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Mr. Bowis: I will write to the hon. Member.
Specialist Advisers
Mr. Bayley: To ask the Secretary of State for Health how many (a) specialist advisers and (b) press or public relations officers are employed by his Department; and what is the total annual salary bill for (a) and (b) above. [42316]
Mr. Sackville: I will write to the hon. Member.
Child Protection
Mrs. Helen Jackson: To ask the Secretary of State for Health what funding has been allowed for child protection services such as health visitors. [42351]
Mr. Bowis: I will write to the hon. Member.
Health Visitors
Mrs. Helen Jackson: To ask the Secretary of State for Health (1) what funding there has been of the health visitor service over the past three years; [42352]
(2) if he will list the number of health visitors by authority over the past three years; [42357]
Mr. Bowis: I will write to the hon. Member.
Dental Implants
Mrs. Helen Jackson: To ask the Secretary of State for Health (1) if he will list by authority how many dental implants were performed this year and last year (a) on national health patients and (b) in the private sector; [42353]
(2) what consultations he has had with representatives of the dental health consultants about the funding of dental implant surgery; [42354]
(3) if he will list by authority those health authorities which have decided not to fund dental implant treatment for NHS patients; [42355]
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(4) if he will list those health authorities that perform dental implant treatment for patients on the national health service. [42356]Mr. Malone: I will write to the hon. Member.
Social Services
Mr. Lidington: To ask the Secretary of State for Health how much money Buckinghamshire county council has spent on social services under both special transitional grant and social services SSA during the financial year (a) 1993 94, (b) 1994 95 and (c) 1995 96 to date. [42359]
Mr. Bowis: I will write to the hon. Member.
AIDS
Mr. Gerrard: To ask the Secretary of State for Health if the NHS will continue to meet the full cost of treating patients with HIV and AIDS with combinations of anti-viral drugs. [42366]
Mr. Sackville: I will write to the hon. Member.
Injection Pens
Mr. Gerrard: To ask the Secretary of State for Health what are his reasons for excluding disposable needles for insulin injection pen systems from the drug tariff. [42367]
Mr. Malone: I will write to the hon. Member.
European Court Decisions
Sir Teddy Taylor: To ask the Secretary of State for Health, pursuant to the oral answer of the Attorney-General of 30 October, Official Report , column 12, relating to decisions of the European Court of Justice and the European Court of Human Rights if he will list those European Court decisions relating to responsibilities of his Department over the past two years; and what was the estimated annual cost to public funds of each decision. [41214]
Mr. Malone [holding answer 2 November 1995]: I refer my hon. Friend to the reply the Minister of State for Foreign and Commonwealth Affairs, the my hon. Friend Member for Boothferry (Mr. Davis), gave him on 7 November, columns 698 702.
Management Costs
Mr. Milburn: To ask the Secretary of State for Health, pursuant to his answer of 27 October, Official Report , column 848 , to the hon. Members for York (Mr. Bayley) and for Dulwich (Ms Jowell) what was the level of management and administrative expenditure in each health authority of the last three years for which figures are available. [41432]
Mr. Malone [holding answer 6 November 1995]: I will write to the hon. Member.
Asbestos-related Diseases
Dr. Wright: To ask the Secretary of State for Health what estimate his Department has made of the number of deaths wholly or partly attributable to asbestos-related disease that are expected in each year until 2030. [41886]
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Sir Paul Beresford: I have been asked to reply.
The estimated number of males dying annually from the asbestos-related cancer mesothelioma in 10 years' time could range from between 1,300 and 2,100; in 20 years' time between 1,300 and 3, 000 and in 30 years' time between 1,000 and 3,200. These estimates are based on a paper: "The continuing increase in mesothelioma mortality in Britain" which was published in The Lancet on 3 March 1995. This paper discusses the uncertainties attached to the projections, which increase very significantly beyond about 2010. It is therefore inappropriate to forecast a figure for each separate year. Projected figures for females are not available.
Currently, there are estimated to be one or two deaths from asbestos- related lung cancer for each death from mesothelioma. The falling prevalence of smoking is likely to reduce this ratio in the future.
