Vaccine fatigue: the great measles comeback

20. July 2012
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For some, they are a harmless childhood disease, for others a serious health hazard. Actually, measles could have been eradicated in Europe long ago, had the vaccination rates been high enough.

“A measles infection is not just a harmless childhood disease”, says Dr. Nina Wagner, a physician at the Department of Child and Adolescent Medicine at the DRK Clinics Berlin/Westend. Measles usually lead to a transitory immunodeficiency that lasts about six weeks. “Bacterial superinfection during this time can lead to serious complications such as pneumonia, otitis or diarrhea and can cause nervous disorders”, she explains. During a measles epidemic, numerous children suffer so badly that they need to be hospitalised, some of them even carry irreversible damage.

Long-term consequences are not to be underestimated

Acute post-infectious encephalitis is a particularly dreaded complication. About 0.1% of measles patients fall ill with it. Headache, fever and loss of consciousness and even coma are involved. For approximately 10-20% of those affected the outcome is lethal, 20-30% of patients suffer from residual damage to the central nervous system. While on average measles-based encephalitis occurs in one in 1000 patients, this only happens in less than one in a million measles vaccinees. Even if a child has survived measles well, it can lead to dangerous late complications. A rare but always fatal late consequence of measles is subacute sclerosing panencephalitis (SSPE), which has until now been observed in one in 10,000 to 100,000 cases. It occurs at some point in time months or as much as ten years after a measles infection and is expressed as a generalised inflammation of the brain. Mostly it is infants who developed measles before their first birthday who are affected by SSPE.

Measles cases at first declining

After an initial fall in numbers, the number of reported measles cases increased again in many European countries in the last two years dramatically. By the end of December 2011, RKI counted 1607 measles cases, that is more than twice as many cases as in the years 2010 and 2009 (2010: 780, 2009: 571), and included one measles-related death. On the website of the Robert Koch Institute (RKI) it can be read that in all likelihood “the number of actual disease sufferers is much higher, since on the one hand a large proportion of patients are not treated by a doctor and on the other hand not all treated medical illness is reported”. Susanne Glasmacher, spokeswoman for the RKI is not yet willing to talk of epidemics: “The measles outbreak in Germany always has a pathogen introduced from outside, which can then be spread by a group of people who have not been given sufficient protection.”

In 2011 France was also overrun by a wave of measles, which consequently had about fifteen thousand sufferers. Six of them died. In total across Europe last year about thirty thousand people got infected from measles. Most were not or were insufficiently vaccinated. Because of its inadequate vaccination coverage, Europe is exporting the virus to regions where it had long since been eradicated, such as North and South America.

Measles-free by 2015

The 53 Member States of the WHO-Euro Region want to have measles and rubella eradicated in Europe by 2015. With the start of the measles vaccine (GDR: 1970, former West Germany: 1973), at first continuously fewer cases of measles appeared in Germany. Since reporting requirements for measles were introduced in 2001, the numbers of transmitted disease cases fell from 6037 in 2001, initially to 123 cases in 2004 and remained – with the exception of 2006 (2,307 cases) – fewer than 1,000 cases of illness per year.

Recommendation for vaccination of STIKO

For optimal protection against measles, the Standing Committee on Vaccination (STIKO) recommends primary immunisation for babies aged between eleven and fourteen months. This should be followed by a second vaccination at fifteen to twenty-three months.

Since August 2010 the recommendation for vaccination by STIKO applies for all adults born after 1970 who have either not yet been vaccinated at all for measles immunisation or only once or have an unclear immunisation status.

The measles vaccine is a live virus vaccine prepared from attenuated measles viruses which are propagated on chicken fibroblasts. While it is available as a single-disease innoculation it is usually included in a combined composition with mumps and rubella vaccines, and also offered with the varicella virus (MMR or MMRV vaccines).

Herd immunity

The measles vaccination rate in Germany – as well as in France, Italy, Austria and Switzerland – according to information provided by the Robert Koch Institute is not sufficient to protect the most vulnerable individuals in society. These include immunosuppressed people, rare individual cases in whom after a single dose of vaccine no immunity is developed, and babies under eleven months. The situation is different in Finland, Sweden and the Netherlands. There, the vaccination rate is very high and measles morbidity accordingly low. The principle of herd immunity requires that 95 percent of a population be vaccinated for protection of the remaining five percent which cannot be vaccinated. In practice this means that 95 percent of the population in Germany (and possibly all of Europe) must receive two instances of vaccination in order to stop the spread of measles virus. Why does this not happen?

