More than a decade ago, British parents refused to give measles shots to at least a million children because of a vaccine scare that raised the specter of autism. Now, health officials are scrambling to catch up and stop a growing epidemic of the highly contagious measles virus.

This year, the U.K. has had more than 1,200 cases of measles, after a record number of nearly 2,000 cases last year. The country once recorded only several dozen cases every year. It now ranks second in Europe, behind only Romania.

Last month, emergency vaccination clinics were held every weekend in Wales, the epicenter of the outbreak. Immunization drives have also started elsewhere in the country, with officials aiming to reach 1 million children aged 10 to 16.

"This is the legacy of the Wakefield scare," said Dr. David Elliman, spokesman for the Royal College of Paediatrics and Child Health. He’s referring to a study published in 1998 by Andrew Wakefield and colleagues.

That work suggested a link between autism and the combined childhood vaccine for measles, mumps and rubella, called the MMR vaccine.

Several large scientific studies failed to find any connection, the theory was rejected by at least a dozen major U.K. medical groups and the paper was eventually retracted by the journal that published it.

Britain's top medical board stripped Wakefield of the right to practice medicine in the U.K., ruling that he and two of his colleagues showed a "callous disregard" for the children in the study. Wakefield took blood samples from children at his son's birthday party, paying them about 5 pounds each ($7.60) and later joked about the incident.

Still, MMR immunization rates plummeted across the U.K. as fearful parents abandoned the vaccine — from rates of over 90 percent to 54 percent. Wakefield has won support from parents suspicious of vaccines, including Hollywood celebrities like Jenny McCarthy, who has an autistic son.

Nearly 15 years later, the rumors about MMR are still having an impact. Now there's "this group of older children who have never been immunized who are a large pool of infections," Elliman said.

The majority of those getting sick in the U.K. — including a significant number of older children and teens — had never been vaccinated. Almost 20 of the more than 100 seriously ill children have been hospitalized and 15 have suffered complications including pneumonia and meningitis. One adult with measles has died, though it's unclear if it was the infection that killed him.

The first measles vaccines were introduced in the 1960s. They dramatically cut cases of the virus, which causes a distinctive rash. Since 2001, measles deaths have dropped by about 70 percent worldwide; Cambodia recently went more than a year without a single case.

Globally, though, measles is still one of the leading causes of death in children under 5 and kills more than 150,000 people every year, mostly in developing countries. Measles is highly contagious and is spread by coughing, sneezing and close personal contact with infected people; symptoms include a fever, cough, and a rash on the face.

Across the U.K., about 90 percent of children under 5 are vaccinated against measles and have received the necessary two doses of the vaccine. But among children now aged 10 to 16, the vaccination rate is slightly below 50 percent in some regions.

To stop measles outbreaks, more than 95 percent of children need to be fully immunized. In some parts of the U.K., the rate is still below 80 percent.

Unlike in the United States, where most states require children to be vaccinated against measles before starting school, no such regulations exist in Britain. Parents are advised to have their children immunized, but Britain's Department of Health said it had no plans to consider introducing mandatory vaccination.

Last year, there were 55 reported cases of measles in the United States, where the measles vaccination rate is above 90 percent. So far this year, there have been 22 cases, including three that were traced to Britain. In previous years, the U.K. has sometimes exported more cases of measles to the U.S. than some countries in Africa.

Portia Ncube, a health worker at an East London clinic, said the struggle to convince parents to get the MMR shot is being helped by the measles epidemic in Wales.

"They see what's happening in Wales, so some of them are now sensible enough to come in and get their children vaccinated," she said.

Clinic patient Ellen Christensen, mother of an infant son, acknowledged she had previously had some "irrational qualms" about the MMR vaccine.

"But after reading more about it, I know now that immunization is not only good for your own child, it's good for everyone," she said.

