Meningitis vaccines

Most cases of meningococcal disease in the UK and Ireland are caused by group B meningococcal bacteria. Currently there is no available vaccine, but a new MenB vaccine, called Bexsero®, has now been licenced by the European Commission, meaning that governments can consider it for implementation.. Find out more.

The MenC vaccine is a conjugate vaccine against Group C meningitis and septicaemia. The MenC vaccine was introduced in the UK in 1999 and in Ireland in 2000 and provides excellent protection against meningitis and septicaemia caused by Group C meningococcal bacteria which used to kill about 150 people in the UK every year. Since its introduction, the vaccine has been offered to almost everyone who was aged under 18 in September 1999 in the UK and up to 22 in Ireland, reducing cases of Group C disease by over 90% in the age groups targeted for vaccination.

In January 2002, the programme of immunisation in the UK was extended to include everyone aged under 25.

Although MenC vaccine has been tremendously successful, it is important to remember that it cannot prevent all forms of meningitis and septicaemia. Even before MenC vaccine was available, Group B meningococcal disease was generally more common, accounting for up to 60% of cases, and no available vaccine can protect against it. There are many other equally deadly forms of meningitis and septicaemia that are not vaccine-preventable. For this reason, it is still crucial to be aware of the symptoms of meningitis and septicaemia.

Is MenC vaccine safe?

• Before it was introduced, the MenC vaccine was tested on over 25,000 people worldwide and shown to be safe and effective.
• Safety testing discovered no serious side effects. Some babies and children had a temperature, an unsettled night, or redness and swelling of skin where they were injected, but the chance of having these mild reactions was no greater than with other childhood vaccines. Older children and teenagers sometimes also complained of headaches. Vomiting was reported in some babies, but this is at least as likely to be due to other vaccines given at the same time.
• Since 1999, more than 33 million doses of MenC vaccine have been given. As with all licensed drugs, safety is continuously monitored. Adverse reactions are unusual, and for babies and toddlers are just the same as the mild reactions reported during the trials. For older children and teenagers, a few additional reactions were very occasionally reported including dizziness, aches and pains, swollen glands and rash. These reactions are not serious and disappear fast.
• It is never possible to be sure that a child will not react seriously to any medicine, vaccine or even food, but parents make decisions every day about the level of risk that is acceptable to them. The risk of severe allergic reaction to MenC is tiny - for every half million doses of vaccine distributed, just one severe allergic reaction was reported, and none were fatal. Although the risk of getting Group C meningococcal disease is not high, it outweighs any small risk from the vaccine.
• The vaccine is not 'live' and cannot cause even a mild form of meningitis or septicaemia.
• There are no new ingredients in the vaccine. All ingredients of the MenC vaccine have already been given to millions of children over many years as components of other vaccines, without causing any harm.

How does MenC vaccine work?

• Conjugate vaccines are made by linking a tiny fragment from the bacteria's sugar coat (polysaccharide) to a protein. Our immune systems respond much more strongly to proteins than to sugars, so conjugate vaccines trigger a long-lasting immune response, and are effective in babies as young as two months of age. However, research has shown that conjugate vaccines provide longer lasting protection if a dose is given in the second year of life ¹ . This has prompted the recent changes to the routine infant immunisation schedule. The new schedule now ensures that protection provided by conjugate vaccines is boosted after the child reaches one year of age.

Who should not be given the MenC vaccine?

• People who have had a confirmed anaphylactic reaction (not just a sore arm or a mild temperature) to a previous dose of MenC vaccine or to any component of the MenC vaccine should not have it ² .
• Vaccination should be postponed in anyone who is ill with a high fever. 

Is there a problem with 'multiple' vaccines?

Some parents might be worried that having DTP, Hib, polio and MenC together will overload babies' immature immune systems.

• Trials showed that all of these vaccines are safe and effective when given together.
• Vaccines do not 'overload' the immune system ³ . In order to work, vaccines must bring on a response from the immune system, but everyday mishaps like scraped knees and sore throats place more of a demand on the immune system than the combination of MenC and all of the routine vaccinations for babies.
• Routine vaccinations are timed to protect babies when they need it most.

