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US county bars unvaccinated children from public spaces amid measles emergency

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1481 (Published 28 March 2019) Cite this as: BMJ 2019;364:l1481

Linked opinion

Measles in America—what’s playing out in New York State is nightmarish

Re: US county bars unvaccinated children from public spaces amid measles emergency

Response 2 to Allan S. Cunningham

NOTE. SUBMITTED EARLIER. DIDN’T CHECK IF IT WENT THROUGH. RESPONDS TO FIRST PARAGRAPH OF CUNNINGHAM (2019) & (2017)

Cunningham writes: “Has Dr. Harrison read Paul Fine and Peter Smith’s editorial about “Non-specific vaccine effects”? (Tropical Medicine and International Health 2007;12:1).”

First, the vaccines mandated for children in US are for diseases almost all children experienced prior to advent of vaccines, not the killed or attenuated; but full strength. We now know that measles, for instance, suppressed the immune system for months, possibly longer, so kids that developed disabilities, even died, after measles could quite well have been its victims. The Fine editorial discusses the controversial finding of excess mortality in children who received a high titre measles vaccine in Africa. For sake of argument let’s accept the finding. Tragic; but measles vaccine is one that Cunningham definitely supports. In the history of medicine, many early interventions failed and even sometimes caused more harm than good, but we didn’t give up on them; but learned from them. Dredging up early vaccine failures seems more an attempt to caste a shadow on vaccines in general. And Aaby’s article starts with “Recent randomised trials have shown that live vaccines such as measles and BCG enhance general resistance, preventing other infections as well as the target infection.” So, his article discusses that randomized trials have look at and continue to look at non-specific effects.

Other findings include early vaccinations reducing risk of childhood leukemia and rotavirus vaccine reducing risk of Type 1 diabetes. The most plausible explanation for Type 1 diabetes is molecular mimicry. Some people have a genetic inheritance where the insulin producing cells have membranes with short sections (antigens) that are similar to the membranes of the rotavirus. So, once our immune system reacts to the rotavirus, they proceed to attack our insulin producing cells, a case of mistaken identity. I admit, as opposed to antivaccinationists, these findings are preliminary; but compelling.

And another article with Aaby as a co-author states: “For example, Bacille Calmette-Guerin (BCG), smallpox, measles, oral polio and yellow fever vaccines may reduce disease and/or mortality from infections other than tuberculosis, smallpox, measles, polio, yellow fever, respectively, and some vaccines have even shown promise when repurposed against certain cancers and/or autoimmune disorders. These heterologous or non-specific effects (NSEs) of vaccines, occasionally also termed ‘’off-target effects”, suggest that some vaccines can provide greater protection than their pathogen-specific intended purpose.”

There is some controversy about the timing of the DTP vaccines in Third World nations and ongoing research is looking at it. However, there is one virus, Dengue, that involves what has been termed “antibody dependent enhancement.” Basically, if first exposed to one of the five serotypes, this alters some proteins in our bodies such that they facilitate entrance of other serotypes, resulting in a deadly condition, dengue hemorrhagic fever. Thus, until a vaccine can be developed that protects against all five serotypes, any vaccine for fewer serotypes actually puts people at grave risk. Cunningham extends it to flu vaccines as well. It would take a separate paper to address his claims regarding the flu vaccine. Yep, there exists some studies that find an increased risk for some; but far more studies contradict these and despite Cunningham’s claim that the dangers of the flu are exaggerated, they are actually worse. If someone dies, for instance, of pneumonia or heart disease, hospitals don’t always conduct serology to determine if they recently suffered from flu. Flu damages lung epithelial cells allowing for opportunistic bacterial pneumonias and the stress of flu can further damage an already weakened heart. And, despite Cunningham’s claims as to effectiveness of the flu vaccine, I would get it if only 10% effective because, though this means that 90% who get the vaccine will still get the flu, it also means a reduced level of severity, reduced risk for hospitalization and death. Since the overall research, despite a few studies, support flu vaccines, I get mine every year and recommend it to friends.

Though Cunningham seems to be unaware, research on both Non-Specific Vaccine Effects/Heterogenous Vaccine Effects and Antibody-Dependent Enhancement have been and continue to be carried out, going back decades before the 21st Century (CDC, PubMed [Note not all PubMed articles found are relevant; but most are.]

Finally, Cunningham writes: “A case can be made for mandating diphtheria, pertussis, polio and measles vaccines for US children. These vaccines should be free, and we should be willing to delay initiating vaccination until 4-6 months of age. Other vaccines should be voluntary until their long-term safety and cost-effectiveness have been established by high quality and unbiased research.”

