be higher .

The only other thing I want to add to is the Wakefiled press conference. With hindsight it was a bad thing to do. However, in his defence he tried to meet with the dept of health to express his concerns, he tried to do it officially away from the public eye. No-one would meet with him or discuss his concerns (and at the time he was highyl respected- one of the top names in his field). He was completely fobbed off. I believe that he went public because he was being presented with these very severely affected children and wondered how many others were being damaged. His mistake I think was that he thought larger numbers may be affected (so he went public, I guess in a kind of knight in shining armour type way of trying to save future families the same grief), when in fact the numbers affected were very small. He becamde too emotionally involved with what the families were going through. Which is probably why for many parents he is a bit of a hero.

My experience of doctors and HVs has generally been good. MY GP and HV have been supportive of our decision to not vacccinated the younger 2. When ds3 was in hospital recently following a seizure the many doctors we saw were understanding when I explained why he wasn't vaccinated. I thought I would get a hard time- I didn't at all.

The only "bad" doctors I have seen in the last 15 years was one locum GP who was just ancient and not up to date, and a consultant I had to see a few years ago who had the most dreadgful bedside manner I have ever come across, who didn't even read the letter from the consultant who had referred me (within discipline- we moved area- and the original one was absolutely lovely and charming). It's like any profession there are some bad eggs, but that doesn't mean the majority are.

The NHS system however is another issue- that sucks!

Having stewed about this all night I feel a little more composed to be able to add another message to this thread. Thank you namechange again for your previous posting, it explains the difficulty we all have in analysing 'risk' extremely well, particularly when it involves our children.

The contraversy on this thread started when I (probably rather too strongly) disagreed with jimjams opinions on the safety of this jab. Having read all the posts jimjams you are obviously extremely well read and knowledgable on the subject but I still stand by my position that the two arguments you put forward in your initial post do not stand up well against the mountains of evidence that MMR does not cause autism.

namechangeagain has mentioned Andrew Wakefield so I won't comment on him again.

Individual case studies are obviously a much harder animal to judge. They are an extremely powerful argument as they are personal and often deeply distressing...we can all empathise with a distraught, angry and frightened parent of a sick or disabled child. The problem arises when you compare such cases to that 'mountain of evidence'. Research on the whole is boring, sterile, nonpersonal and usually makes very hard reading (my very very least favorite subject at Uni was analysing research for evidence based practice), but these reasons are the very ones which allow us to trust their results...they are impersonal and the good ones that are accepted by the medical community are well done and unbiased. Do we then discredit the personal 'human' cases, of course not...we try to learn from them as well, and interpret them 'in the light' of the current medical understanding of a subject.

How does all this then help us to decide on whether to give our children MMR or not, well all I can really comment on there is my own personal experience.
Yes I come from a scientific background and have a medical career, as does DH, but we are also parents. When it came time for DD1 to have her MMR we did not slavishly follow the advice of our HV, we looked at the evidence, both for and against MMR...and we decided wholeheartedly that there was no link between MMR and autism. When it was DD2's turn we did the same again, and she had the jab. Was the decision easy? well yes it was as the research backing this immunisation was so overwhelming, and the evidence of a link so very tenuous.

Is there new evidence? well I imagine there is as the subject is still such a hot potato...but the position of the DOH remains the same (there is a really good section about MMR on their website), until there comes a time when 'good' research is presented that does show a cause or link then I assume their position will stay the same.

I would also like to comment on some of the subsequent postings that implied that health professionals on the whole are lazy, arrogant (and may even have deep-seated personality disorders). I find these comments so deeply insulting that if I could be bothered to work out how to do the red angry face their would be a whole line of them here. There are obviously bad apples in every line of work under the sun, but to imply that the majority of people working in the NHS are lazy and arrogant is preposterous. People who work in health care in this country ARE on the whole kind, intelligent and caring, this is my personal opinion but it comes form working in this environment for many many years. Apart from Doctors, the wages of most health care workers are simply too dire to sustain you in a job if you weren't passionate about what you are doing. We are trying to do the best we can in an underfunded and completely overstretched organisation, we aren't perfect, we are human beings and we are trying to our jobs to the best of our ability, posting comments that claim that most of us are doing quite the opposite are just plain wrong.

Jimjams, do you really mean that the risk from diseases such as measels increases on leaving childhood? I would have thought that it would have decreased, please do enlighten if you can.

BUt Flumpytina the "mountains of research" hasn't been done. There is no research that addresses the question of whether a small subgroup of the autism population may have had their autism triggered by MMR. It doesn't exist. So you cannot say there is the MMR doesn't cause autism as the hypothesis - that is causes it in a small group of susceptible children hasn't even been tested.