Getting immunised with MenC vaccine

Information for parents of babies
Currently in the UK, babies are immunised at 3 and 4 months of age with MenC (one dose at each visit) along with other vaccines in the routine Childhood Immunisation Programme. Additionally, a MenC booster (given as the combined Hib/MenC booster) dose is now also offered to babies at 12 months of age.

In Ireland babies 2, 4 and 6 months of age get MenC (one dose at each visit) along with the other vaccines (DTP, Hib and polio) in the routine Childhood Immunisation Programme.

Information for under 25 year olds
MenC has now been offered to everyone less than 25 years old (in the UK) 4 and aged under 23 (in Ireland) who have not yet received the vaccine. Anyone in this age group (including students) who has not yet received the vaccine can arrange to be immunised by contacting their GP.

Information for first year university students
Nowadays, most students entering first-year university or college have already had MenC through their school in the MenC catch-up programme. Anyone of any age entering the first-year of a full-time undergraduate course that has not been immunised can arrange to get MenC from their GP before they go away to study. Getting immunised before the start of term protects students against the slightly higher risk of Group C meningitis and septicaemia that first-years are exposed to. After term starts, first-year students who are still not immunised can get MenC by registering with their university health centre or other GP practice. In particular, undergraduate students coming to study from abroad who have not been able to obtain MenC at home should take steps to do this.

Information for people without a functioning spleen
People with no spleen, or with a disease or condition that stops their spleen from functioning properly are at high risk of serious bacterial infection. For anyone of any age with no functioning spleen, immunisation with MenC is now recommended and can be obtained through GP surgeries.

References

1. Trotter CL, Andrews NJ, Kaczmarski EB, Miller E, Ramsay ME. Effectiveness of meningococcal serogroup C conjugate vaccine 4 years after introduction. The Lancet 2004;364:365-367
2. Department of Health. Immunisation against infectious disease. Chapter 22 Meningococcal page 246. Ed Salisbury D, Ramsay M and Noakes K. 2006. Third edition. TSO. http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Greenbook/DH_4097254 (accessed 17 May 2007).
3. Offit PA, Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, Landry S. Addressing parents' concerns: Do multiple vaccines overwhelm or weaken the infant's immune system? Pediatrics Jan 2002;109(1):124-9. http://pediatrics.aappublications.org/cgi/content/full/109/1/124 (accessed 17 May 2007).
4. Professional Letter- Chief Medical Officer (2002)1: Extending meningitis C vaccine to 20-24 year olds: pneumococcal vaccine for at-risk 2 year olds. Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Professionalletters/Chiefmedicalofficerletters/DH_4004730 (accessed 17 May)

A conjugate vaccine (made from a tiny fragment of the bacteria's sugar-coat attached to a protein) against Hib was introduced in the UK and Ireland in 1992, and provides long-lasting immunity. Since the introduction of the Hib vaccine, the incidence of meningitis cause by Haemophilus influenzae has been reduced by over 90%, across the UK and Ireland ^1,2 .

Introduction of the conjugate Hib vaccine has also reduced carriage rates of the bacteria ³ . Before the vaccine was introduced, a large proportion of children under age 5 carried the bacteria. Now that vaccination is routine, carriage of the bacteria is much less common, and as a result protection is extended to the rest of the population, even those not immunised. This is called 'herd immunity'.

Is Hib vaccine safe?

Millions of doses given to children worldwide over more than a decade have established an excellent safety record. Adverse reactions are no more common than for other vaccines routinely given to babies and children. The Hib vaccine is not a live vaccine and cannot cause even a very mild form of the disease.

Who gets Hib vaccine?

Currently in the UK, the vaccine is offered to babies at 2, 3, and 4 months of age in the routine immunisation programme, with a Hib booster (given as combined Hib/MenC) offered at 12 months of age. From 10 September 2007 children will be given a Hib-containing vaccine when they have their pre-school booster vaccines at 3-4 years of age. Children born between 13 March 2003 and 3 September 2005 who have already had their pre-school booster injections will be invited for an extra Hib booster (given as combined Hib/MenC) ^{4, 6} .