Inadequate vaccination coverage in Europe

Larger measles outbreaks in Germany in 2010 involved a national accommodation centre for asylum seekers in Schleswig-Holstein, and in 2011 a Waldorf school in Baden-Wuerttemberg and a school in Berlin-Charlottenburg after a trip. All patients were either not vaccinated or had an unclear vaccination status. Susanne Glasmacher of RKI does not mention generalised vaccination fatigue when it comes to the often administered measles-rubella (MMR) combination vaccine. “Even if the vaccination rate in Germany is still not sufficient, nonetheless among school beginners it is rising steadily“, says Glasmacher.

Reasons for why the vaccination rate in Europe is still not sufficient for banishing measles to the history books may not lie at all in the fact that some people consciously reject the vaccination. A number of Europeans simply forget them. Others on the other hand do decide deliberately against vaccination. The reason may be ideological or of a religious nature, or simply fear of side effects such as short, sharp bouts of fever, temporary skin rashes or rare allergic reactions. The fear of health problems caused by vaccine stabilisers – mostly derivatives of aluminum and mercury – is a reason given by a few people to refuse vaccination. Pierluigi Lupalco from the European Centre for Disease Prevention and Disease Control considers this fear to be unfounded: “The vaccines we use today in Europe, the vaccines including measles, mumps and rubella, contain neither mercury nor aluminum.”

Inficting injury?

Michael Friedl, a specialist in pediatrics and adolescent medicine at Heidelberg and also Chairman of the Association Doctors for Individualised Vaccination Decisions, despite this fact still stands skeptically opposed to vaccination. For him they are fundamentally “foreign substances, toxic substances, whose actions and side effects have not in any way been investigated well”. Substances with uncertain long-term effects are “shoved under the skin” of children being vaccinated Friedl stated in December 2011 during an interview with SWR. On the show “Zur Sache Baden-Wuerttemberg: Impfpflicht ja oder nein” (“Onto matters to do with Baden Wuertemberg: yes or no to vaccination?”) he even labelled vaccinations as “willingly inflicting injury on children”. Dr Günter Pfaff, from Epidemiology, State Health Office of Baden-Wuerttemberg, cannot agree with this. “A vaccine that has not been tested extensively would have no chance of coming onto the market”, says Pfaff.

Also, a correlation between the incidence of autism and the MMR vaccine is extremely persistent in the camp of the opponents of vaccination. Englishman Andrew Wakefield in 1998 published such correlations in the prestigious journal Lancet. Lancet revised the article only 12 years later, although his findings were disproved much earlier. In 2011 the German journal Ärzteblatt reported that Wakefield had openly falsified his data.

Vaccinate to protect the little ones?

Dr. Harald Rickert, a pediatrician in Besigheim, near Stuttgart, is a proponent of immunisation medicine. “Hardly any progress has saved so many lives as has immunisation medicine in the last 50 years”, says Dr. Rickert establishing his position. His patients also include the now 18-year-old Max who fell ill at six months from measles. At first he seemed to have survived the disease well, but at age ten the boy was suffering from memory problems and increased mobility disabilities. A few months after the onset of these symptoms, Max fell, probably due to a severe streptococcal infection, into a vegetative state. His pediatrician, Dr. Rickert, even speaks out for mandatory vaccination of all children attending a kindergarten: “Infants under one year are dependent on not being infected by any other”, he states as the basis of his call. Only with the complete immunisation of children attending public care facilities is protection of the youngest children against measles possible.

Vaccination critics see it quite differently. That children under 11 months can be susceptible at all to measles is for Friedl precisely the outcome of vaccinations. Before introduction of measles vaccination, the immune system of mothers would have been “boosted in such a way” via wild measles virus “that the mother-to-fetus protection was sufficient to protect them from disease”. The measles vaccination weakens the “protective nest” of babies so much that measles epidemics could be the only result. For Friedl, measles, as well as chickenpox, has only in recent years been refashioned into a threatening disease. He does not however present scientific evidence for this theory. Max’s tale is for him a “tragic solitary case”.

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