The Turnstone: talking about vaccines #27

Out damned spot (5 minute read)

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If you care about vaccination, and have conversations with people about it, before too long a certain subject is sure to come up: autism. In 1998 a paper was published in the medical journal The Lancet, claiming a link between a vaccine for measles, mumps and rubella (known as the MMR vaccine), and autism. The link between the vaccine and autism has been disproved, and the paper was first retracted and then found to be fraudulent. But beliefs linking vaccines and autism are remarkably persistent.

So, I have put together information and resources about the MMR vaccine, the diseases it prevents, the fraudulent paper and a real tragedy which happened with that same vaccine.

The diseases

Measles is an extremely infectious disease, in fact it’s one of the most infectious diseases known. It used to be a common childhood illness in the days before vaccination. It can cause life-threatening complications such a blindness, pneumonia and brain inflammation (encephalitis). In New Zealand 15 out of every 100 measles cases is hospitalised. In wealthy countries with good health systems, the death rate is around one out of every 5000 cases, but it can be as high as one in 100 in the poorest countries, or even higher in some outbreaks. In 2018 it caused more than 140,000 deaths around the world.

For New Zealand-based information, here is the measles page from the Immunisation Advisory Centre (4 minute read).

Measles | Immunisation Advisory Centre (immune.org.nz)

For international information, here is the measles page from the Vaccine Knowledge Project, which comes from the Oxford Vaccines Group, the group which developed the Oxford/ AstraZeneca vaccine against Covid-19 (4 minute read with three short videos about the devastating effects of complications caused by measles).

Measles | Vaccine Knowledge (ox.ac.uk)

Mumps was another common childhood illness prior to vaccination, although it is more severe in teenagers and adults. Complications can include meningitis, temporary (occasionally permanent) deafness and inflamed testicles or ovaries.

Information from the Immunisation Advisory Centre (3 minute read).

Mumps | Immunisation Advisory Centre (immune.org.nz)

Information from the US Centers for Disease Control (multiple pages, each less than a 1 minute read).

Mumps | Home | CDC

Rubella is a mild disease in most cases, in fact it’s asymptomatic in around 50% of cases, although there are rare complications such as brain inflammation. However, it’s dangerous in pregnant women – frequently resulting in miscarriage or serious harm to the baby. For mothers infected during the first 10 weeks of pregnancy, 9 out of 10 surviving babies will have disabilities such as blindness, deafness, heart defects, stunted growth or learning disabilities.

Information from the Immunisation Advisory Centre (2 minute read).

Rubella | Immunisation Advisory Centre (immune.org.nz)

Information from the World Health Organisation (4 minute read).

Rubella (who.int)

The measles, mumps and rubella vaccine

The vaccines for measles, mumps and rubella are combined in a single vaccine known as MMR. While MMR gives excellent (>90%) protection for measles and rubella after a single dose, it’s less effective for mumps. With two doses, protection for measles and rubella is over 97% and mumps is around 88%.

Information on the MMR vaccine from the US Centers for Disease Control (11 minute read).

Measles, Mumps, and Rubella (MMR) Vaccination | CDC

Information on MMR vaccine safety from the Oxford Vaccines group (10 minute read with 5 short videos).

MMR Vaccine (Measles, Mumps and Rubella Vaccine) | Vaccine Knowledge (ox.ac.uk)

The MMR vaccine is a live virus vaccine, which means it is made from weakened forms of the measles, mumps and rubella virus. This is why the vaccine cannot be given to those whose immune systems are compromised, as there is a chance that the weakened viruses might overwhelm a compromised immune system. However, live virus vaccines are highly effective, and particularly good at dealing with rapidly evolving viruses.

This article, written just a few months before Covid-19 emerged, talks about some of the differences between live virus vaccines and vaccines based on subunits of the target virus (which would include the main vaccines for Covid-19). It gives a very interesting perspective on why live virus vaccines, the oldest type of vaccine, are still important today (5 minute read).

Live attenuated vaccines: should we rethink vaccination strategies? (theconversation.com)

The vaccine controversy

The paper which originally claimed the link between vaccines and autism was published in February 1998, and was based on 12 children with intestine disorders and developmental delay, including autism. Even at first sight, the article is weak. It involves a small number of children, there are no controls (comparisons with unvaccinated children, children without bowel disease or children without developmental delay) and relied on parental recall of the interval between vaccination and when they noticed something wrong with their children, some years after those events occurred.

This article from the Children’s Hospital of Philadelphia summarises some (but by no means all) of the weaknesses in the original study. It also covers another study involving the same author, as well as some of the much larger studies which found no link between the vaccine and autism (8 minute read).

Vaccines and Autism | Children's Hospital of Philadelphia (chop.edu)

In this fascinating article, journalist Brian Deer outlines the story, comparing what was reported in Wakefield’s paper with what parents, doctors and medical records said. The article makes it clear that the original study claiming the vaccine-autism link wasn’t just weak, it was fraudulent (24 minute read).

How the case against the MMR vaccine was fixed | The BMJ

Another MMR story

Good risk communication isn’t just about refuting fraudulent articles such as the one linking vaccines and autism. It means understanding situations where there has been harm from vaccines, and being able to discuss those situations without dismissing them.

In the case of MMR, there is the tragic story from Samoa when, in 2018, two babies died within minutes of receiving the MMR vaccine. The cause was not the vaccine itself, but negligence. The nurses who mixed the vaccine to administer it used a muscle relaxant drug instead of water, which then killed the babies. Both nurses were later jailed (4 minute read).

Samoan nurses jailed over deaths of two babies who were given incorrectly mixed vaccines - ABC News

But Samoa’s tragedy didn’t end there. Vaccination rates had already been poor before the tragic error – in 2017 only 60% of one year olds were vaccinated. After the deaths of the two babies, the government suspended the vaccination programme for 10 months. Then, in September 2019, measles arrived. The resulting outbreak killed more than 80 people, most of them children under four. There are many articles about the outbreak, but I’ve chosen this one because it’s from a Samoan journalist (8 minute read).

'These babies should not have died': How the measles outbreak took hold in Samoa | Samoa | The Guardian

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