Concering the Measles (MMR) Vaccine

[Robert_B]

Hello fellow Science Forums readers,

 

I have been somewhere in the middle of the pro-vaccine and anti-vaccine movement, and decided to crunch some numbers. Would love everyone's take on this, I still don't know where to stand for the measles (MMR) vaccination.

For measles, the U.S. vaccine program started in 1963. I am using that year's population of 189.2 million for these calculations, and all data has been pulled from the CDC's website. I estimated on the high end for the pre-vaccine numbers.

Pre-Vaccine Numbers (0% of the population vaccinated):
- 2.1% chance of measles infection
- 0.025% chance of being hospitalized for measles (1.2% of those infected)
- 0.0021% of encephalitis as a side effect of measles (0.1% of those infected)
- 0.00026% chance of death as a result of measles (0.01% of those infected)

Current MMR Vaccine Numbers (assuming 100% of the population receives the vaccine, still based on the U.S. 1963 population as a reference point):
- 0.03% chance of seizure (jerking or staring) caused by fever
- 0.0033% chance of temporary low platelet count, which can cause a bleeding disorder
- 0.0001% chance of a serious allergic reaction ("less than 1 out of a million doses" is the direct quote from the CDC website)

So, based on those numbers, it is roughly 2.6 times more likely for you to have a serious allergic reaction from the current MMR vaccine than it would be to die from measles, even at the height of it's infection rate.

It is also more likely that you would have a seizure caused by a fever as a vaccine side effect, than for you to be hospitalized for measles.

Thoughts, everyone?

Edited March 24, 2016 by Robert_B

[Daecon]

Yes, but that's about 1 person in every 50 potentially getting measles compared to however many getting an allergic reaction, right?

Edited March 24, 2016 by Daecon

[fiveworlds]

Tells you nothing about how likely it is nowadays to get Measles. My sister acquired the measels before she was vaccinated and was really sick. Don't forget the jab also protects against mumps and rubella.

[StringJunky]

Also, one must consider the risk to people who can't be vaccinated because they are immuno-compromised. In the overarching principle of vaccination, responsibility lies with an individual to their society as much as to themselves and their family.

Edited March 24, 2016 by StringJunky

[Robert_B]

Yes, but that's about 1 person in every 50 potentially getting measles compared to however many getting an allergic reaction, right?

 

Yup absolutely. I think my point is - simply "getting" a virus is not an issue, it is the complications and symptoms of that virus that become an issue.

 

So, you're absolutely right, roughly 1 person in every 50 would contract measles if the vaccine wasn't around at all. But that one person who got it would have a 1.2% chance of being hospitalized, and a 0.01% chance of dying. At some point, those risks become infinitesimally small, no?

Tells you nothing about how likely it is nowadays to get Measles. My sister acquired the measels before she was vaccinated and was really sick. Don't forget the jab also protects against mumps and rubella.

 

Yup, I think my question is how *dangerous* is the measles. Risk of measles vs. risk of the vaccination that protects against it.

 

To your point, I couldn't find any data at all on a solo measles vaccine, only the measles/mumps/rubella (MMR) one. Which to me, mumps and rubella seem to be quite a bit more dangerous than the measles. Anyone know where that data would exist?

Also, one must consider the risk to people who can't be vaccinated because they are immuno-compromised. In the overarching principle of vaccination, responsibility lies with an individual to their society as much as to themselves and their family.

 

Would it be fair to say that by that logic, the restaurant cooking an immuno-compromised person's meal must cook their food with more caution than anyone else's, or a doctor's office must have a separate waiting room for them? At what point does an individual's health become their own responsibility?

 

To give some anecdotal thoughts; my mother is immuno-compromised, and she makes sure anyone coming to visit is not currently sick, she doesn't eat out, etc. It isn't only the measles that would cause an issue for her, it's also the common cold, food poisoning, or any other bacteria/virus/fungus.

Edited March 24, 2016 by Robert_B

[Xalatan]

2.1% of population contracting measles very high actually. For a population of a million, 21 thousand would develop measles if not vaccinated.

 

Talking about the risk of measles complications, the US CDC quotes 1 in 20 will develop pneumonia, the most common cause of death in young children. 1 in 1000 will develop encephalitis, resulting in deafness and intellectual disability. Mortality from measles is 1-2 in 1000.

 

This is also the risk of developing subacute sclerosing panencephalitis.

 

 

http://www.cdc.gov/measles/about/complications.html

[StringJunky]

 

...Would it be fair to say that by that logic, the restaurant cooking an immuno-compromised person's meal must cook their food with more caution than anyone else's, or a doctor's office must have a separate waiting room for them? At what point does an individual's health become their own responsibility?