Measles, Mumps and Rubella
Mr. Smith: To ask the Secretary of State for Health which measles, mumps and rubella vaccines, supplied by which companies, were withdrawn from use in 1992; and for what reasons. [41066]
Mr. Sackville [holding answer 2 November 1995]: The two vaccines were manufactured by SmithKline Beecham and Merieux. As to the reasons for the discontinuation of their use, I refer the hon. Member to the reply I gave him on 6 November, Official Report , column 607 11 .
Mr. Smith: To ask the Secretary of State for Health what plans he has to dispose of measles vaccine surplus to the 1994 95 campaign. [41019]
Mr. Sackville: Surplus measles-rubella vaccines arising from overprovision of diluent has already been returned to manufacturers for which my Department has received reimbursement as credit; a small stock is being held against future requirements.
Mr. Smith: To ask the Secretary of State for Health what information he possesses as to the reason for MMR vaccines being withdrawn in Japan. [41023]
Mr. Sackville [holding answer 2 November 1995]: Urabe-based MMR vaccines have been withdrawn from use in Japan only recently, for the same reasons that they were replaced in this country three years ago. The reason for replacement was restricted to the rate of adverse reactions in the mumps vaccine component.
Mr. Smith: To ask the Secretary of State for Health what information his Department holds as to the shelf life of the vaccines used in the campaign conducted since November 1994 to vaccinate against measles and rubella. [41024]
Mr. Sackville [holding answer 2 November 1995]: The shelf lives of the vaccines used in the measles-rubella immunisation campaign were all two years. The expiry dates of the batches were either 30 or 31 July 1996, 30 August 1996 or 30 September 1996.
Mr. Smith: To ask the Secretary of State for Health what studies have been conducted by his Department into the effects of the modification of natural immunologic response by vaccines in relation to the increase in autoimmune diseases. [41028]
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Mr. Sackville [holding answer 2 November 1995]: I will write to the hon. Member.
Mr. Smith: To ask the Secretary of State for Health which companies were chosen as suppliers of the measles-rubella vaccine in the recent countrywide campaign; and for what reasons. [41018]
Mr. Sackville [holding answer 2 November 1995]: All possible manufacturers were approached. Only SmithKline Beecham and Merieux were in a position to supply--both were awarded contracts.
Mr. Smith: To ask the Secretary of State for Health what assessment his Department has made of the likelihood of the adverse reactions to the administration of both MR and MMR vaccines, in regard to the under- reporting of thrombocytopenic purpura. [41017]
Mr. Sackville [holding answer 2 November 1995]: The Public Health Laboratory Service has recently published a review on an advanced technique for surveillance of adverse reactions. New information was established on the association between idiopathic thrombocytopenic purpura and MMR immunisation. This related to primary immunisation and was of little relevance to the measles-rubella campaign because there was a far lower probability of susceptibility to rubella in children of the campaign age than in those immunised with MMR at 12 to 15 months.
Mr. Smith: To ask the Secretary of State for Health what assessment his Department has made of the problems occurring in the passive surveillance procedures adopted in the United Kingdom to monitor adverse effects of vaccinations. [41031]
Mr. Sackville [holding answer 2 November 1995]: Doctors are aware that suspected adverse reactions to vaccines should be reported through the United Kingdom's adverse drug reactions reporting scheme. It is more likely that acute and serious adverse reactions are reported. The United Kingdom's reporting scheme has successfully detected rare unrecognised hazards with vaccines and other medicines and the scheme receives widespread support from doctors. The limitations of the scheme are well recognised but it is the best scheme currently available for the routine surveillance of adverse reactions to vaccines throughout the UK.
Mr. Smith: To ask the Secretary of State for Health if he will set out each consideration which led his Department to initiate a country-wide vaccination campaign against measles and rubella jointly in November 1994. [41061]
Mr. Sackville [holding answer 2 November 1995]: The key consideration was to protect children against a predicted epidemic of measles. The background is given in the chief medical officer/chief nursing officer letters issued in July and September 1994, copies of which are available in the Library; other supportive information has been published in:
Babad H.R., Noakes D. J., Gay N. J., Miller E., Morgan-Capner P., Anderson R. M.,
Predicting the impact of measles vaccination in England and Wales; model validation and analysis of policy options.
Epidemiol Infect 1995; 114: 319 344.
