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Measles Overview


Quick facts about measles

Quick Facts

Measles (Rubeola)

  • Rubeola, or “red” measles, is a highly contagious respiratory disease spread by coughing, sneezing, or simply being in close contact with someone who is infected with it, even when the rash is not visible.1 Measles tends to be more severe in children under the age of five and adults over the age of twenty.2
  • Symptoms start with a fever, cough, runny nose, red irritated eyes, sore throat with tiny white spots inside the mouth and last 2-4 days before the signature itchy red rash appears on the body around the fourth or fifth day, beginning on the head and moving down the body.3  
  • After coming in contact with someone infected with measles, the incubation period from initial exposure to onset of the rash is between seven and 21 days, with an average of 14 days. The period leading up to the appearance of the rash is characterized by a rising fever that peaks at 103-105 degrees F.4
  • Complications of measles can include bronchitis, diarrhea, ear infections, pneumonia, seizures, encephalitis and death.5 Some studies have demonstrated that vitamin A reduces the risk of death and complications and that children with vitamin A deficiency, especially in underdeveloped countries, are at increased risk for measles complications. 6 Receiving serum immune globulin 6 days after exposure to measles can mediate the severity of measles.7
  • In 1960, three years before the first measles vaccine was put on the market in the U.S., there were about 442,000 reported measles cases and 380 related deaths, 8 9 among the 3.5 to 5 million Americans who were likely infected with measles. 10 11 Historically, the CDC has reported measles death rates to be one in 10,000 cases.12 13 Deaths from measles are rare in the U.S. with the last reported measles related death occurring in 2015.14 Globally 95 percent of deaths from measles occur in developing countries, where measles is one of the leading causes of death among young children.15

Measles Vaccine

  • Currently there are two measles containing vaccines in use in the United States - MMRII - a combination measles-mumps-rubella (MMR) live virus vaccine16 and ProQuad- a combination measles-mumps-rubella-varicella (MMR-V) live virus vaccine.17 Both products are produced and distributed by Merck. The CDC recommends children get an MMR shot between 12 and 15 months of age with a second dose given between 4 and 6 years old.18 
  • Mild side effects such as redness, rash or pain where the shot was given, along with fever and swelling of the glands in the neck or cheeks have been reported following MMR or MMR-V vaccination. More serious side effects that have occurred following vaccination include seizures, thrombocytopenia, pneumonia, meningitis, encephalitis, full body rash, brain damage, permanent loss of hearing, coma, and death.19 20
  • As of November 30, 2018, there have been more than 93,179 reports of measles vaccine reactions, hospitalizations, injuries and deaths following measles vaccinations made to the federal Vaccine Adverse Events Reporting System (VAERS), including 459 related deaths, 6,936 hospitalizations, and 1,748 related disabilities. Over 50% of those adverse events occurred in children three years old and under.
  • As of January 2, 2019, there had been 1,258 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following MMR vaccination, including 82 deaths and 1,176 serious injuries.
  • Evidence has been published in the medical literature that vaccinated persons can get measles because either they do not respond to the vaccine or the vaccine’s efficacy wanes over time21 22 23 24 and vaccinated mothers do not transfer long lasting maternal antibodies to their infants to protect them in the first few months of life.25 26  Food & Drug Administration (FDA) 

Centers for Disease Control (CDC)

Vaccine Reaction Symptoms & Ingredients

Our Ask 8, If You Vaccinate webpage contains vaccine reaction symptoms and more. 

Search for Vaccine Reactions

NVIC hosts MedAlerts, a powerful VAERS database search engine. MedAlerts examines symptoms, reactions, vaccines, dates, places, and more.

Reporting a Vaccine Reaction

Since 1982, the NVIC has operated a Vaccine Reaction Registry, which has served as a watchdog on VAERS. Reporting vaccine reactions to VAERS is the law. If your doctor will not report a reaction, you have the right to report a suspected vaccine reaction to VAERS.

IMPORTANT NOTE: NVIC encourages you to become fully informed about Measles and the Measles vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

What Is Measles?