 

To give some anecdotal thoughts; my mother is immuno-compromised, and she makes sure anyone coming to visit is not currently sick, she doesn't eat out, etc. It isn't only the measles that would cause an issue for her, it's also the common cold, food poisoning, or any other bacteria/virus/fungus.

No, the onus is on the compromised person in that situation. It's not relevant to the epidemiology of disease. Every person not vaccinated for measles, can become a host for the continued evolution (mutation) of that pathogen into a greater variety and more resistant forms. This increases the chances of it affecting the vulnerable. It's called social responsibility.

 

The trouble is that measles isn't prevalent anymore because of the success of the vaccination program. This is now reversing because some short-sighted people, not old enough to have experience of the MMR epidemics, now think the risk from the vaccine is greater than the risk from the disease. Can you not see history repeating itself? Do we have to wait until the unenlightened generations see brain damage, deafness, death etc before they start getting concerned enough to get vaccinated?

Edited March 24, 2016 by StringJunky

[Robert_B]

2.1% of population contracting measles very high actually. For a population of a million, 21 thousand would develop measles if not vaccinated.

 

Talking about the risk of measles complications, the US CDC quotes 1 in 20 will develop pneumonia, the most common cause of death in young children. 1 in 1000 will develop encephalitis, resulting in deafness and intellectual disability. Mortality from measles is 1-2 in 1000.

 

This is also the risk of developing subacute sclerosing panencephalitis.

 

 

http://www.cdc.gov/measles/about/complications.html

 

Interesting data, however, it is actually only concerning children. Eg. "As many as one out of every 20 children with measles gets pneumonia..." and "For every 1,000 children who get measles, one or two will die from it."

 

Which actually puts their death risk at roughly the same as the overall average; 0.01-0.02%.

 

But a valid point nonetheless.

No, the onus is on the compromised person in that situation. It's not relevant to the epidemiology of disease. Every person not vaccinated for measles, can become a host for the continued evolution (mutation) of that pathogen into a greater variety and more resistant forms. This increases the chances of it affecting the vulnerable. It's called social responsibility.

 

The trouble is that measles isn't prevalent anymore because of the success of the vaccination program. This is now reversing because some short-sighted people, not old enough to have experience of the MMR epidemics, now think the risk from the vaccine is greater than the risk from the disease. Can you not see history repeating itself? Do we have to wait until the unenlightened generations see brain damage, deafness, death etc before they start getting concerned enough to get vaccinated?

 

I absolutely am not arguing the efficacy of the vaccine, but rather trying to compare the risk factors of the measles virus vs. the risk factors of the vaccine that protects against it. Based on the stats, those side effects you're referring to aren't as common as one might think.

 

For your social responsibility point, I can't disagree with your personal opinion on the matter (which seems quite well thought out). I would simply pose this question to you; if, based on my preliminary research, the rate of measles infection as well as the complication rates seemed to be declining due to improved sanitation and healthcare, and if the death rate was already quite low (0.00026% chance for the general U.S. population), what do you imagine would happen if the vaccine disappeared altogether in modern-day U.S.A.?

[CharonY]

One thing to note, the less than a million number does not mean that the reaction was due to vaccination. Just that among the many vaccinated at least one showed symptoms. But it could also have other causes. I.e. due to low numbers the causal link is much weaker.

[Robert_B]

One thing to note, the less than a million number does not mean that the reaction was due to vaccination. Just that among the many vaccinated at least one showed symptoms. But it could also have other causes. I.e. due to low numbers the causal link is much weaker.

 

Hi CharonY - thanks for weighing in.

 

I would typically agree, however, a severe allergic reaction is rarely a causal link.

 

You could also say that the death rate of 0.01% (of people who contracted measles in 1963) is a causal link. It was only 450 people out of 4 million who contracted the virus. With the extremely low percentage stats on both sides, you can hopefully see how I have been having difficulty weighing the benefits of the vaccine with the risks.

[StringJunky]

I don't think one should just consider the death rate but also longterm complications. I found a contemporary report (link below) of the 1963 England, Wales and Scotland measles epidemic, which, by its account, was a very mild year compared to previous years. It will probably give you an idea of its significance. You will note that this report even mentions that some medics doubted the need for a national vaccination program because it was only a "mild" disease. As you probably know, it was considered fairly normal to catch measles, mumps, rubella at some point in ones childhood. I caught measles in 1966 at 4 years old. I was lucky and was unscathed by it... I think!

