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Meningitis vaccine

Are there vaccinations for meningitis and septicaemia?

Yes, there are vaccines that protect against some forms of meningitis and septicaemia, but although these vaccines provide excellent protection, they can't prevent all strains of these diseases. As yet there is no vaccine that can prevent all forms of meningitis and septicaemia.

Meningococcal vaccine

Most cases of meningococcal disease in the UK and Ireland are caused by group B meningococcal bacteria, and there is no available vaccine to protect against this, so knowing the signs and symptoms is vital.

MenC (Meningococcal C) vaccine

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 the Republic of 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 the Republic of 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 the Republic of 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 the Republic of 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

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
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).
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).
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)

Hib (Haemophilus Influenzae Type B) vaccine

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 the Republic of 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 the Republic of 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.

UK Hib vaccine catch-up campaign: 10 September 2007 to 3 March 2009

After the small resurgence in Hib disease, apparent from the end of the 1990's, studies showed that protection from the 3-dose primary schedule wanes during infancy. This was addressed by the 2003 Hib catch-up campaign, and the 2006 introduction of a routine booster dose for all children at 12 months (as the combined Hib/Men C vaccine). However, there is a cohort of children born between March 2003 and September 2005 who were too young to have had a booster during the 2003 Hib catch-up campaign, and too old to have received the new Hib/MenC booster after it was introduced in 2006.

Following advice from the Joint Committee on Vaccination and Immunisation, a Hib booster is currently offered to children in this cohort, so that they are as well protected as older and younger children. Children in the target group are those born between 13 March 2003 and 3 September 2005.

For most of these children, the Hib booster is given as part of their pre-school immunisation, at approximately 3 years and 4 months of age. Until March 2009, the pre-school booster will be DTaP/IPV/Hib (rather than DTaP/IPV or dTaP/IPV). This will cover the majority of children in this cohort, as they have not yet received their pre-school immunisations.

Older children in this cohort who had already received their pre-school immunisation when the catch-up campaign began are being offered an additional appointment to receive the Hib/MenC vaccine.

Further information resources about the UK Hib vaccine catch-up

Immunisation Against Infectious Diseases: http://snipurl.com/c6v0
Letter from the Chief Medical Officer:
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Professionalletters/Chiefnursingofficerletters/DH_076965
National Immunisation website:
http://www.immunisation.nhs.uk/publications/VaccineUpdate_143Jan08.pdf
Q&A for Hib booster campaign 2007 to 2009: http://www.healthpromotionagency.org.uk/Resources/children/pdfs/Hib%20QA.pdf

References

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).
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).
Frasch CE, Haemophilus influenzae Type b Conjugate and Combination Vaccines. 1995. Clin.Immunother. 4 (5):376-386
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).
Immunisation Guidelines 2002.
http://www.ndsc.ie/hpsc/A-Z/VaccinePreventable/Vaccination/Guidance/ (accessed May 2007)
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)

Pneumococcal vaccine in the UK

There are currently two vaccines that protect against pneumococcal disease ¹- a 23-type 'polysaccharide' vaccine for people over the age of two and a newer 7-type 'conjugate' vaccine for children aged two months to five years.

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. The vaccine covers the seven types that cause over 80% of serious pneumococcal disease in UK children aged six months to two 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 offered routinely in Canada and Austria.

This vaccine was introduced into the UK childhood vaccination programme on 4 September 2006.

Conjugate pneumococcal vaccine is also recommended for young children with health conditions that put them at particular risk from pneumococcal disease. ²Children under age 5 with any of the risk factors listed below, who have not had the pneumococcal conjugate vaccine as part of their routine immunisations should be offered the vaccine. Risk factors include:

having no spleen, due to injury or disease, or a spleen that does not work properly as in sickle cell disorder, thalassaemia, 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.

Patients about to have splenectomy, cancer therapy, organ transplant, should be vaccinated beforehand if possible: ideally 4 to 6 weeks, but at least 2 weeks before surgery or treatment. Patients about to have cochlear implantation, or an operation to install a CSF shunt should also be vaccinated at least 2 weeks beforehand if possible. Immunisation should not delay cochlear implantation ².

Children who receive the 7-type conjugate vaccine should be offered the 23-type polysaccharide vaccine after their second birthday and at least 2 months after their final dose of 7-type conjugate vaccine. Children under 5 who have already received the 23-type polysaccharide vaccine should be offered the 7-type conjugate vaccine starting at least 2 months after the polysaccharide ².

In addition to the recommendation for people with clinical risk factors, the 23-type vaccine is also recommended for all those aged 65 years and over ².

23-type 'polysaccharide' vaccine

This vaccine is offered to all adults over the age 65, and to older children and adults with any of the "at risk" health conditions listed above. It provides a level of short-term protection against

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

Children over two years of age with "at risk" health conditions are offered the polysaccharide vaccine, at least two months after their final dose of conjugate vaccine.

Children who get severe pneumococcal disease

Any children under 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 any condition that makes them susceptible to pneumococcal infection. These children may then be offered the conjugate vaccine, and in some cases, the polysaccharide vaccine also.

References

Pneumococcal vaccine in the Republic of Ireland

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.

Current schedule of vaccination in Republic of 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.

