Running Header: MEASLES VACCINES

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MEASLES VACCINES

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Measles Vaccines: Breaking Through Incorrect Beliefs

Name Withheld

University WithheldAbstract

The purpose of this paper is to educate its readers, specifically the students and Professor of English Composition II, about Measles, Mumps, Rubella (MMR) vaccinations and the controversy surrounding them. They will learn about why parents choose not to vaccinate their children, and how that choice endangers not only their own children, but most everyone around them as well. It will discuss the false belief of a connection between the MMR vaccine and Autism Spectrum Disorder (ASD), and where this originated. In writing this, my hope is that the reader leaves with an understanding of the importance of proper vaccinations, and why a parents opinion about their childs vaccinations is secondary to societal safety.

Keywords: Measles, Mumps, Rubella (MMR), Autism Spectrum Disorder (ASD)

Measles Vaccines: Breaking Through Incorrect Beliefs

Around December 20th, 2014, a person or family believed to have originated either in Europe or the Philippines, went on a vacation to Disneyland, in California. They, knowingly or not, were infected with measles. A large number of park-goers and employees that day, and in the weeks to come, were subsequently infected by the same strain of the virus. According to Center for Disease Control (CDC) statistics, from December 28, 2014 (The first reported case) to February 20, 2015, about 133 people across seven states were identified as having this particular strain of measles. At 77% of all national cases of measles, this is a textbook definition of an outbreak (CDC a, 2015, para. 1). Measles outbreaks in America today happen because many parents, through lack of information or willful denial of facts, still refuse to vaccinate their children- a highly irresponsible decision to make. But how did this happen? Didnt the United States declare measles to be eliminated from the county in 2000? In short- yes. The definition of an eliminated virus is the absence of continuous disease transmission for 12 months or more. (A specific strain of) Measles is no longer endemic (constantly present) in the United States (CDC b, 2015, para. 2). The virus can still enter the country by a carrier from any other nation, especially those with substandard medical and hygiene practices. Immediately following the elimination in the early 2000s, the annual number of people reported with measles was between 35 and 45. However, that number has been steadily growing every year, culminating with a high of 644 reported cases in 2014. This is a disturbing trend.How important has this vaccine been to the public as a whole? Before the start of the National Measles Vaccination Program in 1963, it is estimated that there were approximately 3 to 4 million people getting measles each year in the United States. Out of those, between 400 and 500 died, 48,000 were hospitalized, and 4,000 developed encephalitis (swelling of the brain) every year from measles. Compare that to 2013, when there were just 159 confirmed cases and no deaths (CDC b, 2015, para. 11).Measles is both a highly contagious, and easily preventable virus that can have dangerous and sometimes deadly results. Between seven to 14 days after infection, the infected person will display high fever, cough, runny nose, and conjunctivitis. (Red, watery eyes) Two or three days after symptoms begin, tiny white spots may appear inside the mouth. Three to five days after symptoms begin, a rash breaks out, usually starting on the face at the hairline, and spreading downwards to the neck, trunk, arms, legs and feet. Small raised bumps may also appear on top of the rash, which may become joined together as the rash spreads across the body. When the rash appears, a fever may spike to more than 104 Fahrenheit. After a few days, the fever subsides, and the rash fades (CDC c, 2014, para. 1, 2). Opposition to vaccination will often cite their own childhood experiences saying they were merely kept out of school for a few days until the rash went away, and that was the end of it. Unfortunately, this is not always the case. One out of every 10 children with measles will develop an ear infection, which can result in permanent hearing loss. In less than one in ten patients, severe diarrhea can be experienced. As many as one out of every 20 children with measles will get pneumonia, the most common cause of death from measles in young children. About one child out of every 1,000 who gets measles will develop encephalitis (swelling of the brain), that can lead to convulsions, and can leave the child deaf or with intellectual disability. For every 1,000 children who get measles, between one and two will die. Measles can also cause pregnant women to give birth prematurely or have a low birth weight baby (CDC d, 2014, para. 2-4).

With all the complications that can happen, it would seem that the sane decision for any parent would be to vaccinate their child as soon as they are able. And yet, unsurprisingly, the largest amounts of outbreaks in America seem to always coincide with areas that have a high concentration of parents who have personal objections to vaccination. This is irresponsibility at its worst, and it is my opinion that this should be classified as child endangerment.