Related:

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• Autism, measles vaccine link further debunked
• Nearly half of US children late receiving vaccines

By Kate Kelland
Reuters

GlaxoSmithKline's Pandemrix swine flu vaccine has been linked to cases of the rare sleep disorder narcolepsy in children in a scientific study in England that confirms similar findings elsewhere in Europe.

The vaccine, more than 30 million doses of which were given during the H1N1 flu pandemic in 2009-2010, contains a booster, or adjuvant, and may have triggered an adverse immune reaction in some children at higher genetic risk of narcolepsy, scientists said in new research published on Wednesday.

Researchers at Britain's Health Protection Agency (HPA) who published the study in the British Medical Journal said the at least 14-fold increased risk they found had "implications for the future licensing and use of adjuvanted pandemic vaccines".

Narcolepsy is a life-long disorder and thought to be an autoimmune disease in which patient's immune system attacks the body's own cells. Its symptoms include frequent bouts of daytime sleepiness and in its severe forms it also causes night terrors, hallucinations and cataplexies - when strong emotions trigger a sudden loss of muscle strength.

Studies in Finland, Sweden and Ireland have also found a Pandemrix link to narcolepsy, and GSK says more than 800 cases linked to the shot have been reported in Europe.

A spokesman for the British drugmaker told Reuters on Wednesday: "We really want to get to the bottom of this and understand more about the potential role of Pandemrix in the development of narcolepsy."

He added, however, that GSK believes "the available data are insufficient to assess the likelihood of a causal association between Pandemrix and narcolepsy."

As Reuters reported earlier this month, scientists investigating the link further are homing in on the vaccine's adjuvant, a booster called AS03, and analysing whether its super-charging effect may have played a role.

According to the UK results, vaccination with Pandemrix at any time was associated with a 14-fold increased risk of narcolepsy, whereas vaccination within six months before onset of the disease was associated with a 16-fold increased risk.

"The increased risk of narcolepsy indicates a causal association," said the research team led by Liz Miller, a consultant epidemiologist with the HPA. They added, however, that because of variable delay in diagnosis, the risk may be overestimated because vaccinated children may have been referred to specialist sleep clinics more rapidly.

Scientists said the risk translated into around one in 50,000, lower than studies have found in other countries such as Finland and Sweden where Pandemrix was used more widely and the risk was around one in 16,000 to 17,000 children vaccinated.

In total, more than 30 million doses of the GSK shot were given in 47 mainly European countries during the H1N1 flu pandemic. It was not used in the United States.

The UK study looked at 75 children aged between four and 18 who were diagnosed with narcolepsy from January 2008 and who attended sleep centres across England. Eleven of the children had been vaccinated with Pandemrix before their symptoms began. 

Finn stressed that Pandemrix is the only vaccine linked to this problem: "There is nothing to suggest that it occurs after other flu vaccines or vaccines against other diseases." 

Narcolepsy is thought to be due to loss of function in cells called hypocretin cells in one of the brain's sleep centres.

John Shneerson, a consultant physician from the Respiratory Support and Sleep Centre at Papworth Hospital in Cambridge who co-led the UK study, said Pandemrix may have triggered an immune reaction against those cells, causing narcolepsy in some children who were genetically vulnerable.

Experts say around 25 percent of Europeans have a genetic profile making them more susceptible. Narcolepsy has no known cure, but specialist doctors say symptoms can be treated with drug combinations aimed at re-regulating the sleep-wake cycle. 

Jerry Lampen / Reuters file

A young child is vaccinated against the H1N1 flu virus in 2009. A new report says the US childhood vaccine schedule is safe.

It sounds plausible. The average baby gets 24 jabs in 24 months -- needle after needle piercing tender little thighs. Some get as many as five shots in a single doctor’s visit. Surely all this immune stimulation is overloading their little bodies, right?

It’s a seductive idea and one that makes sense, but only to people who don’t study the human immune system. A new report released on Wednesday suggests parents can let go of such concerns.

