I’ve been asked to contrast the risk from the disease measles with the risk from the measles vaccine, usually the MMR. MMR stands for Measles, Mumps, Rubella (rubella is german measles) and so the MMR vaccine contains 3 live, attenuated (weakened) viruses that reproduce in the body of the person receiving the vaccine. Live vaccines usually provide a stronger immune response than a killed vaccine, which does not reproduce in the body after being injected. However, there are risks from vaccination, and some MMR vaccine recipients develop symptoms from mild forms of the three diseases. Note that the MMR-V, a newer vaccine, has varicella (chickenpox) added to the MMR components, and is associated with a higher rate of adverse event reporting and federal vaccine injury compensation than MMR.
Many of the vaccine side effects are also side effects of the disease. They generally occur more frequently from the disease than the vaccine. But because virtually every child gets the vaccine, while only one in 100,000 will get measles in their lifetime, children are more likely to suffer a severe side effect from the vaccine than the disease, in the US.
Rarely, there may be lasting seizures, deafness, coma or brain damage, and deaths post-vaccination. These illnesses are termed, for purposes of federal compensation, encephalitis or encephalopathy.
Below are listed the warnings in CDC’s MMR Vaccine Information Statement:
What are the risks from MMR vaccine?
- A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions.
- The risk of MMR vaccine causing serious harm, or death, is extremely small.
- Getting MMR vaccine is much safer than getting measles, mumps or rubella.
- Most people who get MMR vaccine do not have any serious problems with it.
- Fever (up to 1 person out of 6)
- Mild rash (about 1 person out of 20)
- Swelling of glands in the cheeks or neck (about 1 person out of 75)
- Seizure (jerking or staring) caused by fever (about 1 out of 3,000 doses)
- Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 1 out of 4)
- Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses)
Severe problems (very rare)
- Serious allergic reaction (less than 1 out of a million doses)
- Several other severe problems have been reported after a child gets MMR vaccine, including:
- Long-term seizures, coma, or lowered consciousness
- Permanent brain damage
Below are the side effects, following use of a Measles or Rubella-containing vaccine, that the US government has acknowledged are due to these vaccines, for which it will pay compensation through the Vaccine Injury Program. This official list is termed the Vaccine Injury Table.
It lists the vaccine, the serious side effect, and the period following a vaccination during which it would be expected to occur. Note that although the CDC said that joint pains are temporary, they can be be chronic, and a reason for compensation, in some recipients of MMR (usually females):
III. Measles, mumps, and rubella vaccine or any of its components (e.g., MMR, MR, M, R)
A. Anaphylaxis or anaphylactic shock
B. Encephalopathy (or encephalitis)
5-15 days (not less than 5 days and not more than 15 days).
C. Any acute complication or sequela (including death) of an illness, disability, injury, or condition referred to above which illness, disability, injury, or condition arose within the time period prescribed
IV. Vaccines containing rubella virus (e.g., MMR, MR, R)
A. Chronic arthritis
B. Any acute complication or sequela (including death) of an illness, disability, injury, or condition referred to above which illness, disability, injury, or condition arose within the time period prescribed
V. Vaccines containing measles virus (e.g., MMR, MR, M)
A. Thrombocytopenic purpura
B. Vaccine-Strain Measles Viral Infection in an immunodeficient recipient
The federal Vaccine Injury Compensation Program began in 1988. Through March 2014, 967 claims had been made to the program for vaccines against measles. These claims included 58 deaths.
Thousands of reports to the joint FDA-CDC Vaccine Adverse Event Reporting System have been made regarding adverse effects that occurred in close proximity to an MMR or MMR-V inoculation, including several hundred reports of deaths. However, there is no systematic review of most of these reports, and no determination is made as to whether the vaccine caused the reaction, in the vast majority of cases.
UPDATE Feb. 18: I contacted CDC to resolve the contradictions in their data. The Division of Viral Illnesses at CDC responded today, and confirmed that the last death in the United States from acute measles occurred in 2003. Snopes is wrong, and I have asked Snopes to correct their post.
UPDATE Feb.22: Snopes failed to change their website despite receiving a copy of the CDC memo affirming that the last US measles death was in 2003. I must presume Snopes is not as interested in promoting the truth as it claims.
Snopes says there were 2 measles deaths in 2009 and 2 in 2010, citing National Vital Statistics Reports for 2009 and 2010. However, CDC said here that 2 deaths from measles occurred in 2003, not 2009. CDC’s measles experts further say there were only 2 deaths between 2001 and 2011:
From 2001 through 2011, a median of 63 measles cases (range: 37–220) and four outbreaks, defined as three or more cases linked in time or place (range: 2–17), were reported each year in the United States. Of the 911 cases, a total of 372 (41%) cases were importations, 804 (88%) were associated with importations, and 225 (25%) involved hospitalization. Two deaths were reported.
There have been no reported measles deaths since 2011. Therefore, as best I can tell, there have been only 3 US measles deaths since 1993. Because two government databases provide contradictory information as to when those deaths occurred, and how many occurred, Snopes might be right, or my claim of none since 2003 may be right. But the CDC measles experts should be more likely to know the correct numbers than those providing US mortality data for all causes. Here are my additional sources:
So few children die from measles in the US, we cannot reliably calculate a case fatality rate.
Measles Vaccine Effectiveness
One dose of measles-containing vaccine administered at age ≥12 months was approximately 94% effective in preventing measles (range: 39%–98%) in studies conducted in the WHO Region of the Americas (141,142). Measles outbreaks among populations that have received 2 doses of measles-containing vaccine are uncommon. The effectiveness of 2 doses of measles-containing vaccine was ≥99% in two studies conducted in the United States and 67%, 85%–≥94%, and 100% in three studies in Canada (142–146). The range in 2-dose vaccine effectiveness in the Canadian studies can be attributed to extremely small numbers (i.e., in the study with a 2-dose vaccine effectiveness of 67%, one 2-dose vaccinated person with measles and one unvaccinated person with measles were reported ). This range of effectiveness also can be attributed to age at vaccination (i.e., the 85% vaccine effectiveness represented children vaccinated at age 12 months, whereas the ≥94% vaccine effectiveness represented children vaccinated at age ≥15 months ). Furthermore, two studies found the incremental effectiveness of 2 doses was 89% and 94%, compared with 1 dose of measles-containing vaccine (145,147). Similar estimates of vaccine effectiveness have been reported from Australia and Europe (Table 1) (141).
Duration of Measles Immunity after Vaccination
Both serologic and epidemiologic evidence indicate that measles-containing vaccines induce long lasting immunity in most persons (148). Approximately 95% of vaccinated persons examined 11 years after initial vaccination and 15 years after the second dose of MMR (containing the Enders-Edmonston strain) vaccine had detectable antibodies to measles (149–152). In one study among 25 age-appropriately vaccinated children aged 4 through 6 years who had both low-level neutralizing antibodies and specific IgG antibodies by EIA before revaccination with MMR vaccine, 21 (84%) developed an anamnestic immune response upon revaccination; none developed IgM antibodies, indicating some level of immunity persisted (153).