MMR / MMRV
Measles, also known as rubeola, is a viral respiratory infection. Symptoms include fever, cough, runny nose, red eyes and a generalized rash. The characteristic measles rash begins several days after the onset of the fever. The rash is said to “stain”, changing color from red to dark brown before it disappears. The measles rash lasts for up to eight days.
While classic measles is sometimes confused with 'rubella, the infections are unrelated. Rubella is also called 3-day measles or German measles. The rubella rash can look like many other viral rashes. It appears as either pink or light red spots, which may merge to form evenly colored patches. The rash can itch and can last up to 3 days. As the rash clears, the affected skin occasionally sheds in very fine flakes. The primary medical danger of rubella is the infection of pregnant women in their first trimester because it can cause congenital rubella syndrome.
Mumps, caused by the mumps virus, typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite, and is followed by swelling of salivary glands. There is no specific treatment for mumps. Mumps can cause inflammation of the testicles called orchitis. At highest risk are post-pubertal men. Only about 10% of cases are bilateral, therefore the risk of infertility is rare.
Varicella, Chickenpox (varicella) is a common illness that causes an itchy rash and red spots or blisters (pox) all over the body. Until the release of the chickenpox vaccine in 1995, it was a common childhood illness, usually manifesting in children 7 to 9 years of age. Chickenpox usually isn’t a serious health problem in healthy children. But a child with chickenpox needs to stay home from school. The vaccine was actually developed so that parents would not have to miss work to care for their ill child.
After you have had chickenpox, you are not likely to get it again. But the virus stays in your body long after you get over the illness. Long term immunity has always been maintained in adults by re-exposure to the virus during an episode of chickenpox in their children or grand children. Now, long-term immunity is waning in millions of adults. If the virus becomes active again, it can cause a painful viral infection called shingles. In response, Zostavax, the vaccine for shingles, was developed.
March 22, 2019 - GSK’s MMR vaccine safe, effective for US infants “We believe that if MMR-RIT (Priorix, GlaxoSmithKline) is licensed, it could provide a valid option to prevent measles, mumps and rubella in U.S. children,” Klein told Infectious Diseases in Children. “Plus, it could also help to reduce the potential risks of a vaccine shortage.”
January 8, 2018 – Building capacity for active surveillance of vaccine adverse events in the Americas: A hospital-based multi-country network “The study evaluated the associations between measles-mumps-rubella vaccines and two well-recognized adverse events: Immune thrombocytopenic purpura (ITP) and aseptic meningitis. The regional network contributed 63 confirmed ITP and 16 confirmed aseptic meningitis eligible cases to the global study, representing, respectively, 33% and 19% of the total cases. To ensure long-term sustainability and usefulness to investigate adverse events following new vaccine introductions in low and middle-income countries, the network needs to be strengthened with additional sites and integrated into national health systems.”
January 8, 2018 – Enhancing global vaccine pharmacovigilance: Proof-of-concept study on aseptic meningitis and immune thrombocytopenic purpura following measles-mumps containing vaccination “The World Health Organization (WHO) selected 26 sentinel sites (49 hospitals) distributed in 16 countries of the six WHO regions. Incidence rate ratios (IRR) of 5.0 (95% CI: 2.5–9.7) for ITP following first dose of measles-containing vaccinations, and of 10.9 (95% CI: 4.2–27.8) for AM following mumps-containing vaccinations were found. The strain-specific analyses showed significantly elevated ITP risk for measles vaccines containing Schwarz (IRR: 20.7; 95% CI: 2.7–157.6), Edmonston-Zagreb (IRR: 11.1; 95% CI: 1.4–90.3), and Enders’Edmonston (IRR: 8.5; 95% CI: 1.9–38.1) strains. A significantly elevated AM risk for vaccines containing the Leningrad-Zagreb mumps strain (IRR: 10.8; 95% CI: 1.3–87.4) was also found.”
November 7, 2017 – County-level assessment of United States kindergarten vaccination rates for measles mumps rubella (MMR) for the 2014–2015 school year “The lack of local MMR data prevents identification of areas with low vaccination rates that would be vulnerable to the spread of disease. We collected county-level vaccination rates for the 2014–2015 school year with the objective of identifying these regions. … We found that county data can reveal vaccination trends that are unobservable from state-level data, but we also discovered that the current availability of county-level data is inadequate. Our findings can be used by state health departments to identify target areas for vaccination programs.
September 7, 2017 – Effectiveness of a Third Dose of MMR Vaccine for Mumps Outbreak Control “Students who had received a third dose of MMR vaccine had a lower risk of mumps than did those who had received two doses, after adjustment for the number of years since the second dose. Students who had received a second dose of MMR vaccine 13 years or more before the outbreak had an increased risk of mumps. These findings suggest that the campaign to administer a third dose of MMR vaccine improved mumps outbreak control and that 'waning immunity' probably contributed to propagation of the outbreak. (Funded by the Centers for Disease Control and Prevention.)”
August 25, 2017 – Consistency Study of GlaxoSmithKline (GSK) Biologicals’ MMR Vaccine (209762) (Priorix®) Comparing Immunogenicity and Safety to Merck & Co., Inc.’s MMR Vaccine (M M R®II), in Children 12 to 15 Months of Age “Sponsor: GlaxoSmithKline Information provided by (Responsible Party): GlaxoSmithKline”
May 25, 2017 – Antibody persistence in children aged 6–7 years one year following booster immunization with two MMR vaccines applied by aerosol or by injection “We performed clinical and serological follow-up of participants in a previous study of Mexican children aged 6–7 years, in which participants were randomized to four groups receiving, by aerosolized or by injection, the MMR SII vaccine (Serum Institute of India), or the MMR II (Merck Sharp & Dhome). We evaluated the antibody persistence by PRN test for measles and by ELISA for rubella and mumps. The occurrence of clinical events was evaluated via periodic visits of a nurse team to children’s schools and homes.” … “Conclusion Under conditions of no endemic transmission for measles and rubella, and of low circulation of mumps virus, school-aged children remained seropositive to the three viruses one year following booster immunization.
May 16, 2016' – Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations ‘Conclusion: Of U.S. adult travelers who presented for pretravel consultation at GTEN sites, 16% met criteria for MMR' vaccination according to the provider’s assessment, but fewer than half of these travelers were vaccinated. An increase in MMR vaccination of eligible U.S. adult travelers could reduce the likelihood of importation and transmission of measles virus.”
April 15, 2017 – Effect of an Early Dose of Measles Vaccine on Morbidity Between 18 Weeks and 9 Months of Age: A Randomized, Controlled Trial in Guinea-Bissau (full text) “Adverse events associated with MV were defined as fever, convulsions, and skin reactions. Fever may occur around days 5–12 after MV receipt, and the risk of febrile seizures increases around day 8–14. Fever was defined as an axillary temperature of >37.0°C. MV-associated adverse events affecting the skin were defined as generalized exanthema, which occurs around day 7–10 after vaccination. To have a period in which most adverse events would be captured, we analyzed adverse events from 'days 5 to 14.”
April 2017 – Vaccine compliance and the 2016 Arkansas mumps outbreak (full text) “Rapid growth in the number of cases suggests that a substantial proportion of the exposed population might be susceptible to mumps because they have not had or completed the measles, mumps, and rubella (MMR) vaccination. Here, we use digital disease surveillance data to assess the potential role of substandard vaccination coverage within the context of this outbreak.”
March 13, 2017 – IgA vasculitis (Henoch–Schönlein): Case definition andguidelines for data collection, analysis, and presentation of immunisation safety data “Skin manifestations affect virtually all of the patients and often precipitate clinical presentation. They are distributed symmetrically over the lower limbs, commonly extensor surfaces and buttocks. The arms, ears and face can also be involved, whereas the trunk is usually spared. The most frequent lesions are palpable purpura, but larger bruises, maculo-papular rash, and urticarial exanthema are also common. Haemorragic bullae and skin necrosis leading to ulcers are rare. Severity of skin lesions has no influence on prognosis. Swelling and joint pain (in 60–80% of cases an arthralgia, rather than frank arthritis) usually affect the ankles and knees, but other joints may also be involved, especially hands and feet. Abdominal symptoms occur in approximately 60% of patients, usually abdominal pain and bloody stool. However, major gastrointestinal complications develop in about 5% of patients, with intussusception being the most common.” Comment: Henoch–Schönlein is associated with the MMR vaccine. (See June 18, 2016 article below)
March 1, 2017 – 30-year trends in admission rates for encephalitis in children in England and effect of improved diagnostics and measles-mumps-rubella vaccination: a population-based observational study “Hospital admission rates for encephalitis of unknown aetiology have increased by 37% since the introduction of PCR testing. Hospital admission rates for all-cause childhood encephalitis in England are increasing. Admissions for measles and mumps encephalitis have decreased substantially. The numbers of encephalitis admissions without a specific diagnosis are increasing despite availability of PCR testing, indicating the need for strategies to improve aetiological diagnosis in children with encephalitis.” Comment: They are testing encephalitis from the wild infection, not the vaccine strain.
December 7, 2016 – Measles, the media, and MMR: Impact of the 2014–15 measles outbreak “In late 2014, a measles outbreak beginning in California received significant media attention. To better understand the impact of this outbreak, we conducted a survey to assess and compare among vaccine hesitant and non-hesitant new mothers how this outbreak affected vaccine knowledge, attitudes, vaccination plans, and media use.” …”Knowledge of the outbreak was lower among vaccine-hesitant respondents. Few mothers changed MMR vaccination plans after the outbreak.”…”Media sources used the most are not the most trusted. Communication about outbreaks of vaccine-preventable diseases should include spread of accurate information to new media sources and strengthening of existing trust in traditional media.”
November 11, 2016 – A Phase III Randomized, Double-Blind, Clinical Trial of an Investigational Hexavalent Vaccine Given at 2, 3, 4, and 12 Months (pdf download) “The endpoints for the non-inferiority and acceptability of MMRV concomitantly administered with DTaP5-HB-IPV-Hib were antibody response rates at one month after administration of MMRV at Toddler dose.”
Funding for this research was provided by Merck & Co., Inc., Sanofi Pasteur, Inc., and Sanofi Pasteur MSD.
Conflicts of Interest
- Timo Vesikari, Thomas Becker, Andre F. Vertruyen, and Katleen Poschet were investigators for the sponsor supported by research grants.
- Marco Pagnoni, Sheryl A. Flores, Jin Xu, G. Frank Liu, Jon Stek, and Andrew W. Lee are employees of Merck and may hold company stock and/or stock options.
- Florence Boisnard, Stephane Thomas, and Eddy Ziani are employees of Sanofi Pasteur MSD.
