麻疹流行の危険/英国医療事情

英国でも麻疹流行の危険
 この夏に予想外に多くの患者が発生した。今年は既に480人の感染者がでた。このままだと昨年を上回り、ここ10年で最高となるだろう。
 MMRワクチン導入前の80年代後半までは年に平均20人の死者が出ていたが、90年代前半よりの死者は合計で1人に減っていた。しかし昨年死者が出てしまった。就学児の罹患は従来極めて少なかったが、今回は新学期が始まり流行を広める危惧がある。90年代後半よりワクチン接種率が低下している。
 Andrew Wakefield によるMMRワクチンの安全性に疑問を投げかけた研究に対して、GMCによる詳細な調査が行われ、彼の支持している人たちがデモをするといったことで再び話題になった。
 英国では現在、12-15ヶ月と4才でMMRワクチンを接種するプログラムになっている。最新の就学時の接種率は88%である。十分な免疫力がついているのはその3/4である。これらの数値がもっと上がらないと安全とは言えない。
 Dr Wakefield と仲間の2人の教授とが、Lancet に発表した1998年の研究論文で、MMR が自閉症だけでなくクローン病とも関連性があるとして、MMRの安全性に疑問を投げたことについての疑惑が出てきた。しかし、主要な研究の多くはMMRと自閉症との関連性は見いだせていない。
 1996-98年に3人がRoyal Free Hospital's medical schoolにいたときの研究で、12人の消化器疾患患者について、種々の検査を施行したことが問題とされ、その後 Lancet はこの論文の承認を取り消した。3人に対して、この研究は非倫理的で非誠実的であると、GMCは主張し、MMRワクチンについての研究に関して、専門職としての不正行為に対する処分を下す可能性がある。

 予防接種が子どもに害を及ぼすとするグループは、GMC の外でDr Wakefield を支持するデモをおこなった。

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Last Updated: Thursday, 30 August 2007, 13:03 GMT 14:03 UK
Measles 'surge' prompts warning
By Jane Dreaper
Health correspondent, BBC News
http://news.bbc.co.uk/2/hi/health/6970525.stm
画像Measles vaccine
The immunisation was introduced in the UK in 1988

Health experts are issuing a warning about measles after an unexpectedly high number of cases this summer.
Parents are being urged to make sure their children have had both doses of the jab against measles, mumps and rubella before the return to school.
The Health Protection Agency has recorded 480 cases of measles this year - and more samples are arriving each day, with about half testing positive.
Doctors and HPA experts said they were concerned about the number of cases.
HPA immunisation expert Dr Mary Ramsay said: "We've been very worried because the cases have stayed up over the summer holidays.

MEASLES
Measles is a highly infectious virus. It starts with a fever and conjunctivitis before a rash develops
The rash often lasts about a week and other complications can include pneumonia and diarrhoea
The MMR jab is used to immunise children against the disease
Before the triple vaccine was introduced in the late 1980s, there were 20 deaths a year on average in the UK. But since the early 1990s there has just been one in total

"We've had quite a few cases in children of school age and we're worried those cases are going to take themselves into school when term starts soon."
Officials fear this year's figures could end up beating last year's - and those marked a 10-year high.
In previous decades, measles was a far bigger problem, causing on average 20 deaths a year. That is why officials like Dr Ramsay are nervous that the numbers are creeping up again.
She said: "Although the numbers are still small, compared to the history of measles, we're always worried about measles because very rarely it can kill.
"We hadn't had any deaths from measles since the early 1990s but unfortunately we had one death last year and we don't want any more."
Vaccination
Ollie Mullen is one of this summer's measles statistics. Aged eight months, he was too young for vaccination.
His mother, Anna-Maria, was astonished to find that her youngest son's runny nose, temperature and rash were symptoms of a serious disease.
She said: "I feel quite shocked and disappointed that people still haven't got their children vaccinated against measles - and also that I was walking around with an infectious child.
"It's a really horrible illness. Ollie was very miserable and quite lethargic for a week. I would say definitely do get your children immunised."
The latest figures on measles in Britain show high numbers in the east and south-east of England, Yorkshire and Humberside and London.
Doctors' surgeries at Hackney in the east of the capital are feeling the consequences of the backlash against vaccination.
Ollie and Anna-Maria Mullen
There have been more than 120 measles cases in the borough in the past three months - most of them in children aged under five who have not been immunised.
Dr Michael Fitzpatrick is a GP in Hackney who is vehement about the need for parents to get behind MMR.
"I am angry that the effect of this campaign against the MMR vaccine has ended up in outbreaks of measles like this," he said.
"This was inevitable and I think the only surprise is this hasn't happened earlier, and hasn't happened on a bigger scale."
MMR coverage began to drop in the late 1990s - though the medical establishment is relieved that uptake levels are now rising again.
The research which led to questions about the triple vaccine is being scrutinised at the moment in a hearing at the medical regulator.
Parents have held demonstrations outside the General Medical Council in support of Andrew Wakefield, the doctor who questioned the safety of MMR. The outcome of that inquiry will once again put the issue under the spotlight.
The latest figures show that 88% of UK children begin school having had one dose of MMR.
But only three-quarters of them have the full protection afforded by both doses.
Until those figures climb far higher, health officials say people should not assume their children are safe from measles.
The MMR vaccine protects against mumps and rubella, as well as measles.
It is given in the national immunisation programme at 12-15 months and at four years of age.