Travel & Hajj: ACWY quadrivalent vaccine

Protection against meningitis and septicaemia for pilgrims on Hajj or Umrah and for travellers

Summary points:

The ACWY (or 'quadrivalent') vaccine is a compulsory entry requirement into Saudi Arabia.
On entering Saudi Arabia for the purpose of Hajj, Umrah, or for seasonal work in Hajj areas, everyone must present a certificate of vaccination with ACWY, issued at least 10 days, but not more than 3 years before arrival.
Your travel agent or doctor will be able to tell you where you can get vaccinated.
The vaccine available in the UK and Ireland, ACWY lasts for about 3-5 years. It is 80-90% effective in adults ¹. It is less effective in children under 5.
ACWY vaccine is not effective against all forms of meningitis and septicaemia: there is still no vaccine against MenB, for example.
ACWY vaccine cannot stop you carrying the bacteria in your nose and throat.
Protection is not 100%, so it is important to know the symptoms of meningitis and septicaemia so that you can get medical help quickly if a case occurs.
This information is available in a number of languages .

What precautions can travellers take against meningitis and septicaemia?

Pilgrims on Hajj or Umrah , are required to get the quadrivalent ACWY meningococcal vaccination in order to enter Saudi Arabia ². The vaccine is also a requirement for seasonal workers in Hajj areas. It protects against meningitis and septicaemia caused by 4 different strains of meningococcal bacteria: A, C, W135 and Y. http://www.moh.gov.sa/en/modules/news/article.php?storyid=394.

In 2000 there were outbreaks of meningococcal W135 meningitis and septicaemia among Hajj pilgrims and, world-wide ³, many cases of W135 disease occurred after pilgrims returned to their own countries ⁴. Although W135 disease has decreased since quadrivalent vaccination became compulsory for pilgrims to Saudi Arabia, all strains of the bacteria continue to cause cases of meningitis, so there is still a need for protection.

Pilgrims on Hajj can get the quadrivalent vaccine from their doctor or travel clinic. On arrival in Saudi Arabia they will need to present a certificate of vaccination issued at least 10 days, but not more than 3 years before they get there.

Immunity provided by ACWY Vax, the quadrivalent vaccine available in the UK and Ireland lasts for about 3 - 5 years. The vaccine provides 80 - 90% ¹protection to adults but it is generally less effective in young children1. It is effective against A-strain in children aged 3 months or older, but protection against W135-strain in children under 2 years is limited. The current UK recommendation states that two doses of meningococcal ACWY vaccine should be given to children aged 6 months to two years, with an interval of 3 months between the two doses ².

Millions of doses of quadrivalent vaccine have been given around the world. Although no medicine is 100% safe, the chance of a severe reaction from this vaccine is very small.

Meningitis Research Foundation provides information about quadrivalent vaccine for pilgrims on Hajj in Arabic, Bengali (Sylheti), Gujarati, Punjabi, Somali, Turkish and Urdu. Check out this website or call our Free fone 24 hour helpline 080 8800 3344 (UK residents) or LoCall 1800 41 33 44 (Irish residents). An interpretation service in 150 languages is available through the helpline.

Quadrivalent ACWY is also recommended for travel to certain countries in sub-Saharan Africa, particularly for travellers 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 the National Travel Health Network and Centre ( http://www.nathnac.org/pro/factsheets/meningococcal.htm).

Children in the UK and Ireland who get the quadrivalent vaccine still need to be immunised against MenC in the routine immunisation programme for infants. There is no vaccine available against MenB meningitis and septicaemia.

Since no vaccine can prevent all strains, it is important to know the symptoms to look out for so that cases of meningitis and septicaemia are recognised early and treated promptly. Information on symptoms, level of risk and meningitis vaccines is available in 22 different languages in both written and audio format through this website or our 24 hour helpline.

Can you catch meningitis and septicaemia from other travellers on the same aeroplane, ship, bus, or train or in the same hotel or resort?

Getting meningitis and septicaemia from this sort of contact is unlikely. While at least 10% of the people you meet every day carry meningococcal bacteria in the back of their nose and throat, usually, this causes no harm. It is never possible to be completely certain that bacteria will not be transmitted, but the risk in these settings not generally any higher than in every day situations where contact with other people is neither intimate nor prolonged.

Can you catch meningitis and septicaemia from recycled air in air-conditioning systems?

Meningococcal bacteria are very fragile and can only live outside the body for a few moments. It is therefore not an airborne disease, and cannot linger in the air or on objects.

References

GSK UK, ACWY Vax Vaccine Summaries of Product Characteristics, August 2008. http://emc.medicines.org.uk/emc/assets/c/html/displayDocPrinterFriendly.asp?documentid=4204 (accessed October 2008).
Department of Health. Immunisation against infectious diseases. Chapter 22: Meningococcal. October 2008. http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254 (accessed October 2008).
Lingappa JR., Al-Rabeah AM., Hajjeh R., Mustafa T., et al. Serogroup W135 meningococcal disease during the Hajj, 2000. Emerging Infectious Diseases 2003

Measles, Mumps and Rubella

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 ³and 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 ⁶and the Republic of Ireland ⁷.

Cases of Measles

As a result of the decline in MMR uptake, outbreaks of measles occurred in the Republic of Ireland in 2000 leading to at least two deaths ⁸In 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 the Republic of 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