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Running head: MMR CONTROVERSY DISCUSSION 1

Measles, Mumps, Rubella Vaccination Controversy-A Discussion


Amy Johns, RN
Discussion Board Post-September 12, 2013
NURS 350-Research in Nursing
Ferris State University

Running head: MMR CONTROVERSY DISCUSSION 2

Measles, Mumps, Rubella (MMR) Vaccination Controversy-A Discussion
Background
The MMR or measles-mumps-rubella vaccine is one of a series of scheduled vaccinations
that are recommended by the CDC, as described in the document entitled the General
Recommendations on Immunization: Recommendations of the Advisory Committee for
Immunization Practices (2011). It determines the types of vaccines and the timeframe of
administration during childhood (from birth to age 18) to protect against serious communicable
disease (Centers for Disease Control, 2013).
The MMR vaccine is made by several manufacturers including Merck
(merckvaccines.com, 2013). According to a patient information document published by Merck
and available on its MMR webpage, it contains attenuated or weakened forms of the measles,
mumps, and rubella viruses (merck.com, 2010, p. 2). Inactive ingredients are stated as being
sorbitol, sodium phosphate, potassium phosphate, sucrose, sodium chloride, hydrolyzed gelatin,
recombinant human albumin, fetal bovine serum, other buffer and media ingredients, neomycin
(merck.com, 2010, p. 3).
While it is, of course, important to take steps to prevent communicable diseases for the
health and well-being of each individual child, vaccinations can and have already eradicate
disease on a global scale. Smallpox, for example, through concerted vaccination efforts, was
declared eradicated by the World Health Organization in 1979 (World Health Organization
[WHO], 2013). Some disease are becoming very rare (polio and diphtheria, for example) but it
is important to be diligent and consistent (CDC, 2012) as evidenced by a pertussis outbreak in
Japan in 1979. In 1974, 80% of Japanese children had received the pertussis vaccination and in
that year, 393 cases of pertussis were reported. In 1976, rumors about the safety of the vaccine
Running head: MMR CONTROVERSY DISCUSSION 3

and decreased need for pertussis immunization caused vaccination rates to drop to 10%. This
resulted in an epidemic of 13,000 cases of pertussis and 41 deaths in 1979 (CDC, 2012).
L(ook)
A similar situation is the subject of this discussion. It began with the publication of a
paper authored by Andrew Wakefield and 11 colleagues from the Royal Free Hospital and
School of Medicine in London, England. This paper entitled Ileal-lymphoid-nodular
hyperplasia, non-specific colitis, and pervasive developmental disorder in children (Wakefield,
et.al, 1998) and was published by a journal called the Lancet in February of 1998. It posed
evidence linking the MMR vaccine with development of autism and non-specific colitis and
created a fear of vaccinations in parents around the world. The paper was shown to be flawed
and subsequently retracted in February of 2010 (Deer, 2011, p. 77) .
Brian Deer, in his article for BMJ in 2011 called How the Case Against the MMR
Vaccine Was Fixed delves into the manipulation and fabrication of data that Wakefield
authored to establish a link between a supposed new syndrome afflicting certain children who
received the MMR vaccine. This syndrome was a combination of behavioral or neuropsychiatric
symptoms along with non-specific colitis-type bowel disease onset (Deer, 2011, p. 77).
Conflict of Interest
Deer exposes the fact that Wakefield, was working on a lawsuit,3 for which he sought
a bowel-brain syndrome as its centrepiece (p. 77, para. 8). Wakefield had received money
from client for claims that this syndrome has been established when in fact the now-disproven
paper was not even written until two years after Wakefield had received payment (p. 77, para.
8). This demonstrates that Wakefield had clear and dire financial and professional consequences
riding on the establishment of the link between his syndrome and the MMR vaccine.
Running head: MMR CONTROVERSY DISCUSSION 4

Falsified data
Deer researches the 12 cases used in Wakefields paper; parents surveyed whose children
had supposedly developed symptoms after administration of the MMR vaccination. On page 80
of the article, after he elaborates on individual interviews with parents who clarify and negate
Wakefields claims, he summarized his findings in a table. In none of the 12 cases, was there
corroboration of the onset of autistic-type behavioral onset, non-specific colitis symptom and the
MMR vaccine between a review of records and Wakefields paper. Deer establishes fatal
records-falsification in every case.
E(laborate) and A(nalyze)
Deers article was published in 2011, a full 13 years after the Lancets publication of
Wakefields article. After publication of the original article, parents around the world, especially
in the UK (Brown, Long, Ramsay, Hudson, Green, Vincent, Kroll, Fraser, & Sedvalis, 2011)
and the US (myself included) were exposed to mass-media reports of Wakefields research,
creating fear and a cultural wave of resentment and refusal of childhood vaccinations that, to
some extent, still continues to this day.
Brown, et. al. explore parental decision-making with regard to vaccination of their
children 13 years after Wakefields article. The abstract of the article states, Though the
Wakefield paper is now discredited and an MMR-autism link has never been demonstrated
empirically, this concern has manifested in over a decade of suboptimal MMR uptake (Brown,
et. al., 2011, para. 1). Results of this study show that parents are becoming aware of the false
nature of the claims of a link between autism and the MMR vaccine and indicate that parents
who refuse the MMR may have other concerns such as immune system overload (Brown, et. al.,
para. 1).
Running head: MMR CONTROVERSY DISCUSSION 5

