Posted by: Witch Doctor | February 12, 2009

Two very different viruses


The Witch Doctor has a friend whose young sister became severely brain damaged as a result of measles encephalitis. She survived, but was severely mentally handicapped and died tragically many years later as a consequence of this handicap. The aftermath of this one case of measles in an infant resounded throughout the family during this child’s life and for years after her death.

This was a tragedy due to lack of immunisation (measles vaccine was not available at that time.)

Many, many years ago, The Witch Doctor spent a short time as a GP. To this day she can remember a lot of the patients she saw and the conditions and illnesses they had. However, it is one Monday morning she remembers most. The practice nurse who worked in this, one of the first health centres in the UK, phoned in sick. The reason? Her niece, an otherwise healthy toddler, died of generalised vaccinia, a well known complication of smallpox vaccination. The family were devastated.

This tragedy was due to immunisation. It occured in the days smallpox vaccination was given routinely.

Immunisation is confusing, so it is no wonder that there is debate over it and it is no wonder that some parents decide not to have their children immunised. It is all the more understandable since few people today have the memory of death, handicap and grief that these completely preventable infections can cause.

But smallpox and measles are very different types of infection.

Smallpox is (or was) a devastating disease which has a very high mortality rate. You can see photos of children with smallpox here and here. The immunisation given to protect against this particular virus carried with it much more risk than would be acceptable for a disease such as measles or any other of the childhood infectious diseases. Nevertheless, because of the mortality associated with the wild virus, the balance of risk meant that huge numbers of lives could be saved and the ultimate goal could be reached – the eradication of smallpox from the globe. The Witch Doctor remembers well the day that proclamation was made. It was one of medicine’s greatest success stories but it took a long time to achieve.

Measles, on the other hand did not carry a high mortality rate even when it was rife. Commonly, though, it was a very miserable illness for the child, worrying for parents, and on occasion could lead to permanent and serious complications. Almost every medicine, and almost every immunisation has a downside. The downside of measles immunisation, backed by scientific evidence, is considered to be so low that it is a risk well worth taking. The risk of serious side effects is probably many, many times lower than the risk of a child being killed travelling in a car with a safety belt on.

So, because of this, most parents decide to have their children immunised against measles. GPs are happy to discuss the balance of risks with anxious parents and almost all GP’s who have children of their own will have had them immunised.

Sometimes parents may still refuse. Nevertheless, the numbers of patients refusing any routine vaccination are generally very low after reasonable discussion over their concerns with their GP and on almost every occasion everything goes smoothly. There may be the occasional parent who still does not want to go ahead for one reason or another or there may be some children who, for medical reasons, should not be given the vaccine. As long as these numbers are very low, no harm will be done, because if a high percentage of the population is immunised, this particular virus will not get a hold and the number of cases of measles will still remain very low. So, these small number of dissenting parents can still feel a sense of freedom in their decision making and the risk is low too for their children contracting measles.

After all, we live in a free society, and most doctors do understand these worries.

So it is good to be able to choose.

Enter the anti-vaccination brigade.

The alternative brigade who think they know better and knowingly or unknowingly have a way with them of influencing large numbers of the population. This is particularly easy if you have an assertive disposition, and carry a microphone in one hand as you speak into the radio-waves of the country’s largest city.

This changes the balance of the worriers against those who can understand the reasons for doing it the way we do. Immunisation rates fall and more children are left non-immune. As a consequence, all un-immunised children are no longer safe, and those who are immune deficient for example due to chemotherapy for childhood leukaemia are at particular risk when measles rears its head again with its potentially devastating and totally avoidable consequences.

Bear in mind also that if you have a government who relentlessly savages GPs and destroys patient confidence in them for their own political agenda, parents may even start to trust an articulate, rude, radio clown who lacks scientific knowledge of the issue more than a GP who might by nature be less forceful or articulate.

It should also be said, that some of the hype of the anti-measles brigade came about because single vaccines were not made freely available to parents. There were good reasons for preferring the combined MMR vaccine. However,  government action limiting access to single vaccines could generate and escalate negative feelings about all vaccines. A wise government would have had a hands-off approach and left it up to GPs to decide whether a child should have single vaccines if the parents felt very strongly about it. Given that much fewer injections are involved with MMR, most patients would have decided upon using MMR but they would have felt more involved in the decision making.

So The Witch Doctor has a strong message for HMG.

There are many reasons for the reappearance of measles in the UK and unknowingly, the government is fanning the fire. Now is the time to stop undermining the medical profession. In particular, stop undermining GPs – they have a far more difficult job than any of you will ever know – give them the time and space to do it well. Give them time to spend face to face with their patients so they can discuss and explain. Advise GP’s by all means, issue guidelines, give them good scientific information, and the time to read it – and then keep your hands off.

At a time of great demographic change and financial uncertainty the last thing this country needs is a measles epidemic.

redapple.jpg a red apple ……………………

The Witch Doctor – Link to a random page





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