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Risk-Benefit Analysis: Measles, Mumps, and Rubella

admin March 28, 2012

 

Welcome!  This is the eighth post in my vaccine series.  You may have missed  Getting Serious, 10 Bad Reasons Not to Vaccinate, Why “Science” Should Be Carefully Evaluated, What is Herd Immunity All About, How the Immune System WorksIngredients in Vaccines Part 1 or Ingredients in Vaccines, Part 2.

Risk-Benefit Analysis: Measles, Mumps, and Rubella

It’s time to get to the nitty-gritty of this series!  We’ve been laying groundwork for understanding vaccines and the body.  Now we’re going to dive in and take a specific look at each disease and each vaccines.  This is really the most important part — does the benefit of the vaccine outweigh the risk?  Is the disease as scary as we’re told it is?

Let’s find out!

Measles

Measles scares a lot of parents these days.  They’re worried about high fevers (of course, parents worry about fevers in general, which they usually shouldn’t) and complications like encephalitis or death.  Let’s take a look at this disease more carefully: what is it really like?

What is measles?

Measles is an infectious disease that is spread by direct contact with those who have it.  The virus can’t live on surfaces for more than two hours, and is “rapidly inactivated” by heat, light, or acidic pH.  Prior to vaccination, about 90% of people would get it during childhood.  The illness is accompanied by fever and spots

Normal course of the disease

Measles incubates in the body for about a week after exposure (3 – 14 days).  A fever comes first, rising higher and higher, to top out at 103 – 105 normally (this level is not dangerous and if untreated, should kill the illness quickly).  A rash appears at the top of the body and moves down over a period of days.  Measles lasts about a week.  Most people will also experience loss of appetite, diarrhea and soreness in the lymph nodes (throat area).

In most cases the illness is gone in just over a week and there are no complications.

Complications

In up to 30% of cases, there are some type of complications.  This is more likely to happen in children under 5 or adults over 20.  Most “complications” are not serious — diarrhea (8%)  is the most common “complication,” followed by ear infections (7%)  and pneumonia (6%).  Pneumonia is the most common cause of death from measles.

Encephalitis (fever, vomiting, meningeal irritation, headache, stiff neck) occurs in about 0.1% of cases, or about 1 in 1000 (in all countries; in developed countries, this number is only 1 in 10,000 to 1 in 100,000).  About 15% of those who develop encephalitis will die from it (about 1 in 7000 cases of measles using the ‘worldwide’ number, or as little as 1 in 700,000 using the developed countries number).  Worldwide (including developing countries), the number with serious complications is about 1 in 1000 to 1 in 100,000 (depending on the complications).

On average, about 0.2% of people will die from measles (1 in 500).  WHO states that deaths in developed countries are “rare,” but may reach as high as 10% in developing nations.

Measles is more severe and complications are more likely in those who are malnourished, especially those who are deficient in vitamin A.   Vitamin A supplementation has shown a strong protective effect in those with severe measles (against complications like pneumonia or encephalitis).

Vaccine Use

Measles vaccine is recommended in two doses: at 12 – 15 months of age, and again at 4 – 6 years (or when a child enters school).  MMR vaccination in children under 6 months of age is relatively ineffective and not recommended.   It is often stated, but not definitively known if measles vaccine provide life long protection.  One source says the vaccine lasts for around 11 years before protection likely begins to wane.  Estimates of protection range from 87 – 100%.  However, experts note that one of the reasons for continued natural protection to a given illness is because the person is continually “re-exposed” by being around others who are currently infected, providing a “booster” effect.  They question whether or not vaccines can provide lifelong immunity without boosters.  Ultimately how much protection is really afforded is uncertain.

Vaccine Side Effects

According to the VAERS database, there were over 2000 vaccine reactions attributed to measles alone or MMR vaccine in 2011 (this was on the low side; there were years with double or triple the number of reactions, especially in the early 2000s).  About 10% of these were classified as “serious.” Estimates are that between 1 and 10% of the total number of reactions are reported each year.  (Click the second link to scroll through the vaccine reactions, which range from low fever and redness to miscarriage — in adults, high fevers, hives, inflamed joints, measles, encephalitis, and more.)  As reported, this is about 1 in 15,000 who have a serious reaction (but could be as many as 1 in 150, if reporting is only at 1%.  This is unlikely since serious side effects are more likely to be reported than non-serious side effects.  It is likely it is greater than 1 in 15,000 though).

