Tag: MMR vaccine

Vaccination Tragedies are Rare

Vaccines work to prevent at least 2 to 3 million deaths each year worldwide.

Tragically, either because of errors or contamination, vaccines can sometimes actually cause people to get sick.

This can happen when health workers:

  • use a reconstituted vaccine after six hours – live vaccines can quickly become contaminated if they are kept and used for too long a time
  • mixup diluents – in addition to using the wrong diluent vaccination tragedies can occur when a dangerous medication is used instead of a vaccine’s standard diluent
  • improperly handle vaccines – breaking the cold chain
  • a vaccine is given to someone with a true medical contraindication

Fortunately, these situations are rare.

History of Vaccination Tragedies

With billions of doses of vaccines being given each year, it is likely not surprising that we see some problems. But when many of those vaccines are being given to kids, even one mishap, especially if it leads to life-threatening complications, is too many.

That’s why many safe guards have been put in place in the manufacturer and distribution of modern vaccines, so that we don’t see these types of vaccine tragedies:

  • the Cutter Incident, when, in 1955, at least 56 people developed polio and 5 children died after being vaccinated with inactivated polio vaccine that was poorly manufactured by Cutter Laboratories and still contained live polio virus
  • hepatitis-contaminated yellow fever vaccines – some lots of yellow fever vaccines used in the military in 1942 were unintentionally contaminated with the hepatitis B virus
  • the Lubeck Disaster – 75 children died and others got tuberculosis in 1929 Germany after there was a mixup between the BCG vaccine and the strain of Mycobacterium tuberculosis that causes tuberculosis. The BCG vaccine was supposed to be made with a weakened strain of Mycobacterium bovis bacteria instead.
  • the Bundaberg incident – 12 children died in Australia in 1928 after being given contaminated diphtheria vaccine from a multidose vial without preservative
  • tetanus contaminated smallpox vaccine in the 1890s and early 20th century

Although vaccines are much safer now, some rare incidents still occur.

Fifteen infants died and 75 children got sick in Syria in 2014 after they received a neuromuscular blocking agent, atracurium, instead of the measles vaccine they were supposed to get. How? The measles vaccine that was being used is mixed with a diluent, but instead of using the proper diluent, the health worker unintentionally used a bottle of atracurium instead.

In 2015, at least two kids died and 29 got sick in Chiapas, Mexico, among 52 children who were vaccinated. The children were reportedly given a BCG vaccine, the rotavirus vaccine, and/or a hepatitis B vaccine that day. However, the only vaccine that all of the sick children received in common was the hepatitis B vaccine. Since 130,000 doses from the same batch of vaccines had been given in the area, it was not thought to be a manufacturing problem or widespread issue. It was instead bacterial contamination of hepatitis B vaccine vials at that one clinic.

Fifteen children died in 2017 in a village in South Sudan after a poorly trained team that wasn’t adhering to WHO immunization safety standards used the same syringe to reconstitute measles vaccines over a four day period. They also didn’t keep the vaccine vials refrigerated.

“A single reconstitution syringe was used for multiple vaccine vials for the entire four days of the campaign instead of being discarded after single use. The reuse of the reconstitution syringe causes it to become contaminated which in turn contaminates the measles vaccine vials and infects the vaccinated children.”

Statement regarding findings of joint investigation of 15 deaths of children in Nachodokopele village, Kapoeta East County in South Sudan

As you can imagine, the conditions that led to these tragedies aren’t present when most kids get vaccinated.

Even in developing countries, most children get vaccinated by people adhering to WHO immunization safety standards. Why did they happened then? Both Syria and South Sudan have been rocked by war for years, leading to a breakdown in the ability to provide routine health care, even as basic as getting kids vaccinated. And Comunidad La Pimienta, Simojovel, Chiapas is a very poor part of southern Mexico.

These kinds of tragedies aren’t going to happen at your pediatrician’s office, as they don’t even have drugs like atracurium.

What Happened in Samoa?

Two toddlers died after being vaccinated at Safotu Hospital in Samoa.
Two toddlers died after being vaccinated at Safotu Hospital in Samoa.

In Samoa, four years after the deaths of the children in Syria, we are once again hearing about reports of deaths after kids were vaccinated with the MMR vaccine.

Two children in Samoa, both one-year-olds, died within minutes  of being vaccinated on the same day in the same hospital on the island of Savai’i.