Nonetheless, government officials need to take these and other worries into account when they design future studies into vaccine safety, the Institute of Medicine committee advised.

“Our committee found no evidence that the childhood immunization schedule is not safe,” Ada Sue Hinshaw, Ph.D, dean of the graduate school of nursing at the Uniformed Services University of the Health Sciences and chair of the committee, told reporters in a conference call.

The Institute, one of the independent National Academies of Science, was asked to look at studies involving not the vaccines themselves, which have been shown numerous times to be safe, but at the schedule for their delivery.

Babies are vaccinated against diphtheria and tetanus, whooping cough and measles, chickenpox and bugs that cause meningitis, pneumonia and diarrhea. Some shots have to be given multiple times over a period of months to fully protect a child, and the schedule is based on when a child becomes vulnerable to infections, as well as when their immune system is developed enough to respond the vaccines.

“A number of concerned parents say the sched­ule is too ‘crowded’ and have requested flexibil­ity, such as delaying one or more immunizations or having fewer shots per visit,” the committee says in its report.

“Some parents have rejected the vaccines outright, arguing that the potential harm of their child suffering a side effect from the vaccine outweighs the well-documented benefits of immunizations preventing serious dis­ease. Other parents delay or decline immuniza­tions due to worries that family history, the child’s premature birth, or an underlying medical condi­tion may make them more vulnerable to compli­cations. Some simply distrust the federal govern­ment’s decisions about the safety and benefits of childhood immunizations.”

And delaying or refusing vaccination can cause harm -- not only to the children who are not fully vaccinated, but to those around them, the committee noted. “States with policies that make it easy to exempt children from immunizations were associated with a 90 percent higher incidence of whooping cough in 2011,” the report says.

The Centers for Disease Control and Prevention says the U.S. is having one of its worst outbreaks of whooping cough in 50 years and that 18 people, mostly very young babies, have died. 

Furthermore, the vaccines have been fine-tuned. "Although the number of vaccinations recommended is greater than ever before, the vaccines used in the current immunization schedule actually have fewer antigens (inactivated or dead viruses and bacteria, altered bacterial toxins, or altered bacterial toxins that cause disease and infection) because of developments in vaccine technology. From 1980 to 2000, the immunization schedule’s total number of antigens decreased by approximately 96 percent," the report reads.

More than 90 percent of U.S. children are fully vaccinated by the time they start kindergarten, but some states, cities and towns have rates below that. Depending on the infection, having less than 80 percent to 90 percent of the population vaccinated can cause outbreaks that endanger infants too young to be vaccinated, the elderly, and people such as cancer patients with suppressed immune systems.

And the report notes that most new parents today are too young to remember disease outbreaks of the 20^th century. More than 16,000 Americans children were paralyzed by polio in the 20^th century. None was last year, thanks to vaccines, the report notes. Smallpox, which once killed a third of its victims, has been completely eradicated by vaccination.

But the National Vaccine Program Office, the Health and Human Services Department agency that commissioned the report, needs to listen more to worried parents, said Dr. Albert Berg of the University of Washington in Seattle, who served on the committee.

“We recognize that parents have some concerns. We should understand those concerns,” Berg said in a telephone interview.

“We should be all on the same side on this topic. We all want a safe and effective vaccine supply.”

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Giving kids and teens in a New York community a third dose of the measles, mumps, rubella (MMR) vaccine likely helped halt a mumps outbreak in late 2009 and early 2010, according to a new report from the Centers for Disease Control and Prevention.

U.S. guidelines call for kids to get two doses of the MMR vaccine, one at age 12-15 months and the other at 4-6 years. But as evidence from the Orange County, New York, community shows, mumps can spread in very close quarters even when most young people have received both recommended doses.

The study covers a mumps outbreak in the Orthodox Jewish community, which researchers say began at a religious camp in the Catskill Mountains and was spread by a method of schooling involving close one-on-one contact between study partners, known as chavrusas.

