MMR (Measles, Mumps and Rubella)

According to the CDC, MMR is an attenuated (weakened) live virus vaccine. “This means that after injection, the viruses cause a harmless infection in the vaccinated person with very few, if any, symptoms before they are eliminated from the body. The person’s immune system fights the infection caused by these weakened viruses, and immunity (the body’s protection from the virus) develops.”

This vaccine is marketed to protect against Measles, Mumps, and Rubella. Each of these were considered rites of passage in previous generations. They are typically acute illnesses (lasting less than a few weeks) and didn’t typically have long-term effects

MMR is on the CDC recommended schedule as a two-dose series at 12-15 months of age, and again at 4-6 years. The main purpose of the MMR is to offer protection against measles, more than mumps or rubella. The first dose is stated to provide sufficient immunity, but the booster is still recommended when a child is school aged. The 1st dose is 93% effective against measles, the 2nd dose bumps it up to 97% efficacy. By "effective," they mean 93% will develop antibodies after one shot and an additional 4% will develop antibodies after a second shot, therefore 97% of people will develop antibodies after two measles vaccines. (It's not that the second shot is more or less effective than the first. It's that some people don't develop antibodies after one shot. Of those that don't, about half will develop antibodies after a second shot but the other half will not. There are some people who will never develop antibodies no matter how many shots you give them.)

The CDC recommends older children, teens, and adults to get one MMR if they do not have proof of immunity, whether by previous vaccination or by natural means. If you don’t show immunity to rubella while pregnant, they will offer to vaccinate you with MMR after you give birth. You are automagically considered immune if you were born before the year 1957, because it is assumed that you had these illnesses in childhood.

MMR VACCINE INSERTS

Listed below are each of the vaccine types available and a link to the package insert:

• M-M-R II: Measles, mumps, and rubella 
• Proquad (MMRV): Measles, mumps, rubella, and varicella (chickenpox) 

• Measles is an acute respiratory infection caused by a virus (morbillivirus) that used to be a common childhood illness, and it usually creates lifelong immunity. Talk of the illness occurred in many books and movies in the later 1900s (such as this famous clip from The Brady Bunch)
• The first two-ish weeks of a measles infection will have no symptoms. Measles signs and symptoms appear around 10 to 14 days after exposure to the virus. Measles tends to have no lasting effects.
• Measles is communicable about 4 days before the rash appears, and the first 4 days of the rash. It is highly contagious and mainly transmitted like the common cold, via respiratory droplets (coughing and sneezing).
• The early signs and symptoms of measles are similar to most respiratory infections: fever, dry cough, runny nose, sore throat, sensitive and inflamed eyes (sometimes pink eye).
• Two more specific symptoms that will start to appear are: tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek -- also called Koplik's spots -- and a skin rash made up of large, flat blotches that often flow into one another. The rash starts in the face and torso and moves down the body, then it also recedes in the same fashion.
• A MODERATE case of measles can also include ear infections or pneumonia (this is fairly uncommon, and mainly happens in the very young and the immunocompromised).
• In a rare event, SEVERE symptoms include encephalitis (brain inflammation) or severe pneumonia that interferes with lung function and oxygenation. Severe cases of measles typically happen in those who are malnourished (specifically Vitamin A deficiency).
• One rare complication of measles: “Subacute sclerosing panencephalitis (SSPE), a rare but fatal progressive central nervous system disorder, may also occur after a measles. SSPE is believed to be the result of a persistent measles infection of the brain. Signs of SSPE include personality changes, sleep disturbances, distractibility, gradual onset of mental deterioration, muscle spasms, and an elevated anti-measles antibody of the blood and cerebrospinal fluid. SSPE usually occurs an average of 7 years after a measles infection.” (via NVIC.org)

TREATMENT AND PREVENTION

• Treatment of measles is mainly to provide relief from symptoms: staying hydrated, getting rest in a darkened room, and reducing fever when necessary. Use of a humidifier may provide additional relief to a cough and sore throat. Itchiness from the rash can be effectively relieved via cornstarch or oatmeal baths, or topical application of calamine lotion or aloe vera.
• Vitamin A treatment is typically administered to children who are hospitalized for measles in the U.S, as well as to immunocompromised individuals and those who are vitamin A deficient.
• “Many studies have shown that immediate administration of high doses of vitamin A (50,000-200,000 IUs) can help control the severity of the disease, particularly in children who are malnourished.”
• PREVENTION: According to the CDC, measles immunoglobulin within 6 days of exposure may reduce the risk of infection and complications.  (There are risks associated with using this treatment.)