Not surprisingly, as health officials investigate the cause, use of the MMR vaccine had been suspended in Samoa.

So what happened?

“Until the investigations have been completed and reported on we cannot say what did happen.

However, given the batch of vaccine involved had been in use in that country since August last year, and given the same batch of vaccine has been used in South American countries and the Caribbean island nations without incident, it seems unlikely that there was anything wrong with the vaccine.

The reports from the parents of the children affected on Friday indicate the reactions occurred within minutes after vaccination. This would preclude a response to the vaccine viruses as this takes at least a week. While anaphylaxis occurs within minutes and can be fatal when not treated the odds of seeing this twice in a day at the same place, given a chance of 1 in a million doses, is literally astronomical.”

Dr. Helen Petousis Harrison on What happened in Samoa?

Since it happened so quickly, it sounds like it could have been a mix-up with the diluent, as happened in Syria. A five dose vial of MMR is used in Samoa, which means that unlike premixed vaccines, it does have to be mixed with a diluent.

What about contamination? It is known that vaccine vials can be contaminated with Staphylococcus bacteria if they are mishandled. Although Staphylococcus bacteria can directly cause infections, they can also release a toxin that can cause toxic shock syndrome (TSS).

Considering how quickly these children got died though (within minutes), it isn’t likely that the vaccines became contaminated with Staphylococcus toxins. There have been reports of TSS following vaccination in the past, usually with vaccines that don’t use preservatives, but symptoms typically develop over four to 24 hours.

“This particular vaccine batch lot arrived to Samoa in August 2017 and has been in use since then. The same vaccine batch lot used in Samoa is also in use in a number of South American and Caribbean countries (Belize, Ecuador, St. Vincent, Trinidad Tobago, Chile, Aruba, Dutch Antilles, St. Kitts & Nevis and Cuba) with no reports of adverse events from those countries.”

Government of Samoa – Ministry of Health Press Statement

Could this be related to what happened to two other children in Samoa who had died after getting their MMR vaccines?

Almost certainly not. Those children, siblings, died years earlier, one in 2015 and the other in 2017. Neither died immediately after being vaccinated and there are reports that they may have had some kind of an immunodeficiency syndrome that contributed to their deaths.

“A number of media outlets are already covering these tragic events, speculating on the cause of death before the investigation is completed, and the stories have been picked up by the anti-vaccination movement.”

Government of Samoa – Ministry of Health Press Statement

That some folks would use these rare tragedies to scare parents from vaccinating and protecting their kids is shameful. But that’s the modern anti-vaccine movement…

What to Know About Vaccination Tragedies

Kids shouldn’t get sick or die after getting vaccinated. Fortunately, they rarely do, except in extreme circumstances that can make it more likely for errors to occur.

More on Vaccination Tragedies

Measles Deaths in Italy

There have been a lot of measles deaths in Europe over the last few years?

How many?

Would you believe over 100?

Measles Deaths in Italy

Among those measles deaths in Europe, there have been at least eight measles deaths in Italy (four in 2017 and another four in 2018, among just 6,601 cases), including:

Why so many deaths in a developed country with a well-nourished population?

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S.
Dr. Bob Sears actually reassured parents that measles wasn’t deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe – another well-nourished population with lower vaccination rates than the U.S.

If you haven’t guessed yet, as in other countries in Europe, we are seeing more deaths from measles simply because folks aren’t vaccinated and more people are getting measles.

Measles is a life-threatening disease, even in an age of modern medicine, indoor plumbing, sewage systems, clean water, whole foods, vitamins and minerals, etc.

Italy, with about 1/5 the population of the United States, but about equal to the size of California, has had over 600 times as many cases of measles as we have had in the United States over the last few years. To put it in perspective, that would be like having 33,000 cases of measles in the United States.

Think it couldn’t happen? During the measles outbreaks from 1989 to 1991, when vaccination rates had dropped, there were 55,622 cases and 123 deaths in the United States.

Measles in Italy

Again, in Italy, as in other places, almost all of the measles cases, about 90%, have been in those who aren’t vaccinated.

In response to a post praising Italy's decision to dilute their new vaccine laws, some folks thought it was funny that people were dying of measles.
In response to a post from Dr. Bob Sears praising Italy’s decision to dilute their new vaccine laws, some folks thought it was funny that people were dying of measles.