In September through December 2009, close to 400 people became ill in one Orange County village and was concentrated at three local schools.

"Most of these outbreaks of mumps occur in very crowded settings," said Dr. Preeta Kutty, a CDC researcher who worked on the report. "Although the majority of the children (who got mumps) had received two doses of the vaccine, the intensity of exposure overcame that protection."

Because it can take a few days for mumps to cause symptoms, Kutty said infected students may have been exposing their study partners without knowing they were sick.

When other outbreak-control methods such as isolating sick children failed, public health workers stepped in and offered village students in grades 6 through 12 a third dose of the MMR vaccine in January and February 2010.

In their report on that intervention, Kutty and her colleagues found the rate of new mumps attacks in that age group dropped from almost 5 percent of kids in the three weeks before vaccination to 0.13 percent a few weeks after the extra doses were given.

Village-wide, mumps attacks fell from 0.86 percent to 0.21 percent, the research team reported Monday in Pediatrics.

The most common vaccine side effects were redness and swelling from the shot and achy joints and muscles.

Mumps is caused by a contagious virus that causes salivary glands to swell, as well as fever, headache and tiredness. Complications of a mumps infection include inflammation in the brain, testicles or ovaries.

Kutty said even among people in the New York village who didn't get a booster dose of the MMR vaccine, so-called herd immunity likely kept them protected. Out of 2,178 students who had already received two doses of the vaccine, more than 80 percent chose to receive a third during the outbreak.

Still, the researchers can't prove the vaccine was responsible for the drop-off in mumps cases. It's always possible the outbreak had already hit its peak and was on the decline anyway. They emphasized that the study doesn't mean everyone should get a third dose of the MMR vaccine. But in outbreaks, booster shots could be one tool when other infection-control strategies fail, they said.

"We have learned that providing a third dose may be effective in stopping an outbreak," Kutty said.

Dr. Saad Omer, from the Emory Vaccine Center in Atlanta, said that's an important lesson for dealing with future mumps outbreaks, both in the U.S. and elsewhere.

"The vaccine is so safe and the evidence is very reasonable now," Omer, who wasn't involved in the new study, told Reuters Health. "I think (a third vaccine) should be on the list of first-line options for decent-sized outbreaks."

Mumps outbreaks are most common in crowded settings such as college dorms and prisons, he added. So the recent outbreak in religious schools "is not all that unique."

Pediatrician and vaccine researcher Dr. Amanda Dempsey from the University of Colorado Denver said the Orange County outbreak was probably due to a combination of big families and crowded schools as well less than 100-percent MMR vaccine coverage.

She, as well as the study's authors, said the report also highlights the importance of following vaccination recommendations in early childhood.

The boy who first introduced mumps into the Catskill Mountain camp had himself contracted the disease during an outbreak in Britain, where concerns over vaccine safety had led to low vaccination rates. The boy had previously received the standard two doses of mumps vaccine.

"The main way that vaccine-preventable diseases get propagated is through people who aren't fully vaccinated," Dempsey said. "Even small drops in vaccine coverage can have major implications."

Related stories:

Vaccine scares may become more common

Mumps outbreak traced to face-to-face schooling

Whooping cough epidemic worst in 50 years

Two of the three members of a Maryland family who died of flu complications last month also had been infected with the drug-resistant bacteria commonly known as MRSA, according to a report released today (April 26).

All three family members who died were infected with the influenza A virus, and two were also infected with methicillin-resistant Staphylococcus aureus (MRSA), the report from researchers at the Centers for Disease Control and Prevention said. 

The cases serve "as a reminder that influenza can cause very severe illness and can result in death," the CDC researchers wrote.

News reports have identified the family members as Lou Ruth Blake, 81, and her children Lowell Blake, 58, and Vanessa Blake, 56, of Calvert County, Md. Three additional family members were infected with the flu and two needed to be hospitalized, but neither was infected with MRSA and both recovered, the report said.