So, he wouldn’t recommend HiB Type B, despite: “Before Hib vaccination, about 20,000 children younger than five developed severe Hib disease in the United States each year, and about 1,000 died” and many suffered lifetime disabilities. Or rotavirus, despite: “Prior to vaccine introduction, almost all U.S. children were infected with rotavirus before their 5th birthday. Each year, among U.S. children younger than 5 years of age, rotavirus led to more than 400,000 doctor visits, more than 200,000 emergency room visits, 55,000 to 70,000 hospitalizations, and 20 to 60 deaths.”

And I’ve refuted over and over his claim of a lack of long-term safety unbiased research and the timing of vaccinations. He is cherry-picking studies that confirm his bias, ignoring that even if well-done, the risk of uncontrolled variables influencing results exist, which is why I look at as many studies as I can find on a continuous basis over the past 40 years, which he interprets as a lack of humility on my part. So, is Cunningham an antivaccinationist? He does support some vaccines; albeit his RRs question overall vaccine safety and efficacy studies as biased, etc, together with his BIASED cherry-picking, I’ll leave it up to the reader to decide.

References:

CDC (accessed 2019 May 10). Search: Antibody Dependent Enhancement. Available at: https://search.cdc.gov/search/?query=antibody+dependent+enhancement&site...✓&affiliate=cdc-main

CDC (2018 Feb 13). Haemophilus influenzae Disease (Including Hib). COMPLICATIONS. Available at: https://www.cdc.gov/hi-disease/about/diagnosis-treatment.html

CDC (accessed 2019 May 10). Search: Non-Specific Vaccine Effects. Available at: https://search.cdc.gov/search/?query=Non-Specific+Vaccine+Effects&siteli...✓&affiliate=cdc-main

CDC (2018 Apr 23). Rotavirus in the U.S. BURDEN. Available at: https://www.cdc.gov/rotavirus/surveillance.html

College of Physicians of Philadelphia (2018 Jan). Haemophilus influenzae type b (Hib). Available at: https://www.historyofvaccines.org/content/articles/haemophilus-influenza...

Cunningham AS (2017 Sep 22). Vaccine authorities don't want to know about adverse effects. II. BMJ Rapid Responses. Available at: https://www.bmj.com/content/358/bmj.j4100/rr-6

Cunningham AS (2017 Dec 21). Dengue vaccine and influenza vaccine are both subject to increased illness risk via "antibody-dependent enhancement”. BMJ Rapid Responses. Available at: https://www.bmj.com/content/359/bmj.j5759/rr

Cunningham AS (2019 Mar 28). Unlimited tolerance of vaccines? Available at: https://www.bmj.com/content/364/bmj.l1481/rr-21

Morra ME, Kien ND, Elmaraezy A et al. (2017 Nov 22). Early vaccination protects against childhood leukemia: A systematic review and meta-analysis. Scientific Reports; 7: 15986. Available at: https://www.nature.com/articles/s41598-017-16067-0

PubMed (accessed 2019 May 10). Search: Antibody Dependent Enhancement [Found 2581 going back to 1962] Available at: https://www.ncbi.nlm.nih.gov/pubmed/?term=antibody+dependent+enhancement

PubMed (accessed 2019 May 10). Search: Non-Specific Vaccine Effects. [Found 514 going back to 1975] Available at: https://www.ncbi.nlm.nih.gov/pubmed/?term=non-specific+vaccine+effects

Perrett KP, Jachno K, Nolan T, Harrison LC (2019 Jan 22). Association of Rotavirus Vaccination With the Incidence of Type 1 Diabetes in Children. JAMA Pediatrics;173(3):280-282.

Rojas M, Restrepo-Jiménez P, Monsalve DM et al. (2018). Molecular mimicry and autoimmunity. Journal Of Autoimmunity; 95: 100-123. Available at: https://reader.elsevier.com/reader/sd/pii/S0896841118305365?token=BCCBFA...

Saadatian-Elahi M, Aaby P, Shann F et al. (2016). Heterologous vaccine effects. Vaccine; 34: 3923-3930. Available at: https://www.fondation-merieux.org/wp-content/uploads/2017/02/off-target-...

Taylor A, Foo SS, Bruzon R et al. (2015 Nov). Fc receptors in antibody-dependent enhancement of viral infections. Immunologic Reviews; 268: 304-364.

Wikipedia. Antibody-dependent enhancement. Available at: https://en.wikipedia.org/wiki/Antibody-dependent_enhancement

Wikipedia. Molecular Mimicry. Available at: https://en.wikipedia.org/wiki/Molecular_mimicry

Wikipedia. Non-specific effect of vaccines. Available at: https://en.wikipedia.org/wiki/Non-specific_effect_of_vaccines

Competing interests: No competing interests

16 May 2019
Joel A Harrison
Long-Retired Epidemiologist
None
I have NEVER worked for the FDA, NIH, CDC, any pharmaceutical company, nor ever purchased pharmaceutical stocks