Why would any parent refuse to vaccinate their child from a nearly completely preventable virus? There are a few reasons, some holding slightly less logic than others. The first is the misbelief that the Measles, Mumps, and Rubella (MMR) vaccine can cause autism in a small percentage of children. This belief stems from a single 1998 research paper in The Lancet; a highly respected, peer-reviewed English medical journal. In reality, the authors practices were brought into question even before the paper was published. Subsequent investigations revealed that the author had several conflicts of interest, had manipulated evidence, and broken other ethical codes. The Lancet partially retracted the paper in 2004, and fully retracted it in 2010; the same year that the papers author was stripped of his medical license by the English Medical Register. Following the initial claim in 1998, multiple large studies were conducted to look for a connection between Autism Spectrum Disorder (ASD) and the MMR vaccine. Reviews of the evidence were conducted by the Center for Disease Control, (CDC) the American Academy of Pediatrics, the Institute of Medicine of the US National Academy of Sciences, the UK National Health Service, and the Cochrane Library. All found no link between autism and the vaccine. And yet because of the widespread reporting of the claims in the original paper, vaccination rates fell sharply in the western world. One 2011 journal article even went so far as to refer to the Lancet paper as the most damaging medical hoax of the last 100 years (Flaherty, 2011, p. 1302-1304).Additionally, the vaccine additive that the paper pointed to as the supposed culprit, a mercury-based preservative named Thiomersal, was phased out of all routine childhood vaccines due to the controversy, despite no legitimate evidence being found to substantiate the claims (Bigham, 2005, p 89-101). Also, a new paper just released in the top neuroscience journal, Neuron, (Lin et al, 2015, p. 742-754) describes how the genes known to be connected to autism are active during fetal brain development. In simple terms, there is an extremely good chance that autism is something youre born with, not something caused by an external source later in life- especially one as inconsequential as a preservative.Another reason some parents would refuse vaccinating their child from something preventable is the resurgence of the holistic, all-natural lifestyle. These parents want all natural foods for their children, all natural soaps for them to clean with, and as few additives, preservatives, pesticides and chemicals in their lives as possible. These are the same parents who will talk endlessly about the dangers of genetically modified organisms, (GMOs) without ever even stopping to consider that virtually all food we come in contact with today has been genetically modified. They simply feel that the chemicals in the vaccine are unproven, despite countless peer-reviewed studies on the vaccine since its release in 1963. They often feel that the human immune system is powerful enough to overcome any virus it encounters. (Black Plague, anyone?) If this were the case, one in 1,000 children would not be dying from measles complications every single year. A common argument from anti-vaccination campaigners claims if they choose not to vaccinate their child, it shouldnt matter to those of us who do vaccinate. How could our family be at risk if we vaccinate? Thats a valid enough question. Regarding measles, there are four groups of people.

In the first group, two doses of the vaccine provide immunity for most who receive it. In group two, roughly three percent of vaccinated children do not develop a lasting immune response. This group is not fully protected against measles, and if exposed, will likely contract the illness.Group three is the unvaccinated; whether by refusal or because they are too young to receive it. Exposed, unvaccinated children have a 90% chance of becoming infected with measles.

Fourth, there are people- especially children- who cant be vaccinated. Those with cancer. Those who are immunocompromised. Those who are truly allergic to all or a part of a vaccine. (Such as anaphylaxis to egg) These people remain at risk. They cannot be protected, except by vaccinating those around them. This is called herd immunity, when the general population of a group reaches a certain percentage of vaccination and is therefore immune to true outbreaks within the group. This is why refusal to vaccinate is so critically damaging. Not only are those parents putting their own childs life in danger, but also the lives of children and adults around them as well. Effective herd immunity for measles requires vaccination of approximately 95% of an able population. This is one of the highest herd immunity requirements of all diseases or viruses, simply because it is so easily transmitted. Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, the measles virus can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected. Infected people can spread measles to others from four days before to four days after the rash appears (CDC e 2014, para. 1).The vaccine used to prevent measles today is a live attenuated vaccine; that is; it was developed using a live measles virus that was weakened (attenuated) and therefore could no longer cause the disease. It has been modified several times to make it safer (further attenuated) and today is extremely effective in preventing measles outbreak. Anti-vaccination parents act as though they believe vaccines are thought up in a board meeting and released that same day onto an unsuspecting public. In reality, nothing could be further from the truth. Before any vaccination is released to be used on a public scale, it is tested and retested so thoroughly that the process would make even the most difficult Obsessive-Compulsive Disorder patient smile to observe. Peer review takes new meaning when it comes to anything to be injected into ones body. With all this in mind, all anti-vaccination parents should reconsider their position on the issue, and decide if digging their heels in is really worth putting their childs life in danger as well as the lives of those around them. References

Bigham, M., & Copes, R. (2005). Thiomersal in vaccines: balancing the risk of adverse effects with the risk of vaccine-preventable disease. Drug Safety, 28(2), 89-101. doi:10.2165/00002018-200528020-00001

In this paper, Bigham and Copes discuss the movement to remove thiomersal from vaccines as a precautionary measure. They comfortably use highly credible references like the World Health Organization, and effectively use facts and numbers to enhance their position.

The First Author is a Clinical Professor at the University of British Columbia. He is commonly approached when an expert in blood services, vaccines and pathogens is needed. He brings credibility to this paper simply by the background he has established.

