The MMR vaccine is a vaccine against measles, mumps and rubella (German measles). It was first formulated in 1971 and introduced into the UK in 1988. It is produced by a small number of large pharmaceutical companies including Glaxo SmithKline and Merck. The MMR vaccines used in the UK are called Priorix and MMRVaxPro.
The vaccine is generally given in two doses, one at 1 year of age and one just before starting school at 4-5 years of age. The reason for a 2nd dose is partly because the vaccine only creates resistance to measles in 98% of cases(1).
The vaccine is a live attenuated vaccine, meaining that there are live viruses of all three diseases present, but the viruses have been treated so that they have less disease causing capacity. However for a person with compromised immunity they could still pose a problem.
While mumps and rubella are normally mild diseases in infants, measles can be serious and even deadly. In Western Europe it is thought to cause death in about 1 in 5,000 cases(2). Another study found the case fatality rate as less than 0.05% in Europe. This represents a death for less than 1 in 2000(3). In the recent 2013 outbreak in the UK (Wales) there was 1 death among 1,500 reported instances of the disease. In the UK hospitalisation occurs in up to 2% of cases.
Dr Wakefield’s study
There has been a lot of controversy with regard to the MMR vaccine both before and especially after a 1998 study by Dr Andrew Wakefield on 12 children(4). He explored the possibility that a gastrointestinal disease and developmental disorders were caused by the MMR vaccine.
He concluded that there seemed to be a connection between autism and a particular gastrointestinal disease in some cases. He did not conclude that there was a proven link between MMR and autism.
There has been a considerable backlash against Dr Wakefield by the medical establishment. Dr Wakefield’s study was reported by the media in sensationalist terms which discouraged many parents from getting their children vaccinated. This had the potential to lower the percentage of children immunised against measles to below a threshold where measles would again become a common childhood illness. The medical authorities were swift to denounce the report in order to prevent this happening.
Other studies have since been carried out, often with the sole purpose of discrediting the original Wakefield study. Two examples are a study in 2006(5), and a study in 2008(6).
2006: This study, supported by the NIH - National Institue of Health in the US, was based on hundreds of interviews. It acknowledged that regressive autism could be related to gastrointestinal disease, something that Andrew Wakefield had found 8 years before, but did not find a link with the MMR vaccine.
2008: The 2008 case control study looked for measles virus in the bowel of study participants. It was led by Mady Hornig and was in some ways similar to the original Wakefield study. It concluded that MMR didn’t cause autism as they found no more evidence of measles RNA in the bowel of children affected by autism, than in those not affected by autism. However this paper included people who had previously authored papers with Wakefield(7), and to me it seems possible that some were trying to recover their professional reputations. The sample size was not that large either. This means that a definitive answer is impossible as all these kids may have had regressive autism caused by factors other than MMR.
Further studies that question the MMR autism link are found in the Oxford vaccine group website(8).
It appears that it was more important for the medical authorities to protect the health of the community against a known threat (measles) than explore the damage that may have been caused by the MMR virus. After all a developmental disorder can be hard to define let alone pin down the cause.
What damage can the vaccine cause?
Sources from the medical establishment report the following side effects(9):
- Fever, malaise and rashes are reported by the health authorities as occuring in 10% of children in the 2nd and 3rd week after the vaccination.
- Joint pains are reported in 3 out of 100 cases.
- Seizures occur about 1 week after vaccination. According to NHS figures in about 1 in 1,000 cases.
- Contraindicated in cases of severe egg allergy or severe asthma due to the way the vaccines are produced.
The instances of developmental disorders are not reported.
Priorix is produced by GSK-GlaxoSmithKline. MMRVaxPro is produced by Sanofi Pasteur and is considered similar to the MMR VaxPro produced by Merck.
Some studies have shown that 5 times as many boys are autistic as girls(9). However it is thought that autism in girls has been harder to diagnose, and that the comparitive rates may actually be closer than this.
The great debate triggered by Andrew Wakefield and the press concerns the possibility that for a small number of kids with regressive autism, something in the MMR vaccine either caused, or made worse their condition.
