Vaccines and the Measles

Written by Dr. Elvove MD, PC, Home Health Update.
Posted with Dr. Elvove's kind permission.

To evaluate a particular vaccine, it is helpful to compare it to the image of a "perfect vaccine". A perfect vaccine would protect a person from a dangerous infectious disease that exists in the community, and would have no harmful side effects.

A controversy over the measles, mumps, and rubella vaccine (MMR) arose when certain parents of autistic children suggested that there was a causal connection between the MMR vaccine and their child's autism. They reported that after their child's MMR shot and within a period of several weeks, their child stopped babbling, stopped making eye contact, stopped smiling, and became socially withdrawn. Since the incidence of autism is still on the rise and this condition can result in severe life long disabilities for the affected children, this is clearly a cause for great parental and societal concern.

In recent years there were no measles outbreaks in our community, so it was a simple decision to delay the MMR vaccine until at least three years of age when a child's threat of developing autism symptoms seems to pass. Even if the risk of developing autism from the MMR was extremely remote, taking even a small risk didn't make sense if there was no risk of contracting the disease. But now that measles has entered our community, it is time to re-evaluate that policy.

Measles was once considered to be a normal childhood disease. The symptoms of fever, cough, mucous, conjunctivitis, and spotty rash are much more severe than chicken pox and recovery lasts several days longer. A small percentage of patients develop brain or lung infections that can result in death or disability. During the peak of measles epidemics when there were 400,000 cases of measles annually in the U.S., thousands of children experienced death or disability each year. Certainly no one wishes to return to that era.

There is no scientific method to identify those children who are more likely to develop measles complications. However it does make sense that healthy children who have been breast-fed, and are well nourished, and have adequate vitamin D levels are less likely to suffer complications. Many parents work hard to protect their children's health each day by providing adequate protein, vegetables, fruits, vitamins, anti-oxidants, probiotics, and long chain omega-3 fatty acids while avoiding refined, sugary, and processed foods. This proactive approach to good nutrition should be considered a part of the child's "immunization program". This is an ongoing process to bolster the child's immune system. We discuss these issues every day with parents during pediatric office visits.

The federal government and the pharmaceutical industry deny any link between the MMR vaccine and autism. Indeed the rise of autism is likely due to a multiplicity of factors. Possible factors include gender (more common in boys), genetic predisposition, unnecessary ultrasounds during pregnancy, high rates of Cesarean sections, drugs during pregnancy and labor, environmental toxins, poor diet and poor nutrition including formula feeding, and possibly the MMR vaccine. It is possible that in susceptible individuals, the MMR vaccine could tip the scale and trigger autism.

It is difficult to prove the side effects due to a vaccine or to multiple vaccines if the adverse reactions do not occur shortly after the administration of the vaccine. Subtle long-term effects such as learning disabilities, severe allergies, asthma, and behavioral changes may be late effects of vaccines, but this is difficult to prove.

The gold standard scientific approach to determining causality is a double blind randomized study. For example 10,000 children are randomly selected to participate in the study. 5,000 children are randomly assigned to receive the MMR vaccine and the other 5,000 receive a placebo injection. Doctors, nurses, and parents do not know which child received which preparation. Two years later the occurrence of autism is analyzed in each group to determine if there is a statistically significant difference. No such test has ever been done since every child in America routinely receives the MMR vaccine. Without this kind of study it is impossible to definitely prove whether the MMR does or does not trigger autism.

Another problem that can corrupt the vaccine industry is the enormous sums of money generated by the mandate that every child receive three-dozen doses of vaccines prior to Kindergarten. With hundreds of millions of dollars at stake, greed and corruption inevitably result. Wealthy drug companies will contribute to campaigns of politicians that are pro-vaccination. Drug companies are major advertisers on television networks. It is not surprising that those network news anchors chastise parents for not fully vaccinating their children. Sadly the days are long gone when medical industries could be trusted to devote their sole interest to the best treatments for their patients, rather than to their stockholders' bottom line.

The pharmaceutical industry has clashed with the public on various vaccine related problems in the past.

