Letter

Safe, simple, effective

Dear healthmatters—The debate for which Stella Williams calls (healthmatters letters, issue 21) is an ongoing one which is not easily resolved here. It is sad that she has experienced a ‘wall of silence’ from the medical profession. I suspect, though, that what she has experienced is a wall of realism in contrast to the noisy hysteria peddled by some pressure groups. The simple, boring truth is that the vaccines used in the childhood immunisation programme are remarkably safe and carry very few contraindications. Those that do exist (for instance, concurrent high dose long term steroid therapy in the case of attenuated live vaccines) are likely to be known already to the doctor or nurse; children with contraindications are so rare that they are locally well known to those likely to meet them.

Ms Williams asks five specific questions which I will attempt to answer.

1. Measles vaccine is about 95 per cent effective. In those cases where infection occurs in an immunised child, the infection is generally less severe. Since the introduction of widespread vaccination, measles has become a rare disease and doctors have become less familiar with it. I am certainly aware of children whom I believe been wrongly diagnosed. I am not convinced that figures from the past about ‘mild’ measles can entirely be trusted.

2. The outbreak of polio in Oman in which immunised children were implicated was exceptional. Outbreaks of polio in industrialised countries have been almost exclusively in unimmunised groups: serious epidemics were still widespread as recently as the 1950s, and have occurred since in communities who refused immunisation.

3. Whooping cough vaccine is about 90-95 per cent effective. There are two major varieties in use: the killed whole cell preparation (as used in the UK) and the acellular preparation (as used in Japan, and, I believe, Sweden). It is wholly misleading to attempt to suggest that any country has ‘banned’ whooping cough vaccination. The effectiveness of immunisation is evident both in the decline in disease frequency which occurs with immunisation, and in the rise which followed scare stories in the 1970s which caused a large fall in immunisation rates.

4. In the UK each year there is, on average, one case of polio in a child receiving oral polio vaccine, and one case in a contact. These cases are rarely paralytic. Over two million doses of oral polio vaccine are given each year in this country (I myself have had five).

5. The vast majority of the supposed side effects of vaccination listed by Ms Williams are fictitious-not a shred of serious evidence exists to support any association. It is true that mumps meningo-encephalitis can occur following MMR immunisation, but this needs to be put in context. Mumps meningo-encephalitis is usually an extremely mild condition (indeed there is evidence that most children have no symptoms) which occurs far more frequently in unimmunised children exposed to mumps than in immunised children. The best way to protect your child from this is immunisation.

Ms Williams quotes two groups from which she has received information. I wonder just how far these groups would be prepared to back up their views. If a parent, on the advice of such a group, declined to protect their child with immunisation, and the child was subsequently severely damaged by a preventable infection, would they accept their liability? I doubt it. Similarly, a child in such circumstances might have a legitimate claim against their parents-has she considered this? These groups (though they would vigorously deny it) are exercising power without responsibility, and would have to think rather harder if they were made responsible for their actions.

For my part, I am a consultant paediatrician. I have seen children choke with whooping cough-even to the extent that mechanical ventilation barely helps. I have seen children damaged by rubella before birth. I have seen children barely able to breathe with epiglottitis, and reduced to a permanent trance-like existence by haemophilus meningitis. These are real illnesses. They bring great suffering and even death to real children and their families. My own two children are fully immunised-there really is no sensible alternative.