Personal experience
My children were born in March, 1995 (before the Wakefield article) and May 1998
(after the article). Autism diagnoses were on the rise, as were peanut allergies and asthma. The
news media had a different cause every other day; vaccinations, nutrition, food additives and
colorings, your house was too dirty, your house was too clean, etc. When I heard about the
Wakefield article, I was skeptical because it was fraught with shifts in responsibility and lots of
litigious lawyer-speak. Even though I was not a nurse yet, I was not about to make any decisions
of that importance based on the shoddy and drama-driven media coverage. Much later on, I was
aware that the article had been retracted, but I knew that the damage was already done. There is
still a huge resentment of vaccinations in some sectors but it seems that parents are well-enough
educated at their well-child visits and opt for the vaccines, for the most part.
Along with Deers article which establishes the falsehood of Wakefields hypothesis,
there are numerous other studies which also show no link between the MMR vaccine and
autism. One such study is an article published in 2013 in the journal Vaccine, entitled Measles,
mumps and rubella (MMR) vaccination has no effect on cognitive development in children The
results of the Polish prospective cohort study by Dorota Mrozek-Budzyn, Agnieszka Kietyka,
Renata Majewska and Magorzata Augustyniak. This was a study of 369 Polish infants that
demonstrated no link between the MMR vaccine and cognitive impairment.
It is of interest to note that in 2008, measles, a disease that was once considered close to
eradication and was very uncommonly seen in the population of the UK, was placed back on the
UKs Health Protection Agencys endemic list. This means it is considered to be found within
the population and cases are not so reliably tracked to cases of importation (European Centre for
Disease Prevention and Control (ECDC), 2008).
Running head: MMR CONTROVERSY DISCUSSION 6

R(evise)
Before reading this information, I had only a vague sense that Wakefield was judged by
the media and the public to be unethical and that his research was to be completely
discredited. When asked about vaccinations, especially for children, I responded with great
trepidation. As a nurse I am just supposed to give facts and not interject my opinion, values, or
feelings in any way, shape, or form in a discussion with a patient. This is hard to do because
parents plead to have some guidance from medical personnel when it comes to the health of their
children. And even though I dont work in pediatrics, I still get asked, as we all do I suppose. I
am VERY relieved to have this information. This gives me confidence that the benefit of
childhood vaccinations FAR outweighs the risks and I will not be afraid to say this to parents. I
also will know that when adults ask me about vaccinations such as the Pneumovax or the flu
shot, I will implore them to research the topic for themselves and not just go by media
coverage. I am still unsure of what to say when I counsel a patient about receiving a pneumonia
vaccination, however, but it is a whole different story and I just need to research that more in-
depth.

Running head: MMR CONTROVERSY DISCUSSION 7

References
Brown, K.F., Long, S.J., Ramsay, M., Hudson, M.J., Green, J., Vincent, C.A.,Sedvalis, N.,
(2011). UK parents decision-making about measlesmumpsrubella (MMR) vaccine 10
years after the MMR-autism controversy: A qualitative analysis. Vaccine, 30, 1855-
1864. Retrieved from http://ac.els-cdn.com/S0264410X11020883/1-s2.0-
S0264410X11020883-main.pdf?_tid=6869b360-1426-11e3-9714-
00000aacb35e&acdnat=1378164274_378b6e924f39a2088891a35f97cd5bf2
Centers for Disease Control and Prevention, (2011). General Recommendations on
Immunization: Recommendations of the Advisory Committee on Immunization
Practices (ACIP). Morbidity and Mortality Weekly Report, 60(2). Retrieved from
http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf
Centers for Disease Control and Prevention, (2013). Vaccine Recommendation of the
ACIP. [Webpage]. Retrieved from http://www.cdc.gov/vaccines/hcp/acip-
recs/index.html
Centers for Disease Control and Prevention, (2012). Why Immunize?. [Webpage]. Retrieved
from http://www.cdc.gov/vaccines/vac-gen/why.htm
Deer, B. (2011). How the Case Against the MMR Vaccine Was Fixed. BMJ, 342, 77-
82. Retrieved from
https://fsulearn.ferris.edu/bbcswebdav/courses/XLIST_80303.201308/Deer_10MMR.pdf
European Centres for Disease Control, (2008). Measles once again endemic in the United
Kingdom. Eurosurveillance 13(27). Retrieved from
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18919
Running head: MMR CONTROVERSY DISCUSSION 8

Mrozek-Budzyn, D., Kieltyka, A., Majewska, R., & Augustyniak, M., (2013). Measles, mumps
and rubella (MMR) vaccination has no effect on cognitive development in children The
results of the Polish prospective cohort study. Vaccine, 31, 2551-2557. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/23588083
Wakefield, A.J., Murch, S.H., Anthony, A., Linnell, J., Casson, D.M., Malik,Walker-Smith,
J.A. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and
pervasive developmental disorder in children. Lancet, 351, 637-641. Retrieved from
https://fsulearn.ferris.edu/bbcswebdav/courses/XLIST_80303.201308/Wakefield_98MM
R_retracted.pdf
World Health Organization, (2013). Global Alert and Response: Smallpox.
[Webpage]. Retrieved from http://www.who.int/csr/disease/smallpox/en/