Given the current outbreaks of mumps in the U.S. and the similar surge in measles the last few years, the last thing employee health professionals need is people avoiding the MMR vaccine and not immunizing their children.
As this issue went to press, there were mumps outbreaks reported in California, Arkansas, Illinois, and Edmonton, Canada.
Undiagnosed cases — particularly of highly transmissible measles — can set off a laborious and expensive scramble to determine worker exposures and existing immunity.
As employee health professionals are aware, proof of healthcare worker immunity to mumps includes:
- written documentation of vaccination with two doses of live mumps or MMR vaccine administered at least 28 days apart;
- laboratory evidence of immunity;
- laboratory confirmation of disease; or
- birth before 1957.
Could such outbreaks of vaccine-preventable diseases become more common, threatening to tip herd immunity? Public health advocates are concerned that the thoroughly refuted link between the MMR vaccine and autism will resurface in the current political climate. Longtime vaccine safety critic Robert F. Kennedy, Jr. and actor Robert DeNiro recently offered a $100,000 prize to anyone that can prove vaccines are safe.
Specifically, the challenge cited is to “find a peer-reviewed scientific study demonstrating that thimerosal is safe in the amounts contained in vaccines currently being administered to American children and pregnant women.”1
The FDA concluded in a 1999 review of the issue that there was “no evidence of harm from the use of thimerosal as a vaccine preservative, other than local hypersensitivity reactions.”2 Nevertheless, the use of the mercury-containing preservative has been largely phased out, with the FDA reporting that the vast majority of vaccines for children 6 years of age or younger marketed in the U.S. contain no thimerosal or only trace amounts.
“The fact that thimerosal was voluntarily withdrawn has become something in and of itself, a rallying cry that there was something tainted about it the first place, which is untrue,” says William B. Miller, Jr., MD, scientific advisor to OmniBiome Therapeutics, which includes vaccine research. “The idea was the methyl mercury at allowable amounts is difficult to gauge, so let’s not allow any if we can. It is true that how you make the vaccine and what you use for stabilizers has changed over time. It is true that vaccinations can have adverse effects. We recognize there are straightforward allergic reactions, particularly to egg products that are part of the manufacturing stabilization process. So it’s not as if there is absolutely 100% safety. There is a risk to everything you ever do in life.”
That said, thimerosal and mercury have basically been removed from vaccines down to trace levels for at least a decade, he says.
“And the incidence of autism is rising,” Miller says. “The cause and effect was not only established in the first place, but now there is an indication that there was never any linkage because the incidence is continuing to change despite the fact that the additive that the objection is based upon has been removed.”
Earlier this year, Kennedy was reportedly in discussions with then-president-elect Donald Trump about possibly forming a vaccine panel of some sort, but as of press time it was unclear whether that will be pursued.
The mere mention of forming such a panel alarmed public health officials, says William Schaffner, MD, a professor of preventive medicine at Vanderbilt University in Nashville. “[Kennedy] visited the president-elect, came out and made that statement, and then the [Trump] transition team walked that back, so that’s in flux at the present time,” he says. “Many of us are concerned that the integrity of vaccines would be challenged by such a presidential commission. Much of the concerns about vaccines are unfounded, and particularly this myth that autism is related to vaccination. As a scientific and public health question, that is now settled. There is no association between autism and vaccines.”
The concern stems in part from a September 16, 2015, Republican presidential debate, when then-candidate Donald Trump linked vaccines to autism by citing the amount of immunizations given in a short period to babies and young children. The comments were roundly condemned by the medical community, with the American Academy of Pediatrics (AAP) calling them both false and dangerous.
The theory gained traction after publication of a later-retracted study in Lancet that falsely suggested MMR vaccine administration triggered the onset of autism in children.3 However, it appears that much of the autism increase has been due to changing definitions — “diagnostic substitution” — that have increased the number of intellectual disabilities defined as autism. This surveillance artifact accounted for a 64% increase in autism diagnosis from 2000-2010, researchers concluded.4
Despite the preponderance of evidence, the anti-vaccine message has had an effect, particularly in the uptake of the MMR vaccine. A 2015 study estimated that some 9 million U.S. children were susceptible to measles, a disease that had been virtually eradicated in the U.S. through routine vaccination.5 While these unvaccinated children run the risk of a serious or complicated infection, they also pose a transmission threat to infants too young to be vaccinated and others who are contraindicated for vaccination or can mount little immune response even if given MMR.
REFERENCES
- Feldman, K. Robert F. Kennedy Jr. and Robert De Niro are offering $100,000 to anyone who can provide proof that vaccines are safe. New York Daily News Feb. 15, 2017: http://nydn.us/2ks3Sx3.
- FDA. Thimerosal in Vaccines Questions and Answers. July 31, 2105: http://bit.ly/2mYDFUi.
- Editors of The Lancet: Retraction — Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 2010;375:445.
- Polyak A, Kubina RM, Girirajan S. Comorbidity of intellectual disability confounds ascertainment of autism: implications for genetic diagnosis. Am J Med Genet B Neuropsychiatr Genet 2015;168(7):600-608.
- Bednarczyk R, Orenstein WA, Omer, S. Estimating the Number of Measles-susceptible Children in the United States Using the NIS-Teen. Poster 1866. IDWeek Oct. 7-11 2015. San Diego, CA.
Given the current outbreaks of mumps in the U.S. and the similar surge in measles the last few years, the last thing employee health professionals need is people avoiding the MMR vaccine and not immunizing their children.
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