A jab in the dark

A new pre-school booster for measles, mumps and rubella is worrying parents. Information about the vaccine's side-effects is scarce. Are we wise to immunise, as the DoH advises, or should we let our children develop their own immunity?ch

Typical Woman's Hour-listening, newspaper-gobbling middle-class mother that I am, I naturally question everything doctors tell me, assert myself in the surgery as if to the manner born and give birth where and how I like; but I don't remember ever thinking twice about having my children vaccinated. Like most mothers, I take it for granted that once each child has had a bout of chicken-pox, that will be the worst of the childhood illnesses; there will be no mumps, no measles, no whooping cough. And without ever really thinking about it, I'm aware at the back of my mind that the reason for all this is because I got them to the surgery on time for their jabs, that I faithfully followed the programme dictated by the doctors. I'm wise - so I immunise, right?

Increasingly though, it seems that parents such as myself, who have always put their faith in vaccines, are beginning to question the wisdom of them. According to the doctors' paper, General Practitioner, there is "growing concern" about the new MMR (measles, mumps, rubella) booster, introduced for all four-year-olds in October, with GPs reporting a surprisingly high number of calls and queries from anxious parents. The booster means that children now get the MMR at around 15 months, and then again at the age of four. Two years ago, in November 1994, in response to a predicted measles epidemic, there was also a controversial mass vaccination programme in primary schools across the country, where children were lined up in school halls, given a measles/rubella booster and a sticker saying "I was brave".

However, when the MMR was first offered in this country in 1988, Edwina Currie, then health minister, told us: "One jab - for lifelong protection." It now emerges that the medical profession is not sure exactly how long the vaccine's protection lasts - leading parents to question what else is uncertain about vaccines.

The Department of Health is remarkably dismissive of parental concerns. Its leaflet about the new booster does not give much information, simply urging everyone to vaccinate their children on schedule. I found, when I called the DoH press office, a similarly patronising tone, the line being: "We've heard all these trivial concerns before, give me your fax number and I'll send you all the information." They did send through 14 pages of charts and statistics on the safety of vaccines; but for every chart of theirs it seems there is always another study in another journal showing a different picture.

Dr Philip Monk is immunisation co-ordinator for Leicestershire, where he also runs a vaccine helpline. He explained that there are two reasons for introducing the MMR booster. "The first one is that the MMR 'takes' in nine out of 10 children. So in order to catch the one of 10 for whom it has not been effective, we give the booster. The second reason for the booster is that within the field of vaccine research it has become clear that if you administer a vaccine and then measure for antibodies, five years later a minority of the recipients will no longer have antibodies to the disease and 10 years later many more will be without antibodies. So by and large, 10 years seems to be the time the vaccine lasts."

Most adults over 40 in this country, he added, will have been exposed to measles as children, so are therefore immune. "So what we are trying to do now is protect the age group we believe to be most susceptible, the 0-10 year olds." But what about when those four-year-olds reach 14 and immunity possibly ends? I asked. Won't they then be exposed to childhood illnesses at an age when it could be more serious? By that time, he replied, doctors assume the diseases will have been eradicated - but they don't know for sure. "And," he continued, "just to confuse the picture, in recent years, evidence has been emerging that you may still be immune to a disease even though you have no detectable antibodies."

It is this uncertainty which worries parents' organisations concerned with vaccines. Magda Taylor runs an organisation called The Informed Parent which produces a newsletter giving the latest information on vaccines. She has two daughters: her youngest has not been given the MMR. "Personally," said Mrs Taylor, "I feel the research on vaccines is just not good enough yet - obviously, because something like the MMR is still quite new, long- term research is lacking. I think it is far better to go through childhood illnesses, and develop real immunity that way."

While minor side-effects such as fever and rash are accepted, the major concern about the MMR is whether there is any connection between the vaccine and brain damage. The Department of Health says there is no link, but there are parents in this country currently going through long and tortuous legal proceedings to prove a link, who will tell you that it is because the legal process takes so long that the DoH is able to deny any link as yet.

Jackie Fletcher runs JABS, a campaigning group for parents who believe their children were damaged by vaccines, and who are fighting for that to be recognised. My conversation with her kept having to be broken off, because periodically, in the background, her son Robert would throw an epileptic fit. Mrs Fletcher believes Robert's epilepsy was caused by the MMR he had at 13 months. One consultant has told her Robert's symptoms after he had the vaccine were compatible with encephalitis (inflammation of the brain) brought on by the MMR, but another has said the timing of Robert's first fit - 10 days after the MMR - was coincidental. Robert's case is with the lawyers and the legal process could take years. It is one of 330 logged with JABS, of children whose symptoms include chronic arthritis, paralysis and autism.

In the meantime, Mrs Fletcher would like parents to be given more information. "Instead of relying on the DoH leaflet," she said, "parents should be given the Drug Manufacturers' Data Sheet for the MMR, which spells out exactly what the side-effects are. Also, parents should be told they can have a blood test done on their child to check whether the child has antibodies or not and therefore if he or she needs a booster. With the MMR, the blood test can ascertain which of the three illnesses the child is protected against, so it may be the child could have just a booster vaccine against one of the illnesses, rather than the combined dose."

The Data Sheet for the MMR states that although no causal link has been shown between the MMR vaccine and encephalitis, "however, the data suggests the possibility that some of these cases may have been caused by measles vaccine".

Dr Philip Monk, like most doctors, is anxious to dispel worries about brain damage from the vaccine. "The fact is," he said, "one in 5,000 naturally acquired cases of measles get SSPE - sub-acute sclerosing pan-encephalitis, which would lead to brain damage, and death. The likelihood of getting it from the vaccine is one in 100,000."

Doctors complain of media scare-mongering, which is frightening parents off giving their children the necessary vaccines. But it became clear to me, while researching this article, that I really knew very little about the pros and cons of vaccines. I no longer feel quite happy about my youngest child, when she is four, being injected with the MMR at the same time as getting the other pre-school booster (for diphtheria, tetanus and polio). This means a six-point jab in all - a lot for one small system to deal with.

Access to the latest research on vaccines, perhaps in a better leaflet from the Department of Health, easily available in my doctor's surgery, would certainly help me to make up my mind. As Magda Taylor of The Informed Parent said, "Parents like me, who refuse the MMR, are labelled as irresponsible by doctors. Actually we've looked into the subject more than most"