MMR

December 12, 2001

I work on the line that injecting babies with bugs (albeit 'changed' bugs) is

a mad thing to do but just one step better than watching your child die of

the disease. We have 95% uptake rate on MMR. However if parents are

convinced that seperate antigens are safer then I give them the addresses I

have been given of people who are administering sep. antigens and encourage

them to let me know when their child/ren have finished the course so that I

can amend their records accordingly. Only a few actually bother because it

is expensive and usually involves travelling a good distance.

Cowley wrote:

> The TV and newspapers are full of MMR, but there has been no comment on

> Senate so I thought I would ask the question: what is it like out there

> dealing with all this hype? Are there difficulties? Any tips?

>

> I was at a conference on Friday, when the DoH were giving out a glossy

> MMR information pack for health professionals, which I have not seen in

> its entirety before (perhaps others have: much of the information was

> dated 2001). It looks like a very useful information pack; aimed at

> health professionals, it has summaries of all the relevant research and

> even (unusual for DoH and helpful as a teaching tool!) includes lists

> of relevant references and clear summaries about the argument.

>

> It stresses throughout 'helping parents to make an informed decision'

> (which , of course, is to choose to have MMR: no other options are

> mentioned!). The authors clearly believe in the 1970s brand of health

> education; if you know it makes sense, of course you will do it! I

> should stress that I believe the evidence that MMR is safe and

> effective, but the 'you know it makes sense' approach is renowned as a

> poor tool for health promotion. There is a leaflet that emphasises

> working with parents, listening to parents concerns and talking about

> reflective practice, so I should not be cynical: overall, I thought it

> looked like a very useful pack.

>

> It has some very useful graphs and information that may well be

> acceptable for some of the most questioning parents, as well as

> high-literacy information leaflets that are available in English,

> Gujarati, Punjabi, Urdu, Bengali and Cantonese. Most of the pack can be

> downloaded from www.immunisation.org.uk/immprof.html and it can be

> ordered free from HPE Customer Services, PO Box 269, Oxford OX14 4YN or

> fax back on 01235 465 556

>

> I will interested in views from others at the conference (celebrating

> the health visiting/school nursing development programme) about the

> pack, as well as views of the day. Best wishes

>

December 13, 2001

I too agree that when you point out to parents that only 12 cases of Autism

were linked to MMR then ask parents to estimate the number of MMRs given

in each year and we all agree that the percentage is not significant.

Although I am always careful to add that the cause of autism is not yet

known so that we cannot discount anything, but it would be unsafe to stop

preventing a known life-threatening disease like measles on such a thin

thread of supposition.

junet579@... wrote:

Agree

(again Liz) I will always remember as a student nurse in the 1960s nursing

a beautiful previously 'normal' 3 year old who became mentally handicapped

after contracting measles. Consequently, I have pushed the measles vaccine

ever since. Having done extensive reading of articles on the subject from

British and US medical journals via the Internet I really do think the

autism/bowel link is a load of Bs! What I find amazing is that such as

small study on 12 children has been blown out of all proportion whereas

articles on 1000s of kids showing no link has been ignored. The latest

research published on the BMJ's website last week found that some parents

give a history of concerns before the child's 1st birthday and have now

altered the history to connect it to the MMR after all the publicity.

Working amongst Islington's

'chattering classes' I just give questioning parents a bundle of all the

latest scientific research papers to read. One of the best and most recent

is the US research showing immunisation actually boosts the immune system

(See this month's journal or Paediatrics Jan 2002.)

Regards, June

December 13, 2001

Maggie/

I encourage parents who are dead set on single vaccination of M,M,R

by giving them addresses I have been given and asking them to come back

with honest appraisal, details and dates for their childrens' records.

I also emphasise that these organisations have no regulating body and that

I cannot guarantee that their vaccines have been stored/transported safely

and also let them know that Italian Mumps is not so effective. Only

one family have come back to me so far but I have three further families

going that route currently.

Cowley wrote:

Couldn't agree more Maggie. One of the interesting

side issues that came out of my (now very old!) PhD work about health visiting

is that HVs have this knack of looking beyond the immediate problem to

find appropriate solutions, especially when the 'problem' is one that is

regarded very differently by different individuals. There is certainly

no single simple answer to the MMR issue and a lot of different ways of

looking at it.

As you rightly say, there is a huge lack of trust at a much broader

and complex level than only about MMR:

a) lack of trust in science generally, and in medical science (BSE/CJD

is one of many examples)

lack of trust in professionals generally, and

c) lack of trust in politicians generally

The general lack of trust in professionals can be overcome by personal

relationships but that is incredibly labour intensive; also problematic,

given that health visitors have had two decades of being told not to make

personal relationships with our clients! Probably the kinds of post-natal

discussion groups you describe are a good, possibly even better, alternative.

