Tag: rubella

Can Vaccines Cause Arthritis?

Many people think that vaccines can cause arthritis.

Vaccines and Arthritis

That’s not surprising, as there are many case reports associating vaccines and arthritis.

Arthritis is even listed as an adverse reaction in the package insert for the MMR vaccine.

While rubella vaccines can cause arthritis, so can a rubella infection.
While rubella vaccines can cause arthritis, so can a rubella infection.

And chronic arthritis is also listed as a table injury for vaccines containing the rubella virus.

Can Vaccines Cause Arthritis?

So that means that vaccines cause arthritis, right?

Actually, no, it doesn’t. At least not the type of arthritis that most people associate with the term arthritis.

Wait, what does that mean?

Vaccines do not cause juvenile arthritis or rheumatoid arthritis, for example.

“Rubella-containing vaccines (e.g. MMR) can cause mild, acute, transient arthralgia or arthritis, rarely in children but very commonly in certain adult women (between 10-25% of adult female vaccinees without preexisting rubella immunity), usually beginning 1-3 weeks after vaccination and then persisting up to 3 weeks. Other vaccines currently routinely recommended to the general population in the U.S. have not been shown to cause chronic arthralgia or arthritis.”

Do Vaccines Cause Arthralgia or Arthritis?

While rubella-containing vaccines can cause arthritis, it is a mild type of arthritis that is usually temporary, lasting about two days.

“Postpubertal females should be informed of the frequent occurrence of generally self-limited arthralgia and/or arthritis beginning 2 to 4 weeks after vaccination.”

MMR-II Package Insert

It is also rare in children.

And it also occurs after a natural rubella infection. In fact, up to 70% of adult women with rubella develop arthralgia or arthritis.

Of course, arthritis isn’t the rubella complication that we worry about…

During the rubella epidemic in the United States just before the rubella vaccine was developed, there were 2,000 cases of encephalitis, 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 babies born with congenital rubella syndrome.

Vaccines for Arthritis

Except for temporary arthritis after the rubella vaccine, not only do vaccines not cause arthritis, it is recommended that people with chronic arthritis get vaccinated.

“Keeping up with your vaccinations is always a smart move, but getting immunized is especially important when you have an autoimmune disease like rheumatoid arthritis (RA). Both RA and the medicines you take to treat it can increase your risk for infections.”

RA & Vaccinations

And one day, we might even have therapeutic vaccines for arthritis!

Rheumavax completed a phase I clinical trial in Australia a few years ago. That led to the development of a new drug, DEN-181, that is now in phase 1 trials.

What to Know About Vaccines Causing Arthritis

Rubella containing vaccines can cause mild, temporary arthritis, but mostly in postpubertal females and less commonly than after a natural rubella infection.

More on Vaccines and 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

Japan’s Rubella Outbreak Should Be a Warning About What Could Happen Here

Do you remember when we used to have rubella outbreaks in the United States?

There is a level 2 travel alert for Japan because of outbreaks of rubella.

Yeah, me neither, but in the rubella epidemics of the 1960s, rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome.

Japan’s Rubella Outbreak

Thanks to the rubella vaccine, the ‘R’ in the MMR, we rarely hear about rubella anymore.

Tragically, like measles and other vaccine-preventable diseases, rubella is coming back.

RubellaCongenital Rubella Syndrome
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There are still relatively few cases, but most of us would like to keep it that way.

The US had a big spike in rubella cases in the last 1980s.

We remember that with the return of measles in the late 1980s, rubella came back right along with it, causing 13 deaths and 77 cases of congenital rubella syndrome!

And that’s what is happening in many countries right now.

In Japan, for example, in addition to a rise in measles cases this year, they are seeing big outbreaks of rubella, with weekly totals exceeding 100 cases! These are numbers that are close to what they saw during outbreaks in 2013, a year that ended with 14,344 cases of rubella and 32 cases of congenital rubella syndrome.

Japan is on track to have a big rubella year.
Japan is on track to have a big rubella year.

And they are already reporting at least one case of congenital rubella syndrome, a 4 week old, which is not surprising, considering that they had nearly 3,000 cases of rubella last year.

A newspaper article in 1965 warned about the perils of rubella and congenital rubella syndrome.
A newspaper article in 1965 warned about the perils of rubella and congenital rubella syndrome.

Is that what we want to happen here too? Are folks looking forward to having to worry about babies being born with congenital rubella syndrome, a vaccine-preventable disease?

A vaccine-preventable disease that was declared eliminated in the United States in 2004.

More on Japan’s Rubella Outbreak

About those Stanley Plotkin Videos…

Stanley Plotkin is typically described as “a prominent figure in the history of vaccinology, whose work on vaccine development has led to a significant reduction in morbidity and mortality from infectious diseases in the second part of 20th century. “

Why?

For one thing, he developed the rubella vaccine that we still use today.

He also worked on vaccines against CMV, polio, chicken pox, rabies, and rotavirus.

What Did Stanley Plotkin Say While He Was Under Oath?

That’s not why anti-vaccine folks are talking about him these days, or maybe it is…

Mostly, they are misinterpreting comments he made during a videotaped deposition.

“Lori Matheson is fighting her ex-husband, Michael Schmitt, for the right to decide if their two-year-old daughter should be vaccinated.”

Michigan anti-vaccination case to goes to court

A videotaped deposition in a case involving parents who disagreed about vaccinating their daughter…

Even though it isn't his exact quote and anti-vaccine folks don't give you the full context of what he was talking about, it is clear that Dr. Plotkin simply meant that you can't prove a negative.
Even though it isn’t his exact quote and anti-vaccine folks don’t give you the full context of what he was talking about, it is clear that Dr. Plotkin simply meant that you can’t prove a negative.

