How many needles will go into my child?

Now that my daughter is approaching her first birthday, it is time to get her vaccinated, again. This time there are choices: Do I go with the triple MMR injection (the standard choice) so it will be half the pain, half and fuss and free; or do I go with the single injections which means multiple trips, multiple screams and I’ll be paying for the privilege? Whilst on the subject of childhood vaccinations, how about chicken pox (also known as varicella)? Are measles, mumps and rubella any worse than chicken pox?

How affective are these vaccinations? As a parent and scientist I decided to find out what the literature states.

First of all is it worth the bother? Are these diseases really that bad? Let’s take a look at each one individually:

Measles: Measles is highly contagious, meaning it is very each to catch from an infected person. Measles can only survive by direct contact, if it is continually passed on from person to person like the serial killer’s soul in Fallen. It is passed via coughing and sneezing while children are in close contact. Therefore, if a child attends nursery, play groups or school, which are all full of snotty children, they are bound to infect one another, especially since their ‘secretions’ are left everywhere – hands, toys and each other. Due to the temperate climate in the UK, outbreaks usually occur in late winter and early spring during term time. Before vaccinations, there were 500,000 cases with 100 deaths per year. The single vaccine was introduced in the 1960s and the number of cases decreased to less than 100,000 with about 13 deaths. After the MMR was introduced in 1988, the number of cases reduced to less than 10,000 with no more than one death per year (98% reduction in cases before vaccinations were introduced). Measles can lead to complications in up to 40% of infections, mainly in the old and young (mainly babies, toddlers and preschoolers). The most common complication is pneumonia. Blindness can also occur, as can inflammation of the brain and spinal cord (encephomyelitis). Measles is on the World Health Organisation’s list of diseases that can be eradicated but 95% of the population needs to immunised to protect those that cannot be immunised due to medical conditions (e.g. another illness, immune system not working properly).

Mumps: Mumps causes swelling of the glands that produce saliva (parotid glands) – painful! It can also cause inflammation in the fluid surrounding the brain as well as complications with inflamed testis or ovaries which could lead to your children unable to have children of their own (therefore no grandchildren for you). Again, it is spread by direct contact with an infected person through coughs and sneezes. One study also showed that over a quarter of pregnant women who caught mumps during their first three months of pregnancy had a miscarriage but another study did not agree with this finding – so more work needed.

Rubella: Rubella is also known as German measles. In comparison to measles and mumps, it is considered a mild disease but if it is caught during early pregnancy, the child could be born with cataract, deafness and/or heart disease. Before the rubella vaccination was introduced, Rubella cases numbered 12,500,000 in the USA and Europe, with 11,000 fetal deaths. Therefore, if a pregnant woman has not had the rubella vaccine and her children or any children she spends time with catch rubella because they have not been immunised either can potentially cause her unborn child to be born with medical problems. The symptoms of rubella include swollen glands behind the ears and back of the neck and, especially in adults, joint pain.

Single vaccination: The single vaccines were introduced into the UK in the 1960s but due low uptake, the MMR triple vaccine was introduced. The single vaccine means six injections over months in the same place, each with the same side effects but the MMR is just two injections (one at 13 months of age and the second when the child turns 4 or 5). For over 90% of the population, one injection is enough and the second just boosts immunity. This means multiple trips to the surgery and possibly having to take a few days off work.

Chicken pox (varicella): Infection with chicken pox means there is a chance of getting shingles later in life. Shingles causes a painful rash which then develops into itchy blisters. It can also cause complications where the nerve pain lasts for months. Again, chicken pox infections occur mostly in 1-9 year old children during the winter and spring. It is highly infectious and spread via coughs and sneezes. However, as more children attend nurseries and pre-school, the age of infection is reducing. Although chicken pox is thought of as a mild disease, it can lead to serious complications, mainly in the young, old and ill. These complications can affect the brain or cause pneumonia. Out of every 1000 infections, 2-5 will need hospitalisation. The chicken pox vaccine is routinely used in the USA where the number of children getting chicken pox is now fewer. The vaccine is over 80% effective and has been taken up by other countries such as Uruguay, Germany, Taiwan, Canada and Australia. However, it is not available on the NHS as a routine vaccination nor is it offered privately at my GP surgery. If I want my daughter to be protected from chicken pox, I will have to pay for it.

There are no cures for these illnesses. The best that can be done is keep the patient comfortable and allow them to rest while they recover.

How about the MMRV? This is all four vaccines in one – measles, mumps, rubella and chicken pox. The combined injection was tested in over 5000 children in Europe and was shown to be over 94% effective in preventing these diseases. So why has the UK not yet taken it up? Is it because of the unwarranted worries parents still have about the autism link to MMR? This seems to be the case. In fact, there is a link between being overweight and autism (See this blog). There are also concerns about it increasing febrile seizures in children. It sounds serious but it turns out that it is relatively common in children with a fever. For more about MMRV see this blogpost.

Personally, I would have opted for the MMRV if it was available in the UK but as it is not, I’ll go with the MMR and then pay for the chicken pox vaccination.

Update 28th March 2014: Correction – The varicella vaccination is available at my GP surgery but for a fee.

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