[icon name=”user” class=”” unprefixed_class=””]  Perry McLimore, MD., JD.

Introduction

In the news recently is the account of a measles outbreak that apparently started in Disneyland, located in California. Currently, there are almost 100 confirmed cases of measles in California, Arizona, Utah, Washington State, Oregon, Colorado, Nebraska, and Mexico. It continues to spread. Four people have required hospitalization. The overwhelming majority of those infected did not receive the measles, mumps, and German measles (MMR) vaccination, or only had one inoculation of the vaccine.

As a result, the anti-vaccination controversy has been stirred up. Twenty states, including California, allow parents to sign a personal belief waiver relieving their children from the requirement of receiving the MMR vaccine to be enrolled in school. In some areas, as many as, 15 percent of students opt out of the MMR vaccine. Currently, the MMR vaccination rate in the U.S. is less than 90 percent, according to the Center for Disease Control (CDC). The CDC states conditions are ripe for a measles outbreak when 8 percent of the population is unvaccinated.

The Measles

Measles is a highly contagious virus that spreads through the air or by direct contact from someone infected. The disease possesses a three to four day incubation period, whereby the person is asymptomatic, but can spread the virus to others. It begins with a fever, cough, runny nose, and pink eye, then a red, pinpoint rash develops on the head and neck quickly spreading to the rest of the body. If the virus spreads to the lungs, pneumonia results frequently requiring hospitalization. In a minority of people the measles virus infects the brain causing encephalitis. This inflammation of the brain is serious, and is associated with seizures, permanent neurologic deficits, and death.

In 1912, measles became a notifiable disease in the U.S. requiring all healthcare providers and laboratories to report cases. During the early part of the 20^th century, an average of 6,000 measles-related deaths occurred annually in the United States.

Ten years prior to 1963, when a vaccine became available, three to four million people contracted the measles each year in this country. Such caused 500 deaths annually from the measles, and resulted in the hospitalization of 48,000 people. About four thousand people yearly developed encephalitis causing severe neurologic symptoms and death.

Vaccine Development

In 1954, the measles virus was isolated from blood samples from people suffering from the disease in Boston. The isolated measles virus was transformed into a vaccine in 1963. By 1968, an improved vaccine was manufactured. This strain of measles vaccine has remained the same since. For convenience, the mumps and German measles vaccines were combined creating the MMR vaccine.

The MMR vaccine became an outstanding success. The CDC set a goal of eliminating measles in the U.S. by 1982. This goal was not accomplished, but by 1981 the number of measles cases was reduced 80 percent compared to 1980. Unfortunately, in 1989 a measles outbreak occurred infecting people who had received the one-time MMR vaccine. Due to this, the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Academy of Family Physicians instituted a second inoculation of the MMR vaccine.

Currently, the first MMR inoculation should occur at 12 to 15 months of age, and a second dose at four to six years old.

Once the two dose schedule was instituted, the number of measles cases fell drastically. Measles was declared eradicated in the U.S. by the CDC in the year 2000.

Worldwide

Measles, however, remains common in other countries. According to the World Health Organization (WHO), about 20 million are infected with measles yearly resulting in 122,000 deaths from the disease annually. This calculates to about 330 people dying from measles each day

The MMR Vaccine Controversy

In February, 1998, Andrew Wakefield and other U.K. researchers published a paper in the British medical journal The Lancet (Wakefield A, 1998). The paper reported the development of autism and colitis in 12 children after receiving the MMR vaccine. A press conference was called which spread the paper’s findings worldwide. Subsequently, a few celebrities publically supporting the paper, citing accounts of their children acquiring autism after receiving the MMR vaccine. Mass hysteria ensued. The anti-vaccination movement was born. The controversy was prorogated when Wakefield published a paper alleging the measles virus had been isolated in tissue samples from children suffering from autism (Wakefield A, 1999).

Also of concern, the MMR vaccine is suspended in the preservative thimerosal, which contains mercury. This element, in toxic doses, causes a neurologic disorder resembling autism. As a result, the U.S. Public Health Service asked vaccine manufacturers to remove the thimerosal. By 2001, all vaccines were thimerosal free

Consequences

Due to the accusation of a MMR vaccine and autism link, vaccination rates fell sharply (Service, 2003). This was followed by significant outbreaks of the measles and mumps. The outbreaks caused a number of deaths and severe injuries (Fitzgerald M, 2004).

Due to the claims of the Wakefield paper, epidemiological studies were undertaken by the Center for Disease Control (Control, 2008), the American Academy of Pediatrics, the Institute of Medicine (Committee, 2004), the U.K. National Health Services, and the Cochrane Library (Demiceli v, 2012). All these , well-designed studies involving millions of children found no link between the MMR vaccine and autism in children.

The Investigation

A reporter, Brian Deer, in 2004, working for The Sunday Times of London began publishing findings from his investigation regarding Andrew Wakefield and the 1998 paper. Turns out Wakefield received 55,000 pounds from legal aid solicitors seeking evidence to sue the vaccine manufacturers. This is an obvious conflict of interest (Deer B, 2006). Further investigation revealed Wakefield had applied for a patent for a vaccine to take the place of the current MMR vaccine. Also, Wakefield was aware results from his own laboratory did not support his claims in the 1998 paper (Deer B, 2009).