 

Link to PDF direct download: Frequency of Complications of Measles,1963

Edited March 24, 2016 by StringJunky

[Xalatan]

Also, there was the Andrew Wakefield incident and the MMR vaccine scare. Coming up through the medical school system most are ingrained with the benefits of vaccination and it may be difficult to persuade otherwise.

[John Cuthber]

I am not sure if the figures in the OP

"- 2.1% chance of measles infection
- 0.025% chance of being hospitalized for measles (1.2% of those infected)
- 0.0021% of encephalitis as a side effect of measles (0.1% of those infected)..."

are per year or lifetime estimates.

If it's per year (i.e. you have a 2.1% chance of getting measles in any year) then you need to figure in the fact that MMR is a one off event, but measles deaths are cumulative.

 

Also, I' very suspicious of that 2.1% figure- it seems rather low to me.

I know it's not the same thing but when there was an outbreak of Rubella when I was at school-,nearly everyone got it.

Did measles really only infect about 1 in 50?

[Arete]

Another major issue is the inclusion of "0.03% chance of seizure (jerking or staring) caused by fever" for the MMR vaccine, but not for measles for two reasons:

A) These are febrile seizures which, while frightening, do not generally cause any long term effects. They are therefore not generally considered severe side effects.

B) They are caused by elevated body temperature. The fever caused by an attenuated vaccine is shorter in duration and less severe than that caused by the actual disease. Therefore an infant with the measles is at a higher risk of a febrile seizure than the vaccine, yet it is not listed in your comparison for both.

Edited March 24, 2016 by Arete

[swansont]

 

Also, I' very suspicious of that 2.1% figure- it seems rather low to me.

I know it's not the same thing but when there was an outbreak of Rubella when I was at school-,nearly everyone got it.

Did measles really only infect about 1 in 50?

 

 

That also questions the issue of scaling. Higher population density may very well increase the probability of catching the disease

[zapatos]

Also, I' very suspicious of that 2.1% figure- it seems rather low to me.

I know it's not the same thing but when there was an outbreak of Rubella when I was at school-,nearly everyone got it.

Did measles really only infect about 1 in 50?

It may be that if one person in the school got it then everyone got it, but it only occurred in every fiftieth school.

[John Cuthber]

Possibly, but kids from one school know kids at other schools. Most people live in towns and are not isolated.

The real issue is if those numbers are per year, rather than total.

[CharonY]

 

Hi CharonY - thanks for weighing in.

 

I would typically agree, however, a severe allergic reaction is rarely a causal link.

 

You could also say that the death rate of 0.01% (of people who contracted measles in 1963) is a causal link. It was only 450 people out of 4 million who contracted the virus. With the extremely low percentage stats on both sides, you can hopefully see how I have been having difficulty weighing the benefits of the vaccine with the risks.

 

I do not quite follow what you say here. The point with regard to the vaccine is that it is possible that the persons may have gotten the reaction from sources other than the vaccine. In cases of measles-related deaths the frequency is so high (up to 4 per thousand in case of adults >30) that it is much more certain that the deaths are caused by measles (or rather, complications due to measles).

 

I tried to find more data on how often allergic reactions to vaccines occur. However, the only actual data set was from 1990 in which in the USA a total 70 million doses were used and in 11 cases anaphylactic reactions were recorded (I have not found any data on deaths). I.e. assuming that there are no changes in the formulation we are looking at about one case per 6.4 million vaccinated. And this is only assuming that there was a link between the vaccination and the allergic reaction (mostly those with egg allergies).

 

In comparison, before the introduction of vaccination 450 deaths were associated with measles every year. Moreover, in the late 50s every year about 150k patients had respiratory complications and 4000 had cases of encephalitis (each year). As it already has been mentioned, the severity of complications are often worse resulting in close to 50k hospitalizations due to measles each year. So even if the frequency was not high the actual number of severe complications are much higher than vaccine-related issues. As others have noted, protection exists even below 100% vaccination rates. It should also be noted that in these modern times, outbreak have the potential to spread faster and in a larger area than they used to.

[foxy john]

One other reason, not talked about so far, is that childhood vaccination, ( of girls ) against measles means as women, they are immune to measles during pregnancy. Measles during pregnancy gives a very high risk of brain damage to the unborn child. I have heard that in the UK, the cost of the vaccine for the whole country is less than the cost of looking after a brain damaged child for its whole life.

[John Cuthber]

One other reason, not talked about so far, is that childhood vaccination, ( of girls ) against measles means as women, they are immune to measles during pregnancy. Measles during pregnancy gives a very high risk of brain damage to the unborn child. I have heard that in the UK, the cost of the vaccine for the whole country is less than the cost of looking after a brain damaged child for its whole life.

Do you mean measles or rubella (Not that it matters much- the point is still valid)