October 13, 2016 –Non-specific immunological effects of selected routine childhood immunisations: systematic review “The vaccines caused increases in peanut, almond, milk, egg, soy and wheat IgE. Let’s look at the food proteins contaminating the vaccines the patient received. Prevnar 13 contains casamino acids (cow’s milk derived) and soy peptone broth. Polysorbate 80 from EMD Millipore may contain wheat proteins. Polysorbate 80 is present in many vaccines including Prevnar 13.”…”MMR contains chick embryo culture proteins and the vaccine package insert[4] has a warning for patients with egg allergy. Some egg proteins may be common to or cross react with chick embryo proteins.”
August 2016 – Adverse Events After MMR or MMRV Vaccine in Infants Under Nine Months Old “Serious adverse events included developmental disorders, fever and fussiness. There were 44 reports of fever, but only 4 cases began 5–12 days after immunization, the peak risk window. The vast majority of fever reports listed concomitant vaccines, such as diphtheria and tetanus toxoids, acellular or whole-cell pertussis vaccine.”
July 29, 2016 – Mumps-specific cross-neutralization by MMR vaccine-induced antibodies predicts protection against mumps virus infection “The reduced neutralization of wild type mumps virus strains in MMR vaccinated persons prior to infection indicates that pre-outbreak mumps virus neutralization 'is partly strain-specific and that neutralization differs between infected and non-infected persons. Therefore, we recommend the use of wild type mumps virus neutralization assays as preferred tool for surveillance of protection against mumps virus infection.
June 27, 2016 – Safety and immunogenicity of inactivated poliovirus vaccine when given with measles–rubella combined vaccine and yellow fever vaccine and when given via different administration routes: a phase 4, randomised, non-inferiority trial in The Gambia (pdf) “A total of 36 serious adverse events occurred in 35 infants enrolled in the trial. Three infants died, two of whom were hospitalised at the time. None of the deaths were deemed related to vaccination by the data safety and monitoring board. One serious adverse event was defined as possibly related to yellow fever vaccination. The infant developed a significant rash within 24 h of vaccination, although contact dermatitis related to an antiseptic wash was ultimately judged to be more likely.” Comment: Another example how deaths are not related to vaccination.
June 23, 2016 – An analysis of the incidence of measles in Turkey since 1960 “The aims of this study were to evaluate measles incidence and the effect of elimination strategy interventions on the disease from 1960 to 2014 in Turkey. The administration of measles vaccine started in the rural regions in 1970; it was carried out as a campaign along with the National Vaccine Campaign in 1985, and it has been employed as combined measles, mumps, and rubella under the scope of the Measles Elimination Program (MEP) since 2006 in Turkey. While a dramatic decrease in the reporting of measles was observed between 2000 and 2010, the number of the cases has increased since 2011.”
June 23, 2016 – Estimating the Number of Measles-Susceptible Children and Adolescents in the United States Using Data From the National Immunization Survey–Teen (NIS-Teen) “Approximately 12.
June 18, 2016 – Henoch-Schönlein purpura and drug and vaccine use in childhood: a case-control study (full text) “The association between MMR vaccination and HSP confirms previous published findings and adds a risk estimate. Further studies are needed to increase our understanding of the role of drugs and vaccines in the etiology of HSP, a disease with important effects on health of children for its potential, though rare, chronic outcomes.”
June 15, 2016 – Similar Antibody Levels in 3-Year-Old Children Vaccinated Against Measles, Mumps, and Rubella at the Age of 12 Months or 18 Months “MMR induces similar antibody responses in 12-month-old children as compared to 18-month-old children, but in boys increasing age appears to improve the antibody responses.
June 2016 – Vaccines and Febrile Seizures: Quantifying the Risk (pdf) “As reported by Duffy et al,1 influenza, DTaP, and PCV vaccines given together can lead to febrile seizures at a rate of up to 30 in 100 000 children immunized. This means for the average pediatrician, who may care for 1000 children younger than 5 including 3 to 500 between 6 and 24 months of age annually, one could expect to see at most 1 child who experiences a febrile seizure every 5 to 10 years due to administration of these vaccines together in the first 2 years of life.”
Comment: MMR and, especially the MMRV vaccine cause febrile seizures. See here. “The use of MMRV vaccine instead of separate MMR + varicella vaccines approximately doubles the risk for fever and febrile seizures, resulting in 1 additional febrile seizure for every 2300 doses of MMRV vaccine administered instead of separate MMR and varicella vaccines. Providers who choose to use the combination vaccine should be aware of and clearly communicate this increased risk to the families and caregivers of their patients.”
June 2016 – Generation of a More Immunogenic Measles Vaccine by Increasing Its Hemagglutinin Expression “Measles incidence was reduced drastically following the introduction of attenuated vaccines, but progress toward the eradication of this virus has stalled, and MV still threatens unvaccinated populations. Due to the contributions of 'primary vaccine failures' and too-young-to-be-vaccinated infants to this problem, more immunogenic measles vaccines are highly desirable.”
May 1, 2016 – Tolerability of Early Measles-Mumps-Rubella Vaccination in Infants Aged 6–14 Months During a Measles Outbreak in The Netherlands in 2013–2014 (full text) “All covariates were retrieved from the questionnaire. If parents permitted, their infant’s vaccination status was checked in the national vaccination register. All other covariates were self-reported without validation.”
April 29, 2016 – Delayed adaptive immunity is related to higher MMR vaccine-induced antibody titers in children (full text) “The main finding from the current study is the association between delayed adaptive immune maturation and higher magnitudes of MMR vaccine-induced antibody titers. We also show that children born by CS had increased anti-measles titers and were associated with a more immature adaptive immune system, which could thus be a possible mechanism for higher anti-measles titers. A better understanding of the relationship between early-life environmental factors, immune maturation and vaccine responsiveness may lead to novel vaccination strategies.”
April 19, 2016 – Monitoring the process of measles elimination by serosurveillance data: The Apulian 2012 study “As our data showed, the universal routine vaccination changed the epidemiological pattern among adults, in particular young adults (18–24 years), who showed lowest seropositivity rates; in these groups of population there is a risk of the onset of outbreaks due to the presence of susceptible population. This is a paradox linked to the vaccination strategy: when coverage rates keep sub-optimal, measles is more likely to affect young adults and a higher percentage of complications is expected. According to our data, health authorities have to plan a mop-up strategy to actively offer measles vaccination to susceptible young adults.
March 29, 2016 – Affluence as a predictor of vaccine refusal and underimmunization in California private kindergartens “Very high PBE levels (>20%) were seen among secular and non-Catholic, Christian kindergartens but not Roman Catholic, Jewish or Islamic kindergartens. However, the majority of schools at all tuition levels had fewer than 5% of children with a PBE. Kindergartens with an annual tuition of $10,000 or more were over twice as likely to have 20% or more children with PBEs than kindergartens with a lower tuition (p < .01). Additionally, the conditional admission proportions for kindergartens with tuitions of $10,000 or more were 39% compared to 22% for less expensive kindergartens (p < .01). Only about half of all private kindergartens had 95% coverage of the MMR (49%) and pertussis-containing vaccines (51%).”
February 9, 2016 – Similar antibody levels in 3-year old children vaccinated against measles mumps and rubella at the age of 12 months or 18 months “However, boys had lower antibody concentrations compared to girls when vaccinated at 11-13 months. Neutralizing measles antibody titers were above the threshold for protective immunity in all 78 samples analyzed. The measles antibody avidity indexes were high for all children.” … “Conclusions. MMR induces similar antibody responses when given to 12-month-old compared to 18-month-old children, but in boys increasing age appears to improve the antibody responses.”
Comment: We already know boys are more susceptible to the MMR vaccine, even more so if they add Varicella, MMRV. Of course TPTB (the powers that be) have retracted the article, but it is still available here – Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data
December 30, 2015 – Measles Virus Neutralizing Antibody Response, Cell-Mediated Immunity, and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles, Mumps, and Rubella Vaccine in Young Adults “Most subjects were seropositive before MMR3 receipt, and very few had a secondary immune response after MMR3 receipt. Similarly, CMI and avidity analyses showed minimal qualitative 'imp
December 13, 2015 – A Comparison of Postelimination Measles Epidemiology in the United States, 2009–2014 Versus 2001–2008 “During 2009–2014, 1264 confirmed measles cases were reported in the United States, including 275 importations from 58 countries and 66 outbreaks.”…”Among US-resident case-patients during 2009–2014, children aged 12–15 months had the highest measles incidence ('65 cases; 8.3 cases/million person-years), and infants aged 6–11 months had the second highest incidence ('86 cases; 7.3 cases/million person-years).”…”To maintain elimination, it will be necessary to maintain high 2-dose vaccination coverage, continue case-based surveillance, and monitor the patterns and rates of vaccine exemption.” Comment: Compared to adverse events from the MMR/MMRV the cases in infants are infinitesimal. See here
November 17, 2015 – MMR vaccination status of children exempted from school-entry immunization mandates “Results from 2009 surveillance data indicate MMR1/MMR2 coverage of 18–47% among children with PBEs at typical schools and 11–34% among children with PBEs at schools with high PBE rates. Imputation scenarios point to much higher coverage (64–92% for MMR1 and 25–58% for MMR2 at typical schools; 49–90% for MMR1 and 16–63% for MMR2 at high PBE schools) but still below levels needed to maintain herd immunity against measles.”
2015 – Association of measles and mumps with cardiovascular disease: The Japan Collaborative Cohort (JACC) study. “Men with both infections had 0.88 (0.78-0.99) for total CVD. Women with both infections had 0.85 (0.76-0.94) for total CVD, 0.79 (0.67-0.93) for total stroke, 0.78 (0.62-0.98) for ischemic stroke and 0.78 (0.62-0.98) for hemorrhagic stroke. CONCLUSIONS: Measles and mumps, especially in case of both infections, were associated with lower risks of mortality from atherosclerotic CVD.”
August 7, 2015 – Lack of Measles Transmission to Susceptible Contacts from a Health Care Worker with Probable Secondary Vaccine Failure — Maricopa County, Arizona, 2015 “The presence of measles IgG (index standard ratio = 8.2, with ≥1.1 considered seropositive) 2 days after rash onset suggested secondary vaccine failure (waning of vaccine-induced immunity, rather than failure to develop an immune response to administered vaccine [i.e., primary vaccine failure]). Symptoms in these patients range from typical measles to a much milder, modified illness (3). Secondary measles vaccine failure is uncommon, and although measles transmission from such persons has been documented (4), it is not believed to contribute significantly to spread (5).”
July 17, 2015 – Risk of febrile seizure after measles–mumps–rubella–
June 9, 2015 – Immunity to Measles, Mumps and Rubella in US Children with Perinatal HIV Infection or Perinatal HIV Exposure without Infection “High proportions of PHIV children, but not HEU children, lack serologic evidence of immunity to measles, mumps and rubella, despite documented immunization and current cART. Effective cART before immunization is a strong predictor of current seroimmunity.”