Merck’s MMR II was responsible for most of the vaccine reactions.  The package insert specifically notes that it should not be used on pregnant women, and that women who are vaccinated should not become pregnant for at least three months (the VAERS database indicates it has been used on pregnant women).

The vaccine may cause a number of different side effects (see pages 7 and 8 of the package insert, linked above, for the full list) including encephalopathy, diabetes, thyrombocytopenia, diarrhea, vomiting, irritability, headache, anaphylaxis, arthritis (occurring rarely in children but in up to 26% of adults), seizures, Guillaine-Barre syndrome, rash, pneumonia, ear infections, death.  The frequency of any of these reactions is not noted in the package insert; it only says “rarely.”  Other sources and studies also do not list the frequency of side effects.

Bottom Line

Serious complications from the vaccine are slightly more likely than complications from measles, especially in a developed country with access to clean water, excellent nutrition, and medical care.   Vitamin A supplementation is strongly correlated with reduced complications, and measles in and of itself is an acute, non-serious disease.

Risk-Benefit Analysis Measles, Mumps, and Rubella pinterest

Mumps

Is mumps really a scary, terrifying illness?  Most of us don’t know what mumps is really about anymore, and are so worried about the possibility of this “unknown” disease.

What is mumps?

Mumps is an acute viral illness that causes swelling in the salivary glands (which leads to characteristic “chipmunk cheeks”) and possibly other areas of the body.  It is spread through saliva or other bodily fluids from a person who is infected.  It is less contagious than measles, about as contagious as the flu.  20% of cases are asymptomatic, and 40 – 50% are minor and similar to other respiratory illnesses.  Only 30 – 40% of cases actually develop the characteristic swelling.

(This is all according to CDC data.  As always, I would like to know how they know 20% of cases are asymptomatic or that up to 50% are basic respiratory symptoms…are they testing everyone??)

Normal course of the disease

The incubation period after exposure is 2 – 3 weeks.  Early symptoms are low fever, loss of appetite, fatigue, and headache.  This progresses to swelling (often felt initially as an earache) after a few days, and symptoms resolve within a week.

Complications

About 15% of patients may end up with meningitis (stiff neck and headache), but these cases usually resolve in a week or so without complication.  Encephalitis is also possible, but occurs in only 1 in 50,000 cases.

In adult women, ovarian inflammation may occur in up to 5% of cases, but this has not been linked to infertility or any permanent damage.  If a woman is pregnant and in her first trimester, there is a 25% chance of miscarriage.  If she does not miscarry, there is no chance of fetal abnormality (none ever reported).

In adult/teen men, swelling of the testes occurs in up to 20%.  Only 20% of these will have any sort of damage; complete sterility or permanent damage is rare.

Hearing loss occurs in about 1 in 20,000 cases and is usually only in one ear, but is also usually permanent.

Death is very rare, but happens occasionally (about 1 per year, or fewer than 1 in 10,000 cases worldwide; likely less in developed countries).

Vaccine Use

Mumps is included in the MMR vaccine.  Single mumps vaccines are not currently available.  Effectiveness, according to the CDC, is 77 – 91% after one dose; another study (from CDC) suggests two doses confers 88% protection.  According to the WHO, effectiveness ranges from 69 – 96%.

Vaccination is recommended twice; once at 12 months+, and again at 4 – 6 years.

Mumps outbreaks have been reported in highly vaccinated community, suggesting vaccine failure is a possibility.

Vaccine Side Effects

There is no single mumps vaccine; only the MMR.  Therefore the information above for the measles/MMR is valid here too:

Merck’s MMR II was responsible for most of the vaccine reactions. The package insert specifically notes that it should not be used on pregnant women, and that women who are vaccinated should not become pregnant for at least three months (the VAERS database indicates it has been used on pregnant women).

The vaccine may cause a number of different side effects (see pages 7 and 8 of the package insert, linked above, for the full list) including encephalopathy, diabetes, thyrombocytopenia, diarrhea, vomiting, irritability, headache, anaphylaxis, arthritis (occurring rarely in children but in up to 26% of adults), seizures, Guillaine-Barre syndrome, rash, pneumonia, ear infections, death. The frequency of any of these reactions is not noted in the package insert; it only says “rarely.” Other sources and studies also do not list the frequency of side effects.