Wakefield himself by the way agrees with what namechanged said- that children who regress following MMR may be more at risk of regression following other environmental hits as well. (and there are interesting links in physiology between autistic children and Guld war vets with gulf war syndrome- it's early stage research though).

kittywits- no I meant what I said. Many "childhoood diseases" (measles, mumps, chickenpox in particular) are far more dangeours post puberty. Measles in an adult is generally a lot more serious than measles in a 4 year old child. None of these things are particularly good in infancy either- but getting the dieases in childhood used to give lifelong protection which would pass to the baby ivia passive antibodies. That's a whole different topic though.

here's the link to download the Wakefield presentation at A1

The PP slides are pretty clear. It brings up to date his hypothsesis anyway.

namechanged- btw do you know anything about sulphation and/or migraine??

Autism one btw is a huge conference organised annually in the states- it has an emphasis on biomedical issues, but is aimed more at parents than professionals, although clinicians do attend (DAN doctors etc would go).

Am going go have a stab at doing a link thingmy, if I stuff up apologies.

have a look at \link{www.mmrthefacts.nhs.uk/library/research.php}

maybe 'mountains of evidence' is hyperbole but this site certainly highlights that the pro MMR research is somewhat more erm expansive that that against it.

Flumpytina. I think you and JimJams are at cross purposes. I think her point is that the large scale epidemiological research would not highlight the effect on the very small proportion of the population who would be at risk according to Wakefield's hypothesis. They would not significantly influence results, even if there WERE an effect on them.

Apologies JimJams if that is not what you're saying.

That's exactly what I'm saing. Haven't got time to check MMR the facts - but will presume that is includes Taylor's study for example (I'm certain it will). His research doesn't address the question. His paper examines whether MMR is responsible for the massive rise in autism when no-one has ever suggested it is. I will quite happily agree that that in probably 95 out of 100 cases it has played no role in the development of that child's autism- but I'm interested in the 5 cases in that 100, who regressed very quickly after MMR, had big seizures, started with severe gut problems at the same time and lost previously acquired skills very rapidly in the following weeks. The 95 who stiffened on picking up as young babies, or those who regressed but without accompanying gastro-intestinal symptoms are not of interest in this case. And they're all lumped in there.

Similar problem with the Danish study - Meldgaard et al- assume that one is in there as well- it usually is. There was no differentiation between regressive and early onset autism.

And all these studies fail to take into the account the possible role of thimerosal in the early jabs.

All the "mountain of evidence" shows is that for the majority of children their risk of developing autism following the MMR is very low. I don't have any problems with that conclusion- I don't think anyone does now- it's clear. It's also true to say that the majority of autistic children are autistic due to other factors. Don't have a problem with that. But as a parent of a child who is severely autistic I know that his siblings are at a massively increased risk of autism compared to Joe Public (100 times the risk). So I'm interested in any potential trigger. None of the studies you cite have examined whether autism can be triggered in a small group of children by MMR. Not one of them.

flumpytina.
p;[.
i di bd not state that the majority of healthcare professionals are lazy and arrogant.

you DID state that the majority are kind and hardworking.

I stated that I believed them to be no more so than in any other profession.

I also strongly believe that people are drawn to careers for reasons. Many in all the caring professions (social workers, psychotherapists, nurses, doctors etc etc) are compensating for deficiencies in the care they received as children. It doesn't mean that they are bad people, but it certainly means that they are not drawn to the professions because they are angel like beings of goodness, kindness and compassion.

I've obviously hit a sore point. I'm sorry for that.

I also would seriously question the risks posed by measles mumps and rubella to well nourished, and otherwise healthy children living in hygenic environments.

And seriously question the benefits of childhood immunity through vaccines, over the considerably increased risks of catching these in adulthood. As jimjams has said, this, as opposed to what used to be the case, that children caught these diseases, in the vast majority of cases, mild and uncomplicated, and thus had lifelong immunity.

Jimjams, sorry but I don't know anything about migraine and sulphation. I might have known something once but maternity leave has blurred my brain a little.

Kittywits, I'm sorry that your experience of health professionals has been so poor. Most of us enjoy a challenge regarding diagnosis, as a child one of the things that attracted me to medicine was the detective work involved in accurate diagnosis.

Sophable, lol at "angel like beings of goodness, kindness and compassion", I would pmsl if someone described me or any of my friends and colleagues like that . I try very hard to be empathetic, kind and compassionate at work but so do my non-medical friends. I thought that I chose medicine because I was interested in science and people and I wanted to help people. It was only once qualified that I heard the theory that many in caring professions want to be needed by others and that does ring a little true for me.
I feel that the risks to my dd, who seems well nourished and my house is clean enough, from the diseases of MMR are significant enough for me to want to vaccinate. Certainly some of the risks of measles relate to nutrition and environment, that's why it's such a killer in developing countries, but I don't think that the risks of things such as sub-acute sclerosing panencephalitis from measles or viral meningitis from mumps are related in the same way. I really worry that in the future there will be a resurrgence in cases of congenital rubella because of the current uptake levels of MMR. I know that many of those who are recorded as not having MMR have had singles but I just get this nagging feeling that some children will slip through the net with regard to rubella and the next generation will bear the consequences.

