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Press releases Saturday 14 May 2005

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(1) MMR vaccine does not increase risk of Crohn's disease

(2) UK is in the grip of a nationwide mumps epidemic

(3) GMC needs to get its head out of the sand over revalidation

(4) Many HIV patients are not diagnosed early enough

(1) MMR vaccine does not increase risk of Crohn's disease

(MMR vaccine and Crohn's disease: ecological study of hospital admissions in England, 1991 to 2002)
http://bmj.com/cgi/content/full/330/7500/1 120

The measles, mumps, and rubella (MMR) vaccine does not increase the risk of Crohn's disease (chronic inflammation of the intestine), finds a study in this week's BMJ.

It has been hypothesised that the MMR vaccine increases the risk of Crohn's disease, although the evidence for this is sparse. The study provides strong evidence against this theory and adds to the evidence that MMR vaccine is no less safe in this respect than the single measles vaccine.

Valerie Seagroatt, a statistician at Oxford University, analysed national data on hospital admissions for Crohn's disease in children and adolescents over the 12 years from April 1991 to March 2003.

She plotted rates for narrow (3-year) age bands and compared rates for those born before and after the introduction of the vaccine. She found no increase in Crohn's disease associated with the introduction of the MMR vaccination programme, providing strong evidence against the hypothesis that MMR vaccine increases the risk of Crohn's disease.

Contact:
Valerie Seagroatt, Statistician, Unit of Health Care Epidemiology, Department of Public Health, University of Oxford, UK Email: valerie.seagroatt@dphpc.ox.ac.uk

(2) UK is in the grip of a nationwide mumps epidemic

(Mumps outbreaks across England and Wales in 2004: observational study)
http://bmj.com/cgi/content/full/330/7500/1 119

(Clinical Review: Mumps and the UK epidemic 2005)
http://bmj.com/cgi/content/full/330/7500/1 132

The United Kingdom is in the grip of a nationwide mumps epidemic, with almost 5,000 notifications in the first month of 2005 alone, show two papers in this week's BMJ.

The outbreaks are occurring predominantly in 19-23 year olds, but cases are also occurring in susceptible children, underlining the importance of ensuring that all children and young adults have had two doses of the MMR vaccine.

In the first paper (Savage et al), researchers from the Health Protection Agency report that in 2004, the number of mumps notifications in England and Wales increased to 16,436 from 4,204 in 2003. Most cases were in young adults born before 1988, who would not have been routinely scheduled for MMR during childhood.

The highest attack rate was in those born between 1983 and 1986, who were too old to be offered MMR vaccination routinely when it was introduced in 1988, although some may have received one dose of MMR as part of a catch-up programme at school entry.

In the second paper (Gupta et al), the authors suggest that cases in younger children may occur due to the recent fall in uptake of the MMR vaccine among 2 year olds - from around 92% in early 1995 to around 80% in 2003-4, and as low as 60% in some parts of London.

Both papers conclude that the current, two dose MMR schedule is effective in preventing mumps. They also suggest that no opportunity should be missed to offer MMR vaccine to the age group at highest risk, such as when entering school or university.

Contacts:
Paper 1: Health Protection Agency Press Office, Colindale, London, UK
Paper 2: Communications Department, Guy's and St Thomas' NHS Foundation Trust, London, UK

(3) GMC needs to get its head out of the sand over revalidation

(Failure to act on good intentions)
http://bmj.com/cgi/content/full/330/7500/1 144

The General Medical Council needs to get its head out of the sand over revalidation, argues a senior doctor in this week's BMJ.

In June 2000, the GMC set out its initial plans for revalidation to "protect patients from poorly performing doctors who would be identified as early as possible." This was enshrined in law in December 2002.

But by April 2003, the GMC revised its plans, basing revalidation on doctors' annual appraisals, even though appraisals were not set up to judge a doctor's competence. In 2004, the Shipman inquiry forced the GMC to shelve its plans, and a high level review is now being conducted by the chief medical office for England.

The GMC's revised plans for revalidation will not detect poorly performing doctors, writes Professor Aneez Esmail, medical adviser to the Shipman inquiry. Revalidation is supposed to weed out doctors that are not fit to practise, yet appraisal has probably not identified a single doctor whose performance is seriously deficient, despite being in operation for nearly three years.

The public has also been told that revalidation is rather like an MOT test for doctors, yet there are no clear standards by which a doctor's fitness to practise can be determined, no objective test, and no independent scrutiny of that test.

He believes that revalidation has immense value for individual doctors. "As a practising doctor I would like to be able to show my patients that I am practising at a standard which is safe and up to date," he says. "I do not fear revalidation and, like the majority of doctors, would welcome it."

Revalidation is not about catching another Shipman or about judges dictating to doctors how they should regulate themselves. It is about safeguarding patients ? nothing more and nothing less, he concludes.

Contact:
Aneez Esmail, Professor of General Practice, Division of Primary Care, Faculty of Medicine and Human Sciences, University of Manchester, UK Email: aneez.esmail@manchester.ac.uk

Online First
(4) Many HIV patients are not diagnosed early enough

(Newly diagnosed HIV infections: review in UK and Ireland)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38398.590602.E0

Many patients in the UK and Ireland are not having their HIV infection diagnosed until they are at a late stage of disease, finds a study published online by the BMJ today.

These findings reflect national trends reported by the Health Protection Agency.

Researchers surveyed over 100 centres providing adult HIV care in the United Kingdom and Ireland for patients presenting with a new diagnosis of HIV infection in January to March 2003.

Of 977 patients identified, one third presented late. This was more common in older patients and in black Africans, but less likely in homosexual men, regardless of age and ethnicity. Less than half of patients (41%) were diagnosed as part of routine screening.

In the year before diagnosis, 168 patients (17%) sought medical care with HIV related symptoms but remained undiagnosed. Data show that 160 patients had a white blood cell count below the threshold for initiating treatment according to British HIV Association guidelines, indicating that treatment may have been delayed.

"We found a significant number of missed opportunities for earlier diagnosis of HIV infection," say the authors.

There are well recognised advantages of early diagnosis of HIV and starting appropriate treatment with highly active antiretroviral therapy, they write. To improve this situation, the proportion of people diagnosed as having HIV as part of routine screening needs to increase, with people at risk being encouraged to have an HIV test.

Healthcare professionals' awareness of factors associated with late presentation of HIV infection and conditions likely to be related to HIV also need to increase.

Improving the offering and uptake of HIV testing both as part of routine screening and as indicated by associated medical conditions should reduce the number of undiagnosed HIV infections, they conclude.

Contact:
Ann Sullivan, Consultant Physician, Chelsea and Westminster Healthcare NHS Trust, London, UK Email: ann.sullivan@chelwest.nhs.uk

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