Additionally, according to the WHO, low-grade fever, headache, swelling of the salivary glands, and swelling in the ears is possible (sounds just like mumps…).  Meningitis has been reported anywhere from 1 in 400 to 1 in 500,000 in different studies (it seems less likely with the strain of vaccine that is used commonly in the U.S.).

Bottom Line

Interestingly, there is a lot less fear in these reports than in the measles reports.  Mumps is described repeatedly by both CDC and WHO (and other minor sources) as “a mild childhood disease.”  WHO even notes that controlling mumps is a much lower priority than either measles or rubella.  (The entire attitude is interesting — a total lack of scary statistics; a very brief look at the illness with the attitude like “do whatever you want” because they know that mumps is simply not that serious.)  Serious complications from mumps are incredibly rare — so rare that there are not even really statistics on them.  Given the risk of the MMR vaccine, it doesn’t seem worth it compared to the risk of mumps (negligible).

Rubella

German measles, as it’s called…but is it really as “bad” as measles?  Some have heard it is mostly only dangerous to pregnant women.  Let’s see what it’s all about.

What is rubella?

Rubella is a very mild viral illness that, at least in children, is often not very apparent.   The concern is mostly for pregnant women, whose babies may get congenital rubella syndrome if they are exposed at a certain point in pregnancy.

Normal course of the disease

It consists of low-grade fever and general tiredness, followed by a mild red rash that starts at the face and works its way down.  It lasts only for a few days, and then it’s gone.  In some cases, the eyes will be infected (like pink eye), although this is more common in adults.

In adults, arthritis usually accompanies it (this is temporary).

Complications

The most important complication is congenital rubella syndrome, or CRS.  This affects between 1 in 10,000 to 1 250 babies, depending on whether or not rubella is epidemic (this is without vaccination).  CRS can lead to miscarriage, deafness, heart defects, blindness, facial deformities.  Children are also at risk for developmental delays, including learning disabilities and autism.

Rubella can also lead to encephalitis (1 in 10,000; up to 1 in 6000 worldwide), deafness (1 in 6,667), and mental retardation (1 in 1,000,000).

Vaccine Use

This vaccine is made with the use of human diploid cells, i.e. aborted fetal tissue.  The vaccine is supposed to confer 95 – 100% protection after one dose (given around 12 months).

Vaccine Side Effects

The vaccine has a long list of side effects, including: diabetes, fever, fainting, fatigue, diarrhea, vomiting, nausea, headache, dizziness, encephalitis, Guillain-Barre, seizures, ear infections, and more.

Myalgia (muscle pain), swelling of the lymph nodes, irritability, headache, low fever, and tingling of the skin are commonly reported.

A few studies have been conducted that showed a potential link between the MMR and autism (see point #7).  It bears further research, which is not currently being done.

Bottom Line

Rubella in children is an incredibly mild illness with almost no risk of complications.  If vaccination is considered, it should be chosen for adult women who may become pregnant and are not naturally immune to rubella.  This is the only vulnerable population.

Final Thoughts

Whew, that was a lot to work through!  I hope it was all helpful to you.  I tried to break down the numbers as much as I could so that we were working with apples to apples (1 in xxxx vs. 1 in xxx, rather than 1 in xxxx vs. 5 in xxxx).  It was a bit tricky because a lot of vaccine data didn’t mention the frequency of side effects, nor provide links to the data from which they drew their information.  The VAERS database continues to be a good source of information on how frequently vaccine reactions are occurring in the population, keeping in mind that there is a lot of underreporting.

If you have any questions, please feel free to let me know!

**This post has been entered in Monday Mania.**

Are you worried about measles, mumps, and rubella?  Did you or do you plan to get the MMR?

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24 Comments

  1. Excellent, condensed, and very helpful information! Where, or where was this years ago when my kids were babies?! At any rate, thank you for all the work you put into this! I am hoping you will do one of these on the flu vaccine, as my husband is a healthcare worker and will be faced with mandatory flu vax next flu season and we are hoping to have lots of research done before then so that we can present well-researched reasons for his refusal of the shot.

    Reply

    • another blog I read, Kelly the Kitchen Kop, just had a blog post about the same exact situation – health care worker not wanting to get mandatory flu shot required by hospital. She printed the letter the woman wrote (which was very researched and included references) – she did not have to get the flu shot after her appeal.

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  2. Thank you for this! I want to read the rest of the posts you mentioned – getting this kind of information is not as readily available as I wish it was.

