Parents want the best for their children, but sometimes what they perceive to be the best is actually detrimental not only to their children, but to their entire community. Such was the case in January this year, just north of Portland Oregon, where a measles outbreak occurred as a result of low vaccination rates. What started as a single case, grew rapidly to pandemic levels until a state of emergency was declared for all of Washington State on January 25^th, 2019. Measles is readily and effectively preventable by vaccination, but some parents believe that the potential side effects outweigh the risk of an actual measles infection. This is where the issue in Portland stemmed from; masses of unvaccinated children being infected and transmitting the infection to those around them. What caused a widespread state of emergency would have been prevented all together by a little prick in the arm.

The Anti-Vaccination Movement

The anti-vaccination (anti-vaccer) movement has been on the rise since the late 90’s, leaving many individuals at high risk for preventable infections. The movement stemmed from a single study by Andrew Wakefield in 1998. His study published that vaccines, namely the vaccination for Measles, Mumps, and Rubella (MMR), had been shown to cause autism in children. This study was proved fraudulent a few years later when it was found that Wakefield had skewed his results to accommodate those who had funded him (1). Although Wakefield was prohibited from practicing medicine, and his study was redacted, the rumors had already infected people’s minds (1,2). Hundreds of parents refrained from vaccinating their children on the belief that accepting the vaccination would cause autism to develop in later years. Thus communities across the US developed and named themselves the ‘anti-vaccers.’

Protesters in Oregon (7)

One of these communities is located in Portland Oregon, just south of Washington State. This community was the cause of the Measles pandemic which occurred earlier this year. Because they had refrained from vaccinating their children, their children were left susceptible to infection. It only took one case for the infection to spread like wildfire, and because there was such a large community of non-vaccinated children, the infection readily spread to the majority of them. Thus an entirely preventable pandemic broke out from a disease that had been nearly eradicated and took a devastating toll on an entire community.

How Vaccines Work

How Vaccines Work (3)

Vaccines do have side effects, but they are not anywhere near the magnitude of what Wakefield had claimed. Vaccines work by utilizing the body’s natural immune response. There are multiple types of vaccines such as live attenuated, inactivated, subunit, and more. Depending on the pathogen the vaccine is working against, the population in question, and the individual’s needs, different types of vaccines are chosen to best suit and protect each person. The MMR vaccine in particular, is a live attenuated vaccine, meaning that the bacteria in the vaccine are still living, but the disease causing components, or pathogenicity, has been deactivated. This allows for the preservation of antigenic sites in the vaccine, which are vital to form antibodies. These antigenic sites are specific to each pathogen and allow for recognition of pathogens in the immune system. Antigens are also remembered by the immune system, and will allow for immediate reaction and extermination from the immune system, so long as the body has retained the antigen.

Vaccines work by forcing the immune system to come in contact with an antigen in a safe form prior to any contact with the pathogenic form. Like any antigen, once it has entered the system it is digested and processed by immune cells, called macrophages. Macrophages destroy the invader and provide the genetic information to the T-cell. T-cells are lymphocytes, a type of immune cell, which are responsible for the recognition of antigens. These T-cells pair with B-cells, another lymphocyte to provide the information to create an antibody. B-cells are responsible for the production of antibodies, which are specific to each antigen to neutralize and destroy them. These cells have the potential to create multiple antibodies, but will have memory of specific antigens once they have already been introduced by the T-cells. This process allows the storage of antibodies to protect from future infection. Vaccines take advantage of this system to provide protection for pathogens which individuals have not yet come in contact with, or would be detrimental to their health.

MMR Vaccine

The MMR vaccine is used to protect individuals from Measles, Mumps, and Rubella. Each of these pathogens can be treated but also have the potential for long term effects or even death in certain cases. Measles in particular has the potential to cause pneumonia and subacute sclerosing panencephalitis (SSP). SSP is a degenerative disease which only appears 7-10 years after infection and is fatal in all cases. Because there is no cure or effective treatment, the only prevention for SSP is to avoid infection from Measles. This is best done with vaccination, with vaccination effectiveness at 97% with two doses (4). The question is whether the side effects of the vaccine outweigh the risk of infection.

 

MMR Vaccine (6)

As with any vaccine, there are side effects, many of which reflect a minor version of the pathogen they are protecting against. This is true with the MMR vaccine, as it can cause a minor rash and fever, both of which are characteristic of a typical Measles infection. The main concern with any vaccine is managing any allergic reaction to neomycin, which is the material that vaccines are often composed of. Aside from these, there are not many common side effects, especially autism. There is no definitive correlation between the MMR vaccine and the development of autism (5).

