Fact Checking Vaccines and Anti-Vaccine Misinformation

Measles Outbreaks in China

A child getting vaccinated on Children's Immunization Publicity Day in China
A child getting vaccinated on Children's Immunization Publicity Day in China. Photo by China Photos / Stringer/Getty Images

The MMR vaccine is one of the most effective vaccines ever made. Two doses are at least 99% effective at preventing measles infections. Even one dose is about 95% effective against measles.

We have measles outbreaks in the United States not because the MMR vaccine is not effective, but rather because there are still so many unvaccinated people around. Often, these unvaccinated people travel out of the country, get sick with measles, and start the outbreaks.

But if the MMR vaccine is so effective, then why, as many anti-vaccine folks claim, 'is China having measles outbreaks when 99% are vaccinated?'

The simple answer is that this claim is false - China is not having these big measles outbreaks among highly vaccinated people.

The source of the claim is from a real article in PLoS One, "Difficulties in Eliminating Measles and Controlling Rubella and Mumps: A Cross-Sectional Study of a First Measles and Rubella Vaccination and a Second Measles, Mumps, and Rubella Vaccination," which found that in 2011, in Zhejiang province, there were:

  • 9 patients with measles, including 3 infants who were too young to be vaccinated and 6 young adults who were unsure if they had ever been vaccinated
  • 1122 patients with mumps
  • 186 patients with rubella

So no big measles outbreaks, but why the large number of cases of mumps and rubella?

It becomes easy to understand when you look at their immunization schedule.

In the United States, the first live measles vaccine was introduced in 1963, the MMR was introduced in 1971, and a booster dose of MMR was added to the childhood immunization schedule in 1990. That helped to stop the endemic spread of measles in 2000 and rubella in 2004.

In contrast, the measles vaccine timeline has moved much slower in China:

  • a measles vaccine was introduced in 1966
  • continued use of a one-dose, single-antigen measles vaccine through the 1970s and mid-1980s
  • the addition of a single-antigen measles vaccine booster dose in 1985 to children who were 7-years-old
  • in 2007, the switch to a measles-rubella vaccine for 8 months old, with a MMR booster at 18-24 months
  • the addition of a measles-rubella vaccine booster for secondary school students in 2008
  • a campaign to get children between the ages of 8 months and 4 years vaccinated with a measles-mumps vaccine in 2010

So many of the children and young adults who had mumps and rubella would not have had a chance to get a mumps or rubella vaccine. They were too old when they started giving those vaccines and there was no catch-up for older children and adults.

The study authors conclude that "A timely two-dose MMR vaccination schedule is recommended, with the first dose at 8 months and the second dose at 18–24 months. An MR vaccination speed-up campaign may be necessary for elder adolescents and young adults, particularly young females."

Even considering the varied vaccine schedule, the study also clearly states that even for the measles vaccine, there is "less than 95%" coverage in almost all age groups and that "measles cases are at an historic low."

It should be clear that anti-vaccine websites are putting out false information when they say that China is having measles outbreaks when 99% of the population is vaccinated.

300 New Vaccines in the Pipeline

Researchers working on a new flu vaccine.
A universal flu vaccine is one of the new vaccines in the pipeline. Photo by Erel Photography/Getty Images

News of "new vaccines in the pipeline" is typically met with excitement and expectation if you are a typical parent. After all, who wouldn't want new vaccines to protect their kids against RSV, Staphylococcus aureus (including MRSA), or a universal flu vaccine so that we don't have to worry about drifted strains anymore?

Well, it isn't too hard to figure out who wouldn't these new vaccines...

It's the same anti-vaccine folks who don't want the vaccines we have now. And they are pushing misinformation about the idea that "300 New Vaccines in the Pipeline" will mean that kids will soon be getting 300 new vaccines.

It is true that a 2013 report from the Pharmaceutical Research and Manufacturers of America, "Medicines in Development: Vaccines – A Report on the Prevention and Treatment of Disease Through Vaccines," stated that "biopharmaceutical research companies are developing 271 vaccines."

While many of those new vaccines being developed are for infectious diseases, an almost equal number are for cancer, allergies, neurological disorders (like Alzheimer's disease), and other diseases, including a targeted vaccine that "induces an antigen-specific immune activation for smoking cessation and relapse prevention."

And even the new vaccines that are related to infectious diseases are not all aimed at preventing infections. For example, one new vaccine that is being developed, according to the report, is "a therapeutic vaccine for HIV infection intended to delay disease progression."

Of the 137 new vaccines that are aimed at infectious diseases, many are related to the same vaccine. For example, 24 of these new vaccines are related to new HIV vaccines and 35 are related to flu vaccines. Many others are related to vaccines for anthrax, small pox, Ebola, cholera, malaria, and other infectious diseases that likely won't result in a vaccine that would be added to our routine childhood immunization schedule.

