Is MMR better than single antigen vaccines?

F. Edward Yazbak, MD, FAAP & Kathleen Yazbak, BA, MA

MMR and Monovalents, 16 January 2001

Professor Brent Taylor, head of the Department of Paediatrics and Child Health at the Royal Free and University College Medical School, recently asserted that, “Separate vaccines do not provide good protection for children.” (January 14, 2001 Sunday Herald)
http://www.sundayherald.com/news/newsi.hts?section=News&story_id=13747)

However, the medical literature begs to differ. Indeed, immunity in the era of single antigen vaccines– before the widespread use of the triple MMR vaccine– yielded extremely positive results. Quoting the CDC Manual “Epidemiology & Prevention of Vaccine-Preventable Diseases”, 3rd edition, January 1996:

* Following licensure of the (Measles) vaccine in 1963, the incidence of measles decreased by more than 98% and 2-3 year epidemic cycles no longer occurred. p. 92
* Following vaccine licensure (1967), reported mumps decreased rapidly. p. 105
* Following vaccine licensure in 1969, rubella incidence fell rapidly. p. 117

In contrast, the medical literature post-MMR introduction and use is clearly less convincing.

Measles

Finland

Explosive School-based Measles Outbreak. Intense Exposure May Have Resulted in High Risk, Even among Re-vaccinees Mikko Paunio, Heikki Peltola, Martti Valle, Irja Davidkin, Martti Virtanen, and Olli P. Heinonen (University of Helsinki, Helsinki, Finland) Am J Epidemiol 1998;148:1103-10 “When siblings shared a bedroom with a measles case, a 78 percent risk (seven out of nine children) was observed among vaccinees. Vaccinated and unvaccinated students were equally able to infect their siblings. Total protection against measles might not be achievable, even among re-vaccinees, when children are confronted with intense exposure to measles virus.” NOTE: This group’s research is often sponsored by Merck, the vaccine manufacturer

Holland

A measles epidemic in an adequately vaccinated middle school population Van Eijndhoven MJ, et al. ( Ned Tijdschr Geneeskd. 1994 Nov 26;138(48):2396-400. Dutch. PMID: 7990987; UI: 95082975. “Thirty-three of 37 patients with clinical or laboratory criteria of measles had been vaccinated… Primary failure of the measles vaccine might be the cause of the minor epidemic but the results do not cast doubt on the efficacy of the current measles vaccination.”

Canada

Major measles epidemic in the region of Quebec despite a 99% vaccine coverage. Boulianne N, et al. Can J Public Health. 1991 May-Jun; 82(3):189-90. French. PMID: 1884314; UI: 91356447. “The vaccination coverage among cases was at least 84.5%. Vaccination coverage for the total population was 99.0%. Incomplete vaccination coverage is not a valid explanation for the Quebec City measles outbreak” (1989).

Outbreak of measles in a highly vaccinated secondary school population. (Toronto) Sutcliffe PA, et al. CMAJ. 1996 Nov 15;155(10):1407-13. PMID: 8943928; UI: 97099351. “Eighty-seven laboratory-confirmed or clinically confirmed cases of measles were identified (for an attack rate of 7.7%). The measles vaccination rate was 94.2%”

South Africa

The 1992 measles epidemic in Cape Town – a changing epidemiological pattern. Coetzee N, et al. S Afr Med J. 1994 Mar; 84(3):145-9. PMID: 7740350; UI: 95258851 “Immunisation coverage (at least one dose of any measles vaccine) was 91% and vaccine efficacy was estimated to be 79% (95% CI 55-90); it was highest for monovalent measles (100%) and lowest for measles-mumps-rubella (74%).”

West Africa

Measles incidence, vaccine efficacy, and mortality in two urban African areas with high vaccination coverage. Aaby P, et al. J Infect Dis. 1990 Nov;162(5):1043-8. PMID: 2230232; UI: 91037153. “Even though 95% of the children had measles antibodies after vaccination, vaccine efficacy was not more than 68% (95% confidence interval [CI] 39%-84%) and was unrelated to age at vaccination.”

