Measles is more dangerous than we thought, and vaccines are as safe as we thought

As hard as it is to believe, it’s been nearly two years since the infamous Disneyland measles outbreak, which occurred after the holidays in 2014. It was an outbreak whose spread was facilitated by unvaccinated children and that had far-reaching implications. For one thing, in its wake, California passed SB 277, a law eliminating nonmedical exemptions to school vaccine mandates. Opposition to the bill was fierce, and opposition to the law remains fierce, among motley coalition of antivaccine nuts, the vaccine averse, and conservative-leaning anti-government types, with rhetoric routinely invoking Nazis and the Holocaust, as though the law were the first step on the road to the gas chambers and ovens; that is, when it isn’t claiming that vaccines are a plot by white pharmaceutical companies to make African-American boys autistic. Indeed, it was the unholy union of SB 277 and the “CDC whistleblower” conspiracy theory that brought together antivaccine “hero” Andrew Wakefield with Polly Tommey and Del Bigtree to make the antivaccine “documentary” VAXXED: From Cover-Up to Catastrophe, spawning the VAXXED Bus, with Bigtree and Tommey (and sometimes Wakefield) traveling the country to spread the gospel of St. Andy, cast doubt on the safety and efficacy of vaccines, and in general spread antivaccine conspiracy theories to the masses. They were even recently right here in my very city and state. At time, the rhetoric has even gotten violent.

One of the arguments frequently made by antivaccine activists is what I like to call the “appeal to The Brady Bunch” or, sarcastically, “argumentum ad bradi bunchium.” The basic fallacy is simple and named after a 1969 episode of The Brady Bunch in which all the kids caught the measles and enjoyed a week off from school without appearing too sick and the whole thing was played for laughs and a "battle of the sexes" in which the boys want a male doctor and the girls want a female doctor,. Antivaccinationists claim that vaccine-preventable diseases are harmless childhood diseases that really don’t need to be vaccinated against, that they are no big deal, and point to that episode of The Brady Bunch or other old pre-MMR sitcom episodes in which the measles was played for laughs. Indeed, our old friend Dr. Jay Gordon has made just that argument, as has Dr. Bob Sears. Coupled with that, they like to claim that vaccines cause autism, ADHD, and all manner of auto-immune diseases ranging from asthma to much more severe conditions. They even falsely claim that vaccines cause sudden infant death syndrome. As I’ve described many times before, though, vaccines do not cause autism or any of these things, nor is measles a “harmless disease.” Last weekend, we got more evidence supporting both of these contentions. The evidence came in the form of scientific presentations at IDWeek, the annual joint meeting of four professional infectious disease medical societies. Now, I realize that these are currently just abstracts, and, since I didn’t attend IDWeek (not being an infectious disease doctor), I can’t go much beyond what’s in the abstracts and news reports. That’s why I will eagerly look forward to the full publication of these results. In the meantime, I make do with what I can.

First up, there were several news stories like this one by Lena Sun in The Washington Post entitled New data shows a deadly measles complication is more common than thought:

A complication of measles that kills children years after they have been infected is more common than previously thought, according to disturbing data released Friday.

The research, presented at IDWeek, the annual meeting of four professional infectious disease organizations, underscores the critical importance of vaccination for everyone who is eligible. Such widespread vaccination, which results in herd immunity, protects children who can't be immunized. Particularly vulnerable are babies younger than 12 months, who because of their age cannot get the vaccine known as MMR, for measles, mumps and rubella.

The complication is a neurological disorder that can lie dormant for years and then is 100 percent fatal. Researchers don't know what causes the virus to reactivate, and there is no cure once it does. The only way to prevent the disorder is by vaccinating everyone possible against measles.

Those of you who pay attention to these issues will likely immediately recognize that the neurological complication being discussed is subacute sclerosing panencephalitis (SSPE). According to the study:

The first MMR dose is administered at 12 to 15 months of age. Babies younger than that can be infected with measles and later develop this complication, which is called subacute sclerosing panencephalitis, or SSPE.

Scientists once thought the risk of developing SSPE was about 1 in 100,000. Recent research in Germany among children who got measles before they turned 5 identified a rate as low as 1 in 1,700. But the new findings, by researchers at the David Geffen School of Medicine at the University of California in Los Angeles and the California public health agency, found that for babies who get measles before being vaccinated, the rate is 1 in 609.

