Tag: arthritis

What’s the Difference Between the MMR and MMR-II Vaccines?

As most folks know, the original MMR vaccine, which combined the separate measles, mumps, and rubella shots, was licensed way back in 1971.

It included the original rubella vaccine, which was made with a duck embryo derivative of HPV-77 that was attenuated by passing it 77 times in monkey kidney cells.

Wait, what?

HPV?

Before the new conspiracy theories start, no, not that HPV.

It stands for High Passage Virus.

What’s the Difference Between the MMR and MMR-II Vaccines?

And while the vaccine worked, it didn’t work as well and caused more side effects than a RA27/3 rubella vaccine that was already approved in Europe

“Over the next decade, accumulating evidence led to changes in the United States. First, the duck embryo and dog kidney vaccine strains caused significant joint reactions [24–27]. Second, reinfection on exposure to wild rubella virus was demonstrated frequently with all strains except the RA 27/3 vaccine [28–30]. Third, the good safety record of the RA 27/3 vaccine in Europe, plus the majority opinion of scientists, led the US Food and Drug Administration to license RA 27/3. Important pressure for this decision came from Dorothy Horstmann at Yale, who was convinced by her comparative studies of rubella vaccines [31], and by Maurice Hilleman at Merck, who sought a better rubella strain for measles-mumps-rubella (MMR) vaccine.”

Stanley Plotkin on The History of Rubella and Rubella Vaccination Leading to Elimination

So that’s it, they just changed out the rubella component for one that was safer and worked better.

The new and improved MMR-II vaccine was approved by the FDA in 1978.
The new and improved MMR-II vaccine was approved by the FDA in 1978.

And of course, they did the appropriate clinical trials and got FDA approval for this updated vaccine.

The control group didn't get a vaccine during the study.
The control group didn’t get a vaccine during the study.

But did they compare the vaccines against a saline placebo?

“The inclusion of a seropositive control group allowed the rates of reaction to be viewed against the background symptoms unrelated to vaccine administration.”

Polk et al on A controlled comparison of joint reactions among women receiving one of two rubella vaccines.

They actually went a little further, in a double-blind, controlled cohort study comparing it to folks who didn’t receive any vaccine at the time of the study!

Why so many joint issues with the vaccine?

The studies were in adults, who seemed to have more side effects with the vaccine. Still, the side effects, including arthritis, were transient.

What about the idea that it was studied long enough before being approved?

Both the rubella component and the MMR-II vaccine were studied both before and after being approved. In fact, the MMR-II vaccine is probably the most studied vaccine in history!

Believe it or not, they include placebo-controlled trials.

A double-blind, placebo-controlled, cross-over MMR study in twins!

What was the placebo in the Finland twin trial?

“The injections consisted of 0.5 ml of vaccine 2-5 or placebo (the same product including neomycin and phenol-red indicator but without the viral antigens) and were administered subcutaneously by the nurse to the left deltoid or gluteal region.”

Peltola et al on Frequency of true adverse reactions to measles-mumps-rubella vaccine. A double-blind placebo-controlled trial in twins.

If that doesn’t sound like a placebo to you, keep in mind that the MMR vaccine doesn’t contain that many ingredients. Remember, MMR doesn’t contain aluminum or thimerosal. And if the placebo didn’t contain the antigens, then it likely didn’t contain all of the things that went into getting those antigens in the vaccine, such as cell cultures and albumin, etc.

Still, some folks aren’t going to be satisfied unless there is a study with a saline placebo.

“The four other vaccines were commercial products of Merck Sharp & Dohme. The placebo consisted of vaccine diluent.”

Lerman et al on Clinical and Serologic Evaluation of Measles, Mumps, and Rubella (HPV-77: DE-5 and RA 27/3) Virus Vaccines, Singly and in Combination

The vaccine diluent?

What’s that?

It depends on the vaccine, but for MMR-II it’s sterile water.

“Placebo DTP consisted of sterile saline which was dispensed into sterile Tubex syringes.”

Deforest et al on Simultaneous Administration of Measles-Mumps-Rubella Vaccine With Booster Doses of Diphtheria-Tetanus-Pertussis and Poliovirus Vaccines

The MMR vaccine was even tested in placebo controlled trials with other vaccines!

And like other vaccines, the MMR vaccine has been found to be safe, with few risks, and is definitely necessary.

More on the the Difference Between the MMR and MMR-II Vaccines

Autoimmunity as a Contraindication to Getting Vaccinated

Can your kids get vaccinated if they have an autoimmune disease?

Can your kids get vaccinated if you or another family member have an autoimmune disease?

Folks shouldn't be using 23andMe DNA testing to justify their not wanting to vaccinate their kids.
Folks shouldn’t be using 23andMe DNA testing to justify their not wanting to vaccinate their kids.

Can your kids get vaccinated if you did one of those 23andMe genetic risk type tests?