That’s why they passed new vaccine laws – to get back to herd immunity levels of vaccination.

But shouldn’t folks have a choice about getting vaccinated?

Of course.

Even with the new vaccine laws, parents have a choice. As with vaccine laws in the United States, Italy’s new vaccine mandates had nothing to do with forced vaccination.

That’s unlike most of the people who died of measles in Italy. Most of them didn’t have a choice about being vaccinated and getting measles. Some were immunocompromised and couldn’t be vaccinated and at least one was too young to be vaccinated.

Parents had been set a July 10th deadline to provide schools with the relevant documentation, but it will now be possible for parents to simply submit their own confirmation that the child has been vaccinated, according to Giulia Grillo, Italy’s Health Minister, who was speaking at a press conference on Thursday.

Mandatory vaccinations: Italian parents will no longer need to provide doctor’s note

And that’s why it’s unfortunate that the a newly elected government severely watered down a vaccine law that had made getting vaccinated mandatory to go to school.

And it’s unfortunate that people continue to push misinformation about vaccines and vaccine-preventable diseases.

What to Know About the Measles Deaths in Italy

A drop in vaccination rates has led to measles outbreaks and a number of measles deaths in Italy.

More on Measles Deaths in Italy

Is Mutating Mumps More Than the MMR Can Manage?

It is not news that we have been seeing more cases of mumps in recent years.

It is also isn’t news that many of these folks are vaccinated.

“Long Beach has been hit with a mumps outbreak that is vaccine-resistant. According to health officials in the Long Island town, almost two dozen individuals are believed to have contracted the virus, with four confirmed cases and at least 14 suspected ones.”

Natural News

That sites like Natural News is putting out misinformation about vaccine-resistant strains of mumps also shouldn’t be news to anyone.

Why Do Folks Think That Vaccine-Resistant Viruses Are Causing Mumps Outbreaks?

So are vaccine-resistant mumps viruses causing outbreaks?

There is no good evidence of that and plenty of evidence that our current vaccines, even though they aren’t perfect, do cover all wild strains of mumps.

Unfortunately, it might not be surprising that some folks are confused about vaccine-resistant mumps viruses, when we have health officials saying things like:

“Sometimes nature throws a strain at us that might have mutated a little bit, and coverage of the vaccine is not 100 percent.”

Dr. Lawrence Eisenstein, Nassau County Health Commissioner

Dr. Eisenstein’s “might have mutated a little bit” comment got twisted into “the outbreak is most likely attributable to a new strain of the virus that is resistant to vaccines” by health reporters

And out of Arkansas, where there have also been large mumps outbreaks:

“We are actually to the point that we are worried that this vaccine may indeed not be protecting against the strain of mumps that is circulating as well as it could.”

Dr. Dirk Haselow, Arkansas State Epidemiologist

Of course, to say that the vaccine may not be protecting folks “as well as it could” doesn’t mean it doesn’t work because the wild type mumps virus has evolved or mutated enough to surmount our current MMR vaccine.

Is Mutating Mumps More Than the MMR Can Manage?

Although anything is possible, we fortunately have plenty of research that says that the mumps virus hasn’t mutated and that the MMR still works.

During an outbreak, universities make sure students are up-to-date with their MMR vaccines.
During an outbreak of mumps, some kids are getting a third dose of the MMR vaccine.

In fact, although the MMR vaccine is made from the A strain or genotype of mumps, it provides good protection against all 12 known strains of wild mumps viruses, including genotype G that has been causing most of the recent outbreaks.

But how can it cover a different strain of virus that isn’t in the vaccine?

Because not all viruses and vaccines are like influenza.

“The genotyping of the mumps virus is based on the Small Hydrophobic (SH) protein, a nonstructural protein and genetically the most variable one. Based on the SH-protein 12 different mumps viruses were detected up to now. In recent epidemics in Western countries the genotype G was mainly detected, while the mumps viruses used in the live attenuated mumps vaccines belong to genotype A (Jeryl Lynn) and to a lesser extent to genotype B (Urabe). However, antibodies against the SH protein have not yet been observed in human serum. It is, therefore, unlikely that antibodies against the SH protein play an important role in antibody-mediated virus neutralization.”