Gay N. J. Hesketh L. M., Morgan-Capner P., Miller E.
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Interpretation of serological surveillance data for measles using mathematical models: implications for vaccine strategy.Epidemiol Infect
Ramsay M., Gay N. J., Miller E., Rush M., White J., Morgan-Capner P. et al.
The epidemiology of measles in England and Wales; rationale for the 1994 national vaccination campaign.
CDR Review 1994; 4: R141 146.
Christine P.
Measles in Scotland
Commun Dis Envir Hlth Scot 1994; 28(41): 3 8.
For further relevant scientific papers I refer the hon. Member to the reply I gave him on 6 November, Official Report , columns 607 11 .
Mr. Smith: To ask the Secretary of State for Health what considerations led to the decision not to include on the consent form given to parents for children being vaccinated against rubella information on the possibility that it might lead to some increase in arthritis. [41033]
Mr. Sackville [holding answer 2 November 1995]: In preparing the leaflet for parents careful evaluation was given to all side effects. The risk of arthritis in the age group covered by the measles-rubella campaign was considered not to warrant inclusion as the risk is in older women.
Mr. Smith: To ask the Secretary of State for Health what assessment he has made of the claims in a journal which has been sent to him regarding information to parents and professionals in respect of the recent MMR campaign. [40885]
Mr. Sackville: The information for parents was produced after careful consideration of all relevant information and was pre-tested with parents and young people. Extensive information on adverse reactions was provided to all doctors and other health professionals involved in the campaign. The author appears not to have considered all the relevant information in making his claims.
Mr. Smith: To ask the Secretary of State for Health what studies have been (a) conducted and (b) sponsored by his Department into the causes and development of measles encephalitis in
children. [41021]
Mr. Sackville [holding answer 2 November 1995]: Two studies on the rate of acute encephalitis associated with measles infections have been conducted by the Public Health Laboratory Service, and deaths from measles encephalitis were reviewed by the PHLS in 1985. In addition, detailed information on cases on late-onset encephalitis following measles infection subacute sclerosing panencephalitis is collected by the PHLS, and a comprehensive report from this surveillance scheme was published in 1992.
Miller DL. Frequency of complications of measles, 1963. BMJ 1964; 2: 75 78
Miller CL. Severity of notified measles. BMJ 1978. 1: 1255 54 Miller CL. Deaths from measles in England and Wales, 1970 83. BMJ 1985; 290: 433 34.
Miller C, Farrington CP, Harbert K. The epidemiology of subacute sclerosing panencephalitis in England and Wales, 1970 89. Int J Epidemiol 1992; 21: 988 1006.
Column 978
Mr. Smith: To ask the Secretary of State for Health how many cases of (a) mumps and (b) rubella occurred in each year since 1985; and what assessment he has made of the reliability of the data. [41026]
Mr. Sackville [holding answer 2 November 1995]: Since 1985, the most reliable source of data on mumps and rubella incidence is reports of confirmed infections to the Communicable Disease Surveillance Centre from laboratories in England, Wales and Northern Ireland. Cases thus confirmed therefore represent true infections. Laboratory investigation is not performed in all suspected cases, however, and therefore these figures may under-estimate the total number of mumps and rubella infections. Since 1988, statutory notifications of mumps and rubella have been collected at the Office of Population Censuses and Surveys. In a Public Health Laboratory Service study of the accuracy of notification, laboratory confirmation of rubella cases was attempted in 18 districts between 1991 and 1993. Only 29 per cent. of rubella were confirmed by laboratory testing. No formal study of mumps notifications has taken place but, as part of the PHLS saliva diagnosis scheme, we have confirmed only 3.3 per cent. of mumps cases notified this year. This data suggest that notifications substantially over-estimate the incidence of these infections.