In addition, in 2006, further investigation by Deer revealed Wakefield had been paid 435,643 pounds plus expenses by British trial lawyers wanting to prove the MMR vaccine unsafe (Deer B, 2011).

In February, 2009, Brian Deer reported in The Sunday Times that Wakefield had fixed and manipulated data in the 1998 paper to create a link between the MMR vaccine and autism. He falsified data (Deer B, 2011).

General Medical Council

The General Medical Council (GMC) licenses doctors and supervises medical ethics in the U.K. The GMC initiated an investigation into Andrew Wakefield and other researchers. The GMC panel published the results of their findings in January, 2010 (Council, 2010). The panel found Wakefield to be dishonest and irresponsible. The panel accused Wakefield of acting with callous disregard to the children cited in the 1998 paper. They found Wakefield had multiple conflicts of interest, and had falsified data. The GMC stripped Andrew Wakefield of his medical license.

As a result, in February, 2010, The Lancet fully retracted the paper from the published record.

The Washington Post reported that Wakefield predicted he could make 43 millions of dollars yearly from diagnostic kits for the new condition, autistic colitis (Stein R, 2011).

The British Medical Journal’s editor stated in January, 2011:

“The original paper has received so much media attention, with such

potential to damage public health, that it is hard to find a parallel in

the history of medical science. Many other medical frauds have been

exposed but usually more quickly after publication and on less important

health issues.” (Godlee F, 2011)

Conclusion

There has been a rise in autism rates in the 1990s and early 2000s. This increase is secondary to enhanced clinical evaluations of children, not from an actual rise in autistic children. Parents with autistic children want answers. Autism can be devastating to a family. Unfortunately, the time the first inoculation of the MMR vaccine occurs coincides with when symptoms of autism first become evident in a child. When the 1998 paper was published in The Lancet, it received extensive media coverage. The MMR vaccine became the scapegoat for parents with autistic children, and parents with heightened fears of having an autistic child. Now, they had an answer. Don’t immunize my child and he or she will not develop autism.

One good thing emanated from Wakefield’s 1998 paper. It set in motion a and extensive study of causes of childhood autism. Many and prestigious medical societies undertook detailed investigations and analysis of millions of children concerning any possible link autism and vaccinations. Each and every one of these investigations found absolutely no causal relationship between the MMR vaccine and childhood autism.

Examination of Wakefield and the 1998 paper revealed falsified data, poor conclusions, and multiple conflicts of interest. The article was retracted by The Lancet in 2010, and Wakefield’s medical license was revocated by the GMC.

Still, the MMR vaccine-autism myth pervades. Unfortunately, twenty states in the U.S. allow children to be admitted to school without receiving the MMR vaccine. Because of this, outbreaks of the measles and mumps happen placing everyone, particularly the very young and elderly at risk of contracting a potentially fatal disease.

The recent Disneyland outbreak of measles has rekindled the controversy. Hopefully, legislators in all fifty states will make it mandatory for all children to be inoculated with the MMR vaccine before being allowed to enroll in public and private schools.

Many parents will argue such a mandate impinges on their right of privacy. Some will cite religious reasons to not vaccinate their children. However, public health and safety should trump individual concerns. A compelling state interest exists in requiring a child receive the MMR vaccine before entering school. The anti-vaccination movement is based on faulty science and unfounded fears.

Vaccinations represent one of the strongest and effective strategies against many devastating and lethal diseases. No doubt, vaccinations have saved millions of lives and billions of healthcare dollars. Not vaccinating one’s child exposes the public to a preventable risk. Provable scientific fact must override unsubstantiated fear.

References

1. Andrew, W. (1999). MMR vaccine and autism. The Lancet, 949-50.
2. Deer B. (2006). MMR doctor given legal aid thousands. London: The Sunday Times.
3. Deer B. (2009). MMR doctor Andrew Wakefield fixed data on autism. London: The Sunday Times.
4. Deer B. (2011). How the case against the MMR vaccine was fixed. British Medical Journal, 88-94.
5. Deer B. (2011). How the vaccine crisis was meant to make money. British Medical Journal, 455-476.
6. Institute of Medicine Committee, I. o. (2004). Immunization safety review: Vaccines and autism. Washington, DC: National Academy of Science.
7. Center for Disease Control, C. f. (2008). Measles, mumps, and rubella (MMR) vaccine. Atlanta: CDC.
8. General Medical Council. (2010). DR. Andrew Wakefield, Professor John Walker-Smith, Professor Simon Murch. London: General Medical Council.
9. Demiceli v, R. A. (2012). Vaccines for measles, mumps, and rubella in children. Washington DC: Cochrane Library.
10. Godlee F. (2011). Wakefield’s article linking MMR vaccine and autism was fraudulent. British Medical Journal,413-425.
11. Fitzgerald M. (2004). MMR: risk, choice, chance. British Medical Bull, 143-153.
12. Stein R. (2011). Wakefield tried to capitilize on autism link, report says. Washington DC: The Washiington Post.
13. National Health Service (2003). Health professionals2003 childhood immunisation survey report. London: National Health Service.
14. Wakefield A, M. S. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 57-68.