HISTORY OF MEASLES (infection) IN THE U.S.

• In the year 1900, the death rate for measles was 13.3. (The year 1906 had 1,463 deaths, majority in children under 5.)
• Measles became a reportable disease in 1912.
•  In 1920, there were 469,924 recorded cases and 7,575 deaths associated with measles. Increases in measles cases generally occurred in late winter and spring, every two to three years.
• In 1940, the death rate of measles was less than 1 in 100,000. (Dissolving Illusions pg. 192)
• Prior to 1963, measles cases were significantly underreported (according to the CDC, “measles cases probably approached 3.5 million per year, i.e., an entire birth cohort).” And it could have been as high as 5 million cases a year. Prior to the vaccine, nearly all children got measles by the time they were 15 years old, and children rarely went to the doctor because of it.
• In 1960, three years before the first measles vaccine was approved for use in the U.S., there were approximately 442,000 reported measles cases and 380 related deaths among the 3.5 to 5 million Americans who likely were infected with measles. (about .2 rate)
• In 1969, measles deaths were estimated at 1 in 10,000 reported cases. https://stacks.cdc.gov/view/cdc/818 
• When was measles eradicated? They first believed it could be eradicated by 1968, and then again by 1982. It was finally declared eliminated in the year 2000, when there were only 86 reported measles cases. (according to the WHO, eliminated means “the absence of endemic measles virus transmission in a defined geographical area (e.g. region or country) for at least 12 months in the presence of a surveillance system that has been verified to be performing well.”)
• From 2000 to 2007, there were an average of 63 reported measles cases per year.
•  In 2011, 220 cases were reported, usually associated with travelers returning from European and Southeast Asian countries.
• In 2015 – a multi-state outbreak linked to Walt Disney Land in California with no known outbreak source, but probably from an international traveler (147 cases). This caused a media surge and blame on parents of unvaccinated children. It was proven in 2017 that about half the cases were actually vaccine-strain measles
• 2019 – 1,282 cases in 31 states. 128 were hospitalized and 61 reported having complications.

WHAT CAUSED THE DECLINE? 

• The CDC attributes the decline of measles cases and deaths to the vaccine in the mid 1960’s. Is this true?
• The published morbidity and mortality data show that the death rate for measles had already dropped significantly (almost 100 percent) prior to the vaccine being introduced in 1963 (see chart). So, if not the vaccine, then what caused the decline in mortality? IMPROVED NUTRITION.
•  “Before the general nutrition status of European children reached the high level it is today, measles infection was something to be feared.” https://academic.oup.com/nutritionreviews/article/58/suppl_1/S46/1847390
•  “The high impact of the disease can be attributed to poor nutrition status, particularly with respect to vitamin A.” (same as above)
•  “High measles death rates are still reported in countries where children are undernourished and lack the vitamins and nutrients necessary to support the immune system. Yet statistics on measles mortality never distinguish the countries with good nutrition from those without, which leads the public to believe that measles is still something to fear.” (Dissolving Illusions pg. 340)
•  “Child mortality due to measles is 200-400 times greater in malnourished children in LDCs than those in developed countries. In addition, measles brings about acute malnutrition in marginally nourished children.” (this means that during a measles infection, their body is consuming even more of its limited nutrients, and they will do worse if not supplemented during infection.) https://pubmed.ncbi.nlm.nih.gov/3554780/
•  Other speculative causes of decline in reported cases of measles (not just deaths):

1.  the criteria for diagnosing was narrowed, excluding a lot of cases including vaccine-induced measles;
2. increased use of the immune serum globulin, causing a rashless infection that wouldn’t be reported;
3. naturally burning out, like smallpox, causing less diagnosed cases, also influenced by the rise in breastfeeding and improved nutrition status.

