Saturday, March 2, 2019

Measles: two US outbreaks are blamed on low vaccination rates. Another perspective

My 2019 published letter to the BMJ (formerly British Medical Journal): 

BMJ 2019;364:l312

Please allow me to make a few corrections and add context to Ms. Tanne's article. Endemic measles has been eradicated from the US and the whole of the western hemisphere, per the WHO.(1) It does not continually recirculate. But cases are brought into the US, or rarely occur as a clinical response to measles vaccination, (2) multiple times each year. (3) The US averages about 250 reported cases annually.
There have been only 3 deaths from measles in the US since 2000: one in a 75 year old male who was exposed in Israel; one in a 13 year old immunosuppressed male who had received a bone marrow transplant 3 months premortem, who lacked any identified exposure to a measles case; and one in an immunosuppressed woman with multiple comorbidities. Whether any of these deaths was caused by a vaccine strain is unknown, but since vaccine strain measles can be virulent in an immunocompromised host, it is possible. (2)
There are approximately 2500 mumps cases yearly in the US, but no recent mumps-related deaths.(4) There are approximately 10 rubella cases yearly in the US, but since 2012, all rubella cases were infected outside the US. (5)
Thus, there is no evidence that in recent years unvaccinated US children have caused a single death from measles, mumps and rubella. Yet how many column inches, how many hours of TV news have been devoted to scaring the American public about the dire threat of measles? Fear of measles has been the major driver of the campaigns to eliminate vaccine exemptions.  Parents of immunocompromised children have been incited to frenzy about the risks posed to their children by unvaccinated classmates. Yet, when you look closely, the risk is marginal to none.
Even when all eligible children are vaccinated, there will remain those who cannot be vaccinated with live vaccines, and those who fail to achieve immunity from their immunizations. Even after 2 doses, the mumps vaccine is only 86% efficacious. (6) Measles vaccine is 85-95% efficacious after one dose, (7) and 90-98% after two.(8) In US and Canadian measles outbreaks, up to 50% of those developing measles have received two doses of MMR. (8) Thus, there will continue to be disease outbreaks, with or without ending the practice of vaccine exemptions.
During the past 30 years, approximately 89,000 adverse reactions, including about 450 deaths, have been reported to the US Vaccine Adverse Event Reporting System for measles vaccines.
Ms Tanne seems to be singing with a Pharma-led chorus this week, orchestrated with the WHO, BMJ, NY Times and other media outlets. Simultaneously, similar bills have been introduced this month in US state legislatures to end all vaccine exemptions.
But consider: if vaccine exemptions are withheld from children whose families perceive them to be at high risk of an adverse reaction from the MMR, we are likely to experience an inversion in public health: fewer overall viral infections, but more vaccine reactions (and child deaths) then we have now. Public health won't prevail, but Pharma profits will.

Competing interests: No competing interests

22 January 2019
MERYL NASS
Internist, Private Practice
Ellsworth, Maine, USA

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