“Risks associated with use of the 23andMe GHR tests include false positive findings, which can occur when a person receives a result indicating incorrectly that he or she has a certain genetic variant, and false negative findings that can occur when a user receives a result indicating incorrectly that he or she does not have a certain genetic variant. Results obtained from the tests should not be used for diagnosis or to inform treatment decisions. Users should consult a health care professional with questions or concerns about results.”

FDA allows marketing of first direct-to-consumer tests that provide genetic risk information for certain conditions

Not surprisingly, in almost all cases, the answer is yes.

Autoimmunity as a Contraindication to Getting Vaccinated

That doesn’t mean that there aren’t some true medical reasons that kids shouldn’t be vaccinated.

“Contraindications (conditions in a recipient that increases the risk for a serious adverse reaction) and precautions to vaccination are conditions under which vaccines should not be administered. Because the majority of contraindications and precautions are temporary, vaccinations often can be administered later when the condition leading to a contraindication or precaution no longer exists. A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons. However, certain conditions are commonly misperceived as contraindications (i.e., are not valid reasons to defer vaccination).”

Vaccine Recommendations and Guidelines of the ACIP

Which autoimmune diseases are listed as contraindications to get vaccinated?

None.

Which autoimmune diseases are listed as precautions to get vaccinated?

There are just a few, including Guillain-Barré syndrome (DTaP, Tdap, and flu vaccines) and thrombocytopenic purpura (MMR), but they typically don’t mean that you can’t still get vaccinated. And the general precaution to avoid getting a vaccine during “moderate or severe acute illness with or without fever” would apply to a time when you are acutely sick with your autoimmune disease, but you would get vaccinated once your symptoms were under better control.

Other things about autoimmune diseases are simply misperceived as being contraindications or precautions to getting vaccinated. Or they are pushed as anti-vaccine propaganda to scare you away from getting vaccinated and protected or to help you get a fake medical exemption.

“…vaccines are able to prevent some infections in MS patients known to accelerate the progression of the disease and increase the risk of relapses.”

Mailand et al on Vaccines and multiple sclerosis: a systemic review

For example, not only do vaccines not cause multiple sclerosis, they are recommended because they can prevent vaccine-preventable diseases that can make the disease worse for many people.

And flu shots and other vaccines are highly recommended for kids with diabetes, as they are at high risk for flu complications.

Vaccines are safe and necessary, even, and sometimes especially, if you have an autoimmune disease.

And having a predisposition for an autoimmune disease, either because of your child’s family history, or because of the results of some genetic testing kit you ordered on the internet, certainly isn’t a reason to skip or delay your child’s vaccines and leave them unprotected. You’re not avoiding any of the triggers that can cause autoimmune disease and simply increase the risk that they will get a vaccine-preventable disease and get others sick.

More on Autoimmunity as a Contraindication to Getting Vaccinated

Do Vaccines Cause HSP?

Have you ever heard of HSP?

Children with Henoch-Schonlein purpura (HSP) typically have a purplish rash (purpura), joint pain and swelling (arthritis), and severe stomach pains. They can also have blood in their urine (hematuria).

Palpable purpura in a toddler with HSP, likely after a Mycoplasma pneumoniae infection.
Palpable purpura in a toddler with HSP, likely after a Mycoplasma pneumoniae infection. (CC BY-NC-SA 4.0)

While those can all be very scary symptoms, fortunately, they typically go away without any treatment.

What Causes HSP?

HSP, also known as IgA Vasculitis, is an autoimmune reaction.

“Henoch-Schönlein purpura is caused by an abnormal immune system response in which the body’s immune system attacks the body’s own cells and organs.”

What is Henoch-Schönlein purpura (HSP)?

We don’t know why some kids have this abnormal immune reaction.

We do know that it most commonly occurs after a viral upper respiratory tract infection, although other infections, including chickenpox, measles, and hepatitis, can also trigger HSP.

Do Vaccines Cause HSP?

HSP has been associated with almost anything, from medications and foods, to insect bites and exposure to cold weather, so it is not surprising that some folks would think that vaccines could be a trigger too.

There are even some case reports of children developing HSP after receiving a vaccine. It is important to remember that a case report is basically a gloried anecdote though. It is not the kind of high quality evidence you really want if you are trying to make a case trying to prove causality.

One small study did suggest an increased risk following the MMR vaccine, but it only looked at hospitalized children with HSP. And of 288 hospitalized children with HSP, only eight had received a recent vaccine.

A more robust study, Vaccination and Risk of Childhood IgA Vasculitis, recently found that common childhood vaccines did not significantly increase the risk of HSP.

What to Know About Vaccines and HSP

Since some vaccine-preventable diseases can cause Henoch-Schönlein purpura, there is no evidence that vaccines can cause HSP beyond isolated case reports, and the most recent evidence shows that vaccines do not cause HSP, parents should vaccinate their kids, even if they have had a previous episode of HSP.

More on Vaccines and HSP