MMR’s successor – MMRVPosted: March 12, 2014
What is MMRV?
MMRV is the quadruple vaccination against measles, mumps and rubella (MMR; more here) and chicken pox (also known as varicella). Varicella vaccination (developed in Japan) has been used in Japan for twenty years and in the USA since 1995. In 2006, the varicella vaccination was combined with MMR to make MMRV. MMRV was licensed in 2005 and is a routine vaccination in many countries including the USA, Germany and Australia. The advantages of this are to reduce the number of injections and therefore increasing acceptance and uptake, hence increasing coverage. Two injections of MMRV give 94% efficiacy against chicken pox.
Children given the MMRV are more likely than children given MMR to have a fever which might suggest a more rigorous immune response. The greater worry is the associated increase in febrile seizures within two weeks of vaccination although the increase was only 8 children out of 10,000 children (for MMRV) to 3. 5 children per 10,000 children (for MMR). This increase in febrile seizures is small and only occurs in children between 12-23 months; after the age of two years there is no significant difference. Although febrile seizures are frightening for parents, there is no risk of any long-term harm to the child. There is also worry over an universal chicken pox vaccination increasing the likelihood of shingles later in life (only people exposed to chicken pox virus can get shingles) but the rate of shingles had been increasing in the USA, and other countries, before the introduction of the varicella vaccine and did not accelerate when the vaccine was introduced. This suggests to me that there is no link between shingles and the vaccine and therefore this is a needless worry.
Why immunise against varicella in the UK?
The world health organisation recommends routine vaccination to be considered in countries that can afford it and where it is a relatively important public health concern, a socio-economic problem and where at least 85% coverage is achievable. Varicella is considered a mild disease in children and compared to measles and mumps it is. In the USA, where records of chicken pox cases are kept, evidence shows that its introduction has benefitted the economy when the loss of work hours while parents look after a sick child and the hospitalisation costs verses the cost of the vaccine are compared.
Will introducing a new vaccine into the UK be a problem?
MMR uptake rates are still not at 95% in the UK, which is what the WHO recommends. Introducing MMRV, especially with the associated scaremongering around febrile seizures, may reduce uptake further. People still worry about ingredients in the vaccine (e.g. can they be given to children with an egg allergy?), the age of the child (two years or over is considered ideal), how long the vaccination lasts and the potential increase in another more deadly strain developing. These diseases are considered to be too mild and uncommon to warrant vaccination by a lot of people. Parents usually quote a second or third hand experience of an MMR-vaccine link, vaccine failure or adverse events. Several parents who rejected MMR had direct experience of caring for children with autism. Tony and Cherie Blair refusing to confirm the immunisation status of their child did nothing to alleviate parents’ fears.
Parents, falsely, seem to believe in the benefits of natural immunity and how it can be boosted by good nutrition. They also, erroneously, think exposure to low levels of disease causing bugs will boost immunity (they seem to be misunderstanding the hygiene-hypothesis). Although true to an extent, this does not apply to measles, mumps and rubella.
How to introduce a new vaccine?
Parents want GPs to provide impartial advice and give them a leaflet outlining the facts. They do not want to be judged and assumed to be stupid when in fact a lot of parents who do not give their child MMR on time are actually highly educated. Views on disease severity are based on personal experience rather than facts and exposure to increased disease susceptibility is motivation to vaccinate (e.g. in ethically diverse communities or during foreign holidays). Parents use official information leaflets to educate themselves about the disease and adverse symptoms and the decision to vaccinate is an emotional one rather than logical.
Trust in health professionals and vaccine policy is central to acceptance therefore effective communication comparing the facts of disease and vaccine risks in perspective is key. As parents think two years is a better age for immunisations, catch-up campaigns can target 24-36 month olds when parents may be more willing to vaccinate. Face-to-face contact by non-judgemental health providers, whether it is the GP, practice nurse or health visitor, is required.
Although controversial, compulsory vaccination should be considered. This will protect children who cannot be immunised for health reasons and children less than 12 months old for whom these vaccines do not work.
Epetition – Introduction of MMRV vaccine in the UK
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