May 15, 2015 – Measles in Healthcare Facilities in the United States during the Post-elimination Era, 2001- 2014 “Between 2001 and 2014, 78reported measles cases resulted from transmission in U.S. healthcare facilities and 29 healthcare personnel were infected from occupational exposure, of whom 1 transmitted measles to a patient. The economic impact of preventing and controlling measles transmission in healthcare facilities was $19,000- $114,286 per case.”
May 15, 2015 – Adverse Events Following Measles, Mumps, and Rubella Vaccine in Adults Reported to the Vaccine Adverse Event Reporting System (VAERS), 2003–2013 “During this period, V'AERS received 3175 US reportsafter MMR vaccine in adults. Of these, 168 (5%) were classified as serious, including 7 reports of death. Females accounted for 77% of reports.”…”Conclusions. In our review of VAERS data, we did not detect any new or unexpected safety concerns for MMR vaccination in adults.”
May 11, 2015 – Immunogenicity and safety of a combined measles, mumps, rubella and varicella live vaccine (ProQuad®) administered concomitantly with a booster dose of a hexavalent vaccine in 12–23-month-old infants “Antibody response rates to measles, mumps, rubella, varicella, hepatitis B and Haemophilus influenzae type b following concomitant administration of ProQuad® and hexavalent vaccine were non-inferior compared with those following the individual vaccines. Antibody response rates to these antigens were all >95% in all groups.”…”The safety profiles of each vaccination regimen were comparable, with the exception of solicited ProQuad®-related injection-site reactions (Days 0–4), which occurred more frequently in the concomitant than in the non-concomitant groups.”…”Conclusion” These immunogenicity data support the concomitant administration of ProQuad® with a hexavalent vaccine. The safety profile of concomitant ProQuad® and hexavalent vaccination was also in line with that of the individual Summaries of Product Characteristics. Comment: Non-inferior definition a clinical trial that shows that a new treatment is equivalent to standard. Shoving everything in one shot to hide severe adverse effects is criminal.
April 27, 2015 – M-M-R®II manufactured using recombinant human albumin (rHA) and M-M-R®II manufactured using human serum albumin (HSA) exhibit similar safety and immunogenicity profiles when administered as a 2-dose regimen to healthy children “Prior to 2006, M-M-R®II (measles, mumps, and rubella virus vaccine live) was manufactured using human serum albumin (HSA) and each dose of the vaccine contained a relatively small amount (≤0.3 mg) of HSA. Because of specific regulatory requirements and limited suppliers of HSA acceptable for human use, there was a need to replaceHSA with recombinant human albumin (rHA) to mitigate any 'potential risk to theavailabilityof M-M-R®II.”
April 6, 2015 – Intralesional tuberculin (PPD) versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: a comparative clinical and immunological study “MMR resulted in a significantly higher serum IL-12 than PPD. With PPD, IL-4 was increased with statistically significant change compared with pretreatment level. Intralesional PPD and MMR show comparable efficacy and safety in treatment of multiple warts. Serum ILs-4 and-12 increase following antigen injection.” Comment: more sales for Merck.
March 19, 2015 – Cost of Measles Containment in an Ambulatory Pediatric Clinic. “Fifty-two patients, 60 caretakers, and 10 employees were exposed. Personnel time cost $1,961. Exposed patients had a mean age of 9.6 years (range: 2 months-19 years); 34 (65%) were fully vaccinated and 18 (35%) were <12 months of age and too young to be vaccinated. Five patients (10%) were <6 months of age and required IG; 13 infants (25%) 6-11 months of age required MMR vaccination. Caretakers followed up with their physicians for evidence of immunity. One employee had documented evidence of immunity; 9 required measles antibody testing or vaccination. Management of exposed persons cost $3,694; overall clinic costs were $5,655.” Comment: from the statistics above there weren’t any unvaccinated by choice.
March 10, 2015 – Febrile seizures following measles and varicella vaccines in young children in Australia “There were 2013 FS episodes in 1761 children. The peak age at FS was 18 months. The risk of FS was significantly increased 5–12 days post receipt of MMR1 at 12 months (RI = 1.9 [95% CI: 1.3–2.9]), but not after VV at 18 months (RI = 0.6 [95% CI: 0.3–1.2]. The estimated excess annual number of FS post MMR1 was 24 per 100,000'vaccinated children aged 11–23 months (95% CI = 7–49 cases per 100,000) or 1 per 4167 doses.”
March 3, 2015 – Controlling measles using supplemental immunization activities: A mathematical model to inform optimal policy “Vaccines are assumed to be “all or nothing”, so that individuals receiving the vaccine are either fully protected or not at all.'We assume that vaccination gives lifetime protection if it successfully elicits an immune response, and that vaccinating already infected individuals does not increase the rate of infection clearance (i.e. the vaccine has no therapeutic action).”
January 30, 2015 – Adverse events following measles, mumps, and rubella vaccine in adults reported to the Vaccine Adverse Event Reporting System (VAERS), 2003-2013 “During this period, VAERS received 3,175 US reports after MMR vaccine in adults. Of these, 168 (5%) were classified as serious, including 7 reports of death. Females accounted for 77% of reports. The most common signs and symptoms for all reports were pyrexia (19%), rash (17%), pain (13%) and arthralgia (13%).”…”In our review of VAERS data, we did not detect any new or unexpected safety concerns for MMR vaccination in adults.”
January 30, 2015 – Reactogenicity and immunogenicity of measles-rubella combined vaccine in school-entry-aged subjects with naturally acquired measles immunity “There were virtually no clinical reactions related to booster vaccination and a highly significant antibody response to rubella antigen developed, whereas the antibody rise to measles was statistically significant but poor.”
January 2015 – Safety and Immunogenicity Study of GlaxoSmithKline (GSK) Biologicals’ Measles, Mumps and Rubella (MMR) Vaccine (209762) Compared to Merck & Co., Inc.’s MMR Vaccine in Healthy Children 12 to 15 Months of Age “Primary Outcome Measures: Assessment of 'f'ever after MMR'vaccination [ Time Frame: From Day 5 through Day 12 after vaccination ] [ Designated as safety issue: No ]
December 2014 – Common variants associated with general and MMR vaccine–related febrile seizures “Two loci were distinctly associated with MMR-related febrile seizures, harboring the interferon-stimulated gene IFI44L (rs273259: P = 5.9 × 10−12 versus controls, P = 1.2 × 10−9 versus MMR-unrelated febrile seizures) and the measles virus receptor CD46 (rs1318653: P = 9.6 × 10−11 versus controls, P = 1.6 × 10−9 versus MMR-unrelated febrile seizures).” Comment: They can detect which children may have seizures after the MMR. So one size really doesn’t fit all, but, those children are still receiving the MMR vaccine.
October 30, 2014 – ProQuad™ Versus M-M-R II™ and VARIVAX™ in Healthy Children (V221-009)(COMPLETED)Comment: over 40% had fever with MMRV, but, you will not see any neurological serious events listed when it has been proven MMRV causes seizures.
November 28, 2014 – Parental attitudes and decision-making regarding MMR vaccination in an anthroposophic community in Sweden – A qualitative study “Four themes describing parental attitudes toward measles vaccination were developed and three of these, the conformers, the pragmatists and the attentive delayers describe different approaches toward vaccinations among those who actually vaccinate. The last theme, promoters of natural immunity, represents those postponing or refusing vaccination beyond childhood. This study suggests that there is a spectrum of parental beliefs regarding MMR vaccination in this anthroposophic community. Interventions specifically targeted to the anthroposophic community and strengthening health workers capacity for a constructive dialog on vaccine’s benefit and risks may contribute to higher vaccination coverage. This is believed to minimize the risk of future epidemics and contribute to the WHO European Region’s goal of eliminating measles.”
October 10, 2014 – Massive Fraud In Merck MMR Vaccine Testing “The third, a senior CDC scientist, indirectly blew the whistle on Merck as it was really directed at his own actions as well as his CDC colleagues that were part of a 2004 study that involved the MMR vaccine. In this case the claims involve a cover-up of data that showed higher rates of autism in African-American boys after receiving the MMR vaccine.'If the courts side with the whistleblowers, it would represent a moral victory as they repeatedly attempted to stop Merck while still in its employ. Under the False Claims Act, the whistleblowers would receive a share – an estimated 25 percent to 30 percent – of the amount recovered by the government. Previous settlements of this kind have ended in hundreds of millions of dollars and have gone into the billions.”
Vol 11, No 4 2014 – Commentary – Controversies surrounding mercury in vaccines: autism denial as impediment to universal immunisation (full text) “It is biologically plausible that mercury toxicity in genetically susceptible persons may contribute to the numbers with autism and ASD. However there is no clear proof linking the mercury in Thimerosal to the spurt in cases seen in recent years. The apparent linkage of autism to the MMR vaccine (which is Thimerosal free) seems to suggest that mercury exposure through Thimerosal-containing vaccines is not the only factor that may be responsible for the subsequent “autism” and “ASD” diagnoses in developing children.”
September 24, 2014 – Measles Vaccine Coverage and Series Completion among Children 0 to 8 Years of Age in Tianjin, China. “Results: We examined records of 205,982 children living in Tianjin, China. Among children who were age-appropriate for each vaccine, 98.6% received MV, 97.6% received MMR-1, and 76.9% received MMR-2. Of the children who were old enough to receive MMR-2, 78.8% received the complete series, and 71.6%' of children were fully immunized for measles by age 6.” Comment: It looks like Chinese parents know about the MMR vaccine, even with a supposed mandatory vaccine system.
September 2014 – Measles Infection Despite 2-dose Vaccination in Health Care Workers “In the past years, many HCW’s with vaccination-acquired measles immunity have entered the labor market. Their susceptibility to measles may be associated with reduced circulation of the wild virus in the population, which results in an absence of viral challenge and its titer-boosting effect.”
August 20, 2014 – Vaccination perceptions of school employees in a rural school district “Suboptimal vaccination rates of school employees may negatively affect the health and well-being of individuals in the school environment. School employees report a variety of beliefs regarding the influenza and MMR vaccines. While over half of school employees support mandatory vaccination' policies for adults working in the school environment, 'those opposing such a policy report concerns regarding violation of personal choice. Public health officials and school administrators should coordinate efforts to increase vaccination rates among adults in the school environment.”
