Friday, June 05, 2015

Strikes Against the MMR (measles, mumps, rubella)

For those who question the wisdom or evidence in support of the schedule currently recommended by our CDC, there are generally many layers of questions.  Many question the schedule itself; with yet another dose of flu shot being recommended this year and the HPV (human papilloma virus) vaccine recommendations being expanded again-- our vaccine schedule seems quite full to many, especially in the first two years of a child's life (at least 25 shots by age 2, a total of 36 doses).  It certainly is more aggressive than most of the rest of the world.  (google a few and notice just how widely they vary from nation to nation, both in schedule, frequency, and diseases vaccinated against.  For example, Japan's schedule- which recommends 22 doses by age 2, or the Swedish schedule- which recommends 21 doses by age 2 as opposed to ours)

Then there are many who question the one-size-fits-all approach instead of considering each child's environment, personal health history, current health, family history (genetic predisposition) and even weight/body type (there is no dosing difference between a shot given a 5 lb or 10 lb newborn, for ex).

Then we come to questions and concerns about individual vaccines.  Many families feel more comfortable with certain shots than others, and their concerns may vary from shot to shot.  Their concerns may be ethical, practical, or medical in nature.  This is why so many feel insulted and frustrated when all vaccine questions are answered with a pat "oh, don't worry about autism!  That's been disproved so many times."  Whether or not it has, that generally is not the sum and total of a parent's concern on this issue.

Lately one vaccine seems to keep popping up in my life, whether it's reading yet another online story about the "horrible measles outbreaks", or an article in a magazine in which parents are encouraged to speed up their child's doses in preparation for travel, or in an admission form for kindergarden... that vaccine is the MMR.  The issues with the MMR are myriad, and I would like to list them one at a time.  My purpose is simple: to explain clearly why parents may desire to delay or omit this vaccine.  I am not a medically degreed individual, just a parent who enjoys research, can stomach reading medical studies until her eyes start crossing, and desires to empower other parents to make their own decisions, in discussion with their own trusted care providers.  Perhaps this list will be a good starting point for a conversation with your own medical care provider.  I certainly hope so!  As always, please follow the links in order to read primary sources on your own.

1. The MMR is a live vaccine-- that's how it is classified according to its Merck packaging.  According to the CDC's Pink Book, "Live attenuated vaccines are produced by modifying a disease-producing (“wild”) virus or bacterium in a laboratory. The resulting vaccine organism retains the ability to replicate (grow) and produce immunity, but usually does not cause illness."   A few of the main concerns regarding live-virus vaccines:
- Live vaccines seem to be better at provoking more immunity (because they are more like the original disease), and they unfortunately have more side effects for the same reason. The US has therefore traded the live oral polio vaccine (OPV) for the inactivated polio vaccine (IPV).  Again quoting from the Pink Book:
"The more similar a vaccine is to the disease-causing form of the organism, the better the immune response to the vaccine.")  "When a live attenuated vaccine does cause “disease,” it is usually much milder than the natural disease and is referred to as an adverse reaction. [...] Live attenuated vaccines may cause severe or fatal reactions as a result of uncontrolled replication (growth) of the vaccine virus. [...] A live attenuated vaccine virus could theoretically revert to its original pathogenic (disease-causing) form. This is known to happen only with live (oral) polio vaccine." 
The CDC states that live-virus vaccines are only a danger to those with certain immunocompromisation (HIV etc), however many parents wonder if those listed sources of  are the only potential sources-- could family (or personal) history of autoimmune disorders indicate susceptibility?
- encephalitis (brain swelling)-- Travel of a virus into the brain is a rare complication of several viral illnesses, including measles, and is a topic of ongoing research.  Unfortunately, it seems live virus vaccines also carry this risk, as this case study illustrates and as the vaccine inserts themselves state (see all three types of encephalitis listed under "Adverse Reactions").  According to the Mayo Clinic, "Secondary encephalitis often occurs two to three weeks after the initial infection. Rarely, secondary encephalitis occurs as a complication of a live virus vaccination." this in turn can be a factor in developing autism or other learning disabilities.  Encephalitis/encephalopathy is listed as a "Table Injury," meaning it is recognized as a possible vaccine reaction that will be compensated by the federal Vaccine Injury Compensation Program.  Two children were compensated for it this earlier this year.
- live virus vaccines "shed," meaning they are able to be passed on from a recently vaccinated person.  The NVIC's report is here.

