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CAMHS won't see you now

Let GPs lead the measles fightback

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Over the past month, Swansea has been the scene of public health in action par excellence. Clinics have had queues of parents and children waiting for the MMR vaccine. Over a thousand have been vaccinated in days. Nearly 900 cases of measles have been reported, and sadly, horrifically, at the time of writing one fatality has now been linked to (but not proven to be caused by) the outbreak.

In Dublin, in 2000, three children died in an outbreak; at that time they had an MMR coverage in children of 79%.1 London’s coverage is just a percentage point away from that. If avian flu taught us anything, it is that disease can travel fast, globally. Measles kills 430 children a day, says the World Health Organi- sation. How awful would a measles outbreak be in a densely populated place like London?

Here are the numbers. The most recent data shows that in 2012 80.8% of children aged five received two MMRs in London; on the south-east coast, 86%; the figure for England as a whole is 88%. In Scotland we are at 93%, in Wales and Northern Ireland, 90%.2

Measles killed over a thousand people in 1941; almost half a million were notified as having it in 1967. Vaccination works; the two deaths due to measles in the UK between 1992 and 2012 were of children who were immunocompromised.

But pockets of poor MMR uptake remain – and they bring real risk. In the Netherlands, in 2000, the background immunisation rate was an impressive 96%. But at an ‘orthodox, reformed’ school, whose parents mainly refused MMR on religious grounds, just 7% of school children were vaccinated. The inevitable outbreak resulted in 213 cases in 255 pupils, and 327 household contact measles cases.3

Dealing quickly with a lack of herd immunity requires cooperation across teams and communities, and hard work.

In 1995, in Minnesota, an outbreak of Neisseria meningitidis led to nine cases and one death – and the immunisation of 30,000 of 55,000 residents. In one school, a thousand students were vaccinated in 35 minutes.4

Catch-up campaigns have now been announced for England and Scotland targeting those who are either unvaccinated or only partially vaccinated. This is an enormous task, but it is also crucial. It is to be run through GPs and/or school programmes.

Yet we are at the start of the contract year, when we are asked to do all sorts of tickboxing that means little and matters less. And in the wake of the NHS reforms, primary care is becoming fractured, with services tendered for by the lowest bidder.

For once, GPs have an evidence-based public-health intervention to administer; we should be allowed to focus on it at the expense of our contract. Let’s hope that, if needed, our colleagues in public health will be able to make the case for contract suspension to allow concentration of efforts on catch-up vaccination.

We hear all the time from pressure groups about what GPs are ‘ideally placed’ to do. This is one time when it actually makes sense.

Dr Margaret McCartney is a GP in Glasgow


1 Pubmed. ‘Measles outbreak in Dublin, 2000’.

2 HPA. ‘Quarterly vaccination coverage statistics for children aged up to five years in the UK: October to December 2012’.

3 NCBI. ‘Measles outbreak in a community with very low vaccine coverage, the Netherlands’.

4 Public Health Report. ‘How to Vaccinate 30,000 People in Three Days: realities of outbreak management’.

(All pages accessed on 22 April 2013)

Readers' comments (12)

  • ............except we are being asked to deliver this for next to nothing. This is at a time when the QoF threashold has risen, extra work being added by new DES, pension contributions are forced to increase. I need my nursing staff more than ever to concentrate on tackling the chronic diseases and cannot afford the time or the man power to vaccinate 500+ patient in 10-15 age group.

    I completely agree with the need for pubic heath - but why should GPs who are already seeing 10% income reduction further decrease their income to provide what the DoH should be resourcing. My good will has long gone with this government.

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  • Mark Struthers

    Dreadful scaremongering!

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  • Mark Struthers

    Measles mania!

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  • Mark Struthers

    Daft and dangerous!

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  • Mark Struthers

    Christopher Robin
    Had wheezles
    And sneezles,
    They bundled him
    His bed.
    They gave him what goes
    With a cold in the nose,
    And some more for a cold
    In the head.
    They wondered
    If wheezles
    Could turn
    Into measles,
    If sneezles
    Would turn
    Into mumps;
    They examined his chest
    For a rash,
    And the rest
    Of his body for swellings and lumps.
    They sent for some doctors
    In sneezles
    And wheezles
    To tell them what ought
    To be done.
    All sorts and conditions
    Of famous physicians
    Came hurrying round
    At a run.
    They all made a note
    Of the state of his throat,
    They asked if he suffered from thirst;
    They asked if the sneezles
    Came after the wheezles,
    Or if the first sneezle
    Came first.
    They said, "If you teazle
    A sneezle
    Or wheezle,
    A measle
    May easily grow.
    But humour or pleazle
    The wheezle
    Or sneezle,
    The measle
    Will certainly go."
    They expounded the reazles
    For sneezles
    And wheezles,
    The manner of measles
    When new.
    They said "If he freezles
    In draughts and in breezles,
    May even ensue."

    Christopher Robin
    Got up in the morning,
    The sneezles had vanished away.
    And the look in his eye
    Seemed to say to the sky,
    "Now, how to amuse them to-day?"

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  • Mark Struthers

    "The MMR is a massive commercial success and destined to be even more so, precisely because it doesn't work".

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  • To put the record straight because there seems to be a great deal of misconceptions about the MMR controversy: the problems with MMR vaccines started from the first week of the new MMR campaign in 1988. The vaccine policy-makers knew before the launch that 2 of the 3 brands carried a risk of meningitis and the third brand was linked with neurological complications.

    One of the first children vaccinated started with severe convulsions and subsequently died during a seizure. This child was one of a number of children awarded Government recognition of vaccine-damage through vaccine damage payments.

    The vaccine policy-makers were advised by the H.P.A. that the adverse event reporting system needed to be urgently improved because there was a serious under-reporting of side effects and yet failed to investigate thoroughly 1200 children when their details were provided.

    When the parents of these children called for an investigation and for single dose vaccines to be made available to safeguard other children the vaccine policy-makers removed the single dose vaccines from the national vaccination programme.

    There was also an attempt to remove the licence from the importers of vaccines for private clinics just for the single measles, mumps and rubella components.

    And now, when we are told there is an outbreak of measles, there is no let-up by the vaccine policy-makers; they continue to spend huge amounts of tax-payers' money to press home their MMR or nothing policy when the simple solution would be to re-instate the single dose vaccines ordered from the same companies currently supplying MMR for the UK market.

    Do you think the vaccine policy-makers have acted in children's best interests?

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  • Mark Struthers

    Dr McCartney declares that "vaccination works". But is vaccination safe? On this occasion, Dr McCartney didn't say.

    Was MMR/MR safe for Christopher Coulter, a teenager from Northern Ireland?

    Was it fair that one of Her Majesty's most senior health officials, the one entirely responsible for the MMR program, should give evidence before a Tribunal ... on the safety of MMR/MR? What was he going to say, Dr McCartney?

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  • Mark Struthers

    Please watch these videos and keep an open mind about the quality of information being imparted.




    Who do you trust? Who is really interested in vaccine safety? Who has got children's best interests at heart?

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  • Mark Struthers

    There has allegedly been a measles epidemic in the Swansea area that started in November 2012. However, for the end of March, the public health authorities in Wales had reported only 9 confirmed cases - and only 1 for the month of March.

    Is it possible that pundits like Dr McCartney are being taken for a ride?

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