Questions about a paper on the measles vaccine

[Chris_Halkides]

This abstract at PubMed came up in a discussion a few days ago.

"As previously noted among infants born to mothers with history of wild-type measles, antibody responses among children born to vaccinated mothers were reduced based on earlier administration of their first measles vaccine dose at ≤12 vs ≥15 months of age. Negative effects of earlier age at first measles vaccine dose persisted after the second dose. The measles elimination goal may require a careful balance between earlier infant protection and the risk of reduced antibody responses and secondary vaccine failure among successive birth cohorts systematically initiated to measles vaccination <15 months of age."

What is the clinical or epidemiological significance of this finding? How should one respond to someone's using this as evidence for the proposition that getting measles is in some sense a good thing?

 

[dann]

This abstract at PubMed came up in a discussion a few days ago.

"As previously noted among infants born to mothers with history of wild-type measles, antibody responses among children born to vaccinated mothers were reduced based on earlier administration of their first measles vaccine dose at ≤12 vs ≥15 months of age. Negative effects of earlier age at first measles vaccine dose persisted after the second dose. The measles elimination goal may require a careful balance between earlier infant protection and the risk of reduced antibody responses and secondary vaccine failure among successive birth cohorts systematically initiated to measles vaccination <15 months of age."

What is the clinical or epidemiological significance of this finding? How should one respond to someone's using this as evidence for the proposition that getting measles is in some sense a good thing?

Well, having had and survived measles without any serious complications is actually (not just "in some sense") a good thing: You are now immune to measles = a good thing. Having had measles and died isn't quite as good, obviously.
If I understand it correctly, the epidemiological significance seems to be that the measles vaccine shouldn't be given too soon to children of such mothers - not that it is better not to vaccinate the children at all. It doesn't seem to support anti-vaxxer arguments at all.
I could be wrong, though.

 

[casebro]

Reading for my own edification, at least in dog vaccines, is that "puppy shots" are given at a date which hopes to co-incide with the wearing off of the mother's immunity passed through the placenta. The second string of vax is given because the timing might not have been a good guess on the first shot. The OP backs that up.

I guess the OCD thing to do is test all babies for immunity levels until a nadir is reached, THEN vax. But the vax costs a few dollars, multiple labs would cost hundreds. Then there are probaly some diseae we vax for, that do not get immunity via placenta, baby need vax at birth. (???)

 

[Skeptic Ginger]

This abstract at PubMed came up in a discussion a few days ago.

"As previously noted among infants born to mothers with history of wild-type measles, antibody responses among children born to vaccinated mothers were reduced based on earlier administration of their first measles vaccine dose at ≤12 vs ≥15 months of age. Negative effects of earlier age at first measles vaccine dose persisted after the second dose. The measles elimination goal may require a careful balance between earlier infant protection and the risk of reduced antibody responses and secondary vaccine failure among successive birth cohorts systematically initiated to measles vaccination <15 months of age."

What is the clinical or epidemiological significance of this finding? How should one respond to someone's using this as evidence for the proposition that getting measles is in some sense a good thing?

It's a common argument from ignorance, we're better off without the vaccine because the natural disease provides better immunity.

Yes, you get better immunity in the survivors.

So if you don't mind killing off a number of people from the diseases, natural infection does provide better immunity. Also there may be some natural boosting if the infections are endemic in the population. Again, the tradeoff is some deaths and serious consequences from the diseases.

 

[Skeptic Ginger]

Well, having had and survived measles without any serious complications is actually (not just "in some sense") a good thing: You are now immune to measles = a good thing. Having had measles and died isn't quite as good, obviously.
If I understand it correctly, the epidemiological significance seems to be that the measles vaccine shouldn't be given too soon to children of such mothers - not that it is better not to vaccinate the children at all. It doesn't seem to support anti-vaxxer arguments at all.
I could be wrong, though.

This is the key part of the abstract:

The measles elimination goal may require a careful balance between earlier infant protection and the risk of reduced antibody responses and secondary vaccine failure among successive birth cohorts systematically initiated to measles vaccination <15 months of age.

Given MMRV are all live attenuated viruses, residual maternal antibody essentially blocks the attenuated virus thus nullifying the vaccine. It is a balance protecting toddlers after maternal antibody decreases and before risk of natural infection occurs.

If all these idiot anti-vaxxers weren't putting infants and toddlers at risk we could safely give the vaccine at 15 months and there wouldn't be a problem.

Years ago the MMR was given at 12 months but it was found a better response came if you waited until 15 months. This study provides evidence you can't just give an extra dose and negate the problem of giving the vaccine at 12 months. Still if you have an infant at immediate risk, sometimes the vaccine is even given at 9 months. It's best if we can wait until 15 months for the vaccine unless there is an immediate risk of infection.

 

[lionking]

Well, having had and survived measles without any serious complications is actually (not just "in some sense") a good thing: You are now immune to measles = a good thing. Having had measles and died isn't quite as good, obviously.
If I understand it correctly, the epidemiological significance seems to be that the measles vaccine shouldn't be given too soon to children of such mothers - not that it is better not to vaccinate the children at all. It doesn't seem to support anti-vaxxer arguments at all.I could be wrong, though.