Sabbe et al. on The resurgence of mumps and pertussis

It is well known that you need a very specific match of the flu vaccine to the wild flu virus that is going around to get good protection, but for many other viruses, the differences that determine the strain or genotype have nothing to do with how antibodies will recognize the virus.

“Since mumps virus is monotypic, vaccine from any strain should provide lifelong protection against subsequent infection.”

Palacios et al. on Molecular Identification of Mumps Virus Genotypes from Clinical Samples: Standardized Method of Analysis

Like measles, mumps is a monotypic virus.

“Studies have demonstrated that blood sera from vaccinated persons cross-neutralizes currently circulating mumps strains.”

CDC on Mumps for Healthcare Providers

And like measles, the mumps vaccine (MMR), protects against all strains of wild mumps viruses.

“Compared with attack rates of 31.8%–42.9% among unvaccinated individuals, attack rates among recipients of 1 dose and 2 doses of the Jeryl Lynn vaccine strain were 4%–13.6% and 2.2%–3.6%, respectively.”

Dayan et al. on Mumps Outbreaks in Vaccinated Populations: Are Available Mumps Vaccines Effective Enough to Prevent Outbreaks?

And like other vaccines, the mumps vaccine (MMR) works.

Waning immunity may be an issue, but that certainly isn’t a reason to skip or delay this vaccine and put your kids, and everyone else, at risk to get mumps.

What to Know About Mumps Strains and Outbreaks

The MMR vaccines covers all strains of mumps and getting fully vaccinated is the best way to make sure your kids don’t get mumps.

More on Mumps Strains and Outbreaks

Costs of a Measles Outbreak

The endemic spread of measles was eliminated in the United States in 2000, but unfortunately, that hasn’t stopped us from having outbreaks of measles each year.

Since reaching a record low of just 37 cases of measles in 2004, other milestones in the measles timeline we should all know about include that there were:

  • 220 measles cases in 2011, a 15-year record and the highest number of cases since 1996 at least until 2014, when we had at least 667 cases
  • 58 cases in the 2013 New York City measles outbreak and for a short time, the largest outbreak since the endemic spread of measles was eliminated in the United States
  • 382 cases in the 2014 measles outbreak in Ohio and now the largest outbreak since the endemic spread of measles was eliminated in the United States
  • 170 measles cases in the first few months of 2015, including a large outbreak in California that was linked to Disneyland.
  • 188 cases and a measles death in 2015

That’s still far below where we used to be though, especially when you consider that before the first measles vaccine was licensed, there was an average of about 549,000 measles cases and 495 measles deaths in the United States each year.

Containing a Measles Outbreak

Several factors help to limit the measles outbreaks that we continue to see in the United States. Most important is that fact that despite the talk of personal belief vaccine exemptions and vaccine-hesitant parents not getting their kids vaccinated, we still have high population immunity.

In the United States, 90.8% of children get at least one dose of the MMR vaccine by the time they are 35 months old and 91.1% of teens have two doses. While not perfect, that is still far higher than the 81% immunization rates the UK saw from 2002 to 2004, when Andrew Wakefield started the scare about the MMR vaccine. Instead of overall low immunization rates, in the U.S., we have “clusters of intentionally under-vaccinated children.”

It also helps that the measles vaccine is highly effective. One dose of a measles vaccine provides about 95% protection against measles infection. A second, “booster” dose helps to improve the effectiveness of the measles vaccine to over 99%.

To further help limit the spread of measles, there are a lot of immediate control measures that go into effect once a case of measles has been suspected, from initiating contact investigations and identifying the source of the measles infection to offering postexposure prophylaxis or quarantining close contacts.

That’s an awful lot of work.

A 2013 measles outbreak in Texas required 1,122 staff hours and 222 volunteer hours from the local health department to contain.

Costs of a Measles Outbreak

In addition to requiring a lot of work, containing a measles outbreak is expensive.

A study reviewing the impact of 16 outbreaks in the United States in 2011 concluded that “investigating and responding to measles outbreaks imposes a significant economic burden on local and state health institutions. Such impact is compounded by the duration of the outbreak and the number of potentially susceptible contacts.”

