Intended for healthcare professionals


Measles epidemic exposes inadequate vaccination coverage in Pakistan

BMJ 2013; 346 doi: (Published 14 January 2013) Cite this as: BMJ 2013;346:f245

Re: Measles epidemic exposes inadequate vaccination coverage in Pakistan

Dr Tayyiba Noreen touches on an important issue when writing “cases are reported even with so called successful vaccination programs”; “successful vaccination” obviously doesn’t mean that the vaccinated become immune to measles.

Right from the beginning of measles vaccination in the early sixties, reports of measles occurring in the vaccinated started filling pages in medical journals.

Barratta et al. (1970. Measles (rubeola) in previously vaccinated children. Pediatrics; 46 (3): 397-402) investigated an outbreak in Florida, lasting from December 1968 to February 1969, and found no difference in measles incidence between vaccinated and unvaccinated children.

Conrad et al. (1971) published an article in Am J Public Health (61(11): 2304-2310) about the dynamics of measles in the US in the last four years and conceded that measles was on the increase and that “eradication, if possible, now seems far in the future”.

Linneman et al. (1973. J Pediatrics; 82: 798-801) demonstrated that measles vaccines were not provoking a proper immunological response in re-vaccinated children.

Robertson et al. (1992. Public Health Reports; 197(1): 24-31) wrote that in 1985 and 1986, 152 measles outbreaks in US school-age children occurred among persons who had previously received measles vaccine; every 2-3 years, there was still an upsurge of measles irrespective of vaccination compliance.

Despite this obvious lack of success with measles vaccination, in October 1978, the Secretary of the Department of Health, Education and Welfare announced “We are launching an effort that seeks to free the United States from measles by 1 October 1982.”

This unrealistic plan failed: starting in 1982, the US was hit repeatedly by major and sustained epidemics of measles including in fully vaccinated populations. First, this was blamed on the “ineffective, formalin-inactivated (“killed”) measles vaccine”, administered to hundreds of thousands of children from 1963 to 1967.

However, outbreaks and epidemics of measles continued occurring even when this first vaccine was replaced with two doses of “live” measles virus vaccinated, and the age of vaccine administration was changed.

Black et al. (1984. Bull WHO; 62 (92): 315-319) wrote that antibody titres in re-immunised children may fall after several months to very low levels and such children may still experience clinically recognisable measles, although in a much milder form. They concluded that such children are immunologically sensitised but not immune.

They failed to realise that there is no benefit in developing much milder form of measles, as demonstrated by Ronne (1985) in his Lancet (5 January: 1-5) article on “Measles virus infection without rash in childhood is related to disease in adult life”.

To this day, measles outbreaks occur in fully-vaccinated populations in the countries with high vaccination rates (90,000 cases in Sub-Saharan Africa, increasing incidence in China, 6,500 cases reported across Europe, quadrupled incidence of measles in the US in 2011.

A new and especially serious form of measles occurred: atypical measles (AMS), well-described by Nicholson (1979).

He wrote that during measles epidemic in 1974-1975 in Northern California, a number of physicians reported laboratory-confirmed measles in patients who had signs and symptoms compatible with AMS. “In typical measles a maculopapular rash occurs first at the hairline, progressing caudally, is concentrated on the face and trunk, and is often accompanied by Koplik’s spots. In AMS the rash is morphologically a mixture of maculopapular, petechial, vesicular, and urticarial components. It usually begins and is concentrated primarily on the extremities, progresses cephalad, and is not accompanied by Koplik’s spots”.

The largely unvaccinated Amish (claiming religious exemption) did not report a single case of measles between 1970 and December 1987, for 18 years (Sutter et al. 1991. J Infect Dis; 163: 12-16). Similar situation might have applied to the non-Amish communities without any vaccination and measles vaccination actually may have kept measles alive and kicking. [Hedrich 1933. Am J Hygiene: 613-635) described the dynamics of measles epidemics, from 2-3 years to up to 18 years.]

As forewarned by many, including Black et al (1984), “hemaglutinin-inhibiting and neutralizing antibody titers are lower in women young enough to have been immunized by vaccination than in older women” who experienced natural measles. The inevitable result is weakened transplacentally-transmitted immunity (TTI).

This applies to other vaccine-targeted natural infectious diseases, especially the much publicised pertussis: the TTI-unprotected newborns are now getting pertussis.

Well-managed infectious diseases of childhood, i.e. not mismanaged by such measures as the administration of antibiotics and antipyretics, prime and mature the immune system of children and represent developmental milestones.

Having measles not only results in a life-long specific immunity to measles, but also a life-long non-specific immunity to degenerative diseases of bone and cartilage, sebaceous skin diseases, immunoreactive diseases, and certain tumours (Ronne 1985; Lancet; 5 January: 1-5) even in developing countries.

Shaheen et al. (1996. Lancet; 347: 1792-1796) demonstrated lower atopy rates in unvaccinated Guinea-Bissau children, who developed natural measles, compared with those who were vaccinated and did not develop measles.

Alm et al. (1999. Lancet; 353: 1485-1488) demonstrated low incidence of atopy in children of families with an anthroposophical lifestyle (with very low vaccination rates but having had measles), attending the Steiner schools in Sweden, compared with control schools.

Having mumps protects against ovarian cancer (West 1966. Epidemiologic studies of maligancies of the ovaries. Cancer: 1001-1007).

Medicine should adopt a truly scientific and common sense attitude to natural infectious diseases and recognise their vital role in creating healthy immune system, as called for by some 180 Swiss medical doctors (Albonico et al. 1990. Vaccination campaign against measles, mumps, and rubella. A constraining project for a dubious future? Self-published), who inter alia pointed out the role of measles in healing nephrotic syndrome.

Carmon Mota (1973. BMJ; 19 May: 423) described a remission of infantile Hodgkins’disease after natural measles. The large cervical mass vanished without further therapy.

With good nutrition, and good nursing, unvaccinated children are able to overcome measles and other natural childhood infectious diseases, with long-term benefit. Vaccines, in contrast, are not just unprotective, but their immune-sensitising effect changes a normally beneficial disease into a dangerous atypical form. It is time to heed what has been documented repeatedly for decades.

Competing interests: No competing interests

20 January 2013
Dr Viera Scheibner (PhD)
scientist/author retired
Blackheath, Australia