In addition, in the UK, Hib vaccine is recommended for older children and adults with certain immune deficiencies such as people with HIV or those without a functioning spleen (asplenics and hyposplenics), including people who have sickle cell disorder ⁴ .

Currently in Ireland, the vaccine is offered to babies at 2, 4 and 6 months of age in the routine immunisation programme, with a Hib booster dose offered at 12 months of age.

In addition to babies, in Ireland, Hib vaccine is recommended for all children under four years of age who have not previously had the vaccine and for anyone with malfunctioning or lack of spleen, sickle cell disease, HIV or other immunodeficiency, irrespective of how old they are ⁵ .

Is Hib still an important cause of meningitis?

The Hib vaccine is very effective, but no vaccine is 100% effective. It does not work as well in children with certain immune problems. In addition, a very small proportion of perfectly healthy children do not respond to the vaccine well enough to be protected against Hib meningitis. It is unusual for adults and older children to be susceptible to Hib infection, but cases are known to occur, particularly in hospitalised, sick and elderly patients. Illness caused by non-b types of Haemophilus influenzae is also being monitored.

Immunisation has dramatically reduced cases of Hib meningitis, but in countries which have not introduced the vaccine, Hib is still a major cause of serious disease in children.

References

1. JCVI Statement: Haemophilus influenzae type b (Hib) Disease and Hib Vaccine. Executive Summary. http://www.advisorybodies.doh.gov.uk/jcvi/hib.pdf (accessed 17 May 2007).
2. Health Protection Surveillance Centre. Hib FAQs, How safe and effective is the Hib vaccine? http://www.immunisation.ie/en/HealthcareProfessionals/Hib/#howsafe (accessed May 2007).
3. Frasch CE, Haemophilus influenzae Type b Conjugate and Combination Vaccines. 1995. Clin.Immunother. 4 (5):376-386
4. Department of Health. Immunisation against infectious diseases. Chapter 16: Haemophilus influenzae type B (Hib) pages 127-135. Ed Salisbury D, Ramsay M and Noakes K. 2006. Third edition. TSO. http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Greenbook/DH_4097254 (accessed 17 May 2007).
5. Immunisation Guidelines 2002.
   http://www.ndsc.ie/hpsc/A-Z/VaccinePreventable/Vaccination/Guidance/ (accessed May 2007)
6. Professional Letter-  Chief Medical Officer (2003)2: Planned HIB vaccination catch-up campaign: further information Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Professionalletters/Chiefmedicalofficerletters/DH_4004833 (accessed 17 May 2007)

Currently two different vaccines are used in the UK, one in the routine childhood immunisation schedule for all babies and the other for everyone over 65. These vaccines are also available to people with particular health conditions that increase their risk from pneumococcal infection. The single most important thing you can do to prevent pneumococcal meningitis is to make sure your children are up to date with their routine immunisations, and to have the immunisations you are eligible for.

Pneumococcal ‘conjugate’ vaccine (PCV)

The current vaccine in the childhood immunisation schedule, Prevenar13® (PCV13) can protect against severe infection caused by thirteen of the most common strains of pneumococcal bacteria. Conjugate vaccines are explained in more detail in the box opposite.

This vaccine:

• is routinely offered to all babies at 2, 4 and 13 months of age, within the routine childhood immunisation programme,
• is similar to the successful Hib and MenC vaccines, which are also conjugate vaccines,
• provides direct protection to those who are vaccinated. However, because the vaccine also reduces the number of people who are carrying and potentially transmitting the bacteria, people who are not vaccinated also benefit from indirect protection. This is called ‘herd’ immunity. 

PCV13 was introduced in spring 2010 and directly replaced PCV7, which only provided protection against seven strains of pneumococcal bacteria. The change was made to provide broader coverage for children by protecting against six additional strains of bacteria.

Is this vaccine safe for my child?

Yes. The widespread use of PCV7 in over 100 countries, with over 300 million doses distributed worldwide, established a solid safety record. Clinical trial data from studies involving more than 7000 children show that PCV13 has a similar safety profile to PCV7.

What if my child has already received one or two doses of PCV7?

Children who have already received one or two doses of PCV7 can complete their vaccination course with PCV13 with no change to the routine vaccination schedule.