We still don’t know what it cost to contain many big outbreaks, like the ones in New York City and Ohio, but we do know that it cost:

  • over $2.3 million to contain the 2017 outbreak in Minnesota – 75 people got measles, 71 were unvaccinated, and more than 500 people were quarantined over a 5 month period
  • up to an estimated $3.91 million (but likely much more) to contain the 2015 outbreaks in California
  • two unrelated cases in Colorado in 2016 cost $49,769 and $18,423, respectively to investigate
  • $50,758.93 to contain an outbreak at a megachurch in Texas
  • $150,000 to contain (13 cases) an outbreak in Cook County, Illinois
  • $223,223 to contain (5 cases, almost all unvaccinated) to contain another outbreak in Clallam County, Washington, an outbreak that was linked to the death of an immunocompromised woman.
  • more than $190,000 of personnel costs in Alameda County, with 6 cases and >700 contacts, it is estimated that over 56 staff spent at least 3,770 hours working to contain the outbreak
  • $5,655 to respond to all of the people who were exposed when a 13-year-old with measles was seen in an ambulatory pediatric clinic in 2013
  • $130,000 to contain a 2011 measles outbreak in Utah
  • $24,569 to contain a 2010 measles outbreak in Kentucky
  • $800,000 to contain (14 cases, all unvaccinated) a 2008 measles outbreak at two hospitals in Tuscon, Arizona
  • $176,980 to contain a 2008 measles outbreak in California
  • $167,685 to contain a 2005 measles outbreak in Indiana – unvaccinated 17-year-old catches measles on church mission trip to Romania, leading to 34 people getting sick, including an under-vaccinated hospital worker who ends up on a ventilator for 6 days
  • $181,679 (state and local health department costs) to contain a 2004 measles outbreak in Iowa triggered by a unvaccinated college student’s trip to India
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994.
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994. How much did these outbreaks cost to contain?

It is important to keep in mind that these costs are often only for the direct public health costs to the county health department, including staff hours and the value of volunteer hours, etc. Additional costs that come with a measles outbreak can also include direct medical charges to care for sick ($14,000 to $16,000) and exposed people, direct and indirect costs for quarantined families (up to $775 per child), and outbreak–response costs to schools and hospitals, etc.

We should also consider what happens when our state and local health departments have to divert so much time and resources to deal with these types of vaccine-preventable diseases instead of other public health matters in the community. Do other public health matters take a back seat as they spend a few months responding to a measles outbreak?

There were 220 cases of measles in the United States in 2011. To contain just 107 of those cases in 16 outbreaks, “the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

In contrast, it will costs about $77 to $102 to get a dose of the MMR vaccine if you don’t have insurance. So not only do vaccines work, they are also cost effective.

What to Know About the Costs of a Measles Outbreak

Containing a measles outbreak is expensive – far more expensive than simply getting vaccinated and protected.

More on the Costs of a Measles Outbreak

Can I Give My Kids Tylenol When They Have Their Vaccines?

Many parents ask about acetaminophen (Tylenol) when kids get their vaccines.

Is it okay to give kids Tylenol when they get their shots?

The Tylenol and Vaccines Controversy

As you can probably guess, there is no real controversy about Tylenol and vaccines.

Instead, what we are talking about are the myths surrounding Tylenol and vaccines that anti-vaccine folks have created, including that:

  • giving Tylenol right before a child gets their shots somehow increases the risk that they will have side effects
  • giving Tylenol right after a child gets their shots somehow masks the symptoms of serious vaccine damage
  • giving Tylenol after the MMR vaccine is associated with developing autism

Fortunately, most parents understand that like other anti-vaccine misinformation, none of these statements are true.

Why do some folks believe it?

Well, there have been studies warning people about giving Tylenol before vaccines. It had nothing to do with side effects though. They suggested that a vaccine might be less effective if the child got Tylenol before his vaccines. It is important to note that they never really found that the vaccines didn’t work as well, as all of the kids in the study still had protective levels of antibodies, they were just a little lower than kids who didn’t get Tylenol.

Other studies have found the same effect if Tylenol was given after a child got his vaccines. Although interestingly, other studies have found that giving Tylenol after vaccines does not affect antibody titers.

“Antibody titres to diphtheria and tetanus toxoids and pertussis bacteria of the placebo (n = 25) and acetaminophen (n = 34) groups did not differ significantly from each other. It is concluded that acetaminophen in a single dose schedule is ineffective in decreasing post-vaccination fever and other symptoms.”

Uhari et al on Effect of prophylactic acetaminophen administration on reaction to DTP vaccination

Giving Tylenol after the MMR vaccine is not associated with autism.
Giving Tylenol after the MMR vaccine is not associated with autism.

