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  Measles, Mumps and Rubella Vaccination: Parents as Partners in the Decision
  

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By: P. Klein, H. Albonico, R. Koller, D. Pewsner
Measles, Mumps and Rubella Vaccination Parents as Partners in the Decision: A Critical View of the Swiss MMR Immunization Program*

Peter Klein, MD; Hansueli Albonico, MD, Roland Koller, MD, and Daniel Pewsner, MD.

* Originally published as a pamphlet by the Medical Working Group for Differentiated Measles, Mumps and Rubella Vaccination., Second revised ed, Dec., 1988., reprinted with permission. English by Robert F. Lathe and Nancy K. Whittaker, 1994

This pamphlet was written by an ad hoc physicians' group. It is the result of a thorough study of the scientific literature, discussions with experts and experience in everyday medical practice. A complete list of the scientific literature is available from the publisher: Working Group for Differentiated MMR Vaccination, Post Office Box, 3000 Bern 9, Switzerland

Editor's note: The article which follows was written by a group of Swiss physicians as a pamphlet for parents contemplating the pros and cons of the MMR immunization in particular. Realizing that both the directed audience and prevailing conditions here in the U.S. are somewhat different, the article raises issues which are not often addressed on this continent.

In association with the World Health Organization, a mass immunization program against the childhood diseases measles, mumps and rubella has been underway in Switzerland since 1987. All infants and school children are to complete their immunizations within the next years. The official policy is that every child should be immunized unless there are strong reasons against it. There is no legal obligation to participate.

We might assume that all important questions regarding the short- and long-term effects of the three vaccines have been answered. However, this is not the case. The information presently available provides no convincing justification for the routine immunization of children against "MMR."

Measles, mumps and rubella are three quite different childhood diseases. Each of them has its own significance for people, its own course and different possibilities for complications. The same is true for each of the three vaccines. The so-called "MMR Vaccination" is in reality a combination of three quite different vaccines. Thus, the immunization question that faces parents today is, in reality, threefold:

• Should my child be vaccinated against rubella? If so, when?

• Should my child be vaccinated against mumps? If so, when?

• Should my child be vaccinated against measles? If so, when?

The purpose of this pamphlet is to give parents a better understanding of the immunization process, the risks of the three childhood diseases and the respective vaccines, and the unresolved problems in the MMR immunization program. We wish to encourage parents to become responsible partners in the decision.

We assume the reader has knowledge of the official information about the immunization program.

Official Arguments for the MMR Immunization Program

The MMR immunization program is officially promoted with the following arguments:

• The viruses that cause measles, mumps and rubella, and with them the diseases themselves, can be eradicated by the year 2000.

• It suffices to inoculate all babies and school children once. The protection lasts a lifetime.

• The three childhood diseases, measles, mumps and rubella, are of no value to good health. However, each of the three illnesses can lead to complications that the inoculation can prevent. The childhood diseases are an unreasonable burden to daily life.

• The vaccines are harmless, and serious complications are extremely rare. There is no need to fear long-term negative consequences for public health. The MMR vaccination is voluntary. However, parents who do not have their children inoculated are portrayed as irresponsible and antisocial.

Note: Since the beginning of the immunization program, the German Department of Heath has already had to revise its views on the following points:

• The eradication of the cause of the illness cannot be achieved with the MMR program. At most, it is only possible to inhibit the occurrence of the known forms of the three childhood illnesses.

• The length of the protection from the contagion is not lifelong, but unknown.

• There are no reliable complication rates for measles, mumps and rubella in Switzerland. In particular, the rate of measles encephalitis (brain fever) is lower than that previously given.

The Difference Between Natural Infection and Vaccination

It is true that vaccination can produce an immune reaction in an organism without the presence of a true illness and that this will offer protection from infection by the natural pathogen (cause of the disease). But the effect of the vaccine differs in important points from that of the natural infection.