Did PCV7 vaccine reduce cases of pneumococcal meningitis after it was introduced in 2006?

PCV7 has been very successful at preventing the seven strains of pneumococcal infection it covers. In the first two and a half years after the introduction of PCV7, it has been estimated that 959 cases of serious illness and 53 deaths due to invasive pneumococcal disease were prevented².

Meanwhile, as disease caused by the seven most common strains decreased, cases caused by other strains of pneumococcal bacteria had been increasing³. Therefore, the vaccine was upgraded to provide broader protection.

There are over 90 strains of pneumococcal bacteria, but most strains rarely cause disease. PCV13 covers the strains that account for approximately 74% of all severe pneumococcal disease in young children in England and Wales¹.

Severe pneumococcal disease in children aged under 5 caused by strains in Prevenar and Prevenar13

 

Pneumococcal ‘polysaccharide’ vaccine (PPV)⁴

This vaccine provides a level of short-term protection against serious pneumococcal disease caused by the top 23 disease-causing types of pneumococcal bacteria (see box opposite). This vaccine is offered to adults over the age of 65 and children over the age of 2 who have health conditions which put them at increased risk from pneumococcal infection.

What health conditions increase the risk from pneumococcal infection?

Health conditions which increase the risk of infection include⁴:

• having no spleen, due to injury or disease, or a spleen that does not work properly as in sickle cell disorder, and coeliac disease;
• other immunodeficiency, whether inherited or acquired (e.g. HIV);
• immunosuppression as with cancer therapy or organ transplant;
• chronic disease of the heart, kidney or liver;
• chronic respiratory diseases, including, for example, asthma requiring repeated use of systemic steroids, chronic obstructive pulmonary disease;
• diabetes requiring insulin;
• people with or about to have cochlear implantation or other conditions where leakage of cerebrospinal fluid can occur (but vaccination must not delay cochlear implantation).

What protection is offered to people with 'at risk' health conditions?

People with at risk health conditions should be offered vaccination with PCV, PPV or both depending on their age and the condition they have.

In general the following applies to people with “at risk” health conditions*:

• Babies should be immunised according to the routine schedule followed by one dose of PPV after their second birthday,
• Children under 5 years of age, who haven’t previously been vaccinated should be offered PCV and then PPV after their second birthday,
• Children over 5 years of age and adults should be offered PPV if they haven’t already received this.

*People with an absent or damaged spleen, who are HIV positive, receive bone marrow transplants or have chronic renal disease should seek specialist advice as recommendations in these cases can differ.

Children under 2 years of age with at risk conditions and who have already had the full course of PCV7 are eligible for a PCV13 vaccination.

Children who get severe pneumococcal disease

Any child under age 5 years who gets pneumococcal meningitis or other severe pneumococcal disease will be followed up by their GP or paediatrician, to check whether they have an ‘at-risk’ health condition⁵. These children should be offered PCV even if they have already had it. They may also be offered PPV.

ALL children who are under the age of 2 and have missed immunisations are entitled to receive PCV and are entitled to receive other routine immunisations up to age 10.

IMPORTANT: Vaccines cannot protect against all forms of meningitis

It is important to remember that although vaccines can provide excellent protection, there are still some types of meningitis and septicaemia for which there are no vaccines. It is important to be aware of the symptoms of these diseases and to seek medical help immediately if you suspect that someone has meningitis or septicaemia.

References

1. Kaye P, Malkani E, Martin S, Slack M, Trotter C, Jit M, George R & Miller E. Invasive pneumococcal disease (IPD) in England & Wales after 7-valent conjugate vaccine (PCV7); potential impact of 10 and 13-valent vaccines.
2. Report of the Director of Immunisation: April 2009.(Accessed 17 Feb 2010).
3. Pichon B, Beasley L, Slack M, Efstratiou A, Miller E. and George R. Effect of the introduction of the pneumococcal conjugate vaccine in the UK childhood immunisation scheme on the genetic structure of paediatric invasive pneumococci.  (Accessed 17 Feb 2010)
4. Department of Health. Immunisation against infectious diseases. Chapter 25: Pneumococcal. August 2006. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4137924.pdf (accessed 25 Feb 2010).
5. Health Protection Agency. Clinical Management Protocol version 3: January 2007 (accessed 17 March 2008).