The Debate

The debate for whether or not children should be vaccinated has been developing for years now, with no sign of resolution. Often emotion trumps science when parents are looking out for the wellbeing of their children. Many questions in the debate are centered around who should be able to decide whether or not a child is vaccinated. The immune system has a greater teachability at a younger age, as well as a greater need for protection. Vaccinating children gives them the protection they so desperately need while allowing minimal side effects under monitored conditions. These facts only hold up until the fear of false side effects sets in. Many times in debates with worried parents, the most you can do is present the facts and hope they see reason. Reason, in the anti-vaccer debate, is what has the potential to stop pandemics and save the lives of many.

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References

[1] Hussain, Azhar et al. The Anti-vaccination Movement: A Regression in Modern Medicine Cureus vol. 10,7 e2919. 3 Jul. 2018. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122668/ [Accessed 20 March 2019]

[2] Wakefield, AJ et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 28 Feb. 1998. [online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/9500320 [Accessed 20 March 2019]

[3] Mayo Clinic Health Systems. Top 5 FAQ about vaccines. [online] Available at: https://mayoclinichealthsystem.org/hometown-health/speaking-of-health/top-5-faq-about-vaccines [Accessed 23 April 2019]

[4] Centers for Disease Control and Prevention. Measles Vaccination. [online] Available at: https://www.cdc.gov/measles/vaccination.html [Accessed 22 March 2019]

[5] Centers for Disease Control and Prevention. Pink book: Measles. [online] Available at: https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html [Accessed 23 March 2019]

[6] Science-Based Medicine. Still No Association Between MMR and Autism. [online] Available at: https://sciencebasedmedicine.org/still-no-association-between-mmr-and-autism/ [Accessed 22 April 2019]

[7] Statesman Journal. Parents protest Oregon vaccine bill as measles outbreak grows. [online] Available at: https://www.statesmanjournal.com/story/news/2019/03/07/parents-protest-oregon-vaccine-bill-measles-outbreak-grows/3099169002/ [Accessed 22 April 2019]

[8] State of Washington. PROCLAMATION BY THE GOVERNOR. [online] Available at: https://www.governor.wa.gov/sites/default/files/proclamations/19-01%20State%20of%20Emergency.pdf [Accessed 10 March 2019]

[9] World Health Organization. Measles. [online] Available at: https://www.who.int/immunization/diseases/measles/en/ [Accessed 10 March 2019]

[10] Centers for Disease Control and Prevention. Measles Cases and Outbreaks. [online] Available at: https://www.cdc.gov/measles/cases-outbreaks.html [Accessed 10 March 2019]

[11] Centers for Disease Control and Prevention. Signs and Symptoms. [online] Available at: https://www.cdc.gov/measles/about/signs-symptoms.html [Accessed 20 March 2019]

[12] Centers for Disease Control and Prevention. Complications of Measles. [online] Available at: https://www.cdc.gov/measles/about/complications.html [Accessed 20 March 2019]

[13] National Institute for Neurological Disorders and Stroke. Subacute Sclerosing Panencephalitis Information Page. [online] Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Subacute-Sclerosing-Panencephalitis-Information-Page [Accessed 20 March 2019]

[14] Goldstein, Natalie. Vaccines. Facts on File, Inc, 2010. [online] Available at: EBSCOhost, proxygsu-toc1.galileo.usg.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=357599&site=eds-live&scope=site. [Accessed 22 March 2019]

[15] Centers for Disease Control and Prevention. Understanding how Vaccines Work. [online] Available at: https://www.cdc.gov/vaccines/hcp/conversations/downloads/vacsafe-understand-color-office.pdf [Accessed 22 March 2019]

[16] Centers for Disease Control and Prevention. MMR (Measles, Mumps, & Rubella) VIS. [online] Available at: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html [Accessed 22 March 2019]

[17] Centers for Disease Control and Prevention. MMR and MMRV Vaccine Composition and Dosage. [online] Available at: https://www.cdc.gov/vaccines/vpd/mmr/hcp/about.html [Accessed 22 March 2019]

[18] Simon, KA, et. al. Evolution of the immune system in humans from infancy to old age. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707740/ [Accessed 25 March 2019]

[19] National Public Radio. Measles Cases Mount In Pacific Northwest Outbreak. [online] Available at: https://www.npr.org/sections/health-shots/2019/02/08/692665531/measles-cases-mount-in-pacific-northwest-outbreak [Accessed 10 March 2019]

[20] Centers for Disease Control and Prevention. Antigenic Characterization. [online] Available at: https://www.cdc.gov/flu/professionals/laboratory/antigenic.htm [Accessed 8 April 2019]

[21] OZ Bioscience. For Vaccination Research. [online] Available at: https://www.ozbiosciences.com/content/46-vaccine-adjuvants-vaccinationresearch [Accessed 8 April 2019]