HI Namechanged, I do agree that with singles currently administered the way they are there is a risk of rubella being forgotten (although I think many providers get people to have that one first- which is perhaps sensible- although leaves their child at risk of measles longer- is that ethical??? trisky one). DS1 caught rubella- but from a vaccinated child - who spread it to a number of children- because his mother assumed he couldn't have it having had the MMR. Luckily by the time ds1 went down with it I knew he was likely to be developing it, so we were able to stay in (but very mild and so very difficult to spot).

Re SSPE- what are the risk factors? Catching measles before aged 1? In that case surely they should introduce a teen booster so babies can have more chance of passive immunity from the mother. The possibility of waning infant immunity as the MMR generation grow up is something that I think should be monitered.

I'm begining to think that sulphation issues to summarise a huge complex area in two word are important in ds1's case ( and could explain the violent- literally- directed towards himself- arising from peanut butter). It affects the immune system as well, but my understanding is poor - more reading.

namechanged it is a pleasure to read your posts.

if i know you by another name i'm pretty sure i like and admire you....

I"m not for a second arguing that that unconscious process is an exclusive motivation.

and given that i am in the same boat, i feel able to comment.

mmm flumpytina, please visit www.jabs.org.uk, and read about all the children who changed literally overnight after the mmr. doubt their parents are imagining it! If combined mmr is so safe, why wont Tony Blair tell us whether his son has had it, he clearly hasnt, so why not? Wouldn't trust this govt with anything, doctors and hv gets bonuses for each child who receives it, and my hv didnt even know what was in the combined mmr yet she promotes it. SHOCKING

I'm interested in passive immunity. I had both measles and rubella as a child and when tested for immunity to rubella whilst pregnant I was apparently still robustly immune, can I have passed this on to my DD and can I test to check?

Dizie- yep you will have passed it on, but it won't last. About a year is tops (often less) to be honest then they need to make their own antibodies- either from coming into contact via a vax or by coming into contact with the disease. generally naturally aquired immunity (via disease) last longer than vaccine aquired. BUT, naturally aquired isn't necessarily lifelong- especially these days. Previously you caught (say) measles, developed your antibodies then had regular little mini-boosters when you came into contact with other people with measles. Of course there are very few these days so the little mini boosters have gone. Best way to improve the immunity of a vacicnated child? Expose them to the disease! Mini booster off we go. Although of course we never know for sure that they are immune so you risk the disease itself......

OK Jimjams I think I finally get what you are saying... you are talking about a hypothetical risk to children (that have in increased risk of developing autism), that the MMR vaccine may trigger it, and you have pointed out that at this time no research has been done to prove or disprove this hypothesis, phew! Please correct me if I am misunderstanding you.

Well OK I'll accept that point, but why then do you say in one of your postings yesterday that "all the mountains of evidence goes to show is that for the majority of children their risk of developing autism following the MMR is very low".

I'm sorry but I still have real problems with a comment like this, particularly coming from someone who obviously knows a lot about the subject...it's the sort of thing that totally puts the fear of god into parents who are trying to decide what is best for their children (ie opinionrus who's initial posting started this off). "Risk is very low" still means risk is present, and people on the whole (referring back to namechangeagain who has spoken about this much more eloquently than me) have real problems with how to evaluate risk.

What the current large (am I allow to say large...there are a lot of research papers of the previous, unsuccessful, link I gave) amount of evidence on this subject show that there is no link between MMR and autism. no is a very different thing to low....yes there is this hypothetical risk that you have talked about, but as there is no research to back it up then surely decisions should be made in light of what we currently do know.

I hope that makes sense.

Lupo, I am aware of the jabs website and have mentioned in a previous post that single case studies should not be ignored, they should be looked at closely in the light of current medical knowledge...we can and should use them in research. But what do you think all the studies that I have referred to are on... cells in petri dishes...mice? no they are studies on hundreds or thousands of children...children who have had the jab to no ill effect. My very first (cross) posting was that these cases although deeply saddening are unreliable if you are trying to evaluate the risk to your child of developing autism from MMR.

As to Tony Blair...well I think his son is entitled to the same medical confidentiality as the rest of us, and the Blairs have just as much right to look at the current information and decide privately for themselves what is best for their child, quite frankly I think it it none of our business.

As for the bonuses for doctors and HV's for reaching target innoculation levels. That money will go to the practice, not the individual person giving the jab and goes towards administative costs and the time spent for nuses to give the vaccine. It does not cover all these costs. Is it an incentive for that practice to give the jab? well yes a very small one, but this governemnt (trustwothy or not) is quite keen on children being protected against some rather nasty childhood diseases. SHOCKING!

But you are completey wrong therte is no research that shows that there is no risk of developing autism following MMR, because the hypothesis that a subgroup of the population has developed autism following the MMR has never been tested. The only hypothesis that has been tested is that the rise is autim is caused by MMR- when no-one has ever suggested that. It's obvious that the rise in autism is not due to MMR (thimerosal load would be intersting, some research on that). Everyone knows that. But no-one has ever tested whether 5% of autism cases are triggered by MMR- that is the question. And 5% of autism cases is a small number but its not zero.

I don't understand how I can make this any clearer to be honest.