Rubeola, or “red” measles, is a respiratory disease caused by a paramyxovirus, genus Morbillivirus with a core of single-stranded RNA.27 Measles is highly contagious and causes a systemic infection that begins in the nasopharynx. The virus is shed through respiratory secretions (nasal discharge, coughing sneezing) for four days before symptoms appear until three to four days after rash onset, when it is most easily transmitted.28Before the first measles vaccine was licensed in the U.S. in 1963, measles increases were seen generally in late winter and spring29 every two to three years.30

Although the measles virus is closely related to certain animal diseases such as distemper that is found in several animals including dogs, ferrets and wolves,31 it is a disease unique to humans, and is not found in animals.32

Rubeola (not to be confused with rubella, a less serious infection commonly known as “German measles”) symptoms begin 10-14 days after close contact with someone infected with measles. Symptoms and start with a fever, cough, runny nose, conjunctivitis, white spots in the mouth and progresses to a rash that starts on the face and spreads to the rest of the body and lasts for about a week.33 Complications include very high fever, diarrhea, otitis media, seizures, pneumonia, encephalitis (0.1% reported) and very rarely subacute sclerosing panencephalitis (SSPE - a progressive, debilitating and deadly brain disorder) and death.34 35

Other symptoms of measles include:36

  • Light sensitivity
  • Watery eyes
  • Sneezing
  • Body aches
  • Swollen eyelids

Illnesses that may also develop along with measles are ear infections, diarrhea, croup, bronchiolitis and pneumonia. Measles during pregnancy may result in a premature birth or a low birth weight infant.37 Persons who have had measles infection usually will acquire long-lasting immunity.38

Prior to the appearance of the measles rash on the fourth or fifth day after fever begins, measles can be mistaken for several illness including influenza, bronchiolitis, croup, or pneumonia.39 In the past, doctors would diagnosed measles by looking for the presence of tiny white specks surrounded by a red halo inside the cheeks of an infected person’s mouth.40  However, in recent years, measles rash has been frequently misdiagnosed by physicians as illnesses such as scarlet fever, Kawasaki Disease, and dengue.41 As a result, at the October 2012 CDC’s Advisory Committee on Immunization Practice (ACIP) meeting, the committee revised the diagnosing criteria for measles, requiring that measles be confirmed by laboratory testing only. A physician diagnoses of measles based on symptoms is no longer accepted as confirmation of infection.42

Measles virus is easily destroyed by light, high temperatures, UV radiation or disinfectants.43

Is Measles Contagious?

Measles is a highly contagious viral disease that is spread through the air by respiratory droplets, or by coming in contact with nasal discharge/mucous of an infected person. Measles is most contagious during the three days before the rash appears. The rash usually begins around the face and neck, and works its way down the body, with increasing lesions often seen on the face and trunk. The rash lasts 3-7 days and fades from the body in the order in which it appeared. The fever can linger two or three more days, and the cough as long as 10 days after the rash subsides.44

This disease can be transmitted very easily in areas where people are together in close quarters, such as family members in a home, or students in schools or daycare centers,45 or among travelers on an airplane.46 Other high-risk settings for easy transmission of measles include public places where large numbers of people gather and have close contact. Measles transmission has been documented to have occurred even after the contagious person has left the room up to 2 hours before a susceptible person entered the room.47

According to the CDC, Americans born before 1957 have naturally acquired immunity to measles.48 Infants born to mothers, who have had measles and acquired natural antibodies, benefit from a passive maternal immunity passed on to them by their mothers to protect them as newborns. There also is evidence that unvaccinated mothers, who have recovered from measles, can pass short-term measles immunity to their infants when they breastfeed their babies.49 Research on maternal antibodies found that infants born to mothers who were vaccinated against measles had lower levels of maternal antibodies and lost them sooner in comparison to infants born to mothers who had developed natural immunity from prior infection. As a result, most babies born to vaccinated mothers may be at a greater risk of developing measles due to the poor quality and shorter duration of maternal antibodies.50 51

What is the history of Measles in America and other countries?

Measles was first described in the 9th century by Persian physician-philosopher Zakariya Razi. His accurate description of measles was recognized by the World Health Organization in 1970 and recognized as the first written account of the condition.52

In 1757, Scottish physician Francis Home determine that measles was an infection of the respiratory tract and could be found in the blood of affected individuals.53 Home attempted to develop a measles vaccine, however, his vaccine experiments were not successful as the measles virus had not yet been isolated.54 It wasn’t until an outbreak occurred among Boston Massachusetts students in 1954 that researchers Dr. Thomas C Peebles and Dr. John F. Enders were successful in isolating the virus. Measles vaccine development began soon after discovery.55

Prior to 1912, measles was not a reportable disease in the United States, therefore, accurate numbers of cases are not available before this time. In 1920, the United States had 469,924 recorded cases of measles and 7,575 deaths associated with measles.56 From 1958 to 1962, the U.S. averaged 503,282 cases and 432 death associated with measles each year.57 Before the first measles vaccine was licensed in the U.S. in 1963, measles increases were seen generally in late winter and spring58 every two to three years.59