Taking measles as an example, coughing people transmit the virus in droplets to the mucous membranes in the air passages of healthy people. The typical measles symptoms such as high fevers and skin rash are an expression of an intense struggle between the organism and the viruses. The overcoming of the natural illness through the child's own powers of resistance helps his or her immune system to mature and increases resistance against other childhood and adult diseases.

In contrast, the vaccination is a planned infection - living viruses are injected under the skin. These viruses are derived from the natural measles virus and are modified and weakened (attenuated) in the laboratory through a sequence of dozens of animal and human cell cultures and additional substances. The injection bypasses the normal resistance barriers such as the mucous membranes and lymph nodes. The injected virus cannot stimulate the immune system to the same extent as the natural virus does. It is a fact that the antibody concentration in the blood after vaccination is less than after a natural disease. Also, 5-10% of those inoculated do not react at all, or react insufficiently. Experiments with vaccines given through the nasal mucous membranes have been unsuccessful so far.

The goal of the MMR program is to replace all natural measles, mumps and rubella viruses with those developed in the laboratory. Scientists point out that the risks of manipulating living viruses are difficult to estimate. In addition, continuous tests of the quality of the vaccine using countless animal and human experiments are necessary.

How Dangerous are Measles, Mumps and Rubella?

The classic childhood diseases have been around for centuries. For generations, people have accepted them as being something normal. Parents, teachers and observant doctors have always noticed that through childhood illnesses, children can take important developmental steps, and that after overcoming an illness they are often healthier than before. Psychological disorders, such as bedwetting or stuttering, often stop suddenly after a childhood illness. Psychologists point to the significance of these "illness breaks" for the harmonious development of the soul- not only for the child, but also for the entire family. On the other hand, though, the childhood illnesses bring with them the possibility of complications.

Measles

Measles is a common childhood illness with a high fever. It causes major changes, comparable to "molting," to take place in nearly all organs of the body. The organism thus has the opportunity to get rid of wastes and renew itself. This perhaps explains the observed fact that genetically-related diseases such as eczema, asthma, and respiratory illnesses in particular, but also certain kidney diseases (nephritic syndrome), sometimes improve or heal after a case of measles.

However, complications can arise through this far-reaching illness. If the patient does not fully overcome the disease, it can extend to the ears, to the lungs, or to the brain, thus causing a middle ear infection, pneumonia, or the feared encephalitis (brain fever) which can cause lasting damage or death.

Mumps

Mumps is a harmless childhood illness with fever and a painful swelling of the parotid glands. Neuritis could occur, but rarely results in a loss of hearing. Other complications, such as meningitis, can pose a threat when the illness occurs after puberty. Sterility after a mumps infection of the testes cannot be proven scientifically. The World Health Organization's recommendation for Europe does not include inoculation against mumps.

Rubella

Rubella is a harmless childhood disease with fever, swelling of the lymph nodes and a rash. It is dangerous only when a woman becomes ill with it during pregnancy. Then the embryo can be severely damaged (rubella, embryopathy).

The best protection against rubella illness during pregnancy is having had rubella as a child.

Until recently, only girls who did not have any antibodies at puberty were inoculated. Rubella antibodies can be detected through a blood test.

The incidence of complications from childhood illnesses depend; primarily upon the age and health status of the child, and upon the nature of the treatment. It can be observed that medication that suppresses the symptoms, for example, a medication that strongly reduces fever, inhibits the body's resistance. With measles, it also appears important that the rash completely break out. In earlier times, the danger of an "inward turn" of the measles rash (i.e., failure to fully break out) was well known. Modern observations confirm that children who have the measles without a real rash more often become ill with chronic pains and cancer in later life. Finally, the patient needs sufficient rest and protection from over stimulation.

Today, the way to treat childhood illness has been largely forgotten. An intensive combating of the symptoms has replaced the supporting of the child's natural powers of resistance.

What about Measles Encephalitis?

When considering medical procedures, such as inoculations, the main thing is always to carefully weigh the possible advantage against possible damage. However, in Switzerland there is no mandatory reporting of complications of childhood illnesses, and mandatory reporting of inoculation complications has only recently been introduced. Thus, we can only work with estimates. We can use the example of measles encephalitis to show that the uncertainty of these estimates is great.