There are currently two vaccines that protect against pneumococcal disease; a 23-type 'polysaccharide' vaccine for and a newer 7-type 'conjugate' vaccine.

23-type polysaccharide vaccine

This vaccine can protect most adults for five years or more against the top 23 disease causing types of pneumococcal infection. However, it does not work in children under two years old and is less effective in people with immune deficiencies and the under-fives.

7-type conjugate vaccine

The newer 7-type 'conjugate' vaccine is similar to the successful Hib and Men C vaccines, which provide stronger, more long-term protection than the plain polysaccharide vaccines, even in babies. This vaccine covers the seven types that cause over 80% of serious pneumococcal disease in Irish and UK children aged 6 months to 2 years and about 75% in the under fives in Europe generally. The routine use of this vaccine in America since June 2000 has established a good safety record and shown that it is effective.  It is now also offered routinely in the UK, Australia, Canada, Austria, Italy, Spain and Norway.

This vaccine was introduced into the Irish childhood vaccination programme on 1 September 2008.

A newer 13-type vaccine will replace the 7-type later on this year.

Current schedule of vaccination in Ireland for children born on or after 1st July 2008

2 months	4 months	6 months	12 months	13 months	4-5 years
Diptheria/ Tetanus/ Pertussis/ Polio / Hib/ Hepatitis B ('6-in-one')	Diptheria/ Tetanus/ Pertussis/ Polio / Hib/ Hepatitis B ('6-in-one')	Diptheria/ Tetanus/ Pertussis/ Polio / Hib/ Hepatitis B ('6-in-one')
	MenC	MenC		MenC
Pneumococcal		Pneumococcal	Pneumococcal
			MMR		MMR
				Hib
					Diptheria/ Tetanus/ Pertussis/ Polio ('4-in-one')

There is a catch-up programme if your child was born between 02/09/06-30/06/08. You can view this immunisation schedule at http://www.immunisation.ie/en/HotTopics/Text_15413_en.html

Please remember that although meningitis vaccines that are currently available can provide excellent protection, there are several major forms of meningitis and septicaemia for which there is no vaccine.

Meningococcal infection can cause meningitis, septicaemia or both. Five strains of meningococcal bacteria (A, B, C, W135 and Y) cause most cases. Although it occurs in all countries, it is much more common in certain areas, for example there are epidemics in the ‘meningitis belt’ of sub-Saharan Africa, usually due to meningococcal A or W135 bacteria, and from time to time there are outbreaks in other countries.

Large epidemics of meningococcal disease have also been linked to the Hajj pilgrimage, at first due to A-strain and then in 2000 and 2001 due to W135^[1]. Many cases of meningococcal disease also occurred world-wide after pilgrims returned to their own countries^[2].

Because of these epidemics, quadrivalent ACWY vaccination has been a compulsory entry requirement into Saudi Arabia for pilgrims on Hajj and Umrah, and for other travellers in Hajj season since 2002. It protects against meningitis and septicaemia caused by four different strains: A, C, W135 and Y. Vaccination is also recommended for travel to sub-Saharan Africa and certain other countries, especially if travellers will be living or working with local people or visiting during an outbreak. An up-to-date list of countries with potential risk can be obtained from www.nathnac.org.

Pilgrims on Hajj or Umrah are required to present a certificate of vaccination with ACWY, issued at least 10 days, but not more than 3 years before arrival. This also applies to seasonal workers in Hajj areas.

What vaccines are available?

There are two ACWY vaccines available. The old one (ACWY Vax®), a ‘polysaccharide vaccine’, is based on meningococcal sugars, and sugar-based vaccines do not work very well in young children. The newer one (Menveo®) is a conjugate vaccine, with the meningococcal sugars linked to a protein, and protein vaccines work very well even in babies. Although both vaccines are suitable for travel, the Department of Health recommends that children over 5 years of age and adults are vaccinated with Menveo® because it provides better and longer lasting protection. Children under 5 should always be vaccinated with Menveo®. For babies under one year of age, two doses one month apart are needed for protection, but older children and adults should receive a single dose^[3].