And unfortunately, many of these new vaccines are very early in the development process, in phase I and phase II trials, which means that they may never actually become vaccines that help to prevent or treat disease.

Anti-vaccine folks are pushing misinformation when they say or imply that "300 New Vaccines in the Pipeline" means that kids will soon be getting 300 new vaccines.

Deaths from Measles vs. the Measles Vaccine

Snopes rated this measles myth as false.
Even Snopes has rated this measles myth as false. Photo by Vincent Iannelli, MD

Several anti-vaccine websites have been reporting that there have been "Zero U.S. measles deaths in 10 years, but over 100 measles vaccine deaths reported."

This one is very easy to debunk.

In the first place, there have been at least 7 measles deaths in the United States since 2005. And in addition to these deaths from acute measles infections, there have an additional 19  deaths from subacute sclerosing panencephalitis (SSPE), a late complication of natural measles infections.

That's significantly more than "zero U.S. measles deaths in 10 years."

And the second part about the measles vaccine deaths? That isn't true either. They are using VAERS data, but ignoring the fact that:

When evaluating data from VAERS, it is important to note that for any reported event, no cause-and-effect relationship has been established. Reports of all possible associations between vaccines and adverse events (possible side effects) are filed in VAERS. Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine. The report of an adverse event to VAERS is not documentation that a vaccine caused the event.

For many of the VAERS submissions, it is quite easy to see that there is no cause-and-effect relationship between a person's death and the vaccines they got. For example, in one VAERS report from 2005, a child with multiple medical problems died two weeks after getting the MMR vaccine and the cause of death was acute bronchopneumonia, bronchopulmonary dysplasia, dilated cardiomyopathy & prematurity - not the measles vaccine.

In another VAERS report, four days after getting his vaccine, the "vaccine recipient started to bleed on both hands and walked over a filled bathtub."

Over 10 million doses of a measles containing vaccine (typically MMR or Proquad) are given to children in the United States each year. That's why measles deaths are not at the level that they were in the pre-vaccine era, about 300-500 deaths each year. Measles didn't just disappear and if more and more parents stop vaccinating because they are more afraid of the vaccine than the disease, it will just come back. And of course, we are already seeing that with some of our current outbreaks.

Should you fear the measles vaccine? That so many kids are getting vaccinated against measles and that the vaccine so rarely causes serious problems is a testament to how safe it is. Anti-vaccine websites may try and scare parents from getting vaccinated, but don't let their misinformation about measles deaths and measles vaccine deaths stop you from vaccinating your kids and getting them protected against measles and other vaccine-preventable diseases.

Vaccine Mandates Equals Forced Vaccination

School vaccine mandates typically include a Tdap booster at age 12.
School vaccine mandates typically include a Tdap booster at around age 12. Photo by Kevork Djansezian/Getty Images

There have been vaccine mandates in the United States since the 1827, when Boston became the first city to require all children attending public schools to be vaccinated against smallpox.

Surprisingly though, it took a long time to get vaccine mandates protecting more children. It wasn't until the 1980-81 school year that there were laws in all 50 states mandating that children entering school required vaccinations first.

This followed continued measles outbreaks in the mid-1970s and studies showing that states with vaccine mandates had much lower rates of measles than states that didn't. And it likely explains why there were 10 measles deaths in the United States as late as 1980, even though the measles vaccine was introduced in 1963.

It took even longer for the vaccine mandates to cover kids in all grades and not just those entering school, to cover kids in daycare, and to cover kids in college. And tragically, it didn't take long for politicians to chip away at those vaccine mandates. Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions.

Still, even before the addition of personal belief vaccine exemptions and without the abuse of religious exemptions and medical exemptions, vaccine mandates have never equaled forced vaccination.

Even the Vaccination Act of 1853 in the UK, which required everyone to get a small pox vaccine didn't actually force them to get vaccinated. It originally levied fines on people until they got the vaccine, but they soon allowed a conscientious exemption to vaccination, which many people took advantage of. Over the years, so many people were claiming conscientious vaccine exemptions in the UK that in 1946 they repealed their vaccine requirements altogether.

So what is a vaccine mandate?

Since a mandate is typically defined as an 'official order to do something,' a vaccine mandate would be an order to get a vaccine. But it is hardly an order to hold down and force a vaccine on someone. For example, a flu vaccine mandate for health care workers at a Children's Hospital simply means that they would need a yearly flu vaccine to continue working around kids in the hospital.

Likewise, state laws that mandate vaccines aren't forcing kids to get vaccinated. They are typically mandates to get vaccinated before attending daycare, public and private schools, and/or college. What are the consequences of not obeying the vaccine mandate? It is not a forced vaccine. The consequence is that your child doesn't get to go to daycare or school with other kids who are vaccinated and protected against vaccine-preventable disease or who have a true medical reason why they can't be vaccinated.

