Recent reports have highlighted proposed changes to childhood vaccination recommendations in the United States (US), including recommendations to reduce the number of routinely recommended childhood vaccines and to separate the measles, mumps and rubella (MMR) vaccine into individual components. Questions have also been raised about the safety of MMR vaccination and a potential link between vaccination and autism.
In response, the British Society for Immunology (BSI) has provided the following expert comment.
Professor Alex Richter, Guidelines Lead on the British Society for Immunology Clinical Immunology Professional Network (BSI-CIPN), and Professor of Clinical Immunology and Director of Clinical Immunology at University of Birmingham, said:
“It is difficult to argue the extraordinary success of the MMR vaccine; extensive global research confirms that two doses of the MMR vaccine are 97% effective at preventing measles, a devastating viral infection which results in hospitalisation in 1 in 6 unvaccinated children. A recent study published in the Lancet by Kaythorpe et al. in association with GAVI have found that Measles was the second most effective vaccination behind human papilloma virus preventing just over 6 deaths per 1,000 vaccines.
The question always is “at what cost”? Thankfully we have really robust monitoring data on its safety as the MMR has been used extensively for 50 years now. Just this year, Burstain et al. published a large cohort study in the Paediatric Infectious Diseases Journal. They investigated the health records of 2.5 million children and found no association between the MMR vaccination and autism which is consistent with multiple previous reports.
We often forget that many patients in communities cannot have the MMR vaccine as their immune system cannot control the vaccine to make an immune response. These are children and adults that might have had a transplant, cancer treatment, suffer from HIV infection or have an autoimmune condition which means their immunity following the MMR vaccine is lost. As their immune system remains suppressed, they can't have the MMR vaccine but are at risk of much poorer outcomes than individuals with a healthy immune system. As vaccination rates fall the rates of measles rise quickly, as it is one of the most infectious viruses known to science, and these vulnerable patient groups are increasingly exposed.”
Is there any evidence for calling the MMR “quite lethal”?
“No, this is misleading and not in line with numerous safety studies on MMR.”
What do we know from scientific evidence about autism rates now versus when there were fewer vaccines – and does this mean the two things are linked?
“There is no evidence to date linking autism with vaccination. Just because there are associations does not mean causation. An example I like is that ice cream sales and shark attacks rise and fall together, but eating ice cream does not cause a shark attack – hot weather drives people to eat ice creams and swim in the sea putting them at risk of shark attacks. Just because we have more vaccines doesn’t mean these have caused the increase rates in autism. So many societal and environmental factors have changed over the last 50 years to try and link this to a vaccine where there is no association in large cohort studies seems misplaced. It is essential that we focus energy, funds and scientific expertise on the origins of treatments of autism to improve outcomes for those that are affected by this condition.”
Is there robust scientific evidence for the 18 childhood vaccines recommended by the American Academy of Pediatrics (AAP) – does it make sense to only recommend 11 of these?
“The decision making around the AAP recommendation is based on evidence of disease severity, including death and serious complications, vaccine effectiveness, vaccine cost and vaccine safety. I haven’t seen the evidence to date to reduce from 18 to 11 or even a clear rationale for this.”
Is there scientific evidence that it’s better to have vaccines in a series of visits to the general practitioner (GP) rather than together?
“I am not aware of evidence showing it is better to have individual vaccines to separate them. Conversely, we know that higher number of GP visits for vaccines reduces attendances rates and puts children at risk due to non-complete vaccine courses. There are of course then additional costs to the patient and the health care professional for the additional visits as well as hidden costs such as cold chain, production and delivery costs for individual rather than combined vaccines.”
What is the evidence of the safety or risks of aluminium in vaccines?
“Aluminium salts have been used over the last 70 years to help improve the immune response to vaccines. Large scientific studies show that the tiny amounts of aluminium in shots do not cause chronic illnesses or allergies as have been alleged. Babies consume much more aluminium from daily food and breast milk than from aluminium containing vaccines.”
You can download copies of the BSI’s guides to vaccinations (including the guide to childhood vaccinations) on our website. These guides are designed to answer common questions around how vaccinations work and why they are important.