2. The MMR is a combination vaccine- by that I mean that it is not a shot for a single illness, but rather for three:  measles, mumps and rubella.  The technical name is "polyvalant." It stands to reason that giving the body three separate pathogens to identify and mount antibodies against would be more taxing than giving one at a time. One recent study (published in Human & Experimental Toxicology) analyzed reported adverse vaccine effects by number of vaccine doses given at one time, and found
"Our findings show a positive correlation between the number of vaccine doses administered and the percentage of hospitalizations and deaths reported to VAERS. In addition, younger infants were significantly more likely than older infants to be hospitalized or die after receiving vaccines."
(Interestingly this is also being discussed among vets and dog-owners, as multiple vaccines at once is linked with higher adverse reactions, especially in small dogs. Example here.)  Many parents (myself included!!) would like the option of monovalent (single dose) vaccines, but separate shots for each MMR component are no longer available in the US though they can be found in parts of Europe and in Japan.

3.  The MMR is a viral vaccine- viruses are very very very tiny, so small they can only be seen under an electron microscope.  So, when they are cultured, there is no way to isolate just the viruses.  Rather, infected tissue (of whatever animal the virus is being cultured in) is used.  While many efforts are made to purify and test the tissue for harmful substances, there is no way to test for every possible contaminant:  you can only test for what you know might be there. Viral vaccines therefore are most at risk for being contaminated.  Several examples include the contamination of several batches of past polio virus vaccines with simian virus-40, now implicated in numerous human cancers (I explored this topic more thoroughly here.), or pig virus contamination (PCV1) of the rotavirus oral vaccine in 2010.  The FDA suspended the use of the vaccine during investigation and determined that the viral contaminants would not harm humans.  However, the very fact that it was unexpectedly present in a vaccine is a bit alarming.  (Was 4 weeks really long enough to evaluate long-term effect on children?)  There have also been findings of contaminants in measles virus cultures and a monkey virus contaminant in RotaTeq.

4.  Measles is not a dangerous disease in healthy children- contrary to what our media would have us believe, measles is neither deadly nor risky in healthy children.  Sure, the typical symptoms are not exactly pleasant:  high fever, cough, runny nose, watery eyes, and a rash (according to CDC), but even when measles infection in childhood was nearly universal, with 3-4 million cases per year, the number of deaths was approximately 500/year (source: Pink Book).  That works out to a 0.017%- 0.0125% death rate, or between 1 in 6000-8000. (If you got the measles, you had about a 1 in 7000 chance of dying of it, and if you survived, you were immune for life.  No more chance of dying of measles ever again in your life.)  Just for perspective, in 2015 in the US our odds of dying in a cataclysmic storm or from heat stroke are around 1 in 6, 700.  Our odds of dying from choking on food are double that (1 in 3000), and our odds of dying in a car accident or poisoning is about 1 in 110. (All numbers from the National Safety Council.) The odds of dying of measles are about the same as dying in a tornado or hurricane... way less likely than dying of choking, and even less likely than dying from poisoning.

There have been no measles deaths in the US for the past 10 years.  In other countries, where malnutrition and poor sanitation are concerns, measles complications can be fatal (which isn't surprising, given that anything is life-threatening for a malnourished person)-- however even then, the WHO says:
All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This treatment restores low vitamin A levels during measles that occur even in well-nourished children and can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.
The virus is quite contagious due to coughing but is fairly easy to eliminate from surfaces, "rapidly inactivated by heat, sunlight, acidic pH, ether, and trypsin. It has a short survival time (less than 2 hours) in the air or on objects and surfaces." (Pink Book)

5. Mumps is not a dangerous disease in healthy children- similarly to measles, mumps was once viewed as a childhood rite of passage (my mom remembers getting it as a child).  Like measles, mumps infection confers life-long immunity.  The options for supporting the immune system through the infection with vitamins, nourishing foods, rest and herbs are myriad when the patient is a healthy child. Mumps symptoms typically are swollen glands under the throat, headache, fever, tummy ache and malaise.  Even the CDC FAQ on the disease states:
Almost all people with mumps fully recover after a few weeks. During the illness, many people feel tired and achy, have fever, and may have parotitis. Some may feel extremely ill and be unable to eat because of pain around the jaw, and some may develop serious complications. Men and adolescent boys can develop orchitis, which rarely results in sterility. Women and adolescents girls may develop oophoritis. Meningitis and loss of hearing can also occur, and in rare cases this hearing loss can be permanent. The most serious complication is encephalitis, which can lead to death or permanent disability, although rarely.
As with many "childhood" diseases, disease complications tend to increase with age; in this case, only males that have gone through puberty are at risk for potentially developing sterility.  It is worth noting that with vaccination, formerly childhood diseases such as mumps have shifted to diseases which adults or babies are more at risk for (due to moms not being able to pass on natural immunity via breast milk, and vaccine protection wearing off in some individuals).  This is concerning to many.  As far as the encephalitis risk, see point #1 which points out that this is also a danger with vaccination-- arguably more of a danger than it was with the natural disease itself.