SUMMARY:

• Is it common? It is not common in the U.S., but it is still common and sometimes fatal in developing countries.
• Is it serious? Rarely
• Is it treatable? Only by supportive measures

MEASLES IN THE U.S. NEWS

• Measles, Back In The Days Before The Marketing Of the Vaccine https://www.youtube.com/watch?v=mDb0ZS3vB9g
• MEASLES FOR DUMMIES Highwire episode 
• Measles outbreak Disneyland 2015 https://www.cnn.com/2015/01/21/health/disneyland-measles/index.html
• Measles outbreak in New York 2019 https://www.washingtonpost.com/health/2019/09/03/new-york-city-declares-end-largest-measles-outbreak-nearly-years/
• Measles and Immune Amnesia https://www.tetyanaobukhanych.com/blog/should-you-be-afraid-that-measles-gives-you-immune-amnesia

VERIFIED MEASLES DEATHS IN THE U.S. SINCE 2000

• 2003 – 2 deaths https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5331a3.htm#:~:text=In%202003%2C%20two%20measles-related,and%20died%20in%20January%202003

1. The first was attributed to measles encephalitis in a child aged 13 years who had chronic granulomatous disease, received a bone marrow transplant in October 2002, and died in January 2003
2. The second measles-related death was in an international traveler aged 75 years infected in Israel who had measles pneumonitis and encephalopathy

• 2015  – 1 death https://www.google.com/amp/s/amp.usatoday.com/amp/29624385

1.  "The woman's measles was undetected and confirmed only through an autopsy, according to the Washington State Department of Health....The woman, who died of pneumonia, had other health conditions and was taking medications that suppressed her immune system, the health department said.

• Mumps is an acute viral infection that mainly affects salivary glands (near your ears) and can cause swelling of those glands. It used to be a common childhood illness, and it usually creates lifelong immunity. Most people who contract mumps completely recover in two weeks.
• In the 1960s, about 1 in 1,000 people caught mumps. 1 in 5,000 reported cases resulted in death, however, like measles, the symptoms were so mild that it was often unreported. Overall, 1 in about 4 million died in the population. 
• In the U.S. today, we typically get between 2,000 and 5,000 cases a year of mumps. However, since “up to 30 percent of people infected with mumps infection are asymptomatic and up to 50 percent may exhibit signs of a mild nonspecific illness, it is very likely that mumps infection rates are significantly higher than the number of reported cases.” (via NVIC.org)
• 20% of mumps cases have no symptoms
• The telltale symptoms include: swollen salivary glands which cause puffy cheeks, pain in your face, and pain while chewing or swallowing. Other symptoms can include fever, headache, muscle aches, weakness and fatigue, and loss of appetite.
• Mumps is highly contagious for about 9 days after symptoms appear. It is transferred via saliva droplets (sneezing/coughing) as well as through sharing utensils or cups with an infected individual. Symptoms typically appear 16-18 days after infection.
• COMPLICATIONS of mumps are rare but potentially serious and typically happen in adults rather than children. These complications usually involve inflammation in various parts of the body: testicles (orchitis) in 3-10% of cases; ovaries and/or breast tissue (oophoritis 1%); brain (encephalitis), membranes, and fluid around the brain and spinal cord (meningitis less than 1%); deafness (less than 1%); and pancreas (pancreatitis – pain in upper abdomen, nausea, and vomiting – less than 1%). Death from mumps is extremely rare.

RISK OF INFERTILITY

• Orchitis – swelling in one or both testicles in puberty-aged males. This is painful but very rarely leads to sterility.
• “Neither inflammation of the testicles nor inflammation of the ovaries caused by mumps has been shown to lead to infertility." https://www.cdc.gov/mumps/about/complications.html
•  “If you have had mumps-induced orchitis, the likelihood of having a fertility problem is reasonably low and permanent infertility is extremely unlikely.” https://livehealthy.chron.com/infertility-caused-mumps-1232.html
•  “In a relatively small number of cases, a dose of the mumps will stop a man's sperm production for up to a year, but thereafter it will recover. Sperm production may not go back to its previous level, but more often than not, the man will still be able to get his partner pregnant.” https://www.sharedjourney.com/mumps-and-male-infertility.html

TREATMENT

• There is no direct treatment or cure for mumps.
• Supportive measures include rest, cold compresses, pain relief, soft foods and soups, plenty of fluids.
• Basic naturopathic immune support can include vitamin A, C, and D, zinc, ginger tea, probiotics, NAC, etc.