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Last Updated: Monday, 16 July 2007, 11:44 GMT 12:44 UK
MMR scare doctor 'paid children'
http://news.bbc.co.uk/2/hi/health/6289166.stm
Dr Wakefield arriving at the GMC hearing
Dr Wakefield stands by his findings
The doctor who first suggested a link between MMR and autism paid children £5 for their blood samples at his son's birthday party, a hearing was told.

画像Dr Andrew Wakefield and two colleagues face professional misconduct charges over their controversial research into the measles, mumps and rubella vaccine.

The General Medical Council alleges the trio acted unethically and dishonestly towards the Lancet medical journal.
They all deny the allegations in the case which could last several months.
Immunisation rates
The case centres on research carried out by Dr Wakefield, and colleagues Professor John Walker-Smith, and Professor Simon Murch, which raised doubts about the safety of the triple vaccine.
The suggestion of the 1998 research paper - published in the Lancet - was that MMR was linked not only to autism, but also to the bowel disorder Crohn's disease.

Dr Wakefield continues to vigorously deny any allegation of wrongdoing
Dr Wakefield's solicitor

Doctor on misconduct charges
It led to falling numbers of parents immunising their children and a row over whether the then prime minister, Tony Blair, had vaccinated his son, Leo.
But the medical establishment has repeatedly argued that the triple vaccine is perfectly safe.
And a host of major studies has since failed to find any evidence of a link between MMR and autism.
The allegations against the doctors relate to investigations for their study on 12 youngsters with bowel disorders carried out between 1996 and 1998.
At the time, all three doctors were employed at the Royal Free Hospital's medical school in London, with honorary clinical contracts at the Royal Free Hospital.
It was also alleged that 11 children were subjected to a series of invasive tests, including colonoscopies, lumbar punctures, blood and urine tests and MRI scans.
This was contrary to their best clinical interests and Dr Wakefield did not have the "requisite paediatric qualifications" nor sought the right approval for the tests, the charge sheet went on.
Dr Wakefield and Prof Walker-Smith are also accused of acting "dishonestly and irresponsibly" in failing to disclose in the Lancet paper the method by which they recruited patients for inclusion in the study.
And it is alleged that a drug was administered to one child for experimental reasons.
The allegations that he took blood from children at his son's birthday party date back to prior to 20 March 1999.
Later on, he joked about the incident while giving a presentation at the Mind Institute in California, and said he intended to get samples the same way in the future, the hearing was told.
Another of the key allegations against Dr Wakefield is that he was being paid at the time for advising solicitors on legal action by parents who believed their children had been harmed by MMR.
Deny
All three doctors are accused of conducting the study on a basis which was not approved by the hospital's ethics committee.
One example is that some of the children may not have qualified for the study on the basis of their behavioural symptoms.
In a statement ahead of the hearing Dr Wakefield's solicitor said: "Dr Wakefield continues to vigorously deny any allegation of wrongdoing."
The Lancet has disowned Dr Wakefield's 1998 paper, the editor admitting he would not have published it if he had known about what he called a "fatal conflict of interest".
The campaign group, Jabs, which believes MMR has damaged children, has been demonstrating in support of Dr Wakefield outside the GMC.

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