Until quite recently, it was thought that the risk of SSPE after measles is 1-2 per 10,000 cases. So how did the study authors derive their new, much higher estimate? Well, here’s the abstract, Subacute Sclerosing Panencephalitis: the Devastating Measles Complication is More Common than We Think:

Background: Subacute sclerosing panencephalitis (SSPE) is a fatal complication of measles. Thought to be rare, SSPE incidence decreased with routine measles vaccination, but infants with measles remain at highest risk of this complication. We reviewed SSPE cases in California from 1998-2016 to understand current risk factors for SPPE.

Methods: SSPE cases had a clinically compatible illness and either 1) measles IgG antibody detection in the cerebrospinal fluid; 2) characteristic pattern on electroencephalography; 3) typical histologic findings in brain biopsy; or 4) medical record documentation of SSPE-related complications. Cases were identified though a state death certificate search, reports from the Centers for Disease Control and Prevention, or through investigations for undiagnosed neurologic disease. Measles IgG detection was performed using indirect enzyme immunoassay at the California Department of Public Health (CDPH) or by immunofluorescence assay at clinical laboratories.

Results: Seventeen SSPE cases were identified. Males outnumbered females 2.4:1. Twelve (71%) cases had a clinical history of a febrile rash illness compatible with measles; all 12 had illness prior to 15 months of age and measles vaccination. Eight (67%) children were living in the United States when they had measles. SSPE was diagnosed at a median age of 12 years (range 3-35 years), with a latency period of 9.5 years (range 2.5-34 years). Many cases had long-standing cognitive or motor problems prior to diagnosis. Among measles cases reported to CDPH during 1988-1991, incidence of SSPE was 1:1367 for children less than 5 years, and 1:609 for children less than 12 months at time of measles disease.

Conclusion: SSPE cases in California occurred at much higher rate than previously published among unvaccinated children who were infected with measles in infancy. Protection of infants younger than 12-15 months of age, when measles vaccine is routinely administered, requires avoidance of travel to endemic areas, or early vaccination prior to travel. Clinicians should be aware of the possibility of SSPE in patients with compatible symptoms, even in older patients with no specific history of measles infection. SSPE demonstrates the high human cost of “natural” measles immunity.

I always say, whether it’s about screening asymptomatic patients for disease or almost anything else, the harder you look for something, the more of it you will find, and this study is yet another example. Case ascertainment for a disaease like SSPE can be difficult, and cases likely slip through the cracks or aren’t aggregated in a central database. This is how it can be pointed out in the news story above that there was a German study reporting a risk of SSPE of 1 in 1,1700, and now this study with an even higher risk. Be that as it may, these are frightening data, showing a risk of SSPE considerably higher than previously thought, particularly in children under 12 months of age. Since the first MMR dose is usually not administered before that, these are the patients who rely on herd immunity, which is degraded and rendered ineffective whenever a certain percentage of the population is unvaccinated. Because measles is so contagious, it’s generally thought that vaccination coverage of 90-95% to attain herd immunity for measles.

Remember, SSPE has a long latency period. In this study, it was 9.5 years after measles infection and could be as long as 34 years. That makes measles the horrible gift that can keep on giving, even after the child has grown up. Antivaccinationists like to claim that measles is “harmless,” a childhood disease that we all endured before the vaccine, but we know better, and this study shows why we know better.

There was another surprising finding not reported in the abstract but reported at IDWeek:

An additional suprising finding is that Asians are disproportionately affected by SSPE, Cherry said. He is not sure why but suspects the disorder could behave like some other diseases, such as influenza, which seem to hit Asians harder and cause higher mortality than other ethnic groups.

So let’s recap. Measles is not harmless, and Asians appear to be at higher risk for its deadliest complication, SSPE.

That’s not all, though. Not only is measles not harmless, but, contrary to what you will read on antivaccine websites, we already know that vaccines do not cause autism, thanks to numerous studies. This study is yet another one showing that vaccines are not associated with SIDS or ADHD, either:

Annual infant mortality rates from SIDS were obtained from the National Vital Statistics Reports for 2007–2013. ADHD prevalence at the state-level were obtained from the National Survey of Children's Health for 2003, 2007, and 2011. The analyses were adjusted to control for variation due to sociodemographic factors.

The data showed mean incidence for SIDS was 39.9 per 100,000 live births and 8.9 per 100 children for ADHD. The rates for SIDS declined over time from 55.6 to 38.7 per 100,000 live births (P=0.4), whereas ADHD diagnoses increased from 7.8% to 11.0% (P=0.3). Mean coverage for each of the 5 vaccines significantly differed, from 47.7% to 95.1% (P<0.01).

Dr. Shaw stated, "State-level vaccination coverage was not found to be associated with SIDS or ADHD rates for each of the vaccines evaluated (P>0.22)."

