Measles Mumps Rubella - MMR
Differential durability of immune responses to measles and mumps following MMR vaccination.
SYNOPSIS
These data suggest that specific immune outcomes may wane at different rates and highlight our currently incomplete understanding of protective immune responses to mumps and measles.
CITATION
Richard B. Kennedy Inna G. Ovsyannikova, Antonia Thomas, Beth R. Larrabee, Steven Rubin, Gregory A. Poland, Vaccine, Volume 37, Issue 13, 22 March 2019, Pages 1775-1784
SUMMARY
The development and wide-spread use of mumps vaccine resulted in a dramatic and sustained decrease in the incidence of mumps disease; however, since 2000, an increase in the size and number of mumps outbreaks in the United States and other countries has sparked renewed interest in the durability of mumps-specific immunity elicited by mumps vaccination. The most likely explanation for mumps cases in previously immunized persons may be secondary vaccine failure, or waning immunity. Researchers examined changes in markers of measles and mumps immunity at two timepoints, approximately 7 and 17 years after two-dose MMR-II® vaccination, and found that the mumps IgG titers exhibited a large and significant decline during this time period. There was a similar discrepancy with measles-specific immune responses.
Adverse events following immunisation (AEFI) reports from the Zimbabwe expanded programme on immunisation (ZEPI): an analysis of spontaneous reports in Vigibase from 1997 to 2017
SYNOPSIS
More than one in ten vaccine-related adverse events in Zimbabwe are serious (11%), and measles-containing vaccines are one of the vaccines most frequently responsible for serious and systemic reactions.
CITATION
SUMMARY
The authors examined passively collected reports of adverse events following immunization (AEFI) in Zimbabwe from 1997 to 2017. Given widespread underreporting to the country’s still-developing vaccine surveillance system, just 272 Individual Case Safety Reports (ICSRs) were available, of which 11% represented “serious events.” Of these, 6% were deaths and 5% were life-threatening or involved prolonged hospitalization. Measles-containing vaccines had the highest AEFI reporting rate and were also strongly associated with serious events, as was a six-component vaccine containing antigens for oral poliovirus, diphtheria, tetanus, pertussis, Haemophilus influenzae type b and hepatitis B (OPV/DTP-Hib-HepB). The majority of AEFI were systemic (versus vaccine site reactions)—and systemic events, again, were associated with measles-containing vaccines.
Combining Childhood Vaccines at One Visit Is Not Safe
SYNOPSIS
Infants vaccinated with multiple vaccines at once have much higher hospitalizations and death rates than infants who receive fewer simultaneous vaccines
CITATION
Neil Z. Miller. Journal of American Physicians and Surgeons, Summer 2016.
SUMMARY
“Our study showed that infants who receive several vaccines concurrently, as recommended by CDC, are significantly more likely to be hospitalized or die when compared with infants who receive fewer vaccines simultaneously. It also showed that reported adverse effects were more likely to lead to hospitalization or death in younger infants. The safety of CDC’s childhood vaccination schedule was never affirmed in clinical studies. Vaccines are administered to millions of infants every year, yet health authorities have no scientific data from synergistic toxicity studies on all combinations of vaccines that infants are likely to receive. National vaccination campaigns must be supported by scientific evidence.”
Measles virus neutralizing antibody response, cell-mediated immunity, and IgG antibody avidity before and after a third dose of measles-mumps-rubella vaccine in young adults
SYNOPSIS
When young adults fully vaccinated in childhood with two doses of measles-mumps-rubella (MMR) vaccine are given a third dose, measles antibody levels revert to near-baseline levels within a year.
Citation
Fiebelkorn AP, Coleman LA, Belongia EA, et al. Measles virus neutralizing antibody response, cell-mediated immunity, and IgG antibody avidity before and after a third dose of measles-mumps-rubella vaccine in young adults. Journal of Infectious Diseases;2016;213(7):1115-23.
Summary
When fully vaccinated young adults who received two doses of measles-mumps-rubella (MMR) vaccine in childhood are given a third dose (MMR3), measles antibody levels revert to near-baseline levels within a year. In this study—after just one month—MMR3 failed to produce any “substantial improvements in the quality of the immune response” for 96.8% of subjects. Individuals who had low or negative vaccine-induced antibodies at baseline were more likely to remain low or negative both one month and one year after the MMR booster, suggesting that “inherent biology” influences whether individuals respond to measles vaccination. Those who received their first MMR dose before 15 months of age also had significantly lower antibody levels later in life. The CDC and FDA researchers conclude that “MMR3 is unlikely to solve the problem of waning immunity in the U.S.”