6. Rubella is a danger to unborn babies of moms who've never had rubella- it is not a danger to healthy children, nor even to unborn babies of moms who have had rubella.  So the question is whether or not routine vaccination of children is the most effective, most risk-free way of avoiding infection of moms during pregnancy in order to avoid CRS (congenital rubella syndrome).  Would it be advantageous to allow children to contract it naturally, allowing girls to then convey that rubella protection to their own infants later on via breast milk? Vaccine immunity can wear off in many individuals, and doesn't transmit as well via breast milk. Perhaps a vaccination for girls who show no immunity to rubella by age 12 would be a better option?  (This study on CRS in women in Saudi Arabia discusses just this, mentioning that immunizing children seems to limit CRS in younger mothers while increasing risk of it in older mothers as immunity wanes, while selective vaccination does better at allowing for life-long natural immunity but doesn't lessen the incidence of rubella itself.  However this is not necessarily a bad thing, as the study describes rubella as a "mild, self-limiting viral infection.")

7. Concerns with the measles component include many indications that it compromises gut health- Dr. Natasha Campbell-McBride (MD) has written extensively about this in her book Gut and Psychology Syndrome, where she describes the findings of live measles infections-- of the same strain in the vaccine-- in the guts of certain patients, causing extensive gastrointestinal problems, and surprisingly, a host of chronic and neurological conditions, among them Autism Spectrum Disorder. Read one study finding association between measles virus in the gut and developmental disorders here.  The gut dysbiosis-autism link has begun to be studied from several angles, among them the use of probiotics to reduce symptoms of autism (especially after this study in mice- here summarized by Autism Speaks).

8. Concerns with the mumps component include indications that the vaccine is ineffective and falsified data was used to obtain FDA approval- this article summarizes the current 3 court cases well.  Essentially, the concern is that Merck used one form of the attenuated mumps virus in testing in order to show 95% efficacy, when in practice that efficacy has not been true since at least 1999.
"Merck 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. In reality, Merck knows and has taken affirmative steps to conceal -- by using improper testing techniques and falsifying test data -- that its Mumps Vaccine is, and has been since at least 1999, far less than 95 percent effective." (Read more in the court documents for Chatom v Merck. )
There is evidence supporting the idea that the mumps component is not efficacious from India as well.

9. Concerns with the rubella component include its origin in tissue taken from aborted babies, which raises ethical concerns for many, and health concerns due to the presence of foreign human DNA. - From the MMR insert:  the rubella component contains the "Wistar RA 27/3 strain of live attenuated rubella virus propagated in WI-38 human diploid lung fibroblasts." As this 1964 paper entitled ""The Limited in vitro lifetime of human diploid cells" explains, "WI-38 and WI-44 [came] from female human fetal lung. All embryos were obtained from surgical abortions and were of approximately three months’ gestation."  (And as I understand it, the numbers refer to the number of cell lines that were "tried" before this cell line worked... so many many more than two babies' bodies were used to develop just those cell lines.)  The cell lines used to culture the current rubella vaccine came from a healthy human child whose life was ended by her mother at 3 month gestation for no medical reason-- many parents who believe abortion to be murder find any connection to aborted fetal tissue abhorrent-- even those who believe in the efficacy of vaccines.  Until a new medium is found for the rubella vaccine line (as the pope has urged Christians and pro-life individuals to clamor for), many parents find it reprehensible to use the current rubella vaccine (as well as other vaccines using human tissue obtained through abortion), and as such would object to the MMR.
- Those who may find no ethical dilemma in the use of cell lines originating in aborted human babies still may have concerns about the medical consequences of the injection of any tissue containing foreign human DNA-- recently, researcher Helen Ratajczak implicated the use of human (fetal) DNA in vaccines in the rise of autoimmune diseases, among other factors (published in the Journal of Toxicology).  Here is part of her explanation of why this may be:
"Because it's human DNA and recipients are humans, [...] That DNA is incorporated into the host DNA. Now it's changed, altered [... and the] body kills it. Where is this most expressed? The neurons of the brain. Now you have [the] body killing the brain cells and it's an ongoing inflammation. It doesn't stop, it continues through the life of that individual"  (source)
Another analysis of vaccine safety data has implicated the human tissue in the varicella, Hep A and second dose of the MMR in rises in autism disorder.  (Article from the Journal of Public Health here). Levels of human tissue in vaccine samples were found to be far above the current "safe" level.  The human tissue is implicated in a rise in childhood leukemia and lymphoma as well. (quote from study author Dr. Deisher here.)

