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Problem Based Learning Scenario 3: "Mrs Moonshine and MMR"

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Problem Based Learning Assessment 1 Candidate: 13027 Community Health Sciences BMedSci Hand in Date: 09/01/2006 Word Count: 2,998 Problem Based Learning Scenario 3: "Mrs Moonshine and MMR" "Mrs Moonshine is visiting the paediatric community clinic. She I seen by a practise nurse and discusses the MMR vaccine with him. She is concerned about her child Henry, who is due to receive the vaccine. She has read reports about the vaccine and brings an article about a study which she has read to the clinic and wants to know why the medical community does not respect it. The practice nurse declares that the study was methodologically flawed and lacked internal validity. Later Mrs. Moonshine demands that Henry is given the three vaccines as separate injections. The practise nurse insists that this is dangerous and offers to refer her to the immunisation co-ordinator. What issues are raised here? Consider the implications for research and practice?" (Community Health Sciences Problem Based Learning booklet 2005) Objectives derived from above article: Page 1. Define Terms - Immunisation Coordinator and Internal Validity. 2 2. Critical Appraisal of the Wakefield et al paper . 4 3. Advantages and disadvantages of MMR (measles, mumps, rubella) combined vaccine and individual vaccines. 7 4. Public perceptions of MMR vaccines and how it affects clinical consultations. 8 5. Medicalisation of Autism. 9 6. 1. Define Terms Immunisation Coordinator The amount of health professionals involved in administering vaccines are vast and ranges from doctors to school nurses.1 This factor calls for a regulatory body to provide an efficient method of controlling all health promoting individuals to ensure efficient service is provided to the public. This body was names the District Immunisation Coordinator (DIC) in 1985 and was commissioned by the Department of Health and Social Services through all the relevant health authorities.1 "In 1988 the main objectives of a DIC were highlighted to include: * Coordinate the work of all those involved with immunisation * Establish a commitment, with all concerned, to immunisation * Provide ...read more.


It is surprising that a prestigious journal such as The Lancet would publish such a journal with clear lack of internal validity and this goes to show the extent of the interest in the field. 3. Advantages and disadvantages of MMR (measles, mumps, rubella) combined vaccine and individual vaccines The whole issue surrounding the link between MMR and Autism has made parents look at alternatives. This inadvertently brought to light other options available to parents such as single vaccines, which in some theories would mean less burden on the immune system compared with the combined vaccine that are said to overload it. 19 To explore this theory a German study found that vaccinated children were immune to those particular diseases but were less likely to be infected with other viruses and bacteria also. Hence a combined vaccine was found to "boost" the immune system rather than weaken it.20 The previous pertussis and single smallpox vaccines contained more antigens than the current MMR and individuals are exposed to hundreds of times as many antigens everyday in the activities we undertake such as eating, breathing and even drinking.21 Also the usage of three separate vaccines could leave children vulnerable between the administration processes. This would perhaps mean that they would acquire other infections prior to receiving the next vaccine. 26,27 The financial burden on the health service would also inevitably increase, in treating these infections and in funding single vaccines which are more costly than a combination and the children will be enduring the trauma of more injections than necessary. The use of separate vaccines has never been tested for use in this country in a national scale. It is simply the advent of the Autism scare stimulated by the Wakefield et al paper that forced people to consider alternatives to the MMR vaccinations which have been tried at tested much more rigorously for use in the UK.22 Seven international expert groups have reviewed the evidence relating to MMR and ASD. ...read more.


Journal of Infections 2000;41: 172-5. 21 Bedford H, Elliman D. Misconceptions about the new combination vaccine. British Medical Journal 2004;329:411-412. 22 Howell J, Duggal H, Howell K, Ghebrehewet S, Quigley C, Lewendon G, et al. Health professionals' attitudes to MMR vaccine. British Medical Journal May 2001;322: 1120. 23 Medical Research Council. Review of autism research: epidemiology and causes. Department of Health (UK) 2001. 24 Ramsay ME, Yarwood J, Lewis D, Campbell H, White J. Parental confidence in measles, mumps and rubella vaccine. British Journal of General Practice 2002;52: 912-6. 25 Bellaby P, Communication and miscommunication of risk: understanding UK parents' attitudes to combined MMR vaccination. British Medical Journal 2003;327: 725-728. 26 Middleton E, Baker D. Comparison of social distribution of immunisation with measles, mumps, and rubella vaccine, England, 1991-2001. British Medical Journal 2003;326: 854. 27 Evans M, Stoddart H, Condon L, Freeman E, Grizzell M, Mullen R. Parents' perspectives on the MMR immunisation: a focus group study. British Journal of General Practice 2001;472: 904-910. 28 Lutwick SM. Pediatric vaccine compliance. Pediatric Clinicians of North America 2000; 47: 427-34. 29 Mullany L. Considerations for implementing a new combination vaccine into managed care. American Journal of Management and Care 2003;9: S23-9. 30 Author unknown. MOVIEPROP.COM'S MOVIE REVIEW PAGES - Rain Man. Available; URL: http://www.movieprop.com/tvandmovie/reviews/rainman.htm (Accessed 01/01/2006) 31 Fombonne E. The epidemiology of autism: a review. Psychology of Medicine 1999;29: 769-86. 32 Rutter M, Silberg J, O'Connor T, Simonoff E. Genetics and child psychiatry: II empirical research findings. Journal of Child Psychology and Psychiatry 1999;40: 19-55. 33 Veenstra-Vanderweele J, Cook E. Genetics of childhood disorders: autism. Journal of American Academic Child Adolescent Psychiatry 2003;42: 116-8. 34 Charman T, Baird G. Practitioner review: diagnosis of autism in 2-3 year old children. Journal of Child Psychology and Psychiatry 2002; 3: 289-306. 35 Stone WL, Lee EB, Ashford L, Brissie J, Hepburn SL, Coonrod EE, et al. Can autism be diagnosed accurately in children under three years? Journal of Child Psychology and Psychiatry 1999;40: 219-26. 36 Cochrane A, Holland W. Validation of screening procedures. British Medical Bulletin 1969;27: 3-8. ?? ?? ?? ?? 1 ...read more.

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