had five of the Billboard top 15 songs, including top of the chart “Heartbreak Hotel.” Better yet, 1955 was the beginning of the end for measles in the United States. That year, 3–4 million people, mostly children, developed measles, with 450 deaths, about 50,000 hospitalizations, and 4,000 cases of encephalitis (infection in the brain which can cause permanent brain damage.). But during 1955, pediatricians at Boston Children’s Hospital were hard at work on a vaccine. The previous summer, a strain of measles had been sampled from an 11-year-old boy, David Edmonston. This strain was worked on in the lab, grown through many generations, until it was no longer likely to cause symptoms in humans, but would produce an antibody response.
After conducting tests in primates, the vaccine’s developers were ready to see what would happen in humans. They chose the traditional mad scientist route and injected their creation into themselves. All developed antibodies without any adverse reaction.
Fast forward to the year 2000 where Faith Hill’s “Breathe” tops the charts and there are 86 cases of measles in the United States instead of 3,500,000 and zero deaths instead of 450. Unfortunately, a British physician, Andrew Wakefield, had published a fraudulent paper in The Lancet two years earlier claiming the MMR (Measles, Mumps, Rubella) vaccine causes autism. He started a company to profit from this fabrication by testing for a nonexistent condition, “autistic colitis.” He also received $675,000 from lawyers wanting to sue drug companies that made the vaccine and who were now in need of patient “victims.” The goal for his company was to create hysteria regarding the MMR vaccine, generate lawsuits, and drive revenue by conducting expensive testing on the plaintiffs. A prospectus for his company estimated $43 million in annual revenue from litigation-driven testing.
A later review of the article he published in The Lancet demonstrated that of the 12 supposed cases of autism from the MMR vaccine, several of the children already had developmental problems prior to ever receiving a dose, a fact omitted from his paper, and several others did not have autism at all. Wakefield lost his job, he was stripped of his medical license, and The Lancet formally retracted his paper, calling it a fraud. He also was found to have falsified lab reports on the 12 children in his study.
Currently, worldwide about 145,000 children die of measles every year, mostly in Africa, India, and the far East.The vaccine can be administered in the developing world for $1 per dose, but there are many economic, social, and logistical barriers to immunization. In the United States, we are at risk for a recurrence of measles for a different reason—vaccine refusal. The scientific fraud perpetrated by Wakefield in The Lancet paper ignited a movement in which otherwise fairly mainstream parents are not vaccinating their children against potentially lethal diseases. It is particularly a problem in California. At my former elementary school in Los Angeles, for example, about 20% of the students are not immunized against measles, polio, or whooping cough. At Hawthorne Elementary in Beverly Hills, the numbers are closer to 25–30% unvaccinated. Some schools in the city have 40–50% of the kids unvaccinated. When the vast majority of kids are vaccinated, it can be very difficult for measles to spread through the population because human beings are the only known host for measles. But as vaccination rates fall below 90%, it is possible, as we’ve seen recently at Disneyland, for measles to make a recurrence. Legislation in California is pending that would reverse this trend.
Vaccine refusal didn’t start with those wacky Californians. David Edmonston, the 11-year-old boy from whom the current measles vaccine is derived, refused to vaccinate his own children against measles, claiming that it was a mild, self-limited disease, even though there were hundreds of deaths and thousands of children hospitalized the very year he was infected.
The current anti-vaccine movement is driven by two factors. The first, of course, is profit. Here, I quote Upton Sinclair: “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” Fraudsters with their books and websites and vitamins must create and then feed a core constituency—parents who can be swayed to not vaccinate their children against potentially lethal diseases, but who need the veneer of “scientific” cover to make themselves feel less guilty. The other factor is the neurobiological tendency of human beings to believe in conspiracy theories. From the faked moon landing, to the CIA assassination of president Kennedy, to the aliens at Area 51, it is just the nature of our species that some individuals are susceptible to the suspension of all critical intellectual faculties and believe in things which are completely false.
Some of my more libertarian-leaning readers might say that if parents are stupid enough to listen to nutjobs like Andrew Fleming or Andrew Mercola and their kids die of measles, well that is just Darwinian evolution at work. However, the problem is more complicated than that. First, the MMR vaccine is highly effective, but not 100% effective. As the rates of vaccine refusers go up and measles recurs in the community, there will be kids who get measles even though their parents made sure they had the appropriate immunizations. Also, the occasional child with a bone marrow transplant or other immunocomprise might not be able to receive an MMR since it is a live vaccine. Vaccination strategies depend on a component of what is called herd immunity. Herd immunity means that if most, but not all people in the population are immunized, then the disease won’t spread through the population. If there is only a 2 or 3 percent anti-vaccine fringe parents, their children are protected by the 98% of parents who vaccinate their children. As vaccine rates fall, measles can recur, as it has.
Measles can cause
brain inflammation acutely from which some,
but not all patients recover.
In our practice, we are checking for adequate measles immunity in all patients born after 1957. Patients born before then are generally considered immune since measles circulated widely during that time. When patients lack immunity, I am recommending they receive two doses of the MMR vaccine, at least 28 days apart. The MMR vaccine is not given to pregnant women or to patients with certain conditions that suppress the immune system, such as people on drugs like Enbrel or Humira.
Often, measles is a mild to moderate two week illness, but occasionally it produces a pneumonia which can be fatal. The other feared complications are neurologic. Measles can cause brain inflammation acutely from which some, but not all patients recover. In addition, measles can rarely cause a slow destruction of the brain that begins 7 or more years after recovery from an otherwise uneventful case of the measles. This rare, but devastating form of brain damage is called subacute sclerosing panencephalitis, or SSPE. Subacute means happening slowly, sclerosing meaning that scar tissue forms, and panencephalitis means inflammation of the entire brain. If you Google “Sarah Walton SSPE Video,” you can watch a mom who decided not to give her child the MMR vaccine talk on camera about SSPE and what it has done to their lives. She tells her story while tube feeding her 24 year old daughter. How anyone can promote vaccine refusal after seeing this video is beyond comprehension.
This, then, is the Heartbreak Hotel. Public health experts, virologists, immunologists, drug companies, pediatricians and others developed, tested, and distributed a vaccine which essentially eliminated measles in the United States fifteen years ago. Over two generations, we’ve probably saved 25,000 lives and prevented 200,000 cases of deafness and brain damage from measles. Now, owing to fraud, pseudoscience, and conspiracy theorists, it is just matter of time until children start dying from measles again.