August 8, 2014 – Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data (full text) “RESULTS: When comparing cases and controls receiving their first MMR vaccine before and after 36 months of age, there was a statistically significant increase in autism cases specifically among African American males who received the first MMR prior to 36 months of age. Relative risks for males in general and African American males were 1.69 (p=0.0138) and 3.36 (p=0.0019), respectively. Additionally, African American males showed an odds ratio of 1.73 (p=0.0200) for autism cases in children receiving their first MMR vaccine prior to 24 months of age versus 24 months of age and thereafter.”
August 7, 2014 – Safety and Immunogenicity of Human Serum Albumin-Free MMR Vaccine in US Children Aged 12–15 Months “(MMRII; Merck & Co) is currently the only measles-mumps-rubella (MMR) vaccine licensed in the United States. Another licensed vaccine would reinforce MMR supply. This study assessed the immunogenicity of a candidate vaccine (PriorixTM, GlaxoSmithKline Vaccines [MMR-RIT]) when used as a first dose among eligible children in the United States. COMMENT: Human serum albumin is a very common protein found in human blood. It is used in very small quantities as a stabiliser in one of the MMR vaccines (MMRVaxPro, 0.3mg per dose), and in one of the chickenpox vaccines (Varilrix). Priorix will still have human fetal diploid cells.
- produced in chick embryo cells
- produced in human diploid (MRC-5) cells
- Cell Culture Infective Dose 50%
July 31, 2014 – Personal attitudes and misconceptions, not official recommendations guide occupational physicians’ vaccination decisions “The attitude towards vaccination most strongly affects whether occupational physicians recommend the measles, mumps, and rubella (MMR) vaccination: physicians with less positive attitudes recommend MMR to HCP in a more restricted way. A more positive attitude towards vaccination also relates to fewer misconceptions. Occupational physicians’ knowledge and attitude further influence the extent to which pregnant HCP receive vaccinations against influenza. Knowledge about official recommendations does not influence the recommendation of influenza vaccination for pregnant women. Conclusions Reasons for vaccination gaps in HCP might have their roots in occupational physicians’ incomplete knowledge of vaccination recommendations. Attitudes, which are related to misperceptions, also influence which vaccinations are recommended to HCP. Official recommendations, and not personal attitudes and misconceptions, should guide occupational vaccination behavior.
July 1, 2014 – Vaccines: Can Transparency Increase Confidence and Reduce Hesitancy? (pdf) “The authors did report adverse events associated with vaccines, including high-quality evidence that the MMR vaccine is associated with febrile seizures and the varicella vaccine is associated with complications in immune-deficient people. There was moderate-quality evidence for purpura associated with the hepatitis A and MMR vaccines, febrile seizures with the pneumococcal conjugate 13 vaccine, and intussusception wit rotavirus vaccines.
June 9, 2014 – Risk of febrile seizures after first dose of measles–mumps–
rubella–varicella vaccine: a population-based cohort study (pdf) “The risk of seizures 7 to 10 days after vaccination was twice as high with MMRV as with MMR+V (relative risk [RR] 1.99, 95% confidence interval [CI] 1.30–3.05). The excess absolute risk of seizures was 3.52 seizures per 10 000 doses of MMRV relative to MMR+V. In high-risk children, the risk was not differentially higher for MMRV (RR 1.30, 95% CI 0.60–2.79).”…”“Policy-makers need to balance these findings with the potential benefits of administering the combination vaccine or determine 'whether the 'choice of vaccine rests with clinicians and/or parents.”
May 14, 2014 – Booster immune response in children 6–7 years of age, randomly assigned to four groups with two MMR vaccines applied by aerosol or by injection “Aerosol immunization may be a useful tool to reach and sustain the elimination of measles, rubella, and congenital rubella syndrome. We compared booster seroresponses to aerosolized or injected MMR vaccines containing different strains of measles (Attenuvax or Edmonston–Zagreb) and mumps (Jeryl–Lynn or Leningrad–Zagreb).” Comment: Measles, Mumps, and Rubella spread through the air may conveniently immunize those around the vaccinated child. The percentages of immunity aren’t high numbers”
April 1, 2014 – AAP Grand Rounds MMR vaccine associated with increased risk of fever, seizure in older children (full text) “The primary outcomes were postimmunization medically attended fever events in the outpatient setting and seizure events in the emergency department (ED) or hospital setting during the 42-day period after immunization with MMR or MMRV. These outcomes were identified using ICD-9 codes. Consistent with previous data, days 7 to 10 within this 42-day postimmunization period were considered to be the risk interval for fever and seizures, and days 0 to 6 and 11 to 42 were considered to be the control intervals.”
March 26, 2014 – Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011. “This is the first report of measles transmission from a twice-vaccinated individual with documented secondary vaccine failure. The clinical presentation and laboratory data of the index patient were typical of measles in a naive individual. Secondary patients had robust anamnestic antibody responses. No tertiary cases occurred despite numerous contacts. This outbreak underscores the need for thorough epidemiologic and laboratory investigation of suspected cases of measles regardless of vaccination status.”
March 2014 – The economic burden of sixteen measles outbreaks on United States public health departments in 2011 (full text) “Measles outbreaks will likely continue to occur in the US mainly because of the persistent risk of imported measles cases derived partly from the increased disease transmission and number of outbreaks in the European region. Such a risk is magnified by the presence of susceptible sub-populations in the US due to lack of vaccination, the variety of potential outbreak settings (hospitals, clinics, airports, cruise ships, etc.), the limited state and local response capabilities, and the lack of awareness of vaccine recommendations in a few susceptible individuals traveling to endemic countries. Beyond the impact on local and state public health departments, responses to measles outbreaks also affect hospitals, clinics, as well as non-health public departments such as schools, universities and occasionally' local police departments enforcing quarantines or supporting control actions.
February 7, 2014 – Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011 "'Demonstration of waning immunity requires measurement of neutralizing antibody titers before revaccination or infection and at time points subsequent to the antigenic stimulation. Detection of IgG is a proxy for immunity, not an absolute correlate of protection from disease."
February 7, 2014 – Association of the use of MMRV in infants by pediatric infectious disease specialists with that of other affiliated providers “These data suggest that while most providers followed the ACIP recommendation to administer MMR and V separately, Pediatric Infectious Disease specialists’ vaccination practices may impact compliance with ACIP recommendations by other providers. Further study of the drivers behind the use of MMRV rather than MMR + V as the first dose of measles-containing vaccine is needed to determine if reinforcement or if clarification of ACIP recommendations is needed to elucidate when MMRV might be preferred over MMR + V.”
February 2014 – Risk Factors for Transmission of Mumps in a Highly Vaccinated Population in Orange County, NY, 2009–2010 (full text) “In this population of highly vaccinated students, we found that exposure to increasing number of mumps cases was associated with an increased risk of developing mumps. Although 2 doses of mumps-containing vaccine is effective in preventing mumps for most exposed persons, our findings suggest that the vaccine may not be as effective if there are multiple, prolonged and intense mumps exposures. To 'address this issue, the Centers for Disease Control and Prevention has issued guidance for considerations for use of a third dose of MMR vaccine in specifically identified target populations along with criteria for public health departments to consider while making a decision.
January 15, 2014 '– Increased emergency room visits or hospital admissions in females after 12-month MMR vaccination, but no difference after vaccinations given at a younger age “At 12 months, we observed a significant effect of sex, with female sex being associated with a significantly higher relative incidence of events (P = 0.0027). The relative incidence ratio (95% CI) comparing females to males following the 12-month vaccination was 1.08 (1.03 to 1.14), which translates to 192 excess events per 100,000 females vaccinated compared to the number of events that would have occurred in 100,000 males vaccinated.”
January 15, 2014 – Increased measles–mumps–rubella (MMR) vaccine uptake in the context of a targeted immunisation campaign during a measles outbreak in a vaccine-reluctant community in England “Uptake of MMR vaccination significantly increased during the outbreak following the immunisation campaign. Those amenable to MMR vaccination seem to have benefited from the campaign more than those with no previous vaccinations. Future evaluations should address what made a few parents change their mind and have their children vaccinated for the first time during the outbreak.”
January 14, 2014 – Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination (full text) “In this study, we have used a systems approach to the analysis of sex differences in the immune system in humans. These data reinforce and extend previous reports, and point toward a mechanistic hypothesis that may drive the sex disparities observed in responses to vaccination. Differences in vaccine responsiveness in males versus females have been reported for most commercially available vaccines including yellow fever, influenza, measles, mumps, rubella, and hepatitis, among others. As in these studies, we find stronger responses to influenza vaccination and significantly increased serum levels of proinflammatory molecules in females compared with males, specifically LEPTIN (25), IL-RA and CRP.
January 9, 2014 – Decline of varicella vaccination in German surveillance regions after recommendation of separate first-dose vaccination for varicella and measles–mumps–rubella “Germany introduced routine varicella (V) vaccination in 2004. Due to a slightly increased risk of febrile convulsions after first-dose application of combined measles–mumps–rubella–varicella (MMRV) vaccine separate first-dose vaccinations with MMR and monovalent V vaccine were recommended in September 2011.”…”Acceptance of V vaccination depends in part on the use of combination vaccine.”
December 25, 2013 – Risk of febrile convulsions after MMRV vaccination in comparison to MMR or MMR+V vaccination“This study in children younger than 5 years, 90% of them between 11 and 23 months, shows a risk of FC similar in magnitude for Priorix-Tetra™ as has previously been reported for ProQuad® suggesting a class effect for these quadrivalent vaccines.”
December 5, 2013– Case of Vaccine-Associated Measles Five Weeks Post-Immunisation, British Columbia, Canada, October 2013 (full text) “Possible explanations for this prolonged shedding of measles vaccine virus include interference with the immune response by host or vaccine factors. Immunoglobulin administration early in the incubation period has been reported to extend the time to onset of symptoms, but in this child there was no such history and no known immunosuppressive illness. The two-fold rise between acute and convalescent measles-specific IgG suggests the vaccine-mediated immune response had been underway prior to the onset of symptoms. Investigations clarified that there were no shipping, handling or cold-chain deviations for the specific vaccine used, and that it was administered by a public health nurse trained in immunisations. The potential immunological impact of the older age of the child at the time of receiving the first dose of MMR vaccine, 33 months versus the typical 12-15 months of age, and the co-administration of meningococcal C and pneumococcal conjugate vaccines are areas for future investigation.
November 14, 2013 – Motor palsies of cranial nerves (excluding VII) after vaccination: Reports to the US Vaccine Adverse Event Reporting System (full text) Cranial nerve palsies were reported after a wide variety of vaccines (Table 3). Most reports (43; 63%) listed a single vaccine. Among reports listing single vaccines, the most common vaccines were influenza vaccine seasonal trivalent inactivated',' human papillomavirus vaccine quadrivalent, influenza H1N1 va'ccine inactivated, and zoster vaccine live. Among reports listing multiple vaccines, the most common vaccines included hepatitis A vaccine; measles, mumps, and rubella vaccine live; diphtheria and tetanus toxoids and acellular pertussis' vaccine; Hemophilus influenzae type b vaccine; and 'pneumococcal conjugate vaccine 7-valent. There was no conspicuous clustering of live or inactivated vaccines with palsies of particular cranial nerves.