CDC a: Center for Disease Control., (2015).Measles cases and outbreaks http://www.cdc.gov/measles/cases-outbreaks.html para. 1

The Center for Disease Control is the American subject matter expert agency concerning any virus, infection, or disease currently known to man. The cases and outbreaks they reference on their page reflect the most accurate information available in the United States today.

Despite having some of the most technically adept scientists on staff, the Center for Disease Control never fails to present all data and information in a highly user-friendly format that is accessible to any American. The goal of their website is education and advocacy, and allows me to piece critical data into a single report much more easily.

CDC b: Center for Disease Control., (2015). Frequently Asked Questions about Measles in the U.S. http://www.cdc.gov/measles/about/faqs.html para. 1, 2, 11 CDC c: Center for Disease Control., (2014). Signs and Symptoms of Measles http://www.cdc.gov/measles/about/signs-symptoms.html para. 1, 2

CDC d: Center for Disease Control., (2014). Complications of Measles http://www.cdc.gov/measles/about/complications.html para. 2-4

CDC e: Center for Disease Control., (2014). Transmission of Measles http://www.cdc.gov/measles/about/transmission.html para. 1

Flaherty, D., (2011). The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science. Annals of Pharmacotherapy, 45(10), 1302-1304 doi:10.1345/aph.1Q318

A slightly more argumentative paper, Flaherty nevertheless maintains professionalism while deftly navigating the Andrew Wakefield paper and the highly damaging effects it has had on society in the western world as a whole. Flaherty is careful not to restrict his discussion of the damage done to just the United States, but to places like England as well.

The Wakefield paper, while devastating for parental confidence in vaccinations, is an extremely important piece of MMR vaccination background today, and Flahertys methodical and thorough explanation is just the right amount of information I was seeking for my own paper.

Lin, G., Corominas, R., Lemmens, I., Yang, X., Tavernier, J., Hill, D., Vidal, M., Sebat, J., Iakoucheva, L. (2015). Spatiotemporal 16p11.2 Protein Network Implicates Cortical Late Mid-Fetal Brain Development and KCTD13-Cul3-RhoA Pathway in Psychiatric Diseases. Neuron, 85(4), 742-754 doi:http://dx.doi.org/10.1016/j.neuron.2015.01.010

In the paper referenced in this highly-touted neural psychology journal, much ground-breaking neural hypothesis and discoveries are discussed. The study focused on copy number variants (CNVs) in particular regions that have previously been connected to ASD. However, they learned that not all CNVs were activated during the same growth period. Activation of various CNVs was staggered throughout fetal development. The two genes, known as KCTD13 and CUL3, have ASD-associated mutations, and become activated around the middle of development. These genes regulate the protein RhoA, which is crucial to brain development. RhoA is responsible for the development and maintenance of neurons, while also assisting in the regulation of their migration.This collaborated group of researchers, headed up by Lilia Iakoucheva, has expertise and credibility in surplus. Dr. Iakoucheva holds a Ph.D. in molecular biology and immunology. An assistant professor at the University of California, San Diego; she has previously worked with the Pacific Northwest National Laboratory as well as the Rockefeller University. The paper is very transparent and specific about their methods, and there is a high likelihood that the results of this paper can ultimately lead to ground-breaking therapies.Self-Reflection Discussion

This essay was a good and bad for me. Good because I had researched the material previously for my informative essay, and bad because I felt a degree of burn-out on the subject matter. However, the only other topics I feel passionate about enough to write an argumentative essay about would have likely been too controversial, for example various aspects of religion in society. In this essay it was important for me to focus on my position of the argument- that MMR vaccines are extremely important and anti-vaccination beliefs are not only dangerous to the family of the parent refusing treatment, but dangerous to everyone in contact with them as well. I wanted to be able to present the facts about the issue without resorting to speculation. I wanted to show, in simple terms, that a belief in a link between MMR vaccines and Autism is entirely unfounded and counter-productive.I would like to think the argumentative aspect of the paper came slightly easier for me, since even my original draft of my informative paper took a side at one point. Thats the difficult part when writing about a topic you feel passionate about- getting too passionate. I wanted to raise the points that you regularly hear in the media from the anti-vaccination camp and address them all individually as briefly but effectively as possible. In hindsight, I had intended to more clearly define the oppositions beliefs; I wanted to format it in a line them up and knock them down delivery method. I didnt achieve this, but I think I did a fairly good job discussing the beliefs of the opposing side.A big concern for me was using so many references from the Center for Disease Control website. I didnt want my reference page to become too top-heavy. After making final adjustments though, I think I did a fair job of balancing references.Regarding the final question of this reflection; how well I believe I accomplished the tasks asked of me in this assignment; I would only say that while I know I have a large margin of room for improvement, I think for my first informative and argumentative essays in 21 years I did a very good job.