The only thing that this had to do with side effects though, is that the kids who got Tylenol had a little less fever.

Could giving Tylenol mask something like encephalitis, which some anti-vaccine folks think can be vaccine induced?

Nope. It typically can’t even keep someone from getting a febrile seizure.

What about the association of MMR, Tylenol and autism? Although one study did suggest that to be true, the study, a parental survey, was found to be “fatally flawed.”

Can I Give My Kids Tylenol When They Have Their Vaccines?

So, can you give your kids Tylenol when they get their vaccines?

The better question is, should you give your kids Tylenol either before or after they get their vaccines?

Have some Tylenol or Motrin on hand after your kids get their vaccinations, just in case they need a dose.
Have some Tylenol or Motrin on hand after your kids get their vaccinations, just in case they need a dose. Photo by Vincent Iannelli, MD

Notwithstanding the very small chance that giving Tylenol might cause decreased immunogenicity (lower antibody production) if you give it before your kids get their vaccines, since there is a good chance that they won’t have any pain or fever and won’t even need any Tylenol, then why give it?

Skip the “just in case” dose and wait and see if they even need it.

What about afterwards?

If your kids have pain or fever and are uncomfortable, then you should likely give them something for pain or fever control, such as an age appropriate dose of either acetaminophen or ibuprofen. Will that cause lower antibody production? Maybe. Will that mean that their vaccines won’t work. That’s doubtful. It certainly won’t lead to increased side effects though, unless they a reaction to the dose of Tylenol itself.

Should you give a pain or fever reducer after a vaccine “just in case?” Again, there is a good chance that your kids might not need it, so it is likely better to wait and see if they do, instead of giving a dose automatically after their shots.

There is even some evidence that giving acetaminophen or ibuprofen before vaccines, or as a routine dose right after, especially with booster shots, doesn’t really prevent side effects that well anyway. They work better if given on an as needed basis instead, and these kinds of doses are less likely to be associated with decreased antibody production.

What to Know About Tylenol and Vaccines

Giving a pain or fever reducer either before or after your child’s vaccinations likely won’t affect how it works, but since it often isn’t necessary, it is likely best to only given one, like Tylenol or Motrin, if it is really needed.

More on Tylenol and Vaccines

Can MMR Shedding Start a Measles Outbreak?

Have you ever noticed that any time that there is a new outbreak of measles, folks tend to ask the same basic questions.

How did the outbreak start?

Why weren’t they vaccinated?

Was it from shedding?

Wait, what?

Shedding??? Really?

Can MMR Shedding Start a Measles Outbreak?

It seems that the idea that the MMR vaccine sheds and can lead to measles outbreaks is one of those anti-vaccine myths that just won’t go away.

It comes back with each new measles outbreak.

The myth that MMR shedding leads to measles outbreaks is commonly spread on Facebook, like this discussion on a recent outbreak at a Kansas City daycare center.
The myth that MMR shedding leads to measles outbreaks is commonly spread on Facebook, like this discussion on a recent outbreak at a Kansas City daycare center.

While the oral polio vaccine is indeed associated with shedding and vaccine associated disease, that doesn’t happen with MMR. Experts don’t even recommend any restrictions for use of the MMR vaccine for household contacts of people who are immunosuppressed. And yes, your kids can even visit a cancer patient if they just had their MMR, as long as they don’t have RSV, the flu, or some other contagious disease.

What about the fact that a study once found measles virus RNA in the urine of of kids who had recently been vaccinated? Doesn’t that mean that they were shedding the vaccine virus?

No. It doesn’t.

To be considered shedding, those measles virus RNA particles in their urine would have to be contagious. Now, measles is spread by respiratory secretions. So how are measles virus RNA particles in urine going to become airborne and get someone else sick?

They don’t.

Another Facebook post about MMR and shedding.
Most measles outbreaks in daycare centers have been started by an unvaccinated child or worker who traveled out of the country.

But what about that case in Canada? Anti-vaccine folks like to bring this up when they talk about shedding. In 2013, there was a case of vaccine-associated measles. That proves that the vaccine sheds, right?

Absolutely not!

“Of note, only one case report of transmission from vaccine-associated measles has been identified.”

