In the wake of new federal recommendations on childhood immunizations, Stanford University pediatric infectious disease specialist Dr. Yvonne Maldonado warned that public health policy based on unfounded fears could erase decades of public health progress.
”The measles, mumps, rubella, varicella vaccine — MMRV — has quietly protected millions of children around the world for decades,” said Maldonado, speaking at a Sept. 26 American Community Media news briefing. “When we talk about vaccines, we often focus on the newest developments, but sometimes it’s just as important to remember the tools we already have: safe, effective, and time-tested tools like MMRV that prevent serious childhood diseases.”
“The science behind MMRV vaccines is robust. Clinical trials and decades of real world data show greater than 90% protection after two doses for each of these four diseases,” she said.
The MMRV vaccine is typically given in two doses, the first at age 12-15 months, and the second at 4-6 years of age.
ACIP Recommendations
The Advisory Committee on Immunization Practices — which informs the Centers for Disease Control and Prevention — met Sept. 18 and 19 to issue guidelines on several vaccines. On Sept. 19, the committee voted to no longer recommend the combined MMRV vaccine for children under age 4. It recommended that children under 4 should get the varicella vaccine separately, noting the risk of febrile seizures in young children.
Additionally, the committee voted to no longer cover the MMRV vaccine for children under 4 through the Vaccines for Children federal program, which provides vaccines for low-income children.
Maldonado had served on ACIP until June, when Health and Human Services Secretary Robert F. Kennedy Jr., fired the entire board and replaced them with 8 hand-picked members, many of whom have expressed concerns about vaccines at large.
Measles Outbreaks
Measles is one of the most contagious childhood illnesses; prior to the introduction of the MMR vaccine in 1971, 3-4 million children per year were infected with the illness, which caused complications like brain swelling, deafness, pneumonia, and even death. Measles cases were rare after the vaccine was introduced.
But outbreaks have occurred this year in several states: Texas had one of the largest, with over 800 reported cases. 92% of cases were in children who were unvaccinated according to data from the CDC.
Mumps is often dismissed as just swelling of the cheeks, but can cause meningitis, deafness, and infertility, said Maldonado. Rubella is an invasive virus that can cause miscarriage, stillbirth and congenital rubella syndrome, which leads to heart defects and blindness. Chicken pox can lead to painful shingles in later life, said the doctor, adding she has seen all of these diseases in her practice.
Single Shot
“Each of these diseases alone is dangerous. Together, they represent a major threat to child health, and that’s why a combination vaccine like MMRV is so valuable,” said Maldonado.
The pediatrician expressed her concerns over the new ACIP recommendations, noting that a single shot covers four diseases. “That means fewer injections, less stress for children, and more efficient clinic visits,” said Maldonado. “Combination vaccines have helped keep overall vaccine coverage in the United States among the highest in the world.”
She refuted the ACIP committee’s concerns about febrile seizures. About eight per 10,000 children experience a febrile seizure with MMRV compared to about four per 10,000 with separate shots, so the risks are slightly elevated.
But febrile seizures — which can cause uncontrollable muscle movement in children, loss of consciousness, and strained breathing — usually last less than 15 minutes and are harmless, said Maldonado. “They do not cause long-term harm, and the benefits far outweigh the risks.”
Re-Emergence of Preventable Diseases
Maldonado and her colleagues at Stanford and Baylor University have conducted modeling based on vaccine uptake, which currently hovers at about 92% nationwide. The researchers modeled what would happen with several vaccine preventable diseases over the next 25 years.
“And what we found is really sad and surprising. Even at current vaccination levels, we’re going to start to see millions of cases of these diseases and their complications. But with the increase of just 5% vaccine coverage in the US, we would see a massive reduction in these diseases in the next 25 years or so,” she said. Measles, which were considered completely eradicated in the year 2000 will return to being a normal circulating virus in the next 5 years and polio will return in 10 years, said Maldonado. The modeling was presented in a research paper published last April in the Journal of the American Medical Association.
“Vaccines are one of the greatest achievements of modern medicine,” said Maldonado. “I think we are at a pinnacle of human society. We are living longer. We are living healthier than we ever have in the history of humankind. The life expectancy around the world is better. Extreme poverty has been almost eliminated, child mortality is dropping. So we’re doing better.”
“We need to focus on ways to keep that going and yes, address chronic conditions, but not get rid of things that work,” she said.