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  3. I thought you did an excellent job on this article. It really gives a great run down on what the illnesses really are and the percentages of effectiveness/complications are reported nicely. Great information for anyone weighing the benefits/risks of vaccinating their child/ren.

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  4. First, this analysis is more than adequate as far as it goes.

    However, the issues of the apparent in-use effectiveness of each component of the current MMR vaccines were not addressed.

    For the USA, the CDC’s ‘Summary of Notifiable Disease” reports, published in the CDC’s Morbidity and Mortality Weekly Report (MMWR) clearly provides the information needed to assess the “effectiveness” of the vaccine in preventing measles, mumps, and rubella.

    Based on my review of those records, including, for measles, what happened prior to the 2nd-dose recommendation and what may have really triggered that recommendation, the results of the review of the “notifiable disease” reports for measles, mumps and ruvbella indicate that:
    1. The 2-dose regimen using Merck’s MMR II(R) vaccine for rubella appears to be highly effective
    (with less than 10 cases reported per year in the most recent years in a nation of 310-plus million
    resident);
    2. For mealses, the protection seems to be adequate at present but the trend may be towards decreasing
    effectiveness s the population of those with natural measles immunity continies to decline.
    3. For mumps, there is no effective protection (with thousands of cases annually occurring in periodic
    waves of peaks and valleys) and the “effect” of vaccination is to postpone the childrren’s risk until
    they are adults when the risk of serious harm from having mumps is significantly higher.

    Based on the preceding realities, at a minimum, the mumps component should be removed from the US recommended vaccination program and the current MMR II vaccine replaced by an appropriate measles and rubella vaccine (an “MR” vaccine) with the mumps vaccine only being given to children approaching puberty who have no antibody evidence of having had mumps.

    For more details on the preceding issues, please visit my web site, http://www.dr-king.com and read the applicable articles posted in the “Documents” section that discuss measles, mumps and/or rubella and the use of the MMR vaccine in the USA and, for measles, in France.

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  5. But doesn’t that mean that the child who contracts rubella (which is “not readily apparent” and probably not serious enough in the child to necessitate keeping him home) could be running around exposing every pregnant woman on the street to a disease that could seriously harm or deform her unborn baby?

    It seems that maybe the point of giving children a rubella vaccine wouldn’t be so much to keep the child from getting rubella but to protect other, more vulnerable members of the population.

    Or is it that so long as the pregnant woman had the rubella vaccine when she herself was a kid, that would keep her baby safe? So is there an argument for vaccinating girls, whether as toddlers or at puberty, to protect their developing children?

    Reply

    • Hi Katie, you could make an argument for vaccinating non-immune teen girls or young adults who may become pregnant. I think it is their responsibility to make that choice, if they need to, to protect themselves. I don’t think vaccinating all babies to protect women is the answer, though.

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      • Exactly. I think each person at risk should take precautions themselves, rather than expect every single other person they come into contact with to do so. For this reason, I intend to have my daughters vaccinated for rubella as teenagers, IF they don’t have any antibodies for it AND a vaccine not containing fetal cells is available by then. Meanwhile I’ll be on the lookout for wild rubella, I guess! I am vaccinated for rubella and had my antibody levels tested to be sure … but if I became pregnant without being immune to rubella, I would be very, very careful to avoid exposure. That generally would have to mean avoiding kids, because I’m not sure whether they shed the virus after being vaccinated, and if they had wild rubella, it might not be evident by the time they are contagious. But I would take whatever precautions I could, considering the severity of deformities that rubella can cause. My mom worked in special ed with a “rubella baby” who was blind, deaf, and retarded. I wouldn’t want that to happen to my child, so I’m glad I’m vaccinated, despite any risk the shot might have been to me.

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    • Immunity from the rubella vaccine doesn’t last forever, while immunity from having had the natural disease is life-long. It would be better to deliberately expose schoolchilldren to rubella and let them gain immunity naturally, and not risk adverse effects from the vaccine.

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  6. @Peggy, it states right in the package insert of the vaccine that the source is an aborted fetal cell line. How much more neutral, non-religious can you get?

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  7. You didn’t mention male sterility as a complication of adult measles. But I’m positive I’ve heard of that as well.