Murti et al. on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013

That child got measles about 5 weeks after she was vaccinated in the middle of a measles outbreak. Because she had no links to the other cases and she tested positive for vaccine-strain measles, it is thought that she had MMR vaccine-associated measles, which is extremely rare.

Shedding Light on Measles Outbreaks in Daycare

MMR shedding is not causing outbreaks of measles – or rubella and mumps, for that matter.

If shedding from the MMR, by any method, got kids sick, then why aren’t there even more cases of measles?

Daycare centers everywhere have a mix of infants and toddlers, including some who are intentionally unvaccinated, those who are too young to get their first MMR, and those who are just getting vaccinated.

When a case of measles does pop up though, it isn’t because of shedding, it is typically because someone who wasn’t vaccinated traveled out of the country, got measles, and brought it back home, exposing others.

What to Know About MMR and Shedding

Measles outbreaks are not caused by shedding from the MMR vaccine.

More on the MMR and Shedding

Recommendations for Reporting on Measles Outbreaks

Unfortunately, we hear news reports about measles outbreaks a lot more than we should.

We don’t get much information in many of those news reports though…

Anatomy of a Measles Outbreak Report

The big reason we don’t get a lot of information in those news reports is that many of them are simply repeating health department press releases.

A news release from the Texas Department of State Health Services.
A news release from the Texas Department of State Health Services.

Those press releases often leave a lot of important information out though.

Although that information might not be available yet, if you are a journalist covering a measles outbreak, instead of simply repeating the health department news release, you might call the local or state health department and ask a few questions:

  • Where did the person get measles? Most cases these days are imported – an unvaccinated person travels out of the country and returns home with measles, starting an outbreak. If they didn’t recently travel out of the country, then there’s a problem – where did they get measles? Unless there is already an ongoing outbreak in the area, then that means someone else in the area has measles that we don’t know about.
  • Where did the person go while they were still contagious and might have exposed others?
  • Hold old are they and were they vaccinated?

Do we have a right to this information? While the Health Insurance Portability and Accountability Act (HIPAA) protects a person’s medical information, those rules don’t necessarily always apply in an emergency or outbreak situation. Plus, you are still getting de-identified information.

“Health care providers may share patient information with anyone as necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public.”

HHS on HIPAA Privacy in Emergency Situations

How is knowing someone’s vaccination status going to be helpful? Unvaccinated folks tend to cluster together, so knowing the person is unvaccinated, especially an unvaccinated child, might indicate that many more people have been exposed. But then, most measles outbreaks are started by someone who is unvaccinated…

Important Points for Covering Measles Outbreaks

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
The symptoms of measles include a high fever, cough, runny nose, and red, watery eyes. The rash doesn’t start until 3-5 days later, as the fever continues. Photo by Jim Goodson, M.P.H.

In addition of covering the basics about the person with measles, there are other important points to cover, especially that measles is a vaccine-preventable disease!

Two doses of the MMR vaccine offers great protection against measles, and is especially important if you are unvaccinated and are going to travel out of the country. Even infants as young as six months old should get an MMR before international travel.

While most people hopefully know all that, they may not know:

  • the vaccination rates in your area schools
  • the non-medical vaccine exemption rates in your area schools
  • the number of measles cases in your area and in your state over the past few years
  • that measles is very costly to contain
  • that the incubation period for measles is 10 to 21 days after you were exposed, so it can take that long before you show symptoms
  • that they should warn their doctor or hospital before getting evaluated so that they can make sure you don’t expose other people, as measles is very, very contagious
  • that the quarantine period for unvaccinated people who have been exposed to someone with measles is typically up to 21 days after their last possible contact
  • that a dose of MMR within three days of exposure can help prevent your child from getting measles if they aren’t already fully vaccinated
Vaccine preventable diseases are just a plane ride away.
Vaccine preventable diseases are just a plane ride away.

You should also consider interviewing and quoting a local pediatrician and reinforcing the facts that vaccines work and they are safe.

And obviously, as we see with these outbreaks, vaccines are necessary.

You should avoid also false balance in your reporting.

You should fully cover each outbreak in your area, as they help remind people to get vaccinated and protected.

What to Know About Reporting on Measles Outbreaks

Journalists can help reduce the size of measles outbreaks with good reporting that vaccines work and that they are safe and necessary and by reminding folks to get vaccinated and protected.

More on Recommendations for Reporting on Measles Outbreaks