ALL healthcare is about balancing risk. When I prescribe a medicine, I have an expectation that the treatment will help my patient and not cause them harm. Similarly, if I arrange a lower bowel examination (sigmoidoscopy) in a 60-year-old individual who has noticed blood in their motions, I am doing this to rule out serious conditions such as cancer, with no intention that the individual suffers any physical or psychological damage.
Unfortunately, nothing I do as a doctor has zero risk. However, the recent panic associated with the outbreaks of measles in England and Wales has highlighted the difficulties we all have in evaluating risks.
When my three daughters had their measles, mumps and rubella (MMR) vaccination we did, like all parents, weigh up the possible side-effects in relation to the risks of the illnesses that it was designed to prevent.
However, the decision we came to was not only influenced by the – now discredited – scare stories prevalent at the time concerning autism, but also by my own experience as a doctor (both in the UK and in Africa) of the devastating impacts of these illnesses.
Measles is a highly infectious disease and causes a range of symptoms including fever, coughing and a characteristic skin rash. However, it can also result in fits, pneumonia and inflammation of the brain.
When I was a medical student in the late 1970s and early 1980s, 13 children died every year from measles in the UK. Mumps can affect the testes and ovaries (in some cases leading to infertility) and also cause pancreatitis, meningitis and deafness.
Although rubella is a much milder disease for the affected individual, it can, if contracted during pregnancy, result in devastating effects to the unborn child including cataracts, brain damage, deafness and heart problems.
In the NHS, the first MMR vaccine is given to children when they are around 13-months-old. They will then have a second booster MMR injection before starting school, usually between the ages of three and four. It is recommended that the vaccine should also be considered in women planning pregnancy and in people born between 1970 and 1990 who might have not have been adequately immunised against measles and mumps in the past. It is also particularly important to be aware that a single dose of MMR does not confer full protection and therefore two doses are always required. Over the years, I have encountered some parents who thought a jab was similar to a blood test: it isn’t. It is much quicker, simpler and, often, quite painless. However, it is always best if parents adopt a relaxed approach to the prospect of immunisation and for the child to attend wearing clothes that can be removed or rolled up easily.
If parents are not sure about their child’s immunisation status, or whether their child might have had measles, mumps or rubella in the past, I would also suggest that they err on the side of caution and have the vaccination. School leavers are also generally offered a booster MMR to make sure that they receive both doses.
The side effects of MMR are usually mild. Some children might develop a slight fever, malaise and/or a rash a week or so after immunisation. In rare cases a small rash of bruise-like spots may appear a number of weeks after the injection.
Although some serious side effects might occur, such as allergic reactions and fits, these are extremely rare. It is also important to recognise that whereas one in 1,000 children may experience a febrile fit after MMR (with no longer term complications), one in 200 children catching measles will have a convulsion and one in 1,000 will develop inflammation of the brain (encephalitis). It is now also recognised that there is no link between the MMR vaccine and autism or bowel disease.
There are certain groups that should not be given MMR – such as pregnant women, individuals with a weakened immune system and those who have had previous severe allergic reactions to MMR, neomycin or gelatine.
However, if you are not sure, or have any further questions, I would urge you to chat to your GP, practice nurse or health visitor rather than just avoiding the immunisation.
In my career, I have seen two cases of encephalitis secondary to measles and witnessed the devastating effects that this had on both the children and their families. I really don’t want to see any more.
Dr Nick Summerton is a GP in East Yorkshire.