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Editorials

Measles: neither gone nor forgotten

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3976 (Published 25 September 2018) Cite this as: BMJ 2018;362:k3976

We DO need a broad look at vaccination policies and programs

WE DO NEED A BROAD LOOK AT VACCINATION POLICIES AND PROGRAMS

I am old enough to have seen children with measles during my medical career. It is a bad disease: before the vaccine one or two of every 1000 measles-afflicted children in the US died; one of every 1000 developed encephalitis, often with resultant brain damage. Universal measles vaccination has been lifesaving, and well worth the risk of reduced transplacental immunity and increased vulnerability in adults….Nevertheless, Bernadette Pajer is absolutely right to criticize the medical community for failing to step back and examine the overall impact of immunization programs on public health.

Years ago, Paul Fine and Peter Smith said this: “The dramatic global decreases in frequency of most of the diseases targeted by EPI vaccines (e.g. measles, polio, pertussis, tetanus and diphtheria) are measures of success of that programme, but mean that any non-specific effects will assume greater relative importance than in the past.” They suggested that, as new vaccines are introduced into all populations, we need “…not only to evaluate the immunologic benefits, but also to evaluate possible longer term beneficial or adverse non-specific effects.” (Fine, Trop Med Int Health 2007;12:1) As immunization schedules have expanded, our ignorance of overall risks and benefits have also expanded.

Some specific points:

1) I doubt that vaccinations are a major cause of our increase in autism, but without properly controlled trials we can neither prove nor exclude causation, contrary to what we hear endlessly from vaccine authorities. A recent survey of US home-schooled children found that neurodevelopmental disorders, including autism, were 3 to 4 times as frequent in vaccinated vs. non-vaccinated children: P<0.001. Partially vaccinated children had intermediate risks. (Mawson, J Transl Sci 2017;3:1) This study is likely to be biased, but it was reasonably well designed and cannot be dismissed out of hand.

2) There are other “mystery diseases” like SIDS and Kawasaki disease that have been associated with vaccinations and dismissed by vaccine authorities, again without properly controlled trials.

3) The latest mystery disease is acute flaccid myelitis/AFM. It afflicts mainly children as they return to school in September. A role has been suggested for vaccinations via “provocation paralysis.” (Cunningham, BMJ rapid response, Jan.30, 2015) So far, public health authorities have not investigated the possibility.

4) Unlike Ms. Pajer, I do not worry about a decline in herd immunity from measles vaccination, but I suggest that this may be occurring with influenza as a result of universal vaccination against influenza during the last 10-15 years. Our influenza seasons seem to be getting worse in the face of increasing vaccination, and there are regular reports of “negative vaccine effectiveness” (i.e. increased risk of illness) against some strains of virus and in some age groups.

5) Ms.Pajer might remember news reports of a 6 year-old boy from Ferndale, Washington who died of an AFM-like illness with encephalitis. He had received several vaccinations, including a flu shot, 14 days before the onset of his fatal illness. (Aleccia, Seattle Times, November 2016)

We do need a broad look at the risks and benefits of our vaccination programs.

ALLAN S. CUNNINGHAM

Competing interests: No competing interests

08 November 2018
Allan S. Cunningham
Retired pediatrician
Cooperstown NY 13326, USA