Prior to the introduction of the measles vaccine in 1963, the CDC admits there was massive underreporting of measles cases and that “because virtually all children acquired measles, the number of measles cases probably approached 3.5 million per year (.i.e., an entire birth cohort).”60 Other doctors reports that up to 5 million cases of measles occurring every year in the United States. 61 In 1960, three years before the first measles vaccine was put on the market in the U.S., there were about 442,000 reported measles cases and 380 related deaths62, 63 among the 3.5 to 5 million Americans who likely were infected with measles. 64 65 In 1969, measles deaths were estimated at 1 in 10,000 cases.66

The CDC attributes the drop in reported measles cases and deaths in the U.S. to use of the measles vaccine beginning in the mid-1960’s,67 however, published measles morbidity and mortality data give evidence that death rates for measles had dropped significantly in the U.S. before the measles vaccine was introduced in 1963.68 69 

In 1967, public health officials announced that measles could be eradicated from the United States within a few months, with the introduction and use of measles vaccines.70 However, mass vaccination of infants beginning at approximately one year of age and the push for all children entering school to receive a dose of measles vaccine, did not result in eradication and outbreaks of measles continue to occur in highly vaccinated populations.71 72 However, by the end of 1968, 22,231 measles cases had been reported to the CDC.73

In 1979, public health officials launched an effort to eliminate measles in the United States through vaccination, with a goal of eradication by October 1st, 1982.74 In 1982, there were a record low 1,697 reported cases of measles in the United States 75 and while public health officials conceded that the goal of elimination had not been met, they publicly stated that it was “right around the corner”.76

A resurgence of measles in the United States occurred between 1989 and 1991, when reported measles cases increased 6- to 9-fold over the previously studied period between 1985 and 1988. During this resurgence, more than 53,000 cases of measles occurred as the result of 815 separate outbreaks.77  132 deaths in the U.S. were suspected to be associated with measles during this outbreak.78 As a result of the large increase in number of reported measles cases, the CDC’s Advisory Committee on Immunization Practices changed its measles recommendation, and all children were advised to receive an additional dose of measles vaccine prior to school entry.79

Reported measles cases dropped by the early 1990’s and in an eight-year period between 1993 and 2001, there were 1804 cases of measles reported in 120 outbreaks. 80 After only 15 measles cases were reported between 1999 and 2001, public health officials declared that measles was no longer endemic in the United States.81 In 2000, with only 86 reported cases of measles, 82 the CDC declared measles to be eliminated in the United States.83

Between 2000 and 2007, the U.S. recorded an average of 63 cases of measles a year. The numbers increased again in 2008 to 140 reported cases84 before decreasing again in 200985 and 2010.86 Measles cases increased again in 2011 to 220, with the majority linked to travelers returning from, or visiting, other countries, including those in Europe and Southeast Asia.87 

In 2014, there were 667 reported measles infections in the United States with the CDC reporting many to be associated with a large outbreak in the Philippines.88 An Amish community in Ohio experienced an outbreak that included 383 cases. 89

In January 2015, a multi-state measles outbreak linked to a California amusement park occurred, affecting 147 individuals. No known outbreak source was determined, however, the CDC believed the infection to have resulted from an international traveler as the particular strain was reported by the CDC to be identical to a strain that caused a large outbreak in the Philippines in 2014.90

The 2015 measles outbreak prompted a media firestorm, with newspapers and health officials blaming the parents of unvaccinated children, calling them ignorant, anti-science, and worse.91 State legislators quickly began introducing vaccine legislation, with many bills aimed at eliminating or severely restricting religious and conscientious/philosophical vaccine exemptions. Vaccine choice advocates were highly successful in defeating many of these bills, however, California lost its personal belief exemption and Vermont lost its philosophical exemption but retained its religious exemption.92

During the 2015 California measles outbreak, many suspected cases actually occurred in persons who were recently vaccinated. 194 measles virus sequences were collected in 2015, with 73 cases found to have actually been vaccine strain measles.93 While referred to by the CDC as a vaccine reaction, a rash and fever occurring 10-14 days following vaccination is indistinguishable from wild type measles and requires confirmation by genotyping.94 Multiple studies have been published on vaccine strain measles and the inability of physicians to differentiate between wild and vaccine strain measles without genotyping.95 96 97 98 99 100

In 2017, a 75 case outbreak occurred, affecting mainly Somalian Americans living in Minnesota.101 A total of 122 cases of measles were reported in 2017.102

Between January 1 and December 29, 2018, 349 cases of measles cases have been reported to the CDC and linked to 17 separate outbreaks. Measles cases have been reported in 26 states and the District of Columbia.103

“Modified” measles can also occur in persons with some degree of immunity, as well as in previously vaccinated persons, who get a milder form of measles. “Atypical” measles can occur in a person, who was previously vaccinated with a killed-virus vaccine used from 1963 to 1967, and who is exposed to wild-type measles. 104The course of atypical measles is generally longer than natural measles.105 

Measles is a common infection seen in many developing countries, especially in Asia and Africa. The World Health Organization estimates that 7 million measles infection occurred in 2016 and reported 89,780 measles related deaths. Measles complications more frequently affect young children who are malnourished and are insufficient in vitamin A. Children with immunosuppressive disease such as HIV are also more likely to suffer from complications.106

Can Measles cause injury and/or death?