Overall, the study showed that neither SIDS nor ADHD rates were influenced by vaccination coverage.

Science, people. It is your friend. It is also the friend of vaccines. It is not, however the friend of antivaccinationists. Not only that, but, as I’ve described before, the measles vaccine protects against more than the measles, because the price of “natural immunity” is a two to three year period of immunosuppression with an increased risk of death.

As I said before, I’ll look forward to the publication of the full versions of both of these studies, but in the meantime, here’s some more ammunition to counter antivaccine pseudoscience. Don’t say I never gave you anything.

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Orac, I think something went very wrong with the formatting.
In addition, very interesting. And quite surprising that an ethnic group can be disproportionately affected by something.

By Julian Frost (not verified) on 01 Nov 2016 #permalink

During the SB277 hearings testimony came up of a four year old in a hospice in CA dying from SSPE. Learning there weee so many more cases in CA alone from the 1989-1991 outbreak is very concerning. I hope we have none from the Disneyland one.

By Dorit Reiss (not verified) on 01 Nov 2016 #permalink

Could the Asian bias have something to do with babies of pre-MMR age being taken out of the country to visit family in Asia? Also, adoptees from China/Phillipines who had measles before coming to the US would have an increased risk and skew the tables...

By Catherina (not verified) on 01 Nov 2016 #permalink

@ Julian

I think something went very wrong with the formatting.

Worse, it's contagious. It's infecting you, too, and surely me, now.

for babies who get measles before being vaccinated, the rate is 1 in 609.

Holy. Guacamole.
We are not talking about having been 10% off, but about being one or two orders of magnitude wrong. It's for one specific sub-group of infected people, but still...
It's a very serious re-evaluation of the risks of an infectious disease.
(up to 34-year latency cases of SSPE on record? Hitting close to home, I got measles the natural way a few decades ago)

@ Julian Frost

And quite surprising that an ethnic group can be disproportionately affected by something.

Why? It could be a mix of a widely shared genetic marker and local environment's influence. It has happened for other ills.
Asians already have a high tendency* to have genes making alcohol or lactose harder on them to digest. Liver carcinoma are also more common/deadly for them than for Europeans.

* a tendency, but not a monopoly. And I'm not up-to-date on us Westerners' genetics flaws, but I'm pretty sure we share a few.
A tendency to institute democratic regimes and then vote into office a power-mad gasbag, Palpatine-like, maybe?

By Helianthus (not verified) on 01 Nov 2016 #permalink

@Helianthus,
Palpatine isn't the real danger. Although unlikely to gain office, the real danger uncovered are the sheer number of morons who support Trump in spite of dozens of disqualifying traits/actions.

for babies who get measles before being vaccinated, the rate is 1 in 609.

Holy. Guacamole.

That was my reaction too. How could such a huge difference be missed? Were kids less likely to get measles as infants before the introduction of vaccination, or was SSPE frequently misdiagnosed? In any case, prepare for the usual antivax whining about the media using "scare tactics" to get people to vaccinate their kids.

By Sarah Auclair (not verified) on 01 Nov 2016 #permalink

Oops - comment in moderation because autocorrect filled in my full name instead of my 'nym. That should be "Sarah A."

In the SSPE results-section the researchers stated, "Many cases had long-standing cognitive or motor problems prior to diagnosis".

SSPE may demonstrate a high human cost for the disabled.

By Michael J. Dochniak (not verified) on 01 Nov 2016 #permalink

Asians already have a high tendency* to have genes making alcohol or lactose harder on them to digest. Liver carcinoma are also more common/deadly for them than for Europeans.

And then there are those among Mediterranean populations who will die if they have quinine or fava beans - enhanced resistance to malaria, though, goes along with that one.

And sickle cell anemia, IIRC, is more prevalent among the African American community.

@Julian #1

Between jobs I temped for a company that did the typing for large drives for people who were willing to donate bone marrow from several countries.

Different ethnic populations have fairly significant differences in immune system genes (and you can only look at so many of the markers at a time on one plate and we picked the initial screening for the one most likely to type most of the people from that part of the world), so IMO could be one reasonable place to start to look for the mechanism of why only some people get SSPE.

Differences in those genetic markers are correlated with other differences in disease prevalence as well so wouldn't be completely unreasonable.

Sarah A & Michael Dochniak: I would bet that SSPE does indeed tend to go undiagnosed. Michael hit the nail on the head there by pointing out how many cases had longstanding neurological problems -- it's not a disease that suddenly kills you, so it could easily look like something else. It's a degenerative disease, and it can kill gradually. Plus, it's a complication of measles encephalitis, which itself can cause considerable brain damage, so how easily would you discern new damage due to SSPE from the problems the child already has?