    It’s frustrating, because there are basically no serious risks of contracting these diseases as a child. But now that they’re not circulating much, it’s hard to make sure you get them as a child. Instead, many of us (or our kids) are going to miss out on getting them young, and get them as adults instead. It also means that we don’t have as complete immunity from being vaccinated as we would from the wild disease — for instance, because I was vaccinated rather than catching the measles, I can’t give measles immunity to my kids in my breast milk. So in a way, the vaccine has made my very young babies LESS safe than they would have been if no one were vaccinated.

    Reply

    • Yes, and that’s exactly why whooping cough is so dangerous now. Mothers don’t have immunity to it and can’t pass it to their babies via breastmilk as they should. Therefore, very young babies are catching it when it is very serious and they are more likely to die from it. Typically, when no one was vaccinated for it, children did not get whooping cough until they were over a year old and it was no longer so dangerous. Of course, the “usual” answer is to vaccinate more and more…vaccinate the adults, vaccinate the babies as young as possible, etc. Eventually, especially since mutations are going on, that’s not going to work anymore. It’s definitely a line of reasoning to consider when examining the decision to vaccinate.

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    • Sterility from mumps is very rare. Even if a man is affected, it’s usually just on one side, and he can still produce viable sperm on the other side. Much better just to get the natural disease as a child, and then you don’t have to worry even about that.

      Reply

  8. Thank you so much for putting this together! Have you done any research regarding the link between vaccines and severe food allergies? I’m just starting to look into it as I have a suspicion that my daughter’s routine immunizations may have caused her allergies. Also, have you written anything on the legal ramifications for refusing your child’s vaccines? This whole process intimidates me, but I know it’s the best choice, since obviously I don’t want to cause any more damage. It’s so comforting to know there are others out there who share my convictions, and I’m not the only conscious Mama who choses to think for herself. I’m sharing this on FB. Looking forward to exploring your blog!

    Reply

    • Hi Rebecca, I haven’t found much about vaccines and allergies yet, but http://www.fourteenstudies.org may have some information for you. It makes sense based on what I know — vaccines can damage the gut, which leads to allergies. I’ll be discussing the legal issues towards the end of the series, after I finish all the risk-benefit posts.

      Reply

  9. […] Welcome!  This is the ninth post in my vaccine series.  You may have missed  Getting Serious, 10 Bad Reasons Not to Vaccinate, Why “Science” Should Be Carefully Evaluated, What is Herd Immunity All About, How the Immune System Works, Ingredients in Vaccines Part 1, Ingredients in Vaccines, Part 2, or Risk-Benefit Analysis: MMR. […]

    Reply

  10. […] a point and used Snope.com as a definitive resource to support their point. You can read the blog here, it’s well worth the read! Here is a copy of the comment and reply from the […]

    Reply

  11. […] How the Immune System Works, Ingredients in Vaccines Part 1, Ingredients in Vaccines, Part 2, Risk-Benefit Analysis: MMR, or Risk-Benefit Analysis: […]

    Reply

  12. […] System Works, Ingredients in Vaccines Part 1, Ingredients in Vaccines, Part 2, Risk-Benefit Analysis: MMR, Risk-Benefit Analysis: DTaP, Risk-Benefit Analysis: Chicken Pox, Hib, […]

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  13. has anyone had any experience w/ homeoprophylaxis?

    Reply

  14. […] written more on measles here, and here, and here. I’ve addressed the ridiculousness that is “herd immunity” here, and […]

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  15. Thank you for doing the worl! I was creating my own powerpoint of each vaccine and its ingredients, the illness and symptoms, the risks and history. I came by your page and while I still intend to finsih my own homework, I wanted to say thanks to you!

    Reply

  16. Thank you for this. My son (now 4) received this vaccine on an alternate schedule, but still at 15 months. It has been the only vaccine he has reacted to, and for that reason alone we are postponing the MMR for his brother (currently 20 months). We are in transition between cities, though, so we may just opt not to pursue the MMR at all. I’m getting to the point now that I don’t want to use the vaccines developed from aborted fetal tissue AND I think with Baby #3 we will just postpone any other “necessary” vaccines til after 2. They are such a headache.

    Reply

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I’m Kate, mama to 5 and wife to Ben.  I love meeting new people and hearing their stories.  I’m also a big fan of “fancy” drinks (anything but plain water counts as ‘fancy’ in my world!) and I can’t stop myself from DIY-ing everything.  I sure hope you’ll stick around so I can get to know you better!

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