Comments on active ingredients:
The measles part of the vaccine is considered to take effect 6-10 days after vaccination. A raised temperature, measles like rash are comon side effects. This is the part of MMR hypothesized to cause regressive autism.
The mumps part of the vaccine gets to work around 3 weeks after immunisation. A raised temperature and swollen glands are the most common side effects.
The rubella part of the vaccine may cause arthritis although this normally goes away again.
Comments on non-active ingredients:
All the ingredients in vaccines are administered in very small doses. The medical authorities claim that the amounts of the non-active ingredients are so small that health consequences are negligable.
Gelatine. Is in Priorix and not in MMRVaxPro. Vegetarians may object to the usage of gelatine which normally comes from the sinews of dead cows or pigs.
Recombinant human serum albumin. Is in MMRVaxPro, but not in Priorix. This is a genetically engineered blood transport protein.
Sorbitol. Both priorix and MMRVaxPro contain this. It is a natural sugar alcohol often made from corn syrup. Some people with inherited fructose intolerance may not be able to take this.
Neomycin. An antibiotic is contained in both MMRVaxPro and Priorix. They use 25micrograms per dose in order to prevent contamination of the vaccine by bacteria. Neomycin is a very strong antibiotic that in larger doses would cause kidney damage. However, this has not been reported in relation to MMR or any other vaccines that use it to my knowledge.
Egg protein (ovalbumin). Trace amounts in both MMRVaxPro and Priorix. Children with a severe egg allergy were told to avoid these vaccines until 10 or more years ago. However nowadays the amounts are considered so small as to not constitute any risk. The growth medium for the vaccines is chicken embryo, which is later on than the egg stage, and so the egg protein is changed and much less abundant.
Human lung cells. The rubella portion of the MMR is grown on lung cells taken from an aborted foetus in the early 1960s. The purification process is considered to remove all traces.
Thiomersal. A mercury containing preservative used to prevent fungal contamination is no longer used for UK vaccines.
An individual measles jab can be obtained from: Direct Health 2000, 6 GroveMarket Place, Court Yard, Eltham, London SE9 5PU, 020 8294 2780 at a cost of around £45.
A website with a range of regional clinics can be found at: http://www.childrensimmunisation.com/contact-us/
A UK company that provides a personalised immunisation service is: http://www.babyjabs.co.uk/
Getting immunised. In my opinion it is important to get immunised to prevent measles becoming a common childhood illness again. However, I’m disappointed by the attitude taken by the Department of Health which deliberately took away the option of a single virus. I’m unconvinced that the extra choice would have reduced immunisation rates. Certainly as a medically literate parent I find the attitude of the authorities particularly arrogant both when they spend our taxes on denouncing any alternative to their preferred solution, and when they have deliberately reduced choice.
There is no doubt in my opinion that Andrew Wakefield was a scientist just trying to do his job. I personally find the slurs on his character and his being struck off the General Medical Council register depressing and disturbing(11).
Autism. I honestly don’t think the case has been proven either way. It seems quite likely that most kids will be fine, but a very small percentage could be affected and I don’t think any studies have shown conclusively one way or the other whether this is true.
I allowed my daughter to have the MMR feeling that the undoubted risk was outweighed by my social responsibility to prevent measles outbreaks. The size of the risk is an unknown. From my research I'd say less than one in a thousand. That risk is of course meaninless if you are one of the parents with kids affected by the vaccine.
- http://ca.gsk.com/media/591220/priorix.pdf priorix 98% measles resistance rate.
- http://www.ovg.ox.ac.uk/measles measles death rate
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3231907/ measles death rate
- http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)11096-0/abstract Wakefield’s paper
- http://www.ncbi.nlm.nih.gov/pubmed/16729252/ 2006 Richler et al. study
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526159/ 2008 Hornig et al. study
- http://www.ncbi.nlm.nih.gov/pubmed/11007230 2000 Wakefield study
- http://www.ovg.ox.ac.uk/mmr-vaccine#side effects The case for MMR being safe (a list of studies).
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120664/ MMR side effects in 2001
- http://www.autism.org.uk/About/What-is/Myths-facts-stats Autism prevalence
- http://news.bbc.co.uk/1/hi/health/8695267.stm GMC Dr Wakefield struck of register