October 21, 2013 –Measles in Children Vaccinated With 2 Doses of MMR “When the first dose was administered at 12 to 13 months compared with ≥15 months of age, the risk of measles in participants outside the outbreak school was '6 times higher (95% confidence interval, 1.33–29.3) and was 5.2 times higher (95% confidence interval, 1.91–14.3) in the pooled estimate (participants from the outbreak school + outside that school).”
October 14, 2013 – Validation of the French national health insurance information system as a tool in vaccine safety assessment: Application to febrile convulsions after paediatric measles/mumps/rubella immunization “The results suggest a significant increase of febrile convulsions during the 6–11 days period following any MMR immunization (IRR = 1.49, 95% CI = 1.22, 1.83; p = 0.0001) and no increase 15–35 days post any MMR immunization (IRR = 1.03, 95% CI = 0.89, 1.18; p = 0.72). These results are in accordance with other results obtained from large epidemiologic studies, which suggest the usability of the SNIIR-AM as a relevant database to study the occurrence of adverse events associated with immunization. For future use, results associated with risk of convulsion during the day of vaccination should nevertheless be considered with particular caution.”
September 13, 2013 – Notes from the Field: Measles Outbreak Associated with a Traveler Returning from India — North Carolina, April–May 2013 “During April and May, direct and indirect transmission from the returning traveler resulted in 22 identified cases of measles (including the two cases first reported), for a total of 23 cases overall. Most cases were among residents of a largely unvaccinated religious community in rural North Carolina. Eighteen (78%) of the 23 patients were unvaccinated, three (13%) had been fully vaccinated with 2 doses of measles vaccine, and two (9%) had unknown vaccination status. The 23 patients ranged in age from 1 to 59 years. Measles was confirmed by laboratory testing of specimens from 16 patients (70%). Specimens collected from eight cases were sent to the Vaccine Preventable Disease Reference Center at the Wisconsin State Laboratory of Hygiene for molecular characterization. Genotype D8, the most commonly identified measles genotype in India, was identified in the specimens from all eight cases.”
September 2, 2013 – Anterior Uveitis and Cataract After Rubella Vaccination: A Case Report of a 12-Month-Old Girl “We report the case of a 12-month-old girl who developed a unilateral anterior uveitis with rubeosis and cataract 3 months after an MMR vaccination at 9 months of age.”
September 2013 – Mumps Postexposure Prophylaxis with a Third Dose of Measles-Mumps-Rubella Vaccine, Orange County, New York, USA (pdf) “Although 2 MMR doses are sufficient for preventing mumps in most settings, administering a third MMR dose may be worthwhile in specific outbreak contexts, even if it does not offer protection as PEP. Our findings support the need for additional evaluations in which third doses of MMR vaccine are used as PEP in outbreaks among populations with 2-dose vaccination coverage. Future studies on administering any dose of MMR vaccine for mumps PEP during mumps outbreaks are also warranted.”
August 2013 – Antibody Persistence and Booster Vaccination of a Fully Liquid Hexavalent Vaccine Coadministered With Measles/Mumps/Rubella and Varicella Vaccines at 15–18 Months of Age in Healthy South African Infants “Phase III, open-label, 2-center trial. Infants previously primed at 6, 10, 14 weeks of age with DTaP-IPV-Hep B-PRP-T either without (group 1: N = 218) or with hepatitis B at birth (group 3: N = 130) or control DTwP-Hib, hepatitis B and oral poliovirus vaccine vaccines (group 2: N = 219) received the same vaccine(s) as booster (except hepatitis B for group 2) at 15–18 months of age, coadministered with measles/mumps/rubella and varicella vaccines (MMR+V).
July 4, 2013 – Nonfebrile Seizures after Mumps, Measles, Rubella, and Varicella-Zoster Virus Combination Vaccination with Detection of Measles Virus RNA in Serum, Throat, and Urine “We report the case of a child presenting with nonfebrile seizures 6 and 13 days after the first vaccination with a measles, mumps, rubella, and varicella (MMRV) combination vaccine. Measles virus RNA was detected in the patient’s serum, throat, and urine. Genotyping revealed the Schwarz vaccine virus strain.”
May 8, 2013 – Waning of Maternal Antibodies Against Measles, Mumps, Rubella, and Varicella in Communities With Contrasting Vaccination Coverage (full text) “Our observations suggest that mass vaccination with MMR shortens, in due time, the duration of protection by maternal antibodies against measles, mumps, and rubella. Our study was conducted 20 years after introduction of the MMR vaccine, in 1987, when about 25% of women of childbearing age were vaccinated with MMR vaccine when they were young. This proportion of women of childbearing age who have been vaccinated with MMR will increase rapidly in the coming years because the vaccination coverage of each age cohort is >90%. We expect that this will further shorten the duration of protection against measles and rubella by maternal antibodies in infants and that a decreasing duration of protection against mumps by maternal antibodies will become more detectable among infants in the near future.”
April 30, 2013 – IdIdiopathic Thrombocytopenic Purpura Is More Severe in Children with a Recent History of Vaccinationiopathic Thrombocytopenic Purpura Is More Severe in Children with a Recent History of Vaccination (full text) “Conclusion: In this study, a higher rate of more severe ITP in recently vaccinated young children was observed, in comparison with other probable etiologies. In order to reach a more accurate result, studying the same topic on children older than 1.5 years is recommended.”
March 25, 2013 – Local public health response to vaccine-associated measles: case report (pdf) “The virus was sequenced using the World Health Organization standardized method and revealed measles genotype A, sequence designation MVs/Ontario.CAN/08.12 [A] (VAC), which is a vaccine strain. Viral cultures from the NP swab and urine were negative and the throat swab grew HSV-1. The full clinical and immunologic course of this case will be described elsewhere.”
March 2013 – Seropositivity Rates for Measles, Mumps, and Rubella IgG and Costs Associated with Testing and Revaccination “Retrospective analysis of IgG test results and patterns for measles, mumps, and rubella revealed generally high seropositivity rates, with that of mumps being the lowest. A simplified cost analysis shows that when there is a suspicion of nonimmunity, serological testing may be cheaper than vaccination.”
March 2013 – Dispelling vaccine myths: MMR and considerations for practicing pharmacists “Pharmacists can play a role in providing up-do-date information to patients to dispel myths concerning vaccine safety. Accurate peer review remains an important step to ensure correct information is given to health care providers and the public.”
February 26, 2013 – Knowledge, attitudes, beliefs and practices of general practitioners towards measles and MMR vaccination in southeastern France in 2012 “GPs considered the following were potential barriers to the 2nd dose of MMR (MMR2): parents/patients’ belief that measles is harmless (80%), parents/patients’ fear of the vaccine’s side effects (50%), difficulty in documenting vaccination (48%), and lack of reminders for MMR2 (16%). Finally, some GPs also had misconceptions about the severity of measles (13%) and the usefulness of MMR2 (12%), which also served as barriers.”
February 13, 2013 – Local public health response to vaccine-associated measles: case report (pdf) “In this report, we 'describe a case of vaccine-associated measles in an immunocompromised child and the decisions made by Peel Public Health regarding contact tracing and the exclusion of susceptible, immunocompromised contacts.”…”It is uncertain if cases have not been reported because vaccine-associated measles strains are not transmissible or because of extremely low infectivity. Alternatively, susceptible contacts of these cases could have been infected, but were not detected because they had subclinical disease. Vaccine-associated mumps in close contacts of children who had received primary vaccination with MMR have been reported so transmission of vaccine-associated measles seemed theoretically possible.”
January 30, 2013 – Investigation of an outbreak of hypersensitivity-type reactions during the 2004 national measles-mumps-rubella vaccination campaign in Brazil “Unlike earlier publications, this outbreak linked to a single manufacturer of MMR showed no association with a prior allergic history to eggs or other foods, including gelatin; subsequent studies implicate the dextran stabilizer in MMR from manufacturer A as the likely cause of HAEs.”
December 17, 2012 – Do HIV-positive adult immigrants need to be screened for measles–mumps–rubella and varicella zoster virus immunization? “According to CD4+ cell counts, vaccination was feasible in 71.6% of patients at first visit. In conclusion, more than a third of HIV-infected immigrant patients are susceptible to at least one easily preventable infectious disease. Special attention should be given to immigrant women of childbearing age.”
November 19, 2012 – Adverse events following a third dose of measles, mumps, and rubella vaccine in a mumps outbreak “A comprehensive search for AE following MMR vaccination was conducted using physician records and the Vaccine Adverse Events Reporting System (VAERS). A literature search was performed for published reports pertaining to AE associated with mumps-containing vaccine, using the Jeryl-Lynn strain, from 1969 to 2011. A total of 1755 individuals received the third dose; 1597 (91.0%) returned the survey. Of those, 115 (7.2%) reported at least one local or systemic AE in the 2 weeks following vaccination.”
November 6, 2012 – Febrile seizures and measles–mumps–rubella–varicella (MMRV) vaccine: What do primary care physicians think? “After receiving data regarding febrile seizure risk after MMRV, few physicians'report they would recommend MMRV to a healthy 12–15-month-old child.”
November 6, 2012 – Measles, mumps, and rubella virus vaccine (M–M–R™II): A review of 32 years of clinical and postmarketing experience “Postmarketing surveillance has limitations (including incomplete reporting of case data), but allows collection of real-world information on large numbers of individuals, who may have concurrent medical problems excluding them from clinical trials. It can also identify rare adverse experiences (AEs). Over its 32-year history, ∼575 million doses of M–M–R™II have been distributed worldwide, with 17,536 AEs”
September 19, 2012 – Waning Antibody Levels and Avidity: Implications for MMR Vaccine Induced Protection “Measles and rubella induced high avidity antibodies and mumps low avidity antibodies both after vaccination and natural infection. Waning of both the concentration as well as the avidity of antibodies might contribute to measles and mumps infections in twice MMR vaccinated individuals.”
September 7, 2012 – When, and how, should we introduce a combination measles–mumps–rubella (MMR) vaccine into the national childhood expanded immunization programme in South Africa? “The naturally acquired immunity to rubellain women of childbearing age in South Africa has been estimated at over 90%, so that introducing a rubella containing vaccine in childhood may paradoxically increase the proportion of girls reaching puberty still susceptible to rubella.”