10.  Childhood infectious diseases involving fevers (such as measles, mumps and rubella) may actually be beneficial in healthy children.  
- There is evidence that infectious diseases in childhood are protective against chronic or autoimmune diseases later in life, reducing the risk of cancer, asthma & allergies.  Fevers have even been used as part of cancer treatments and infectious diseases (including measles!) were found to cure disorders of the kidney in the past.
- Other research has collaborated the "old wives tale" that fevers always come before growth spurts, perhaps because the stimulation of the immune system by disease provides a "push" that allows the child to then grow.
- The protective/positive effects seem to be due partially to the effect fever/infection-suppressants has on the gut flora of children, and partially due to the need for all aspects of the immune system to be balanced and properly developed (Th1- cell-mediated immunity which includes the use of fevers, Th2 - antibody immunity).  The same mechanism that will kill tumor cells gets trained to "clean up" by killing viruses using fevers.  Hippocrates, the father of modern medicine, was reported to say:  “Give me a medicine to produce a fever and I can cure any disease.” Maybe he was on to something.

My point in summarizing these 10 "strikes" against the MMR is not to suggest that anyone who uses the MMR is stupid, uneducated, or irresponsible-- no, my goal is to explain that the reasons why SOME parents choose not to use this particular shot are varied, not one-size-fits-all.  If you hear that a friend or patient, client or family member has chosen to skip this vaccine, remember that they may not be worried about "that guy who said the mercury in the MMR causes autism."  They likely have multiple reasons for their choice, based in ethical, medical, or personal reasons!


chx said... You never ever know what happens if someone contract measles. The side effects can surface years, decades later. Vaccinate your children.

Eowyn's Heir said...

Sorry, but clearly you did not read the actual post. I smell a troll.

You could just as easily sub the word "measles vaccine" for "measles" in the above sentence. Not good enough. "You never know what might happen if you get the measles vaccine. Side effects can surface years later. Don't vaccinate your children."

I'll take my chances with the measles, thanks. Statistically I have a much lower rate of risk as a healthy well-few child in a time of peace.

chx said...

You know me, right? Perhaps putting a human face on a nick helps -- we met in Coppenhagen. I am not a troll. I am just baffled and concerned. It's hard to counter the chances of an unknown side effect vs the known side effects which are definitely happening but -- the problem is, there's more than one person in the picture. What about, for example, their children? Congenital rubella syndrome? Or

Eowyn's Heir said...

Hello- yes, I do remember you. Thanks for stopping by. Glad to know you are actually looking for discussion :). I really don't understand your questions/comments in light of the actual post, though. I believe the congenital rubella issue is one reason mass vaccination in childhood is a BAD idea-- as I mention above. Studies find lower incidences of CRS when moms are allowed to contract wild rubella as kids, as that immunity is permanant (and transmits via breastmilk), and only vaccinated just before puberty if they don't catch it on their own, because vaccine-aquired immunity can wear off, leaving them vulnerable to the disease while pregnant. If you read through the full post, follow the links I've linked to and take each argument in turn, I hope you will see where I am coming from and why I put forth 10 separate causes for concern with the MMR. I'm not trying to say get it or don't, or that we don't need a safer version or we do-- I'm saying "these are 10 reasons many parents will find this vaccine objectionable."

Again, thanks for stopping by! I welcome discussion from fair-minded folks. :)

Eowyn's Heir said...

(see concern #6 for a full treatment of this exact issue).

Eowyn's Heir said...


(Kids are really only in danger of measles complications if they are Vitamin A deficient or generally weakened by malnutrition or undernutrition. If you read the post, you will see in concern #3 a risk comparison. Even in the past, when measles was endemic (everyone was exposed to it), chances of dying from measles were about 1 in 7000. Right now odds of dying from choking are 1 in 3000. Odds of dying from poisoning are 1 in 110. (in the US). Measles never has been dangerous in healthy kids.