Measles Virus Neutralizing Antibody Response, Cell-Mediated Immunity, and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles, Mumps, and Rubella Vaccine in Young Adults
SYNOPSIS
Researchers did not find compelling data to support a routine third dose of MMR vaccine.
CITATION
Amy Parker Fiebelkorn, Laura A. Coleman, Edward A. Belongia, Sandra K. Freeman, Daphne York, Daoling Bi, Ashwin Kulkarni, Susette Audet, Sara Mercader, Marcia McGrew, Carole J. Hickman, William J. Bellini, Rupak Shivakoti, Diane E. Griffin, Judith Beeler, Measles Virus Neutralizing Antibody Response, Cell-Mediated Immunity, and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles, Mumps, and Rubella Vaccine in Young Adults, The Journal of Infectious Diseases, Volume 213, Issue 7, 1 April 2016, Pages 1115–1123,
SUMMARY
Two doses of measles, mumps, and rubella (MMR) vaccine are 97% effective against measles, but waning antibody immunity to measles and failure of the 2-dose vaccine occur. A third MMR dose (MMR3) was given to young adults to see if it would make a difference in waning immunity. Immunogenicity was assessed over 1 year. Most subjects were seropositive before MMR3 receipt, and very few had a secondary immune response after MMR3 receipt. Similarly, cell-mediated immunity (CMI), and immunoglobulin G (IgG) antibody avidity analyses showed minimal qualitative improvements in immune response after MMR3 receipt. We did not find compelling data to support a routine third dose of MMR vaccine.
Interindividual variations in the efficacy and toxicity of vaccines
SYNOPSIS
Researchers warn of sizable difference in individual reaction to vaccines, stress need to avoid increasing side effects of vaccines.
CITATION
Chandan Thomasa, Majid Moridanib. Toxicology 278, 2010 204-210.
SUMMARY
“A number of currently available vaccines have shown significant differences in the magnitude of immune responses and toxicity in individuals undergoing vaccination. A number of factors may be involved in the variations in immune responses, which include age, gender, race, amount and quality of the antigen, the dose administered and to some extent the route of administration, and genetics of immune system. Hence, it becomes imperative that researchers have tools such as genomics and proteomics at their disposal to predict which set of population is more likely to be non-responsive or develop toxicity to vaccines.. With the increasing number of side effects associated with a number of vaccines reported over the years, it has become imperative to develop new technologies that can effectively assist in the development and evaluation of vaccines for efficacy and toxicity.”
Post-vaccination encephalomyelitis: Literature review and illustrative case
SYNOPSIS
Australian scientists describe the role of vaccines in triggering acute disseminated encephalomyelitis (“ADEM”).
CITATION
William Huynh, Dennis J. Cordato, Elias Kehdi, Lynette T. Masters, Chris Dedousis. Journal of Clinical Neuroscience, 15 (2008) 1315–1322.
SUMMARY
“Post-infectious and post-immunization encephalomyelitis make up about three-quarters of cases, where the timing of a febrile event is associated with the onset of neurological disease. Post-vaccination Acute disseminated encephalomyelitis has been associated with several vaccines such as rabies, diphtheria-tetanus-polio, smallpox, measles, mumps, rubella, Japanese B encephalitis, pertussis, influenza, hepatitis B, and the Hog vaccine. We review ADEM with particular emphasis on vaccination as the precipitating factor.”
Abnormal measles-mumps-rubella antibodies and CNS autoimmunity in children with autism
SYNOPSIS
Utah state scientists find autoimmune reaction to MMR in children with autism, including autoimmunity to myelin basic protein, a brain building-block.
CITATION
Singh VK, Lin SX, Newell E, Nelson C. Journal of Biomedical Science. 2002;9:359–364.
SUMMARY
“[A]s described herein, autistic children showed a serological correlation between MMR and brain autoimmunity, i.e., over 90% of MMR antibody-positive autistic sera also had autoantibodies to brain MBP. This is quite an intriguing observation in favor of a connection between atypical measles infection and autism; an atypical infection usually refers to infection that occurs in the absence of a rash. An atypical measles infection in the absence of a rash and unusual neurological symptoms was recently described to suggest the existence of a variant MV in children and adults. In light of these new findings, we suggest that a considerable proportion of autistic cases may result from an atypical measles infection that does not produce a rash but causes neurological symptoms in some children. The source of this virus could be a variant MV or it could be the MMR vaccine.”
