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Should measles vaccination be compulsory?

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2359 (Published 05 June 2019) Cite this as: BMJ 2019;365:l2359

Measles vaccination has substituted one problem for another

Supplementary to my earlier letter [1] it strikes me that public criticism of vaccine products may come a poor third in the spread of measles in comparison with failure of outreach and failure of the vaccine technology itself. In addition to the 1996 paper by Markowitz which I cited [2] I note a number of papers pointing to failure of immunity as a result of the programme [3-11].

Even with 100% coverage and three doses it seems unlikely that synthetic herd immunity is set to do anything but decline: meanwhile censuring and criminalising critics and dissenters is only distracting in a politically unpleasant way from the problem. I am personally grateful to the editor for her recent call for "civil discourse, and debate" [12]

[1] John Stone, 'Advocates of compulsory vaccination also need to acknowledge risks', 6 June 2019, https://www.bmj.com/content/365/bmj.l2359/rr-0

[2] Markowitz LE, Albrecht P, Rhodes P, Demonteverde R, Swint E, Maes EF, Powell C, Patriarca PA., 'Changing levels of measles antibody titers in women and children in the United States: impact on response to vaccination. Kaiser Permanente Measles Vaccine Trial Team.', Pediatrics. 1996 Jan;97(1):53-8., https://www.ncbi.nlm.nih.gov/pubmed/8545224

[3] Kontio M, Jokinen S, Paunio M, Peltola H, Davidkin I, 'Waning antibody levels and avidity: implications for MMR vaccine-induced protection', Infect Dis. 2012 Nov 15;206(10):1542-8. doi: 10.1093/infdis/jis568. Epub 2012 Sep 10.

[4] Sandra Waaijenborg, Susan J. M. Hahné, Liesbeth Mollema, Gaby P. Smits, Guy A. M. Berbers, Fiona R. M. van der Klis, Hester E. de Melker, and Jacco Wallinga, 'Waning of Maternal Antibodies Against Measles, Mumps, Rubella, and Varicella in Communities With Contrasting Vaccination Coverage', J Infect Dis. 2013 Jul 1; 208(1): 10–16.

[5] Zhao et al, 'Low titers of measles antibody in mothers whose infants suffered from measles before eligible age for measles vaccination' Virol J. 2010; 7: 87., Published online 2010 May 6. doi: 10.1186/1743-422X-7-87

[6] Kang et al, 'An increasing, potentially measles-susceptible population over time after vaccination in Korea', Vaccine
Volume 35, Issue 33, 24 July 2017, Pages 4126-4132, https://www.sciencedirect.com/science/article/pii/S0264410X17308551

[7] Fiebelkorn 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', J Infect Dis. 2016 Apr 1; 213(7): 1115–1123.
Published online 2015 Nov 23. doi: 10.1093/infdis/jiv555

[8] Paunio et al, 'Secondary measles vaccine failures identified by measurement of IgG avidity: high occurrence among teenagers vaccinated at a young age', Epidemiol Infect. 2000 Apr;124(2):263-71.,https://www.bmj.com/content/365/bmj.l2359/rr-0

[9] Rosen JB, Rota JS, Hickman CJ, Sowers SB, Mercader S, Rota PA, Bellini WJ, Huang AJ, Doll MK, Zucker JR, Zimmerman CM., 'Outbreak of measles among persons with prior evidence of immunity, New York City, 2011', Clin Infect Dis. 2014 May;58(9):1205-10. doi: 10.1093/cid/ciu105. Epub 2014 Feb 27

[10] Felicia Roy, Lillian Mendoza, Joanne Hiebert, Rebecca J. McNall, Bettina Bankamp, Sarah Connolly, Amy Lüdde, Nicole Friedrich, Annette Mankertz, Paul A. Rota, Alberto Severini , 'Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR'
https://jcm.asm.org/content/55/3/735 "Of the 194 measles virus sequences obtained in the United States in 2015, 73 were identified as vaccine sequences (RJ McNall, unpublished data)".

[11] Rosen JB, Rota JS, Hickman CJ, Sowers SB, Mercader S, Rota PA, Bellini WJ, Huang AJ, Doll MK, Zucker JR, Zimmerman CM., 'Outbreak of measles among persons with prior evidence of immunity, New York City, 2011', Clin Infect Dis. 2014 May;58(9):1205-10. doi: 10.1093/cid/ciu105. Epub 2014 Feb 27

[12] Fiona Godlee, 'What should we do about vaccine hesitancy?',
BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l4044 (Published 06 June 2019)

Competing interests: No competing interests

20 June 2019
John Stone
UK Editor
AgeofAutism.com
London N22