August 2012 – Immunogenicity and Safety of Two Tetravalent (Measles, Mumps, Rubella, Varicella) Vaccines Coadministered With Hepatitis A and Pneumococcal Conjugate Vaccines to Children Twelve to Fourteen Months of Age “Exploratory analyses revealed 2 adverse events requiring further investigation: localized measles/rubella-like rash (GSK+4C) and grade 3 fever (GSK-20C). Although there appeared to be a small increase in fever 7–10 days after vaccination for GSK MMRV when compared with the licensed vaccine, there were no differences in the proportions of subjects taking antipyretics or seeking medical advice. Merck MMRV vaccine has been associated with an increase in febrile seizures in 12–23 month olds compared with MMR and varicella vaccines administered separately at the same visit.”
July 24, 2012 – Measles linked to temporary immunosuppression in children with HIV “Measles infection resulted in temporary but significant immunosuppression in children and adolescents with HIV who were taking antiretroviral medications, according to data presented here.”
July 20, 2012 – Perceptions of mumps and MMR vaccination among university students in England: An online survey “Those least likely to take up vaccination included students not registered with a GP; mature students; and those who did not consider mumps to be a serious disease.”
June 28, 2012 – Healthcare Workers’ Role in Keeping MMR Vaccination Uptake High in Europe: A Review of Evidence “Similar to the situation for healthcare workers, we found that there was a small proportion of parents who were very reluctant to have their children vaccinated with the MMR vaccine, regardless of proof of its efficacy and safety. However, most vaccine-decliners are simply under-informed or received misconceived information. Better informed and trained health professionals could have a substantial impact on the vaccination choices of those parents. For example, the results of Ciofi degli Atti et al. are indicative of the fact that that more efforts are needed to educate mothers (as well as physicians) regarding the risks associated with measles, as well as the fact that intercurrent illness is rarely a contraindication to immunisation.”
June 6, 2012 – Immunogenicity and safety of a quadrivalent meningococcal conjugate vaccine administered concomitantly with measles, mumps, rubella, varicella vaccine in healthy toddlers “Two age groups were concurrently enrolled: 7- to 9-month-old infants who received 2 doses of MenACWY-CRM (Menevo) at 7, 9 and 12 months. Subjects were then randomized to receive MMRV (ProQuad) at 12 months with Menovo or to receive MMRV only at12 months. Using predefined criteria, immune responses to the antigens in MMRV were compared between those who did and did not receive Menevo. Immune responses to Menevo was measured by the percentage of subjects with human serum bactericidal activity (hSBA) titers ≥ 8, were compared between those who did and did not receive concomitant MMRV.” Comment: 'The only thing the researchers care about is “did we get an antibody response to all 8 antigens?” This study involved the combination of meningitis vaccine, Menevo (4 antigens) AND MMRV (ProQuad), which is measles, mumps, rubella AND chickenpox at the same time. ProQuad has been pulled off the market at least 3 times due to seizures.
May 28, 2012 – Lessons from an online debate about measles–mumps–rubella (MMR) immunization “We selected the 13 longest branches containing 466 posts from 166 individuals. One third of these individuals were explicitly critical of MMR immunization and one third sought information. The remainder were ambivalent but seeking no information (5%), supportive (14%), or unstated (15%). Among five author categories, only 4% identified themselves as health professionals. Topics included alleged adverse effects of immunization (35%); autism spectrum disorders treatment and causes (31%); vaccine ingredients (12%); a conspiracy (9%); immunization policies (8%); and measles, mumps or rubella (4%). Scientific concepts of evidence failed to compete with lay concepts and personal anecdotes prevailed.”
April 30, 2012 – Recurrent 6th nerve palsy in a child following different live attenuated vaccines: case report (pdf) “There is limited information in the literature regarding the safety of a repeat dose of a live vaccine in this setting. As detailed above, a recurrent case of a nerve palsy has been described post MMR. [5,7] A second and further dose is recommended to increase the likelihood of sero-conversion, but ultimately further immunizations should be considered on an individual basis.
April 27, 2012 – United States District Court for The Eastern District of Pennsylvania United States of America ex rel., Stephen A Krahling and Joan A Wlochowski, Plaintiffs V. Merck & Co., Inc. Defendant – Amended Complaint for Violations of the Federal False Claims Act Jury Trial Demanded (pdf) “This case is about Merck’s efforts for more than a decade to defraud the United States through Merck’s ongoing scheme to sell the government a mumps vaccine that is mislabeled, misbranded, adulterated and falsely certified as having an efficacy rate that is significantly higher than it actually is. Specifically, in an effort to maintain its exclusive license to sell the vaccine and its monopoly of the U.S. market for mumps vaccine, Merck has fraudulently represented and continues to falsely represent in its labeling and elsewhere that its mumps vaccine has an efficacy rate of 95 percent or higher. This is the efficacy rate on which Merck’s original government approval for the vaccine was based more than forty years ago. In truth, Merck knows and has taken affirmative steps to conceal — such as by using improper testing techniques, falsifying test data in a clinical trial, and violating multiple duties of government disclosure that the efficacy rate of Merck’s mumps vaccine is, and has been since at least 1999, significantly lower than this 95 percent rate.”
April 19, 2012 – A collaborative approach to investigating the risk of thrombocytopenic purpura after measles–mumps–rubella vaccination in England and Denmark “The assessment of rare adverse events following vaccination may not be possible within a single country due to an insufficiently large denominator population. In 2008 a European consortium (VAESCO) was funded to perform collaborative vaccine safety studies. To help assess the feasibility of multi-country collaboration England and Denmark, who have established vaccine safety research infrastructures, undertook to work to a common protocol and share results and data to estimate the risk of a known true adverse event, thrombocytopenic purpura (TP) following measles–mumps–rubella (MMR) vaccination. The two countries obtained similar relative incidence estimates of about 2 in the 6 weeks post vaccination. This equates to an attributable risk of 1 TP per 50,000 doses.” Comment: Thrombocytopenic purpura (TP) is a rare disorder of blood-coagulation, causing extensive microscopic clots to form in the small blood vessels throughout the body. These small blood clots, called thrombosis, can damage many organs including the kidneys, heart and brain. In the era before effective treatment with plasma exchange, the fatality rate was about 90%. With plasma exchange, survival at six months is around 80%.
March 23, 2012 – The putative link between the MMR vaccine and autism and refusal to vaccinate. (full text translation) “This episode invites to think about the credibility and trust in the authorities and professionals to the population, as well as the suspicions that may arise when there are potential conflicts of interest among professionals, industry magazines and the population. A special area of interest is on the distorted expectations of health interventions, including vaccination, particularly with regard to both individual and collective prevention.”
March 2012 – Booster vaccination of pre-school children with reduced-antigen-content diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine co-administered with measles-mumps-rubella-varicella vaccine: A randomized, controlled trial in children primed according to a 2+1 schedule in infancy. “One month post-booster, all subjects were seroprotected/seropositive for anti-diphtheria, anti-tetanus, anti-PT, anti-FHA and anti-poliovirus 1-3; 99.3% of dTpa-IPV and 60.4% of DTPa-IPV subjects were seropositive for anti-PRN; 98-100% of subjects were seropositive against MMRV[measles, mumps, rubella, varicella/chickenpox] antigens post-booster. Pain at the injection site (dTpa-IPV: 63.6%; DTPa-IPV: 63.2%) and fatigue (dTpa-IPV: 26.5%; DTPa-IPV: 23.7%) were the most commonly reported solicited local and general symptoms, during the 4-day follow-up period. Comment: This is a double scream. The first scream is that in this study, children were injected with FIVE vaccines and 10 vaccine antigens, including 4 live viruses, at the same time time. The MMRV vaccine, commonly called ProQuad, is measles, mumps, rubella and varicella {chickenpox} all in one shot. This combination has been associated with increased risk of seizures. Secondly, they call this combination ‘safe’ even though side effects were only followed for FOUR days.
February 27, 2012 – UK parents’ decision-making about measles–mumps–rubella (MMR) vaccine 10 years after the MMR-autism controversy: A qualitative analysis “This study corroborated some previous qualitative work but indicated that the shrinking group of'parents now rejecting MMR comprises mainly those with more extreme and complex anti-immunisation views, whilst parents opting for single vaccines may use second-hand information about the controversy.”
February 1, 2012 – The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents (full text) “ITP is unlikely after early childhood vaccines other than MMR. Because of the small number of exposed cases and potential confounding, the possible 'association of ITP with hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines in older children requires further investigation.” Comment: ITP is Idiopathic thrombocytopenic purpura a the condition of having an abnormally low platelet count (thrombocytopenia) of unknown cause (idiopathic). Platelets are the cells in the blood that form blood clots. Purpura is the appearance of red or purple discolorations on the skin that do not blanch (turn white) on applying pressure. It is caused by bleeding underneath the skin.
February 2012 – Vaccines for measles, mumps and rubella in children “The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate. The evidence of adverse events following immunisation with the MMR vaccine cannot be separated from its role in preventing the target diseases.”
December 12, 2011 – Adverse Events following 12 and 18 Month Vaccinations: a Population-Based, Self-Controlled Case Series Analysis (full text) “However, the 12 month vaccines which typically contain the first dose of the MMR vaccine is associated with an increased risk of an emergency room visit approximately 4 to 12 days after immunization, peaking between days 8 and 11. This increase in rate of a child experiencing at least one event for every 158 vaccinated individuals is associated with a similar acuity as the control period.”
November 24, 2011 – MMR, Autism and Thanksgiving “At a congressional hearing on April 6, 2000, Bernard Rimland, PhD, who founded the Autism Society of America in 1965 and the Autism Research Institute (ARI) two years later, stated, “Autism starting at 18 months rose very sharply in the mid-1980s, when the MMR vaccine came into wide use.”
October 22, 2011 – Large Measles Outbreak in a High School in Canada: Lower than Expected Vaccine Efficacy in Two-dose Recipients and Higher Risk With Younger Age at First Dose “In this large school outbreak, nearly half the cases were two-dose recipients and VE was lower than expected. Despite a second dose administered 6 months after the first dose given at 12-14 months, the risk of measles is significantly higher than with a first dose given at ≥15 months. If these results are confirmed in other settings, the recommended age at first dose will have to be reconsidered.”
August 28, 2011 – Prevention of Varicella: Update of Recommendations for Use of Quadrivalent and Monovalent Varicella Vaccines in Children “A'personal or family (such as sibling or parent) history of seizures is now a precaution for MMRV (ProQuad) vacc'ination. Children with a personal or family history of seizures generally should be vaccinated with MMR and varicella vaccines, because the risks of using the MMRV in this group of children generally outweigh the benefits.” Comment: V = varicella (chickenpox) vaccine. Giving four live-virus vaccines simultaneously seems to be horribly toxic to the central nervous system.