I am interested in your students 'straw poll' about Leo Blair, Maggie.

Am I the only person who received a letter this weekend from Judith Moreton

at Health Promotion England, sent to my home address? It enclosed

a copy of a Times leader explaining why the Prime Minister had made the

right decision in not revealing his son's immunisation status; appealing

for us to trust him because he is not a hypocrite. I wonder about

the wisdom of that letter, because the lack of trust in politicians in

general means that discussing the Blair baby only makes matters worse

by adding another, different 'distrust' issue into the debate.

It brings in party politics and risks suggesting that if you are good 'New

Labour' you will have your baby immunised: dangerous ground indeed

(and, after last year's experience, health visitors know what happens when

you trust this government. . . . !! see how easy

it is to get off at a tangent).

Perhaps the lack of trust in science has become such a big issue because,

as a society, we have somehow allowed parents to lose trust in themselves

and their own good judgement. Maybe that is why the sharing of experiences

of childhood illness, sharing how mothers can look after children

at that time and even 'sharing the spots' years ago (although no

longer recommended!) was a good thing: it builds trust in children

surviving despite everyday illnesses and faith that parents can have the

ability to see them through.

Instead; we have MMR, parents being enjoined to trust an unfamiliar

science instead of their own experience. This is made even worse

by the hugely moral overlay and judgemental approach: the 'good parent/bad

parent' thing: emphasis not on their own opinions, abilities

or skills but on whether or not they comply with what scientists

and politicians say. Creating a culture of blame in an atmosphere

of reduced choice does not seem a good way to increase trust. Perhaps

if society did more to build trust in parents in general, parents would

have more trust in their own judgement and would feel less badgered and

guilty about the decisions they are asked to make.

Of course, we know that the public health is best served by looking

at the promoting uptake of the immunisation to enhance herd immunity and

the MMR is the best way to achieve that, none of which is of much interest

to a parent putting their own child's interests first. And since

there are no official records of single vaccines adminstered, we have no

way of knowing what the true immunisation status of 'the herd' is.

The government have rather painted themselves into a corner on that one,

because if there is no massive measles epidemic, it may well be because

of the uptake of single vaccinces; but that will reduce the credibility

of the 'fear measles' campaign still further. But if they start to

count the uptake of single vaccine, that will be considered a U-turn in

policy.

Also, I have a feeling (with no scientific evidence) that the population

as a whole has a collective fear of epidemics of plague proportions:

raising the hype about measles just increases the fear about autism;

there is no scientific logic to it, but fear creates fear. The way to break

out of that vicious cycle would be to have more research about autism,

not more health promotion about measles.

But what about the work on the ground? Would holding 'immunisation

parties' so that all parents could share their fears and feelings and get

to support one another help to increase trust and reduce fear? They

would probably work better if choice and open acceptance of different views

were to be a genuine element: perhaps they should be timed to take

place 2-3 months before the MMR is due. Such group interactions would

certainly require skillful facilitation to ensure they did not just increase

the hype still further: not something for a 'leader of teams' to delegate

to a junior member, I think. And is anyone keeping a local

record of the total numbers of measles vaccines (including single vaccines)

adminstered?

I see the BBC are planning to talk about MMR as part of their 'your

NHS' day on Wednesday, so I'll shut up now: too much already!

.

Maggie Lavin wrote:

Regarding the MMR - three points from last couple

of weeks:

1.After spending all of Monday morning carrying out an

unofficial MMR Helpline, I am now dealing with what I

can, then directing clients to NHS Direct (who are paid to

provide a 24 hour helpline and have all the info at their fingertips).

2.Saying that, I am finding that each query is as individual as the

families concerned and that having a relationship with them and

knowledge as to how they will react is of most help.

3.Interestingly, my student HV carried out a straw poll in our Postnatal

chat group and 99.9% of them said it wouldn't matter at all whether

or not we knew if Leo had been jabbed. It all goes back to BSE/CJD

and the betrayal of TRUST. Seems we need to be looking at this.

Best wishes,

Maggie Lavin, borough HV

February 12, 2002

,

Interesting comments - what I am picking up is that it is the thoughtful

parents who are questioning the MMR.

In the areas where I am working which are mainly deprived immunisation rates

are only around 70% and I do not think that isnecessarily a reaction to

MMR - rather it is mobile populations, lack of health visiting, poor generl

practice, poor accessibility etc.

These issue are not forming part of the agenda

Margaret