HISTORY OF MUMPS IN THE U.S. (mainly sourced from nvic.org)

• Earliest reports of mumps date back to 5 B.C.
•  1945: the mumps virus was isolated
• Mumps was nationally reportable between 1922 and 1950
• The first mumps vaccine, Mumpsvax, was introduced in 1967. In 1968, the CDC resumed collecting data on mumps infections.
• Prior to widespread vaccination, there were mumps outbreaks in the U.S. every 2-5 years. these outbreaks were mainly among children (5-9 years old) and in crowded, confined populations (schools, military bases).
• A gradual decline of reported mumps cases: 1968 – 152,209; 1977 – 21,436; 1985 – 2,982
• A resurgence in cases from 1985 to 1987 (12,848 cases). Nearly 1/3 of these cases were in people age 15 or older.
• 1989: less than 700 reported mumps cases. This year the CDC’s ACIP recommended two doses of MMR due to the resurgence of measles in the U.S.
• 2005-2006 outbreak: 6,584 cases reported in Iowa, centralized around a university and among mainly vaccinated college students.
•  2009-2010 outbreak: mainly among adolescent Orthodox Jewish boys, majority of whom were previously vaccinated (4,603 cases)
• 2018: 2,251 reported cases of mumps in the U.S.

SUMMARY

•  Is it common? No
• Is it serious? No
• Is it treatable? No

MUMPS IN THE U.S. NEWS 

2009/2010 outbreak in New York among Jewish community that was mainly vaccinated 

• https://www.jta.org/2010/02/12/united-states/mumps-outbreak-hits-jewish-boys
• http://archive.boston.com/news/education/higher/articles/2010/02/12/jewish_youths_are_at_center_of_outbreak_of_mumps/  
• https://www.reuters.com/article/us-mumps-schooling-idUSBRE89U1UG20121031

2011 mumps outbreak at UC Berkeley – 29 cases, presumed source is an unvaccinated student who had recently traveled to Europe 

• https://sanfrancisco.cbslocal.com/2011/10/05/mumps-outbreak-reporterd-on-cal-campus/
• https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6148a2.htm

(  RUBELLA SECTION:  COMING SOON!  )

This little boy received the MMR vaccine at 14 months of age. Four months after MMR vaccination, he was diagnosed with SCID (Severe Combined Immune Deficiency Syndrome). He was diagnosed with autoimmune haemolysis and developed a persistent H1N1 infection. He received successful Stem Cell Therapy and his immune system improved, but six months after Stem Cell Therapy he started regressing and losing cognitive abilities, motor skills, and language. He developed seizures. His hearing was affected and he developed personality changes and behavioral changes.

Sound familiar?

After multiple hospitalizations, he died at 69 months of age.

On autopsy, vaccine-strain mumps virus was found in his brain and this was determined to be the cause of chronic encephalitis - FOUR YEARS AND SEVEN MONTHS AFTER HE WAS VACCINATED.

From the report:

"Using deep sequencing of fresh brain biopsy material, we identified the Jeryl Lynn 5 mumps virus (MuVJL5), a component of the measles, mumps, rubella (MMR) vaccine that had been administered to the child before the diagnosis of SCID. Similar to findings in measles viruses recovered from cases of SSPE, the mumps virus genome from the brain showed evidence of biased hypermutation, particularly in the matrix (M) gene. Comparison with sequence data from the original vaccine batch used to immunise this child identified the expansion of variants present at low frequency in the vaccine as well as de novo fixed missense substitutions. This case represents the first conclusive demonstration of chronic panencephalitis due to mumps virus." (from the MMR vaccine. And yes... it was the same strain used in both the UK and the US).

Here is the study