What do anti-vaccine folks think he said?

“I would say it is logically true that you cannot say, you cannot point to proof that it doesn’t cause autism. ”

Stanley Plotkin, M.D.

No, he isn’t saying that vaccines are associated with autism.

“I could not say that as a, as a scientist or a logician. But I can say as a physician that, no, they do not cause autism, because as a physician, I have to take the whole body of scientific information into consideration when I make a recommendation for a child.”

Stanley Plotkin, M.D.

All he is saying is that you can’t definitively prove a negative.

One of the different things in communicating the fact that there is no link is that science and English are not really the same language. So when a scientist says, “We have no evidence that there’s a link between vaccines and autism,” what they’re really saying is, “We are as positive as someone can humanly be that there’s no link.”
Seth Mnookin explain it well – One of the different things in communicating the fact that there is no link is that science and English are not really the same language. So when a scientist says, “We have no evidence that there’s a link between vaccines and autism,” what they’re really saying is, “We are as positive as someone can humanly be that there’s no link.”

For example, just because I have never seen a black swan, I can’t use that as proof that black swans don’t exist somewhere. After all, I haven’t been everywhere.

“…scientists can be at a real disadvantage in this debate because they, by their nature, are careful in how they present their conclusions.”

Vaccines: Last Week Tonight with John Oliver (HBO)

What else do anti-vaccine folks have a problem with?

Remember the rubella vaccine he developed?

“After a detour to obtain credentials as a pediatrician, I returned to Wistarto work on rubella. Those years were fraught with advances and reverses, controversy and eventually vindication. The pandemic of CRS babies in 1964-65 was an important stimulus to research on the vaccine. “

Stanley Plotkin’s On the Occasion of the Presentation Of The 2002 Albert B. Sabin Gold Medal

During the rubella epidemic of 1964-65, there were 12.5 million rubella virus infections, which “resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with congenital rubella syndrome.”

And that’s just in the United States.

The controversy?

“There were only two fetuses involved in making vaccines. When fetal strains of, fibroblast strains were first developed, I was involved in that work trying to characterize those cells; but they were not used to make vaccines.”

Stanley Plotkin, M.D.

It is well known (this isn’t some shocking truth as some are trying to push) that some vaccines are made with fetal embryo fibroblast cells (the WI-38 and MRC-5 cells) from cell lines that are derived (they can replicate infinitely) from two electively terminated pregnancies (abortions) in the 1960s.

Those two fetuses weren’t the only two fetuses ever used in research though, they were just the only ones used to actually make vaccines.

“Human diploid cell strains (HDCSs) are batches of cells that are currently used for different purposes, including culturing viruses for the manufacturing of vaccines”

A brief history of human diploid cell strains.

They had to get to the point where they knew how to make vaccines in human cell lines though and that’s what he is talking about in the deposition.

“Q. In any event, so we have 76 in this study. Would you approximate it’s been a few hundred fetuses?


A. Oh, no, I don’t think it was that many. Probably not many more than in this paper. And I should stipulate that we had nothing to do with the cause of the abortion.”

It took some experimentation to find the right kind of cells and the right methods, but ultimately, they found that fetal embryo fibroblast cells were the best to use to grow many viruses.

Copies of those same cells are still used today.

What about the other “issues” brought up in the deposition?

Did he experiment on orphans, people who were mentally handicapped, or those who lived in third world countries?

“I don’t remember specifically, but it’s possible. And, again, I repeat that in the 1960s, that was more or less common practice. I’ve since changed my mind. But those were, that was a long time ago.”

Stanley Plotkin, M.D.

Those were different times, but Dr. Plotkin’s vaccine studies weren’t unethical and weren’t like what was done at Willowbrook, in which children were purposely exposed to hepatitis, with the justification that most of them ended up getting it anyway.

Surprisingly, in the early 1970s, there was still some debate about the ethics of doing experiments on children, and as you can see, using ableist language to describe children with a disability.
Surprisingly, in the early 1970s, there was still some debate about the ethics of doing experiments on children, and as you can see, using ableist language to describe children with a disability.

And from those times, experts developed the rules for how things are now done.

Ironically, anti-vaccine folks are pushing this stuff about Plotkin, but don’t understand why leaving kids completely unvaccinated and unprotected in a study is unethical.

“One is morally free to use the vaccine regardless of its historical association with abortion. The reason is that the risk to public health, if one chooses not to vaccinate, outweighs the legitimate concern about the origins of the vaccine. This is especially important for parents, who have a moral obligation to protect the life and health of their children and those around them.”

National Catholic Bioethics Center FAQ on the Use of Vaccines

Or why it’s immoral to push anti-vaccine propaganda or put others at risk to get a vaccine-preventable disease.

“Results indicate that the total number of cases of poliomyelitis, measles, mumps, rubella, varicella, adenovirus, rabies and hepatitis A averted or treated with WI-38 related vaccines was 198 million in the U.S. and 4.5 billion globally (720 million in Africa; 387 million in Latin America and the Caribbean; 2.7 billion in Asia; and 455 million in Europe). The total number of deaths averted from these same diseases was approximately 450,000 in the U.S., and 10.3 million globally (1.6 million in Africa; 886 thousand in Latin America and the Caribbean; 6.2 million in Asia; and 1.0 million in Europe).”

Olshansky et al on The Role of the WI-38 Cell Strain in Saving Lives and Reducing Morbidity

Dr. Plotkin’s work has helped save millions of lives.

“His achievements in vaccinology are on a scale that truly can be measured in lives saved and lives restored.”

On the Occasion of the Presentation Of The 2002 Albert B. Sabin Gold Medal

And that’s why anti-vaccine folks are attacking him.

More on Stanley Plotkin