Egypt

Sero-epidemiological study of measles after 15 years of compulsory vaccination in Alexandria, Egypt. Tayil SE, et al. East Mediterr Health J. 1998 Dec;4(3):437-47. [MEDLINE record in process] PMID: 10415952; UI: 99344441. “Approximately 80% of the children with measles had been vaccinated.”

United Kingdom

Reasons for non-uptake of measles, mumps, and rubella catch up immunization in a measles epidemic and side-effects of the vaccine. Roberts RJ, et al. BMJ. 1995 Jun 24;310(6995):1629-32. PMID: 7795447; UI: 95315783. “Many of the objections raised by parents could be overcome by emphasizing that primary immunization does not necessarily confer immunity and that diagnosis of measles is unreliable.”

United States

Measles outbreak in a fully immunized secondary-school population. Gustafson TL, (1987) Lievens AW, Brunell PA, Moellenberg RG, Buttery CM, Sehulster LM. N Engl J Med 1987 Mar 26; 316(13):771-4 “We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.”

Measles Outbreak among Vaccinated High School Students– Illinois MMWR: June 22, 1984 / 33 (24); 349 “The outbreak involved 16 high school students, all of whom had histories of measles vaccination after 15 months of age documented in their school health records”

Measles in an Immunized School-Aged Population — New Mexico MMWR: February 01, 1985 / 34 (04); 052 The school system reported that 98% of students were vaccinated against measles before the outbreak began

Transmission of Measles Among a Highly Vaccinated School Population — Anchorage, Alaska, 1998 MMWR: January 08, 1999 / 47(51); 1109-1111 The 33 case-patients ranged in age from 2 to 28 years (median: 16 years). Twenty-nine case-patients had received at least one dose of measles-containing vaccine (MCV) at or after age 12 months; one person with laboratory-confirmed measles had received two appropriately spaced doses of measles-mumps-rubella vaccine (MMR). At the high school where 17 cases occurred, based on school records, only one of 2186 students had not received at least one dose of MCV before the outbreak; 1057 (49%) had received one dose of MCV, and 1112 (51%) had received two or more doses.

Mumps

Singapore

Resurgence of mumps in Singapore caused by the Rubini mumps virus vaccine strain Goh, K T. Lancet Volume 354, Number 9187 16 October 1999. The measles, mumps, and rubella vaccine containing the highly attenuated Rubini mumps virus strain conferred no protection against acute parotitis in vaccinated children in Singapore. Its introduction into the national childhood immunisation programme has resulted in a reduction in the seroprevalence of mumps to pre-vaccination levels. Epidemiological investigations pointed to primary vaccine failure as the most likely cause for the resurgence of mumps. The seroprevalence of mumps in children less than 5 years of age was 22% in 1989, before the introduction of the MMR vaccine. It increased to 72�4% in 1993 after mumps vaccination (with the Urabe strain and Jeryl-Lynn strain) was introduced. In 1998, the seroprevalence of mumps again fell to 25�6%.

Switzerland

Mumps epidemic in vaccinated children in West Switzerland. Str�hle A; (1997) Eggenberger K; Steiner CA; Matter L; Germann D. Schweiz Med Wochenschr, 1997 Jun, 127:26, 1124-33 Since 1991, 6 years after the recommendation of universal childhood vaccination against measles, mumps, and rubella (MMR triple vaccine), Switzerland is confronted with a large number of mumps cases affecting both vaccinated and unvaccinated children. Up to 80% of the children suffering from mumps between 1991 and 1995 had previously been vaccinated, the majority with the Rubini vaccine strain.

Rubella

Switzerland

The incidence of rubella virus infections in Switzerland after the introduction of the MMR mass vaccination programme European Journal of Epidemiology, vol. 11, no. 3, June 1995, pp. 305-10): In evaluating the impact of the MMR mass vaccination program begun in Switzerland in 1985, “we conclude that MMR mass vaccination has not interrupted the circulation of rubella virus in Switzerland, and that improvements in the implementation and surveillance of the MMR vaccination campaign are necessary in order to avoid [the] untoward effects of it.”

Conclusion

It is Professor Brent Taylor’s personal opinion that the MMR provides ‘better’ protection to children. This view is not supported by medical literature, and does not add any useful insight to the current debate.

January 16, 2001

TL Autism Research, Falmouth, Massachusetts

The opinions expressed may not represent those of organizations to which we belong.