August 2011– IOM Adverse Effects of Vaccines Evidence and Causality “Evidence Convincingly Supports a Causal Relationship: The MMR vaccine is linked to a disease called measles inclusion body encephalitis, which in very rare cases can affect people whose immune systems are compromised and usually occurs within a year of acute measles infection or vaccination. The MMR vaccine also is linked to febrile seizures, which are a type of seizure that occurs in infants and young children in association with fever. Febrile seizures are generally benign and hold no long-term consequences. Six types of vaccines—MMR, varicella zoster, influenza, hepatitis B, meningococcal, and tetanus containing vaccines—are linked to anaphylaxis. The committee also found convincing evidence of a causal relationship between injection of vaccine, independent of the antigen involved, and two types of adverse events, including syncope, or fainting, and deltoid bursitis, or frozen shoulder, characterized by shoulder pain and loss of motion.”
June 15, 2011 – A large observational study to concurrently assess persistence of measles specific B-cell and T-cell immunity in individuals following two doses of MMR vaccine (full text) “…racial and ethnic differences related to different allele frequencies in immune response genes are known to affect immune responses to infection and vaccination and may account for different susceptibility and severity of infectious diseases, as well as potential differences in immune response and adverse reactions to vaccines. Gender-related differences in antibody levels and cellular immune responses have also been reported for viral infections and viral vaccines such as measles-mumps-rubella (MMR), influenza, hepatitis A, hepatitis B, yellow fever, rabies and smallpox vaccine, and may account for differences in vaccine efficacy”
June 2011 – Making Decisions About the MMR Vaccine This study is currently recruiting participants. “Developing a Computer-based Intervention That Provides Individually-tailored Educational Information for MMR Vaccine-hesitant Parents.” Comment: Interesting that they are doing studies on how to write “educational materials” to convince parents to vaccinate with the MMR.
March 1, 2011 – There Goes That Argument! by F. Edward Yazbak, MD, FAAP “Case 1 was about a California toddler who was vaccinated and apparently had fever and symptoms of encephalopathy the same day. The dose of MMR Vaccine he received was from Lot 2018R. Another California toddler (Report 26127) who received a dose of vaccine from the same lot just one week later, developed severe thrombocytopenic purpura within 28 days of vaccination. Her platelet count dropped to 4000/ mm3. The normal platelet count for that age is 150,000-450,000 platelets per mm3. According to the MMR®II product insert, thrombocytopenia is an adverse reaction to the vaccine.” Comment: 'Definitions: Encephalopathy is abnormal functioning of the brain caused by an agent, a medication, a vaccine or a health condition, such as liver failure. The term “thrombocytopenic” (throm-bo-cy-toe-PEE-nick) means the blood has a lower than normal number of platelets, particles in the blood that makes the blood clot. The term “purpura” (PURR-purr-ah) refers to purple bruises caused by bleeding from small blood vessels under the skin. The MMR vaccine can cause both of these.
December 2010 – Thrombocytopenic Purpura Following Vaccination in Early Childhood: Experience of a Medical Center in the Past 2 Decades (pdf) The cause of thrombocytopenia (low platelets) during infancy and early childhood may be different from that of older children, because young children frequently receive vaccines. Thrombocytopenia should not be more than 9 weeks after vaccination. This study, performed to understand if a causal relationship exists between vaccinations and thrombocytopenia, included 20 children with thrombocytopenia under 3yo who were hospitalized between 1989 and 2010. Cases with a history of infection were excluded. Results: Of the 20 cases of thrombocytopenic purpura, 12 followed vaccination and 8 were considered idiopathic. Of the 12 post-vaccination cases, 5 occurred after the second dose of hepatitis B vaccine; 4 occurred after the first dose of DTaP, 2 occurred after the first dose of MMR, and 1 occurred after the first dose of varicella. Conclusion: Vaccination may be a risk factor for infant thrombocytopenic purpura. Comment: Thrombocytopenia is a blood disorder of low platelets that increases the risk of bleeding. Why do doctors deny connections to illness and insist vaccines are safe, effective and harmless?
July 1, 2010 – Measles-Mumps-Rubella-Varicella Combination Vaccine and the Risk of Febrile Seizures (full text) “Temporal scan statistics revealed that seizures clustered most significantly during days 8 to 10 for MMRV vaccination (RR: 7.6; P < .0001]), 7 to 10 days after MMR + varicella vaccination (RR: 4.0; P < .0001), and 7 to 11 days after MMR vaccination alone (RR: 3.7; P < .0001). No seizure peak was observable after varicella vaccination alone, nor was there any significant temporal clustering. During days 7 to 10, unadjusted rates for seizures were 84.6 seizures per 1000 person-years after MMRV vaccination, 42.2 seizures per 1000 person-years after MMR + varicella vaccination, and 26.4 seizures per 1000 person-years after MMR vaccination alone. Unadjusted rates during days 7 to 10 were nearly 8 times higher for MMRV and 4 and 3.5 times higher for MMR + varicella and MMR vaccination alone, respectively. At the largest VSD site (113 MMRV lots used), increased seizure risk was not limited to particular lots.”
June 4, 2010 - Spotlight on measles 2010: Excretion of vaccine strain measles virus in urine and pharyngeal secretions of a child with vaccine associated febrile rash illness, Croatia, March 2010 "We demonstrated excretion of the Schwarz measles vaccine virus in a child with a vaccine-associated febrile rash illness in urine and in pharyngeal excretions. Virus excretion in vaccinees has been reported before, but to our knowledge, this is documented for the first time for the Schwarz vaccine strain. Interestingly, although the blood for serology testing was obtained 14 and 32 days after vaccination, the child still had no antibodies to rubella virus in either serum sample. It is unclear why there was no seroconversion to rubella 32 days after vaccination, although this is not an unusual finding. The dynamics of measles and mumps antibodies were as expected for someone who had either been vaccinated or had natural infection, indicating that the child did not have impaired antibody production kinetics in general.
May 7, 2010 – Use of Combination Measles, Mumps, Rubella, and Varicella Vaccine Recommendations of the Advisory Committee on Immunization Practices (ACIP) “Use of MMRV vaccine has the benefit of requiring one less injection than the alternative of MMR vaccine and varicella vaccine. The risk for a febrile seizure after the first dose of MMRV vaccine, although low, is higher than after MMR vaccine and varicella vaccine administered as separate injections, and use of MMR vaccine and varicella vaccine avoids this increased risk. Children who have febrile seizures generally have an excellent prognosis. However, first febrile seizures often require a medical visit to an emergency department and are distressing for parents and caregivers. Therefore, parents might prefer to avoid the small increased risk for fever and febrile seizures after the first dose of MMRV vaccine compared with the first dose of MMR vaccine and varicella vaccine administered as separate injections. Given the balance of risks and benefits of a first dose of MMRV vaccine compared with a first dose of MMR vaccine and varicella vaccine, and the importance of individual values and preferences in weighing these risks and benefits, decisions should be made by providers and parents or caregivers on a case-by-case basis.”
May 1, 2010 – Adversomics: The Emerging Field of Vaccine Adverse Event Immunogenetics (full text) “An example is that epidemiologic studies have quantified the risk of immune thrombocytopenic purpura (ITP) and anaphylaxis, attributable to the MMR vaccine in the second year of life as 1 case per 40,000 vaccinated children. Recently France et al demonstrated that 76% of ITP cases in children ages 12 to 23 months were related to MMR vaccination. Identification of a genetic association between MMR vaccine and ITP would be important and would inform attempts at developing preventive strategies or improved vaccines. A further example is the expanding recommendations for the use of seasonal influenza vaccine and the potential use of pandemic vaccines globally; studies of the genetic susceptibility to Guillain-Barre Syndrome (GBS) would be important.”
December 2009 – Reduced rate of side effects associated with separate administration of MMR and DTaP-Hib-IPV vaccinations. “The rate of adverse effects in children who received the injections separately was significantly lower than among those who were vaccinated simultaneously (40% vs. 57%).”Comment: Note that children routinely receive all of these vaccines together — MMR, DTaP, HiB and IPV (polio). In the event vaccination is mandatory, insist on individual vaccines spaced out as far as possible.
July 23, 2009 – Observational safety study of febrile convulsion following first dose MMRV vaccination in a managed care setting “These data suggest that the risk of febrile convulsion is increased in days 5–12 following vaccination with MMRV as compared to MMR + V given separately during the same visit, when post-vaccination fever and rash are also increased in clinical trials. While there was no evidence of an increase in the overall month following vaccination, the elevated risk during this time period should be communicated and needs to be balanced with the potential benefit of a combined vaccine.” Comment: V = varicella (chickenpox) vaccine. Giving four live-virus vaccines simultaneously seems to be horribly toxic to the central nervous system.
July 17, 2009 – A new, rapid, and promising approach to aerosol immunization: Inflatable bags and valved masks “Booster doses of MMRV vaccine equal in dosage to injected doses were aerosolized into a 3/4 liter bag that was then inflated. The bag was attached to valved masks, and its contents rapidly inhaled in one or two deep breaths by preschool Mexican children.”
August 2005 – Evaluation of a Quadrivalent Measles, Mumps, Rubella and Varicella Vaccine in Healthy Children “Results: Measles-like rash and fever during days 5-12 were more common after the first dose of MMRV (ProQuad) (rash, 5.9%; fever, 27.7%) than after M-M-RII and VARIVAX (rash, 1.9%; fever, 18.7%).”
March 16, 2005 – £85,000 for parents of MMR victim “Carol Buxton received £85,000 compensation after it was confirmed that the brain damage suffered by her daughter Hannah, who later died after a violent fit, was linked to the MMR jab. Hannah endured up to 40 fits a day following her vaccination in 1988. She died three days before her third birthday.” Comment: This is a report of the Hannah Poling case — the girl who was awarded from the Vaccine Court for her vaccine injury.
March 2005 – The development of a plant-based vaccine for measles. Plant-based vaccination strategies have the potential to overcome the limitations of the current measles vaccine. The measles virus protein has been expressed in tobacco. Oral immunization of mice with plant-derived measles protein resulted in measles antibodies and secretory IgA, indicative of humoral and mucosal immune responses. Collectively, this research represents a significant step towards an effective oral measles vaccine that would be temperature-stable, easy to administer and amenable to inexpensive manufacture. Comment: Edible vaccines are an entire classification of vaccines that are in the pipeline.
March 2004 – MMR mass vaccination campaigns, vaccine-related adverse events, and the limits of the decision making process, in Brazil. “Vaccination is unquestionably a very important tool for disease control. However, vaccines can cause adverse events that may damage the public trust. In recent experience in Brazil, the implementation of mass campaigns with MMR vaccine was associated with outbreaks of vaccine adverse events. The decision-making process regarding the continuation of the use of this vaccine proceeded in the context of uncertainties, fears and contradictions between information from the scientific literature and data generated by a post-licensure monitoring.