The Muslim Council of Britain (MCB) have set up a national network of vaccination clinics in England, Scotland and Wales where Menveo® is offered to pilgrims travelling on Hajj or Umrah at a reduced price of no more than £35. This cost includes the cost of the vaccine, administration and the certificate. Menveo is the vaccine recommended by the Department of Health. For more information, or to find your nearest clinic visit www.mcb-vac.co.uk or call 08455 521 4160. The MCB network of vaccination clinics doesn’t cover Northern Ireland, contact your GP practice for information on vaccination.

Safety and acceptability

The ingredients of both the older polysaccharide vaccine and the newer conjugate vaccine have been in use for many years. Although mild side effects are fairly common, including pain where the vaccine was injected, and sometimes headache, or nausea, these reactions are similar to the reactions caused by routine vaccines.
The new Menveo vaccine has also been certified as Halal by the Indonesian Council of Ulama and the US Islamic Association.

References

1. Lingappa, J.R., et al., Serogroup W-135 meningococcal disease during the Hajj, 2000. Emerg Infect Dis, 2003. 9(6): p. 665-71.
2. Hahne, S.J., et al., W135 meningococcal disease in England and Wales associated with Hajj 2000 and 2001. Lancet, 2002. 359(9306): p. 582-3.
3. 'Green Book'. Department of Health. Immunisation against infectious diseases. Chapter 22: Meningococcal. Updated April 2011. http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254.

Before immunisation was available, measles, mumps and rubella were fairly common diseases that could have very serious complications:

The most common complications of measles infection are otitis media, pneumonia, blindness and encephalitis (inflammation of the brain) ¹ .

Mumps

Can cause complications ranging from inflammation of the pancreas and reproductive organs to deafness, meningitis (inflammation of the covering of the brain and spinal cord) and encephalitis.

Rubella

Can cause birth defects such as deafness and heart defects in babies whose mothers contract the illness while pregnant.

The role of MMR vaccine in preventing meningitis

Before MMR vaccine was introduced, mumps was the main cause of viral (or aseptic) meningitis - about 1,200 people (mainly children) in the UK were hospitalised each year with mumps ² . Most of these cases had meningitis. Mumps was also the most frequent cause of viral encephalitis.

Measles encephalitis occurs in approximately 1 in 1000 cases of measles infection ³ and can be fatal.

Since the introduction of MMR in 1988, mumps and measles meningitis and encephalitis have virtually been eliminated.

Vaccine Uptake

Following adverse publicity about MMR in 1998, uptake of the vaccine in England fell from over 90% to around 80%, causing widespread concern among health professionals about the risk of outbreaks of these diseases. Similar patterns were seen in Scotland ⁴ , Wales ⁵ , Northern Ireland ⁶ and the Ireland ⁷ .

Cases of Measles

As a result of the decline in MMR uptake, outbreaks of measles occurred in the Ireland in 2000 leading to at least two deaths ⁸ In England and Wales in 2006, at least one child has died following outbreaks of measles, the majority of which have been seen in Surrey, Sussex and South Yorkshire ^9. Fortunately, parents' acceptance of MMR seems to be improving again and uptake rates look to be increasing ⁹ .

Separate Vaccines

MMR* is given as two injections, one at 13 months (12 - 15 months in Ireland) and one between 3 - 5 years. Separate vaccines against measles, mumps and rubella would have to be given as six injections over a long period of time. Children would be left without protection in the gaps between injections and there would also be a fall in vaccine coverage as children may not complete the course of injections.

In particular, there is concern about the use of single vaccines and the impact on the occurrence of mumps and its complications. This is because, when seeking separate mumps immunisation, parents may find the vaccine they have obtained is the wrong sort. There are three strains of mumps vaccine available in Western Europe as single vaccines:

• Urabe, which does not have a license in the UK and was withdrawn from use here in 1992 as the vaccine itself was responsible for a higher than acceptable risk of aseptic meningitis ¹⁰
• Rubini which has been shown to be between only 1% and 22% effective ¹¹
• Pavivac, which is not licensed in the UK because there are questions about its safety ¹² .