Routine vaccinations and child survival: follow up study in Guinea Bissau, West Africa.
SYNOPSIS
One dose of diphtheria, tetanus, and pertussis vaccine was associated with a mortality ratio of 1.84 (1.10 to 3.10) and two to three doses with a ratio of 1.38 (0.73 to 2.61) compared with children who had received no dose of these vaccines.”
CITATION
Kristensen I, Aaby P, Jensen H. British Medical Journal. 2000 Dec 9;321(7274):1435-8.
SUMMARY
Research on vaccines in developing countries recommended by the World Health Organization has emphasised serological responses and protection against specific diseases. The aim of the research has been to optimise vaccine schedules for control, elimination, or eradication of disease. In modelling exercises, vaccination against diphtheria, pertussis, tetanus, and polio has been assumed to save 1.52.0% of the children in areas with high infant mortality. However, these assumptions are not supported by data. Mortality was lower in the group vaccinated with any vaccine compared with those not vaccinated, however, recipients of one dose of diphtheria, tetanus, and pertussis or polio vaccines had higher mortality than children who had received none of these vaccines.
Detection and sequencing of measles virus from peripheral mononuclear cells from patients with inflammatory bowel disease and autism
SYNOPSIS
Japanese scientists find vaccine-strain of measles in the guts of children with autism.
CITATION
Kawashima H, Mori T, Kashiwagi Y, Takekuma K, Hoshika A, Wakefield A. Digestive Diseases and Sciences. 2000;45:723–729.
SUMMARY
“Additionally, a new syndrome has been reported in children with autism who exhibited developmental regression and gastrointestinal symptoms (autistic enterocolitis), in some cases soon after MMR vaccine. The sequences obtained from the patients with ulcerative colitis and children with autism were consistent with being vaccine strains. The results were concordant with the exposure history of the patients. Persistence of measles virus was confirmed in PBMC in some patients with chronic intestinal inflammation.”
Detection of Measles Virus RNA in Urine Specimens from Vaccine Recipients
SYNOPSIS
CDC scientists find children given the MMR vaccine shed the measles virus for at least 2 weeks after getting the vaccine, making them vectors to spread measles.
CITATION
Paul A. Rota, Ali S. Khan, Edison Durigon, Thomas Yuron, and William Bellini. Journal of Clinical Microbiology, Vol. 33, No. 9, Sept. 1995, p. 2485–2488.
SUMMARY
“For the study, daily urine samples were obtained from either 15- month-old children or young adults following measles immunization. Overall, measles virus RNA was detected in 10 of 12 children during the 2-week sampling period. In some cases, measles virus RNA was detected as early as 1 day or as late as 14 days after vaccination. Measles virus RNA was also detected in the urine samples from all four of the young adults between 1 and 13 days after vaccination. This assay will enable continued studies of the shedding and transmission of measles virus and, it is hoped, will provide a rapid means to identify measles infection, especially in mild or asymptomatic cases.”
The future of measles in highly immunized populations. A modeling approach.
SYNOPSIS
A computer model was created to study the effect of the measles elimination program in the United States on the number of susceptibles in the population. The simulation reveals that in the prevaccine era, approximately 10.6% of the population was susceptible to measles, most of whom were children less than 10 years of age.
CITATION
Levy DL. American Journal of Epidemiology. 1984 Jul;120(1):39-48.
SUMMARY
Little is known about how an intensive measles elimination program changes the overall immune status of the population. A computer model was created to study the effect of the measles elimination program in the United States on the number of susceptibles in the population. The simulation reveals that in the prevaccine era, approximately 10.6% of the population was susceptible to measles, most of whom were children less than 10 years of age. With the institution of the measles immunization program, the proportion of susceptibles in the population fell to 3.1% from 1978 through 1981, but then began to rise by approximately 0.1% per year to reach about 10.9% in the year 2050. The susceptibles at this time were distributed evenly throughout all age groups. The model did not consider the potential effect of waning immunity. The results of this study suggest that measles elimination in the United States has been achieved by an effective immunization program aimed at young susceptibles combined with a highly, naturally immunized adult population. However, despite short-term success in eliminating the disease, long-range projections demonstrate that the proportion of susceptibles in the year 2050 may be greater than in the prevaccine era. Present vaccine technology and public health policy must be altered to deal with this eventuality.