February 9, 2004 – IOM Meeting Immunization Safety Review – Vaccines and Autism (pdf of power point presentation) Dr. Jeff Bradstreet presents “Biological Evidence of Significant Vaccine Related Side-effects Resulting in Neurodevelopmental Disorders.”
February 9, 2004 – Rep. Dave Weldon, M.D. Before The Institute of Medicine (pdf) “While I have considerable respect for Dr. Gerberding, I am concerned about the ability of the CDC’s National Immunization Program to objectively investigate this matter. The CDC has a built-in conflict of interest that is likely to bias any reviews. Unfavorable safety reports lead to lower vaccination rates. An association with between vaccines and autism would also force CDC officials to admit that their policies irreparably damaged thousands of children. Who among us would easily accept such a conclusion about ourselves? Yet, this is what the CDC is asked to do. Also, the relationship between the CDC and vaccine manufactures has become extremely close. If a conflict of interest does not exist here, then we certainly have the appearance of one.”
October 31, 2003 – Regressive Autism And MMR Vaccination “The possibility that a child, often a boy, who has a genetic predisposition to immune disorders, may be first affected by mercury [in the vaccines administered from birth to his first birthday] and then succumb after receiving 3 or more live virus vaccines and several other antigens on the same day, has never been ruled out conclusively, by reliable unbiased clinical studies.”
May 2003 – Acute pancreatitis associated with MMR vaccination. A 12-year-old girl developed abdominal pain three weeks after having received the second MMR shot. MRCP showed dilatation of bile duct and edema of the head of the pancreas. No stone was to be seen and the calcium level was normal. Hepatitis A virus, Ebstein-Barr virus, cytomegalovirus, enterovirus, serum col hemaggutinins, Yersinia and cystic fibrosis were all negative. We suggest that MMR vaccination may have a causal connection with this case.
2003 – Placing the risk of seizures with pediatric vaccines in a clinical context. In this review we discuss the relationship between commonly administered childhood vaccines such as DTwP and MMR, and the risk of non-febrile and febrile seizure. We summarize that suggest that DTwP and MMR vaccine are associated with a transiently increased risk of febrile seizures, and cause between 5-9 and 25-34 additional extra febrile seizures per 100 000 immunized children, respectively. …Nevertheless, current data suggest that children with febrile seizures do not experience long-term negative effects. …We conclude by discussing the introduction of new vaccines, and note that, even with widespread use, it will take many years before we can be knowledgeable about the risk of rare events with these newly licensed products. Comment: Frightened parents take children with febrile seizures to the ER or to the doctor. Many times, the child is admitted to the hospital overnight for observation. What is the real cost of these vaccines in trying to avoid an illness that, for most, comes and goes in a week?
2003 – Atopic Dermatitis Is Increased Following Vaccination for Measles, Mumps and Rubella or Measles Infection (pdf) “The incidence of atopic dermatitis increased after MMR vaccination and measles infection, which is surprising in view of the hygiene hypothesis. We suggest further study of the possible short-term and long-term effects of virus and bacteria on the immune responses and expression of atopic disease.” Comment: The “hygiene hypothesis” has been extensively investigated by immunologists and epidemiologists and is a theoretical framework for trying to explain the massive increase in allergic disorders. The hygiene hypothesis has been expanded to include exposure to symbiotic bacteria and parasites. The elimination of pathogen exposure is thought to be a problem, but increased number of vaccines are never included as a reason for the massive epidemic of illness among children.
December 2, 2002 – Prevalence of Anti-Gelatin IgE Antibodies in People With Anaphylaxis After Measles-Mumps-Rubella Vaccine in the United States (full text) “Almost one fourth of patients with reported anaphylaxis after MMR seem to have hypersensitivity to gelatin in the vaccine. They may be at higher risk of developing anaphylaxis to subsequent doses of other gelatin-containing vaccines. These people should seek an allergy evaluation before such immunization.” Comment: Anaphylaxis is a severe, whole-body allergic reaction to a chemical that has become an allergen. The reaction can be so severe that it can be life threatening. Gelatin is also in the Varivax {chickenpox} vaccine.
October 2002 – An evaluation of the adverse reaction potential of three measles-mumps-rubella combination vaccines. The three MMR vaccines that we studied are associated with different risks of adverse events. We found vaccine A to cause more reactions than the two other vaccines, especially vaccine B. In addition, vaccine A presented both a temporal and a cause-and-effect association with one case of aseptic meningitis.
July 2002 – Abnormal measles-mumps-rubella antibodies and CNS autoimmunity in children with autism. (pdf) “Thus the MMR antibody in autistic sera detected measles HA protein, which is unique to the measles subunit of the vaccine. Furthermore, over 90% of MMR antibody-positive autistic sera were also positive for MBP autoantibodies, suggesting a strong association between MMR and CNS autoimmunity in autism. Stemming from this evidence, we suggest that an inappropriate antibody response to MMR, specifically the measles component thereof, might be related to pathogenesis of autism.”
July 2002 – Does the MMR vaccine and secretin or its receptor share an antigenic epitope? “It has been suggested that the presence of the measles virus and ‘autistic enterocolitis’ demonstrates the possibility that the MMR triple vaccine may be mediating the inflammation with possible production of antibodies against the virus containing vaccine. Such an antibody may share antigenic determinant to molecules found in the gut. We propose that this may be secretin or its receptor, found in the gut as well as in the central nervous system.”
April 2002 – Potential viral pathogenic mechanism for new variant inflammatory bowel disease (full text) Comment: Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of the digestive tract. IBD primarily includes ulcerative colitis and Crohn’s disease. IBD can be painful and debilitating, and sometimes leads to life-threatening complications.
February 22, 2002 - Detection of measles vaccine in the throat of a vaccinated child "We report here the case of a child presenting with fever 8 days after vaccination with a measles–mumps–rubella vaccine. Measles virus was isolated in a throat swab taken 4 days after fever onset. This virus was then further genetically characterised as a vaccine-type virus."
September 2001 – Infection of Human B Lymphocytes with MMR Vaccine Induces IgE Class Switching “Since many viral vaccines are live viruses, we speculated that live virus vaccines may also induce IgE class switching in human B cells. To examine this possibility, we selected the commonly used live attenuated measles mumps rubella (MMR) vaccine. Here, we show that infection of a human IgM+ B cell line with MMR resulted in the expression of germline epsilon transcript. In additon, infection of freshly prepared human PBLs with this vaccine resulted in the expression of mature IgE mRNA transcript. Our data suggest that a potential side effect of vaccination with live attenuated viruses may be an increase in the expression of IgE.” Comment: There are 5 antibody types. IgM represents acute infection. IgE is the antibody involved with allergic reactions. This is a landmark study that suggests viral vaccines cause an acute infection antibody to develop which then undergoes “class switching” to IgE. This monumental study shows a mechanism for the current epidemic of allergies and asthma in children.
March 21, 2001 – Twin studies of immunogenicity — determining the genetic contribution to vaccine failure “Conclusion: Our data support the concept that genetic influences play a substantial role in the variation of antibody levels following immunization against measles and, to a lesser extent, mumps and rubella.”
March 2001 – Idiopathic thrombocytopenic purpura and MMR vaccine (full test) “Our study confirms a causal association between MMR vaccine and ITP. The best estimate of absolute risk within six weeks of MMR is 1 in 22,300 doses, with two of every three cases being vaccine attributable. This is similar to previous estimates,6 but is considerably less than ITP after natural measles (common), rubella (about 1 in 3000 cases), or mumps (rare). Over 70% of cases of ITP follow virus infections. Comment: More documentation that the MMR is not benign and is causally related to disruptions of central nervous system function and blood disorders.
October 1999 – Measles inclusion-body encephalitis caused by the vaccine strain of measles virus.(pdf) We report a case of measles inclusion-body encephalitis (MIBE) occurring in a previously healthy 21-month-old boy 8.5 months after MMR vaccination. He had no prior evidence of immune deficiency and no history of measles exposure or clinical disease. During hospitalization, a primary immunodeficiency characterized by a profoundly depressed CD8 cell count and dysgammaglobulinemia was demonstrated. A brain biopsy revealed features consistent with MIBE, and measles antigens were detected by staining. The presence of vaccine-strain measles virus in the brain tissue was confirmed. The gene differed from known genotype A wild-type viruses.
May 1999 – Managing the Risks From Medical Product Use Creating a Risk Management Framework – Report to the FDA Commissioner From the Task Force on Risk Management (pdf) “FDA noted that thrombocytopenia following immunization with measles containing vaccines was more severe than was previously perceived. Approximately 40 percent of reports of postimmunization thrombocytopenia described cases with platelet counts # 20,000, a level that has been associated with spontaneous life-threatening hemorrhage. In reviewing all reported cases of post-MMR thrombocytopenia in VAERS, FDA found one case of thrombocytopenia that resulted from positive rechallenge with MMR vaccine. FDA also found two deaths that occurred in children with postimmunization thrombocytopenia;
November 1997 – Measles, mumps, rubella vaccine induced subacute sclerosing panencephalitis. “This paper reports the case of a 15-year-old girl from India who developed SSPE presumably as a result of a delayed effect of measles, mumps, and rubella (MMR) vaccine. She presented with a 2-month history of behavioral disturbances, a deterioration in school performance, forgetfulness, silly smiling, handwriting changes, social withdrawal, and ataxia.” Comment: SSPE is a rare chronic, progressive brain inflammation that affects primarily children and young adults, who have had a measles infection.
May 1, 1996 – Recurrent Thrombocytopenic Purpura After Repeated Measles-Mumps-Rubella Vaccination (pdf) “The occurrence of acute thrombocytopenia purpura, in this child after MMR vaccination at 4 years of, age and again at 9 years of age indicates that MMR, vaccine can cause thrombocytopenia. According to, the IOM, the incidence of MMR-related thrombocytopenia, is estimated to be 1 in 30 000 to 40 000 vaccine, recipients, which is sixfold higher than that reported in the only study of population-based, idiopathic thrombocytopenic purpura. Recurrence, of thrombocytopenia after vaccination provides further, and compelling evidence incriminating MMR, vaccination. Which component of the vaccine (ie, measles, mumps, or rubella live attenuated virus) is, the cause is unknown. Thrombocytopenia after rubella, measles, and, in rare cases, mumps gives, biological plausibility to this complication from each, of these viral vaccines.”
July 1992 – Duration of immunity and occurrence of secondary vaccine failure following vaccination against measles, mumps and rubella “If wild virus can be spread via individuals with subclinical infections, it is doubtful whether population immunity (herd immunity), which is necessary to eliminate the three diseases, can be attained in large populations.”