30 CLINICAL
Mythbuster
Debunking common patient myths and misconceptions
‘ The MMR vaccine causes autism ’
The reality is : the MMR vaccine does not cause autism ; all healthcare professionals should be able to clearly pass on this message and refute false information patients may have heard .
How did the myth arise ? In 1998 , a paper was published suggesting the MMR vaccine caused autism . 1 Within two months , the Medical Research Council had disputed the findings , 2 which were also contradicted by a large retrospective study . 3 However , the damage was done and within three years , uptake had fallen to below the 95 % needed for herd immunity .
The lead author of the now-retracted paper was Andrew Wakefield , then a consultant at the Royal Free Hospital in London . In 2010 , Wakefield was found guilty of dishonesty and serious professional misconduct , and removed from the medical register by the General Medical Council ( GMC ) in its longest ever fitness-to-practise case . The GMC said he had ‘ abused his position , subjected children to intrusive procedures such as lumbar puncture and colonoscopy that were not clinically indicated , carried out research that flouted the conditions of ethics committee approval , and brought the medical profession into disrepute ’. 4 Significant conflicts of interest had not been declared at the time of publication , including that he had a patent for a single measles vaccine , and had received £ 400,000 from solicitors , related to attempts to challenge use of the MMR . 5
More than 20 years later , some parents still believe the MMR causes autism and it is our job as healthcare professionals to be clear that this isn ’ t the case . So , what can you do to help parents of young children to trust the vaccine ?
Ensure parents know measles can kill We can start by giving parents a brief summary of the case , as discussed above . Wakefield still has a large following in the US , and communities he visits have seen rates of measles rise as the vaccine is refused . 6 Make sure parents know this wasn ’ t just a scientist who made a mistake but that he was struck off for dishonesty and stood to make significant sums from reducing faith in the MMR .
Many parents believe measles is a simple childhood infection that won ’ t cause long-term harm . This is wrong ; around 10-20 % of children will get a complication ( even more in developing countries ), and for several weeks after having measles children are much more susceptible to other infections as their immune system is suppressed . Serious complications include fits , blindness and encephalitis – which can occur up to 30 years after the initial measles infection . Adults are more likely to suffer complications , and if a pregnant woman catches measles she is at risk of miscarriage , premature birth and stillbirth . 7
Fans of the books of Roald Dahl might wish to read his account of the death of his daughter Olivia from measles in 1962 , before a vaccine became available . He says : ‘ I noticed that her fingers and her mind were not working together and she couldn ’ t do anything … “ I feel all sleepy ” she said … in an hour she was unconscious . In 12 hours she was dead .’ Sadly , nearly 60 years later , a child who contracts measlesrelated encephalitis is still likely to die , underlining the importance of countering misinformation .
Understand why autism appears more common now and the lack of any connection with the MMR
A common anti-vaccine argument is that autism has become much more common since the increase in the number of childhood vaccinations .
This is largely due to a widening of the diagnostic criteria , 8 rather than an actual increase in cases . There is no increase in autism in children who have had the MMR compared with those who haven ’ t , no clustering of the onset of autism symptoms after the MMR vaccination , and no correlation between rates of autism and rates of MMR vaccination . It is also important to be aware that the incidence of autism in the UK started to increase before the MMR was introduced , and that when Japan withdrew the MMR in 1993 , there was no slowing of the increase in rates of autism diagnoses . 9 The anti-vaccine movement is going strong , with a significant reaction seen against the Covid-19 vaccination programmes . 10 It is our duty as healthcare professionals to counter myths about vaccines whenever possible , to try to protect children from false information and hopefully reduce the number of preventable deaths from measles .
Dr Toni Hazell is a GP in north London
References 1 Wakefield A et al . RETRACTED : Ileal-lymphoidnodular hyperplasia , non-specific colitis , and pervasive developmental disorder in children . Lancet 1998 ; 351 ( 9103 ): 637 – 64 . 2 Bignall J . UK experts convinced on safety of MMR . Lancet 1998 ; 351 ( 9107 ): 966 . 3 Peltola H et al . No evidence for measles , mumps , and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study . Lancet 1998 ; 351 ( 9112 ): 1327 – 1328 . 4 Kmietowicz Z . Wakefield is struck off for the ‘ serious and wide-ranging findings against him ’. BMJ 2010 ; 340 : c2803 . 5 Deer B . How the case against the MMR vaccine was fixed . BMJ 2011 ; 342 : c5347 . 6 Dyer O . Measles outbreak in Somali American community follows anti-vaccine talks . BMJ 2017 ; 357 : j2378 . 7 NICE : Measles - what are the complications ? London : NICE , 2018 . bit . ly / 3vnl2ME 8 Hansen S et al . Explaining the increase in the prevalence of autism spectrum disorders : the proportion attributable to changes in reporting practices . JAMA Pediatr 2015 ; 169 ( 1 ): 56 – 62 9 Public Health England . The Green Book . Chp 21 : Measles . London : PHE , 2013 . bit . ly / 3ww3y0H 10 Boyd S . Pushing back – tackling the anti-vax movement . London : BMA , 2021 . bit . ly / 3yHgr9W
ALAMY nursinginpractice . com Summer 2021