Encephalitis can occur after measles or after a measles vaccination. In the scientific literature, the estimates of the rate of measles encephalitis after the illness vary between 1 in 1000 to 1 in 11,600 cases. The occurrence of encephalitis after inoculation is estimated to be from 1 in 17,500 to 1 in 1,000,000 cases. For Switzerland, the example was given of approximately 70 cases of measles encephalitis (from the illness) per year. With approximately 50% of the children inoculated against measles, there have been only rare cases of encephalitis in the past years.

Such different results exist because encephalitis is not a clearly defined complication. Thus some researchers count the passing confusion that commonly occurs in normal cases of measles as encephalitis.

Medical Concerns about the MMR Eradication Program

Inoculation Complications

All of the symptoms of measles, mumps and rubella can occur, usually in a very attenuated form, after inoculation with the combined MMR vaccine. It is also possible for the complications associated with the illnesses themselves to occur after inoculation. Finally, on occasion complications that do not result from the natural illnesses occur as a result of the vaccination. In individual cases it is difficult to prove the relationship of the illness to the inoculation. For that reason, there are widely varying statements concerning the rates of short-term inoculation complications. The rate of complications presented depends upon whether the pharmaceutical firm producing the vaccine is making the statement, or an organization representing parents of children injured as a result of vaccination. This is a reflection of the fact that these rates are related to personal and economic interests.

Consequences for the Immune System

Perhaps more important than the short-term inoculation reactions and complications are the long-term consequences for the human immune system. As presented above, the vaccines affect the development of the child's immune system differently than the natural illness. When the MMR immunization program began, there was no scientific clarification of the connection between naturally overcome childhood illnesses and resistance to chronic degenerative illnesses, illnesses related to immune system deficiency and cancer. For example, nothing out of the enormous research concerning AIDS answers the question of the connection between immunization and immune system weakness.

Shifts in Ecological Balance

The MMR immunization program can be seen as a widespread public health experiment on the total Swiss population whose long-term result is largely unknown. For several centuries an ecological balance existed between the viruses of the childhood illnesses and human beings. The measles virus, as well as the mumps and rubella viruses, spread throughout our area; children usually became infected in the early years and acquired life-long immunity. Constant contact with the viruses continually renewed this resistance. Babies received an effective immunity from their mothers during the critical first months.

If, for instance, measles was introduced into an area where it normally did not occur, and, therefore, the population had no immunity against it, the illness caused enormous damage. In the last century, such measles epidemics ravaged a large part of the population of the Faroe islands (off the coast of Denmark). Another example in modern times is in Gambia (Africa). Several years ago after an intensive immunization program, the World Health Organization declared that measles was eradicated in that area. The illness reappeared a few years later, but with much larger number of serious complications and deaths than before.

It is possible to shift the ecological balance much more rapidly by mass immunization than by individual inoculation. We know today that the effects of such forced interventions are difficult to estimate.

In spite of that, in recent years in countries with a close-to-l00% inoculation rate (as a result of mandatory inoculation), for example, in the USA or East Germany, it has been possible to verify the following disquieting effects:

• Effective immunization does not take place in a portion of the vaccinated population.

• This portion, depending upon the vaccine and the quality of the inoculation, represents about 5-10%.

Widespread vaccination has led to an increased occurrence of measles, mumps and rubella during puberty and adulthood because children now can only rarely infect one another. Contracting the illness in puberty or adulthood often results in a more difficult recovery and more complications. People who have not or cannot be vaccinated through the routine immunization program, are becoming increasingly endangered as individuals. We must, therefore, determine if such people need to be vaccinated during puberty.

The immune resistance to measles of babies born to vaccinated mothers is less than that of babies born to mothers with a naturally obtained immunity.