State immunization laws and vaccine mandates have nothing to do with forced vaccination. They also don't take away your informed consent, are not against the Nuremberg Code, and are not unconstitutional.

Johns Hopkins Hospital Warns Patients about Vaccine Shedding

Experts no longer tell cancer patients to avoid contact with people who have been recently vaccinated.
Anti-vaccine groups push outdated information about vaccine shedding to scare parents. Photo by Vincent Iannelli, MD

Are recently vaccinated people causing outbreaks of vaccine-preventable diseases?

Should kids be put in quarantine after they get their vaccines?

Of course not, but some anti-vaccine folks continue to push outdated information that hospitals, including Johns Hopkins, warn cancer patients to avoid children who were recently vaccinated.

Although vaccine shedding is a concern with some vaccines, like the oral polio vaccine and the small pox vaccine, it is important to keep in mind that neither has been used in the United States for some time now.

Hospitals no longer warn patients about restricting exposure to people who have recently been vaccinated.

Were websites "scrubbed" of information about shedding as part of some conspiracy?

Of course not. They were simply updated to keep up with the latest guidelines.

These guidelines about kids with cancer aren't that new though.

As far back as 2001, an article in the journal Pediatrics & Child Health, "Practical vaccination guidelines for children with cancer," recommended that household contacts of immunosuppressed children should receive:

  • all routine, age-appropriate vaccines, including DTaP, IPV, Hib, MMR, and Tdap,  and that "no special precautions are necessary because transmission of disease from these vaccines does not occur."
  • the varicella vaccine and that even "in the event of a vaccine-associated vesicular rash, the transmission risk is low and the consequences of infection are limited by the attenuated nature of the vaccine virus."
  • an annual flu vaccine

These recommendations for household contacts of immunosuppressed children are based on the 2000 Red Book: Report of the Committee on Infectious Diseases.

The recommendations in latest (2012) edition of the Red Book  state that "household contacts of people with an immunologic deficiency" should also:

  • receive the rotavirus vaccines if indicated
  • receive either the inactivated influenza vaccine or live attenuated influenza vaccine, giving preference to the inactivated influenza vaccine only if the "immunosuppressed person is a hematopoietic stem cell transplant (HSCT) recipient in a protected environment."

So hospitals should no longer be warning patients about restricting exposure to people who have recently been vaccinated.

In fact, the latest guidelines from the Immune Deficiency Foundation state that except for the live oral poliovirus vaccine, "Close contacts can receive other standard vaccines because viral shedding is unlikely and these pose little risk of infection to a subject with compromised immunity."

The Immune Deficiency Foundation also warns that, "The increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children."

In other words, they are concerned about the risk of disease from intentionally unvaccinated kids and not from those who were recently vaccinated.

Not only is Johns Hopkins Medical Center not telling cancer patients to avoid contact with children who recently received vaccines, they have gone out of their way to correct that misinformation from anti-vaccine websites.

Vaccines and Homeschooling Myths

A young homeschooled girl doing her work.
A young homeschooled girl doing her work. Photo by Tetra Images - Mike Kemp/ Getty Images

Do many parents homeschool their kids because they don't want to get them vaccinated and comply with vaccination laws?

The opposition to a new law in California that would remove personal belief vaccine exemptions is claiming that it will lead all children currently receiving personal belief exemptions to leave those schools and become homeschoolers.

One problem with this idea is that even though 32 states don't allow personal belief vaccine exemptions, avoiding vaccines laws is not a top reason for why most parents choose to homeschool their kids.

Instead, most parents homeschool because of:

  • social reasons - including negative social activity and exposures at public and private schools
  • academic reasons - thinking they can provide a better education for their kids at home and dissatisfaction with public or private school
  • family reasons - such as a child with special needs, not being able to get into the 'right' school, transportation issues, or simply wanting more family time
  • religious reasons - including providing religious instruction at home

What about vaccines?

In one article, "Homeschooling parents’ practices and beliefs about childhood immunizations,"  only "five parents (4%) included a desire not to vaccinate children as a reason for homeschooling."

Also, homeschooling rates are about the same in every state, just under 3% of students. A few outliers include Delaware (2.1%), Florida (2.6%), Indiana (3.2%), Minnesota (1.9%), North Carolina (5.8%), Virginia (2.2%), and Wisconsin (2.0%).

Of these states, only Minnesota and Wisconsin allow personal belief exemptions, and both do have below average homeschooling rates, but so do many of the other states that don't allow PBEs.

On the other hand, both Mississippi and West Virginia, which allow neither personal belief vaccine exemptions nor religious vaccine exemptions have very average homeschooling rates.

If statistics from other states are a guide, passing SB 277 in California won't affect the state's homeschooling rates.

Continue Reading