People infected with both the flu and MRSA have a higher mortality rate than people infected with only the flu, according to the report.

Signs that a person is infected with both include a rapid worsening of symptoms, and signs of pneumonia.

Two of the three family members who died had been vaccinated against flu, according to the report. Although the influenza vaccine does not prevent all cases of flu, it remains the best method for preventing complications from influenza, the CDC said. The agency recommends that all people over 6 months of age be vaccinated against the flu. Hand washing and covering coughs and sneezes can also prevent the flu from spreading, according to the CDC.

People with severe respiratory illness should be treated with antiviral medications, the report said. In addition, when there's a high suspicion that a bacterial infection exists, treatment with antibiotics should be considered.

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By Rachael Rettner
MyHealthNewsDaily

A group of compounds used in a variety of products, including water-resistant clothing and microwave popcorn, may prevent childhood vaccinations from working properly, a new study says.

In the study, children who had higher concentrations of these compounds, called perfluorinated compounds (PFCs), in their blood had lower immune responses to diphtheria and tetanus vaccinations. An insufficient immune response to a vaccination can mean a child is actually vulnerable to catching a disease even though they've been vaccinated against it.

Indeed, the levels of antibodies in the blood of some children exposed to PFCs indicated they were not protected against these diseases by age 7.

"When we take our kids to the doctor's office to get their shots, we expect that the vaccines are going to work," said study researcher Dr. Philippe Grandjean, of the Harvard School of Public Health in Boston. "What we found was that there was an increasing risk that they didn’t work if the kids had been exposed to the PFCs," Grandjean said.

The study is provocative, but the findings are not of immediate public health concern, said Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University in Nashville. Despite the link found in this study, vaccines have largely protected the public against diphtheria and tetanus over the same period of time that PFCs have accumulated in the environment, Schaffner said.

"These are illnesses that have been virtually eliminated from children," in the United States, Schaffner said.

However, Schaffner said investigations into the link between vaccines' effectiveness and PFCs, along with other potential environmental hazards, should continue.

The study will be published tomorrow (Jan. 25) in the Journal of the American Medical Association.

PFCs have thousands of uses in manufacturing, and most people have the compounds in their bodies, Grandjean said. They are slow to break down and persist for many years in the environment.

Studies in animals have suggested PFCs may lower the body's immune response, but their impact on people's health is unclear.

Grandjean and colleagues analyzed data from 587 children living in the Faroe Islands, in the northern Atlantic Ocean between Scotland and Iceland. These islands were chosen because their inhabitants frequently consume seafood, which is associated with increased exposure to PFCs. Still, overall,levels of PFCs in this area are similar to those found in other countries, including the United States, Grandjean said.

The researchers measured levels of PFCs in the blood of 5-year-old children, and tested the children's  immune response to tetanus and diphtheria vaccinations at ages 5 and 7. The kids received complete vaccinations against these diseases, including a booster shot at age 5.

The higher the levels of PFCs were in the blood, the lower the children's response was to the vaccines.

A doubling of the exposure to PFCs was associated with a 49 percent lower level of blood antibodies in children at age 7, Grandjean said.

Children with some of the highest levels of PFCs were two to four times more likely to have antibodies in their blood at a level below what is thought to protect against these diseases.

The study "emphasizes the importance of making sure that the world does not pollute the natural environment," Schaffner said. "Clearly, greater efforts must be made to keep these perfluorinated compounds out of the environment," hesaid.

It's not clear exactly how people come to accumulate levels of PFCs in their body, so advice on how to avoid them may not necessarily work. But Grandjean said, "It would be prudent to avoid microwave popcorn [and] treatment of furniture, carpets, shoes and clothing with stain repellants," unless they are known not to contain PFCs.

Future studies into the health impact of PFCs should examine their effect on the immune system, Grandjean said. The researchers would also like to know if exposure to PFCs is associated with a reduced immune response to other vaccinations.

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