This won’t matter to anti-vaxxers. They are still using the Wakefield “research” for their vile purposes.

 

[bruto]

I have not quite gotten all this. If I read the abstract, it appears that the issue regards mothers who have had wild type measles and also have been vaccinated. Or am I misreading the meaning of the term "vaccinated" in this case, and they mean effectively vaccinated by having wild type measles?

In either case it would appear the issue only arises with vaccinated mothers, however that is defined, and that the children of unvaccinated mothers do not get that initial immunity or that later resistance, or at least that the study does not address them. Or am I getting this completely wrong?

Given the history of measles vaccine, I would suppose that there are few women left at this stage who both did not get measles and did not get some vaccine, unless they're anti-vaxxers, but I wonder what, if any, recommendation would be made for the children of unvaccinated mothers who want them vaccinated.

I'm sure SG will not be at all shy about corrections here.

 

[Skeptic Ginger]

I have not quite gotten all this. If I read the abstract, it appears that the issue regards mothers who have had wild type measles and also have been vaccinated. Or am I misreading the meaning of the term "vaccinated" in this case, and they mean effectively vaccinated by having wild type measles?

In either case it would appear the issue only arises with vaccinated mothers, however that is defined, and that the children of unvaccinated mothers do not get that initial immunity or that later resistance, or at least that the study does not address them. Or am I getting this completely wrong?

Given the history of measles vaccine, I would suppose that there are few women left at this stage who both did not get measles and did not get some vaccine, unless they're anti-vaxxers, but I wonder what, if any, recommendation would be made for the children of unvaccinated mothers who want them vaccinated.

I'm sure SG will not be at all shy about corrections here.

They are not looking at mothers that had both, they are saying maternal antibody from a mother with wild measles infection and from vaccinated mothers both influenced the vaccine response in the infants.

What they are saying is women who have had either the vaccine and/or the wild infection have the same effect on the age of vaccinating their infants.

One key point in the study: "Reduced Antibody Response to Infant Measles Vaccination: Effects Based on Type and Timing of the First Vaccine Dose Persist After the Second Dose."

children born to mostly vaccinated mothers....

Among 5542 children given a first measles vaccine dose at 11, 12, 13-14, and 15-22 months of age, the proportion seronegative decreased from 8.5% to 3.2%, 2.4%, and 1.5%, respectively (P < .001),

The younger the MMR was given the poorer the antibody response the higher the vaccine failure rate.

 

[attempt5001]

This is the key part of the abstract:

Given MMRV are all live attenuated viruses, residual maternal antibody essentially blocks the attenuated virus thus nullifying the vaccine. It is a balance protecting toddlers after maternal antibody decreases and before risk of natural infection occurs.

If all these idiot anti-vaxxers weren't putting infants and toddlers at risk we could safely give the vaccine at 15 months and there wouldn't be a problem.

Years ago the MMR was given at 12 months but it was found a better response came if you waited until 15 months. This study provides evidence you can't just give an extra dose and negate the problem of giving the vaccine at 12 months. Still if you have an infant at immediate risk, sometimes the vaccine is even given at 9 months. It's best if we can wait until 15 months for the vaccine unless there is an immediate risk of infection.

Immunizing too early may reduce vaccine efficacy. Waiting longer to immunize may open up a window of infection risk. That's the challenging balance.

 

[bruto]

They are not looking at mothers that had both, they are saying maternal antibody from a mother with wild measles infection and from vaccinated mothers both influenced the vaccine response in the infants.

What they are saying is women who have had either the vaccine and/or the wild infection have the same effect on the age of vaccinating their infants.

One key point in the study: "Reduced Antibody Response to Infant Measles Vaccination: Effects Based on Type and Timing of the First Vaccine Dose Persist After the Second Dose."The younger the MMR was given the poorer the antibody response the higher the vaccine failure rate.

Thanks. I figured the abstract meant either wild or vaccinated or both (though I wonder how often that's the case), but the language was not entirely clear.

 

[bruto]

Immunizing too early may reduce vaccine efficacy. Waiting longer to immunize may open up a window of infection risk. That's the challenging balance.

Yes,, but if I'm reading it right, that window would only be dangerous if the parents were not immunized. If they were they'd pass some immunity on to their newborn offspring, and if everyone were immunized properly to start with, infection would be very rare, and the benefit of waiting would outweigh the risk by far.

 

[rjh01]

Yes,, but if I'm reading it right, that window would only be dangerous if the parents were not immunized. If they were they'd pass some immunity on to their newborn offspring, and if everyone were immunized properly to start with, infection would be very rare, and the benefit of waiting would outweigh the risk by far.

That is the aim of vaccinations. If only babies could be isolated from people who do have measles (but may not show any symptoms) then all problems would be solved. However parents do tend to take babies on walks and other places where they might meet such people. But a certain % of people are not properly vaccinated for various reasons so a baby could get infected.