  1. In 1976, a vaccine for Swine Flu was administered to 50 million Americans. Three months later the program was abruptly halted due to the emergence of Guillian-Barré syndrome, a serious neurological disorder.
  2. The whole cell DPT vaccine for diphtheria, pertussis (whooping cough), and tetanus was well known to cause screaming spells, high fevers, seizures, and possibly even sudden infant death syndrome in babies. As a result of parents' outcries and lawsuits, a purified acellular pertussis vaccine, the DTaP vaccine, was eventually developed which eliminated most of the adverse reactions.
  3. Drug companies used an antiseptic agent called Thimerosal in their multiple dose vaccine vials to prevent bacterial contamination. This substance contains mercury, a poisonous metal. Parents were alarmed that their children were receiving multiple doses of this toxic metal with each vaccine dose. The drug companies backed down and stopped the use of Thimerosal due to parental concerns.
  4. The Rotavirus vaccine protects against a gastrointestinal virus that affects infants. The vaccine has been pulled from the market twice. The first time due to the incidence of intussusceptions, a kind of intestinal blockage. The second time was due to the discovery of a pig DNA virus found in the vaccine. The FDA reinstated the vaccine claiming, "There was no evidence that the pig virus was harmful to humans". I don't use this vaccine in my practice because breastfed babies do not seem to be bothered by Rotavirus.
  5. Hepatitis B virus infects and damages the liver. This virus can only be transmitted by direct blood-to-blood transfer, contaminated needles, or sexual contact. All pregnant women are routinely tested for this virus. The American Academy of Pediatrics recommends a Hepatitis B vaccination for all newborns prior to discharge from the hospital regardless of whether or not their mother carries the virus. Many parents are outraged that their newborn baby's immature immune system would be assaulted with a vaccine meant for a disease for which their child is not at risk. I vehemently share their outrage and I join these parents in condemning this practice.

Then there is the subject of the use of adjuvants. An adjuvant is a chemical substance like aluminum that irritates and stimulates the immune system in order to make antibodies from smaller amounts of viral, bacterial, or toxoid particles. By chemically irritating the immune system a better antibody response is initiated by a vaccine. Parents are concerned that their babies are being injected with a chemical cocktail containing aluminum, especially if they feel that the benefits are unclear.

Given the many missteps of the vaccine industry in the past, some thoughtful parents have become suspicious of the push for more and more vaccines. Many of these parents are too young to remember the ravages of polio, smallpox, measles, whooping cough, and bacterial meningitis. They do not believe the theory that if a little treatment is good, that a lot of treatment must be better. They have become suspicious of the entire schedule of vaccines recommended by the American Academy of Pediatrics. These are knowledgeable and caring parents, who simply want the best beginning for their children in today's competitive world.

The National Vaccine Injury Compensation Program (NVICP) is a federal government program established in 1988 designed to compensate individuals and families who have been damaged by vaccines. Congress approved this program because pharmaceutical companies were threatening to stop the production of vaccines due to the threats of civil lawsuits. The program is funded by an excise tax on each dose of vaccine and so far has paid out $2 billion. Therefore no one can deny that damages related to vaccines do indeed occur. No other private industry enjoys federal protection from civil lawsuits when their products or services result in damage or injury to consumers. One can only wonder whether this unique federal protection encourages irresponsible behaviors on the part of drug companies in their quest to supply vaccines to children.

A part of the NVICP law requires doctors or nurses to discuss with parents the benefits and risks of each vaccine prior to administration to their child. This legally required information exchange is known as "informed consent". The process of informed consent implies that the parent has the final decision about whether to administer the vaccine after being informed of the benefits and risks.

So what are we to do about the current outbreak of measles in our community? If your child is older than three, there should be no problem administering the MMR vaccine. You would want your child protected against measles, mumps, and rubella before puberty anyway, since these diseases are more severe for adults and for pregnant women. If you as a parent are fearful that your child's illness might result in a severe complication or missed time away from school or work, then strongly consider vaccinating. Otherwise you can stay in touch with your county health department and monitor the number of cases of measles in your area. Then base your decision to vaccinate upon the statistical risk of your children coming in contact with the disease. For those of you unsure about your immunity status, a simple blood test can tell you what your antibody levels are to measles, mumps, and rubella within a day or two.

"Herd immunity" is a public health concept. If most of the individuals in a particular population have immunity to a disease, that disease is unlikely to spread rapidly within the group. Some children have immune deficiency states such as cancer, HIV, or following an organ transplant, and cannot receive live virus vaccines like the MMR. Living in a community that has low herd immunity puts them at a higher risk for contracting measles. For these children due to their reduced immune function, measles could be a deadly or devastating illness. Their parents understandably voice an opinion to require vaccinations of all healthy children in their community to boost herd immunity.

During the current measles outbreak, our office will follow the CDC guidelines for the MMR vaccine. First dose at 12-15 months and second dose at 5 years old. In unvaccinated children over 5 years old, two doses of MMR separated by at least one month. We do recognize however that the parents are to make the final decision.

These are difficult parental decisions to make. No one has a crystal ball that can predict in advance whether a child will develop a disease, a complication from that disease, or an adverse vaccine reaction. It may be sensible to rely on instincts, internal fears, concerns, or confidences to make your decision. We are continually bombarded with opposing opinions. One side will say all vaccines are unnecessary or dangerous — avoid them all. The other side will say vaccines are wonderful--let's develop one for every infectious disease entity. Truth generally resides somewhere between the extreme opinions. We need to gather all the information and make rational and thoughtful decisions based upon knowledge, comfort level, and instincts. We should avoid rigidity and be prepared to review our past decisions when new information comes to light.

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