Monthly Archives: August 2009

The MMR Decision, Part 2 – Singles Not Fabulous

I'm always pleased and flattered to stumble across links back to my own posts (assuming the context isn't "For an example of an atrociously poor piece of writing, click…").  This (the main part of the sentence, not the parenthetical bit) happened to me last night while blog browsing – I found my way to a post about the MMR which linked back (favourably) to the one I'd written on the subject.  This reminded me that I'd never written the follow-up posts I promised at the time, dealing with the 'Yes, but…'s that I can see cropping up in some people's minds in response.  Since this fitted in fairly neatly with my by now depressingly familiar need to find something quick and easy to blog about before the end of the month comes around and leaves me with the dreaded Permanent Gap In The Archives, I'm going to write the first of the promised posts – the explanation of why I didn't opt for separate vaccines instead of the three-in-one.

For those who didn't read or can't remember the previous post and can't be bothered to go read it now, it was about the reasons why I felt the MMR to be far safer than leaving my children at risk of catching the diseases against which it immunises.  The flaw that some people may have spotted in that logic is that those aren't the only two options.  One alternative that many parents opt for is to give the three immunisations as separate jabs rather than as a three-in-one combination, seeing this as a compromise solution that protects their children while avoiding the scaaaaary MMR.

While I think singles jabs are far better than leaving children unimmunised, I have to say that I couldn't see any point to them.  The reason usually given for choosing singles jabs (other than the fact that they haven't hit the headlines in the same way as the MMR has, which does not actually strike me as the best basis on which to make decisions about safety) is that giving the vaccines one at a time avoids overloading the immune system.  This argument makes absolutely no sense whatsoever to me.  We are swimming in germs every second of every day.  The microbes we're exposed to in nature don't form an orderly queue and politely wait their turn to infect us.  If we didn't have the capacity to fight off multiple germs in one go, we would have died out millions of years ago.  True, most of the millions of germs we have to deal with every day are stopped at a much earlier stage by the immune protection granted by our skin and by antibodies in the openings to our respiratory and gastro-intestinal tract – only a tiny proportion of them ever gain entry to the body, and injecting viruses directly into the body bypasses the first line of immune defence.  But the defences provided by the skin aren't perfect, and it's hardly uncommon for germs to get through.  I have a very hard time indeed believing that our bodies aren't perfectly capable of fighting off a paltry three viruses (and bear in mind that we're talking about severely weakened viruses, not the full-strength ones) without any undue difficulty.  I just don't see any reason to assume that immunising against one virus at a time would be any less likely to cause complications than immunising against three in one go.

(I heard about some interesting calculations based, if I remember correctly – which I may not, but it was something like this – the amount of antibody needed to combat a microbe, the number of antibodies that each white cell can produce, and the number of white blood cells in the body, that culminated in working out that the human body can under normal circumstances protect against a staggering ten thousand germs in one go.  This is, of course, theoretical, and I suspect it's probably a major overestimate – it seemed to be based solely on antibody production levels without taking into account that there may be other necessary parts of the immune response that may limit the rate of production of immunity.  However, even if that estimate's out by a factor of a thousand, it would still leave us more than capable of simultaneously whipping up an appropriate level of antibodies to measles, mumps, rubella, and a few common colds and infected ingrowing nails into the bargain.)

Anyway, I could, on the other hand, see a number of reasons for preferring the MMR:

1. The extra research that had been done into the safety of MMR.  Ironically, as a result of the scares there's actually been a lot more research done into MMR than into singles.

2. The extra four needles that my children wouldn't need to have stuck into them if I went for the combined vaccine.

3. The occasional horror story that I'd heard about private clinics not operating according to correct procedure, and giving children vaccine that had been contaminated by bacteria.  (I know, I know… being scared away by occasional horror stories isn't a great reason to make a decision, and is in fact a huge part of why we have an MMR crisis in the first place.  It just seemed to me at the time that going privately might mean I'd end up with who knew what quack clinic, whereas, if I went for the MMR, I'd know that the people giving the immunisation knew what they were doing and were working to standard procedures.  That belief may be unfair.)

4. The need for greater organisation on my part.  I'd need to remember to book all six of the appointments (an initial vaccine and a booster for each of the three) for both children, as opposed to simply turning up on a date sent to me.  Realistically, I knew there was a major risk I wouldn't get it done.

5. Actually, there wasn't a number 5 on my original mental list, because it was so obvious to me that I wasn't going to go for singles that I didn't even get as far as thinking about cost.  However, a quick bit of Googling just now clarified for me that going for the singles option would cost me the best part of £700.  Since I live in the UK, we could get the MMR done without paying a penny.

If someone said to parents "Here's a treatment that we think should reduce the risk of your child ever becoming autistic.  It will cost you upwards of £600, it will involve sticking several needles into your child, and we have no evidence at all that it actually does anything to reduce the risk," then I doubt they'd get very many people accepting.  That's essentially what choosing singles instead of the MMR seems to me to be.  So, again, I found that one a no-brainer.

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