The mumps component of the MMR vaccine is the Jeryl Lynn strain, which is safe and effective but not often possible to obtain as a single vaccine either in the UK or mainland Europe. Children's health could be jeopardised if inappropriate vaccine is given.

Safety of MMR vaccine

Although MMR vaccination has had much adverse publicity, there is no factual basis for this.

Although no medicine is 100% safe, vaccines undergo stricter testing than other medicines. Over 30 years, more than 500 million doses of MMR have been given in over 100 countries, and it has an excellent safety record.

Articles published in medical journals and in the national press claiming that MMR vaccination causes autism and bowel disease have been thoroughly investigated and the evidence from several studies has shown no link between these conditions and MMR or measles vaccines.

There is no evidence that supports getting measles, mumps and rubella vaccinations separately-MMR vaccination is safer and more effective.

In recent years, many myths surrounding vaccination have developed and speculative media stories have understandably raised parental anxiety. Vital signs, Vital issues contains a large section which attempts to dispel these myths. This booklet can be downloaded from our website .

* The MMR vaccines used in the UK are M-M-RTMII and Priorix.

References

1. Perry RT and Halsey NA. The clinical significance of measles: a review. Journal of Infectious Disease. May 2004; 189. (accessed 28 June 2006)
2. Department of Health. Immunisation against infectious diseases. 1996. http://www.dh.gov.uk/assetRoot/04/07/29/84/04072984.pdf (accessed 28 June 2006)
3. NHS Health Scotland. Ready Steady Baby http://www.hebs.scot.nhs.uk/readysteadybaby/moreinfo/hebs_pub4.cfm?TxtTCode=1172 (accessed 28 June 2006)
4. Scottish Health Statistics. Latest Primary Immunisation uptake rates. May 2006. http://www.isdscotland.org/isd/info3.jsp?p_applic=CCC&p_service=Content.show&pContentID=1652& (accessed 28 June 2006)
5. Local Health Board. Neath Port Talbort. Board Meeting, 6th May 2004. http://www.wales.nhs.uk/sites3/documents/245/DirectorOfPublicHealth.PDF#search='uptake%20of%20mmr%20in%20wales (accessed 28 June 2006)
6. CDSC NI. Communicable Diseases Monthly Report. March 2003. http://www.cdscni.org.uk/publications/MonthlyReports/Volume_12_2003/No_1.pdf#search='uptake%20of%20mmr%20northern%20ireland' (accessed 28 June 2006)
7. NDSC. Immunisation Uptake Statistics for Ireland. May 2002. http://www.ndsc.ie/A-Z/VaccinePreventable/Vaccination/Publications/ImmunisationUptakeStatistics/2001/File,926,en.pdf#search='fall%20in%20mmr%20uptake' (accessed 28 June 2006)
8. Parliament of Ireland. Report on Childhood Immunisation. 7 December 2000. http://www.irlgov.ie/Committees-01/c-health/rep-childhood/071200.htm (accessed 28 June 2006)
9. Health Protection Agency. Measles cases so far in 2006. June 2006. http://www.hpa.org.uk/hpa/news/articles/press_releases/2006/060615_measles.htm (accessed 28 June 2006)
10. Dourado I, Cunha S, Teixeira MG, Farrington CP, Melo A, Lucena R, Barreto ML. Outbreak of aseptic meningitis associated with mass vaccination with a urabe-containing measles-mumps-rubella vaccine: implications for immunization programs. Am J Epidemiol March 2000; 151(5):524-530 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10707922&query_hl=24&itool=pubmed_docsum (accessed 28 June 2006)11.
11. Goncalves G, de Araujo A, Monteiro Cardoso ML. Outbreaks of mumps associated with poor vaccine efficacy - Oporto Portugal 1996. Eurosurveillance 1998; 3(12):119-121 http://www.eurosurveillance.org/em/v03n12/0312-222.asp (accessed 28 June 2006)
12. NHS. Ban on import of Pavivac mumps vaccine extended. January 2003. http://www.mmrthefacts.nhs.uk/news/newsitem.php?id=38 (accessed 28 June 2006)