Lastly, I'm sure vaccination has impeded the collection of reliable SSPE incidence data -- areas with the medical resources to reliably detect SSPE also have high rates of measles vaccination, so would have few cases to study. Maybe that's not such a bad thing, even if it has led us to severely underestimate the risk of SSPE when measles is contracted in infancy. Heck, there is concern that even measles itself may evade prompt diagnosis simply because a great many practitioners in America have never seen it.

By Calli Arcale (not verified) on 01 Nov 2016 #permalink

I was surprised yesterday that the AoA commentariat had yet to glom onto the explanation that vaccination has caused mammies to have worse antibodies for babby.

Calli Arcale: "Lastly, I’m sure vaccination has impeded the collection of reliable SSPE incidence data — areas with the medical resources to reliably detect SSPE also have high rates of measles vaccination, so would have few cases to study."

Especially since it was not really recognized to even exist until the early 1960s, just about the time measles vaccination was introduced. It is something that did happen to children, it just took that long to figure out what caused it.

Perhaps someday they will figure out what is causing the recent surge of AFM, acute flaccid myelitis:
http://www.cnn.com/2016/10/05/health/afm-polio-like-flaccid-myelitis-pa…

@Sarah A:

"In any case, prepare for the usual antivax whining about the media using “scare tactics” to get people to vaccinate their kids/"

Yeah, you could call it "scare tactics" to point out that vaccine-preventable diseases carry risks for serious morbidity and mortality. It worked on me; I get my kids their shots so they won't suffer unpleasant diseases, but most especially because I don't want them dying of pneumonia or encephalitis or some other ghastly complication.

Then again, the anti-vaxxers can hardly be accused of measured, moderate discourse themselves:

The diagnosis of autism has skyrocketed in the past several decades! It's gone up by several hundred percent! We're in the middle of an epidemic! All children will be autistic by 2030!!

Pot, meet kettle.

By Heidi_storage (not verified) on 01 Nov 2016 #permalink

Now I see that AoA's done some more cipherin':

The vaccine strain measles virus reactivating and causing all these problems. Makes sense because unvaccinated would have conferred natural immunity unlike the vaccine. They destroyed natural herd immunity and now they are cherry picking data to support mass vaccination instead of admitting what is really happening. I didn't even flinch. Not one single word of any main stream media outlet is to be believed under any circumstances, period.

Yup, the vaccine strain is "reactivating" in those too young to have received it.

Not one single word of any main stream media outlet is to be believed under any circumstances, period.

Not one single word of evidence is to be believed under any circumstances by this dimwit apparently if she thinks vaccine strains have anything to do with SSPE. And so much for "no deaths from measles outbreaks in years".

By Science Mom (not verified) on 01 Nov 2016 #permalink

So just to recap: "natural" measles will suppress your immune system for 2-3 years after infection, and if you get it when you're a baby could come back years later to kill you horribly?
And it's airborne and super contagious?

If I read about a disease like that in a sci-fi novel I'd be like "oh come on, that's a bit over the top."

By JustaTech (not verified) on 01 Nov 2016 #permalink

@JustaTech - It's interesting how humans perceive risk, isn't it? If measles only infected 1 out of a thousand children, but killed everyone it infected, we'd be terrified of it. But because it infects nearly 100% of children (without vaccination) and "only" kills 1 out of a thousand, it's no big deal.

That's a horrifying paper. I'm well past the age where this might be a concern (and re-vaxxed for measles last year in any case, because I'm in the cohort that may have gotten a defective measles vax in Canada), and don't have any kids and don't plan on ever having any, but gaaaahhh.

@Helianthus: Asians already have a high tendency* to have genes making alcohol or lactose harder on them to digest.

TIL I am actually Asian. (Lactose intolerant, does not play well with alcohol. Ancestry from western Siberia and NW Europe, as far as I know.)

By Interrobang (not verified) on 01 Nov 2016 #permalink

On the 'Vaccines are a conspiracy against African-Americans' front, Snopes.com is reporting that at least one Fake News outlet has jumped on that bandwagon and ran an article claiming that vaccines cause birth defects in African-Americans only.

Snopes has deconstructed it.

http://www.snopes.com/epidural-vaccine-targets-blacks/

"all 12 had illness prior to 15 months of age and measles vaccination. "

When they use the word "illness", I think they mean "measles" (?)
Are they saying these children caught measles and THEN received a measles vaccine?

Am I missing something, or is that completely pointless?