Reports to Communicable Disease Surveillance Centre of confirmed infection from laboratories in England, Wales and Northern Ireland 1985-1995 Year |Mumps |Rubella ------------------------------------------ 1985 |360 |828 1986 |547 |2,069 1987 |688 |1,887 1988 |428 |1,031 1989 |265 |760 1990 |94 |705 1991 |52 |249 1992 |49 |201 1993 |37 |1,625 1994 |47 |310 1995 (to week 42) |44 |752
Mr. Smith: To ask the Secretary of State for Health how many yellow card reports covering measles, mumps and rubella have been registered by the Medicines Control Agency identifying cases of possible vaccine damage, in each month since 1992. [41022]
Mr. Sackville [holding answer 2 November 1995]: The number of yellow card reports of adverse reactions related to measles, mumps and rubella vaccine for each month since 1992 is shown in the table.
|1992|1993|1994|1995
-----------------------------------
January |8 |8 |6 |10
February |11 |16 |3 |16
March |15 |13 |13 |15
April |12 |10 |5 |11
May |15 |15 |14 |12
June |17 |11 |7 |15
July |15 |8 |7 |4
August |7 |12 |13 |11
September |44 |10 |9 |4
October |27 |9 |15 |-
November |22 |8 |19 |-
December |9 |5 |20 |-
The report of a suspected adverse
reaction does not necessarily mean
the vaccine was responsible.
Mr. Smith: To ask the Secretary of State for Health what consideration was given to the conclusions in the communicable disease report, volume 4, review number 7 of 24 June 1994, as to the need for a mass campaign against rubella before the decision to institute a measles and rubella campaign in November 1994 was taken. [41032]
Mr. Sackville [holding answer 2 November 1995]: The results of the summary of districts in England and Wales were consistent with the decision to include rubella vaccine in the immunisation campaign of November 1994. The article identified current policy at that time but also stated that there are no contradictions to a second vaccination in girls. The article did not address the issue of rubella immunisation in boys.
Mr. Smith: To ask the Secretary of State for Health what considerations he has given to including decisions not to include details of each of the known side effects of immunisation in the booklet "Measles: Why every child in school needs to be protected from measles this autumn"; and if he will make a statement. [41020]
Mr. Sackville [holding answer 2 November 1995]: The content of the measles booklet was underpinned by research by the Health Education Authority among parents to establish what information they regarded as most important. This research showed that parents were unaware of the seriousness of measles. The final leaflet reflected parents information priorities about the need for measles and rubella immunisation. Side effects from measles rubella vaccine are rare but the more common ones are covered in the booklet. Doctors and other health care workers were given more detailed information on the full range of possible adverse reactions. Parents were advised to discuss any further concerns with their family doctor.
Mr. Smith: To ask the Secretary of State for Health what assessment has been made of the policy implications of the scientific article on measles, mumps, rubella and varicella, a copy of which has been sent to him. [40884]
Mr. Sackville: The scientific article in The Lancet --volume 345, 4 March 1995-- a copy of which is in the Library, has been considered by the Department of Health, and the Joint Committee on Vaccination and Immunisation, and its importance is acknowledged. It describes a valuable technique for investigating more serious adverse reactions--that is, those likely to lead to hospital admission. Wider evaluation of the technique would be appropriate. The policy implication of the article is that active surveillance reveals a higher than previously reported risk of thrombocytopaenia and a fourfold reduction of risk of febrile convulsions after the change in the immunisation schedule that we implemented in 1990. The article has no relevance to varicella, for which there is no UK licensed vaccine.
Mr. Smith: To ask the Secretary of State for Health what assessment has been made of the incidence of measles in 1994 95 among unimmunised 17- year-olds. [41062]
Mr. Sackville [holding answer 2 November 1995]: During 1994, there were 19 confirmed cases of measles infection in 17-year-old children- -all of whom were unimmunised--reported to the Public Health Laboratory
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Service. So far in 1995, there have been only five confirmed cases and all of these cases occurred in unimmunised people.Mr. Smith: To ask the Secretary of State for Health what recent representations his Department has received from the Association of Parents of Vaccine Damaged Children. [41068]
Mr. Sackville [holding answer 2 November 1995]: A number of letters have been received concerning the measles-rubella campaign and the childhood immunisation programme in general.
Mr. Smith: To ask the Secretary of State for Health what mechanism exists for parents who have lost confidence in their general practitioner to pass on confidential information concerning the suspected deleterious effects of measles immunisation vaccinations on their children. [41006]
Mr. Sackville: Doctors are asked to report adverse reactions when, based on their clinical judgment, there is a likelihood of the reported event being related to the administration of the vaccine. We believe that there was good compliance with standard reporting procedures during the course of the campaign. It is open to parents to make representations on specific issues of concern to them to their local family health services authority through the complaints procedures.