The vaccines do not give lifelong protection. The inferior immune reaction to the vaccine, along with decreased opportunities for natural renewal of the immunity, leads to a recurrence of the illnesses in spite of vaccination. In the USA, for example, measles and its complications have become rare today due to mandatory (see footnote above) vaccinations. Nevertheless, every year there are small measles epidemics, increasingly often among adults, at least half of whom have been properly vaccinated. During such outbreaks in the USA and in East Germany, massive programs for contagious disease control are put into effect that always include re-inoculation.

In the case of rubella, because of the early age of vaccination, the possibility exists that during the critical time of pregnancy, there will be insufficient immunity to prevent infection. There have even been cases of rubella embryopathy in spite of correctly administered inoculations.

Such side effects of the immunization program can be eliminated only when the three viruses are, in fact, totally eradicated worldwide. Present experience shows that this decisive goal of the program is quite unrealistic in practice.

Is the MMR Vaccination Voluntary?

In Switzerland there is no legal necessity for MMR vaccination. However, in many respects parents, children, teachers and doctors face strong pressure to comply with the immunization program:

The official information is one-sided and evokes both an unnecessary fear of childhood illnesses and an uncritical trust in the usefulness and safety of the vaccine.

Vaccination is elevated to the level of a moral necessity. "Who Loves Them Well, Will Vaccinate Them Well," is the title of the French language pamphlet for parents.

With the rise of routine immunizations, anyone who is not or cannot be vaccinated is increasingly in danger of possible illness in adulthood.

Parents and doctors who refuse the routine MMR vaccination must fear being held responsible for the anticipated negative effects of the immunization program.

Although we can speak of a legally voluntary program, in reality the immunization program is becoming increasingly mandatory. This is a principal part of the eradication strategy inherent in the program.

You Be the One to Decide!

In summary, we must ask ourselves why we should change the current relatively favorable balance of the childhood illnesses measles, mumps and rubella in Switzerland through a mass immunization program. Serious complications are at present rare. At the level of immunization reached today by the "voluntary" program (50% of all Swiss children), the natural viruses are still present and enable a continued renewal of immune resistance after either the illness itself or the vaccination. Thus, the vaccinations can remain effective. At the same time there are increased reports from countries with a high immunization rate concerning unforeseen problems, such as epidemics, the necessity for re-inoculation and so forth. The goal of the program, namely the eradication of the three illnesses, has shown itself to be unreachable. Thus we must question whether the usefulness of mass MMR immunization outweighs the long-term dangers to public health. (In third world countries, the possible usefulness of measles vaccination must be judged in a fundamentally different manner.)

Then, why not maintain the present practice of individual vaccinations?

Why not, as has been done until now, individually address the question of vaccination for each of the three very different childhood diseases? (Each of the vaccines is available individually and in two-part combinations.) The general guideline might be that if there is no compelling reason to immunize an individual, then that person will not, as a rule, be vaccinated. A legitimate reason for immunization might certainly be the views of the parents on childhood diseases. A refusal of immunization for personal reasons deserves the same respect.

The situation of unvaccinated children who have not had the childhood illnesses before puberty deserves particular mention. We should seriously reconsider the respective inoculations, particularly the rubella inoculation for girls. Due to the uncertain level of immunity, it is recommended that girls vaccinated against rubella as small children have a blood test (antibody count) toward the end of junior high school (around age 14).

There are no compelling arguments for measles, mumps and rubella vaccinations that would make the parents' participation in the decision unnecessary. Further, it is not possible to scientifically decide the question of immunization against these three diseases once and for all. In individual cases, however, there are certainly objective or factual considerations to aid in the decision. A personal conversation with the doctor is most important. Fear, propaganda and mass immunization do not provide the basis for a reasonable use of the vaccines. Only complete and balanced information for parents and doctors can do so. This pamphlet is intended to be a step in that direction.

Peter Klein, MD, Hansueli Albonico, MD, Roland Koller, MD, Daniel Pewsner, MD.

Working Group for a Differentiated MMR Vaccination,

Post Office Box 3000

Bern 9, Switzerland





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