By Craig Thomas (not verified) on 01 Nov 2016 #permalink

Usually when a child has the actual disease, like measles, they don't get the vaccine. My kids all got chicken pox in 1994, including the six month old baby. When the varicella vaccine came out they did not get it... because... wait for it... they had already had the disease!

By they way, the kids who got measles would be given an MMR vaccine to protect them from mumps and rubella. Which, in case you don't know, are two other different diseases.

They destroyed natural herd immunity

Natural herd immunity... where people are protected from catching a disease by the fact that they have already caught it. The Gazoogle tells me that it is a popular term of art among the antivaxx oxy-morons,
It must be like Natural Bear Protection, which consists of letting the bears eat people.

By herr doktor bimler (not verified) on 01 Nov 2016 #permalink

The vaccine strain measles virus reactivating and causing all these problems. Makes sense because unvaccinated would have conferred natural immunity unlike the vaccine. They destroyed natural herd immunity and now they are cherry picking data to support mass vaccination instead of admitting what is really happening.

Well there it is.
The stupidest thing I'll read all day.
@herr doktor bimler, my preferred way of describing natural herd immunity is that it's like burning something to fireproof it.

By Julian Frost (not verified) on 01 Nov 2016 #permalink

@Julian Frost:
Well, burning things to stop fires actually is a perfectly valid tactic: it's called a firebreak, creating a controlled fire to remove the dead vegetation in one area so the big uncontrolled fire can't cross the region because there is nothing left to burn.

That said, the human immunity equivalent would be something more like a leper colony, a large-scale quarantine where you prevent anybody from leaving the infected area and then wait for the infected people to all die off. I don't think that's exactly where we want to go.

By Jenora Feuer (not verified) on 02 Nov 2016 #permalink

Though, thinking about it again, I suppose vaccination really is more like a firebreak: creating a large pool of people that can't 'burn' anymore to make it harder for the disease to get from one place to another.

By Jenora Feuer (not verified) on 02 Nov 2016 #permalink

"...SSPE cases had a clinically compatible illness...characteristic pattern on electroencephalography;..." Huh?

JT, what about that comment confuses you?

By Julian Frost (not verified) on 03 Nov 2016 #permalink

No part of this comment (excerpt of abstract) confuses me. What confuses me is how there can be so many comments on this study (one way or the other) from an abstract before a full paper, with data that can be scientifically scrutinized, is published. It is well known that this type of retrospective study is fraught with confounding factors and biases. I fully appreciate the pro vs anti vaccination polarization that has occurred, but if questions are to be put to rest, then they must be done so with good science. My point here is, that you or of the commenters here - including myself - have no idea what the science is behind this study because it has not yet been published in full. Never lose the ability to think critically. Its what makes science good.

What makes science good is repeatability, such as the efficacy of vaccinations.

@MarkN That might be true, however the discussion here is about one particular study not about the efficacy of vaccines in general.

Not one single word of any main stream media outlet is to be believed under any circumstances, period.

The AoA commentariat were always going to be Trump supporters.

More seriously, nothing demonstrates the echo chamber behaviour of that group so well as this statement.

By Chris Preston (not verified) on 07 Nov 2016 #permalink

The AoA commentariat were always going to be Trump supporters.

Nah, they've hardly been in lockstep overall. I'm just waiting for how "Linda1" (Disqustink "LZ") is going to hold up after the forced universal vaccinations fail to materialize.

Oh, wait, she didn't believe in ZEBOV and repeatedly invoked Kary Mullis on the fakitude of RT-PCR.

You have claimed : "It was an outbreak whose spread was facilitated by unvaccinated children."
I would like to see your evidence that this is correct. Can vaccinated children shed measles virus, and infect other people ? Can previously vaccinated people who are overdue for their re-vaccination reduce 'herd immunity' by being susceptible to infection ?

@Norman:

Can vaccinated children shed measles virus, and infect other people?

In theory. However, as far as I know, there is no evidence that this has ever happened.

Can previously vaccinated people who are overdue for their re-vaccination reduce ‘herd immunity’ by being susceptible to infection?

Slightly. But the key point is this:
When we look into the vaccine status of those who were infected in outbreaks, we invariably find that a disproportionate number are deliberately unvaccinated or undervaccinated, or too young to be vaccinated. So Orac is correct to say that “It was an outbreak whose spread was facilitated by unvaccinated children.”

By Julian Frost (not verified) on 08 Nov 2016 #permalink

" I’m just waiting for how “Linda1” (Disqustink “LZ”) is going to hold up after the forced universal vaccinations fail to materialize."

That conspiracy theory is inoperative.

On to the new ones!!!

By Dangerous Bacon (not verified) on 08 Nov 2016 #permalink