Mr. Smith: To ask the Secretary of State for Health what guidance is issued to doctors, nurses and other medical service professionals in regard to the level of information that they are expected give parents on potentially adverse effects of immunisation against measles. [41069]
Mr. Sackville [holding answer 2 November 1995]: Health service professionals are given extensive information on possible adverse reactions to vaccines. The United Kingdom Health Departments' "memorandum", Immunisation against Infectious Disease, published by Her Majesty's Stationery Office, provides information on adverse reactions. In addition, for the measles-rubella immunisation campaign the chief medical officer's letters of July, September and October 1994 covered adverse reactions in some detail and included an information booklet for health care professionals.
Mr. Smith: To ask the Secretary of State for Health what tests are conducted on children before immunisation against measles to establish their existing levels of blood antibodies. [41029]
Mr. Sackville [holding answer 2 November 1995]: None. The European advisory group on immunisation of the World Health Organisation has specifically advised against testing of blood for antibodies because of potential unreliability of information obtained and the impractical scale of the exercise. This practice is not known to be routinely undertaken in any country in the world.
Mr. Smith: To ask the Secretary of State for Health how many updates have been prepared and circulated by the chief medical officer, the chief nursing officer and the chief pharmacist on the national measles-rubella immunisation campaign since December 1994; and if he will place copies in the Library. [41025]
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Mr. Sackville [holding answer 2 November 1995]: There has been one joint communication from the chief medical officer, the chief nursing officer and the chief pharmacist on the measles-rubella immunisation campaign since December 1994. This was a letter dated 19 December 1994: "Update on National Measles-Rubella Immunisation Campaign". A brief article also appeared in CMO's update 6, dated July 1995: "Success of measles/rubella immunisation campaign". Both letters are available in the Library.
Mr. Smith: To ask the Secretary of State for Health (1) what papers or research reports have been prepared or sponsored by his Department on adverse reactions to immunisation against measles; [41030]
(2) what studies have been (a) conducted and (b) published by the United Kingdom Public Health Laboratory Service on investigation into the effects of measles-mumps-rubella-immunisation inoculation on convulsions amongst recipient children. [41060]
Mr. Sackville [holding answer 2 November 1995]: Extensive studies of measles vaccine were conducted by the Medical Research Council before the introduction of measles vaccine in 1968. Two reports from these studies summarised the incidence of adverse events. Subsequently, a study of symptoms following measles vaccination was conducted by the Public Health Laboratory Service in a large number of children between 1970 and 1980.
Before the introduction of MMR vaccine in 1988, studies were conducted by the Public Health Laboratory Service to measure the rate of adverse events, including convulsions, associated with the vaccine. The study involved over 10,000 children in three district health authorities in the United Kingdom. In 1993, a pilot study to evaluate new methods for monitoring adverse events following vaccination, including MMR vaccine, was conducted.
This involved linking computerised hospital admissions data to child health vaccination records in five districts of England and Wales.
Measles Vaccine Committee. Vaccination against measles: a clinical trials of measles given alone and live vaccine preceded by killed vaccine. BMJ 1966; 1: 441 6. Measles Vaccine Committee. Vaccination against measles: a study of clinical reactions and serological responses of young children. BMJ 1965; 1: 817 23. Miller C. Surveillance after measles vaccination in children. Practitioner 1982; 226: 535 7.
Miller C, Miller E, Rowe K, et al. Surveillance of symptoms following MMR vaccine in children. Practitioner 1989; 223: 69 72. Farrington P, Pugh S, Colvile A et al. A new method for active surveillance from diphtheria/tetanus pertussis and
measles/mumps/rubella vaccines. Lancet 1995; 345: 567 9.
Mr. Smith: To ask the Secretary of State for Health when the decision was taken, and on what basis, to place a notification for competitive tender in the Official Journal of the European Communities for the vaccines to be used in the immunisation campaign initiated in November 1994 against measles and rubella. [41067]
Mr. Sackville [holding answer 2 November 1995]: The normal procedures of the European Communities public procurements directives did not allow sufficient time for manufacture of vaccines. Therefore, no notification for competitive tender was placed in the Official Journal of
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