 

[Skeptic Ginger]

Yes,, but if I'm reading it right, that window would only be dangerous if the parents were not immunized. If they were they'd pass some immunity on to their newborn offspring, and if everyone were immunized properly to start with, infection would be very rare, and the benefit of waiting would outweigh the risk by far.

The pieces get a bit complicated.

Before 1957 almost everyone got wild measles, literally.

From 1963 to 1968 a killed vaccine was used. That vaccine needed boosters but no one knew it until cases of measles started showing up in teens and young adults who had had the killed vaccine.

So, we've undertaken vaccinating anyone born between 1957 and 1968 who didn't have documentation from a physician of a case of measles.

It was also found that 2 doses of MMRs were needed to decrease the vaccine failure rate.

Because of the disease and vaccine history, it's going to be extremely rare for a person within childbearing age who had wild measles to have also gotten the vaccine.

I know that's TMI, but in case anyone was interested...

 

[attempt5001]

Yes,, but if I'm reading it right, that window would only be dangerous if the parents were not immunized. If they were they'd pass some immunity on to their newborn offspring, and if everyone were immunized properly to start with, infection would be very rare, and the benefit of waiting would outweigh the risk by far.

You've had some helpful responses already, so this is a bit reiterative, but residual material antibody (whether the mother was infected or vaccinated) with kill the active virus in the vaccine before it can effectively trigger the child's own native (and lasting) antibody response. So it is important to wait until residual maternal antibody is gone (or sufficiently reduced) before inoculating the child. However, waiting opens up a window during which the child has waning residual protection and no native protection, so they are at increased risk of infection; not from their vaccinated mother, but from the general population. Yes, if general population vaccination rates are high, the risk associated with that window is lowered.

 

[bruto]

Speaking of vaccines, I ran across this rather interesting article regarding the peripheral benefits of vaccination.

 

[pgwenthold]

Speaking of vaccines, I ran across this rather interesting article regarding the peripheral benefits of vaccination.

It's almost like vaccination stimulates the immune system to do a better job of fending off all kinds of disease!

You'd think the that all-natural crowd would love something like that.

 

[attempt5001]

Speaking of vaccines, I ran across this rather interesting article regarding the peripheral benefits of vaccination.

Nice. Thanks for sharing. Some interesting potential mechanisms to explore there.

 

[luchog]

So if you don't mind killing off a number of people from the diseases, natural infection does provide better immunity.

Actually, in the case of measles at least, that is not necessarily true.

I don't have the link handy, but I recall reading a study a few years ago that found survivors of measles, even if they suffered no other complications, were actually no more resistant than vaccinated people who followed the regular booster regimen, and more vulnerable to infections from certain other viruses.

ETA:

Speaking of vaccines, I ran across this rather interesting article regarding the peripheral benefits of vaccination.

Not he article I was thinking of, but it appears to address the same issue of measles reducing immunity to other diseases

 

[Skeptic Ginger]

Speaking of vaccines, I ran across this rather interesting article regarding the peripheral benefits of vaccination.

Some cautions here.

So they designed a new study of 16 adults,

That's a pilot study, not a reliable conclusion study.

The same result has been found as a consequence of live polio vaccine and bacille Calmette-Guerin, or BCG, vaccine for tuberculosis. When those vaccines are introduced to poor areas of the world, studies have shown, deaths from many other causes, not just the vaccine-targeted disease, go down.

Meaningless unless they carefully ruled out other variables.

In the new study, when researchers introduced bacteria to the blood of vaccinated volunteers in follow-up lab tests, they found increased levels of infection-fighting cells, says Melita Gordon, an author of the study and a professor at the University of Liverpool.

Meh, kind of a no-brainer other aspects of the immune system would mount a response to introduced sepsis.

In developing countries, where infectious diseases are common, vaccinating people against typhoid with live salmonella could reduce deaths from a range of diseases, Gordon says. But that's often difficult in poor countries because of a lack of resources and difficulties in transporting and storing live vaccines.

Based on a study of 16 people? Too soon.

Scientists began gathering evidence on the broad-based protection conferred by live vaccines as early as the 1960s, when the measles vaccine became available in the developed world. As they observed or surveyed people in areas of the world where vaccines were newly introduced, they found again and again that deaths went down not just from the disease targeted by the vaccine but from many other diseases, says Pennington,

Now researchers are trying to figure out why.

IOW, to find out which variables are acting.

This is like one of those, "We now know" science news articles. The reporter is not writing exactly what one would see in the actual study conclusion.

 

[Skeptic Ginger]

Actually, in the case of measles at least, that is not necessarily true.

I don't have the link handy, but I recall reading a study a few years ago that found survivors of measles, even if they suffered no other complications, were actually no more resistant than vaccinated people who followed the regular booster regimen, and more vulnerable to infections from certain other viruses.

ETA:

Not he article I was thinking of, but it appears to address the same issue of measles reducing immunity to other diseases

Not all vaccines are live vaccines that produce natural immunity. This really needs to be looked at on a vaccine by vaccine basis.

Essentially what you are saying is vaccines work. If disease is prevented that is a yes/no outcome.