Worldwide, measles is one of the leading causes of death in children living in undeveloped countries. In 2016, the World Health Organization attributed 89,780 deaths to measles infection, with most deaths occurring in children under the age of five.107 In the United States, the last reported death related to measles was reported to have occurred in 2015.108 This death occurred in an immunocompromised woman who had been previously vaccinated for measles. Initially, the death was attributed to pneumonia, however, when the presence of measles was found on autopsy, health officials revised her cause of death.109

Complications from measles include: 110 111 112

  • Otitis Media
  • Bronchitis
  • Croup
  • Diarrhea
  • Pneumonia
  • Seizures
  • Appendicitis
  • Hepatitis
  • Myocarditis (inflammation of the heart muscle)
  • Thrombocytopenia (blood disorder)
  • Death

Measles also can cause a miscarriage in a pregnant woman, or cause her to give birth prematurely, or have a low-birth-weight baby.113

In developing countries, serious malnutrition, vitamin A deficiency and immunosuppressive diseases such as HIV/AIDS often lead to more severe cases of measles and a higher risk of death.114

A rare but fatal disease of the central nervous system, subacute sclerosing panencephalitis (SSPE - a progressive, debilitating and deadly brain disorder) can also develop later in life after a measles infection earlier in life.115 Signs of SSPE include:116 

  • Changes in personality
  • Sleeplessness
  • Distractibility
  • Gradual onset of mental deterioration
  • Myoclonia (muscle spasms or jerks)
  • An elevated anti-measles antibody (IgGP in the serum and cerebrospinal fluid)

While measles infection has the potential to cause injury and death, it has also been noted to have a positive impact on improving health outcomes. Published studies report on the improvement of kidney disease, including nephrotic syndrome, following measles infection.117 118 119 120 Measles infection has also been noted to result in long term remission of juvenile rheumatoid arthritis, 121 122 123 and psoriasis.124 A positive history of measles infection prior to college was also noted to reduce the risk of Parkinson’s disease.125 Additionally, a published case study reported remission of Hodgkin’s Disease and the complete disappearance of a cervical tumor following measles infection.126

Who is at highest risk for getting Measles?

Those most at risk for developing measles are poorly nourished young children, especially those with insufficient vitamin A, or those whose immune systems have been weakened by HIV/AIDS or other diseases.127 Crowded living conditions can also put people at high risk of contracting measles, even in highly-vaccinated populations.128 129

The vaccine induced immunity that most mothers pass on to their infants have been found to be much lower and shorter acting than those produced following natural measles infection putting infants at higher risk for measles infection. 130 131 132 133 Children vaccinated prior to the waning of maternal measles antibodies are also at risk of measles related to vaccine failure.134

Who is at highest risk for suffering complications from Measles?

Children under age 5 and adults over 20 are most at risk for complications from measles. The CDC estimates that 30 percent of measles cases result in one or more complications.135 Undernourished or vitamin A-deficient children, along with individuals with immunosuppressive diseases such as HIV/AIDS, are at highest risk of severe complications.136 Adults who contract measles are more at risk of developing acute measles encephalitis than children.137

Immunocompromised individuals are also at higher risk of complications from measles, including those with HIV infection, congenital immunodeficiencies, and those persons with disorders requiring chemotherapeutic and immunosuppressive therapy.138 139

Pregnant women who contract measles may at higher risk for developing complications including miscarriage, pre-term labor, and low birth weight infants. Birth defects have not been associated with measles infection.140

Studies also show that complication rates and deaths are significantly higher, and recovery times longer, in infants and children who acquire measles in healthcare settings such as hospitals.141

Can Measles be prevented and are there treatment options?

There is no cure for measles. Once a person is infected, treatment primarily involves alleviating the symptoms with fluids and fever-reducers, and observation for signs of encephalitis and other measles complications.142 143

Many studies have also shown that immediate administration of high doses of vitamin A (50,000-200,000 IUs) can help control the severity of the disease, particularly in children who are malnourished.144 145 In the United States, vitamin A treatment is often recommended for children hospitalized for measles, and those who are immunocompromised, as well as for individuals found to be vitamin A deficit.146, 147

According the CDC, measles immunoglobulin can be administered within six days of measles exposure to high risk populations that include pregnant women without adequate blood titers for the prevention of measles, infants younger than 1 year of age, and persons with severe immunosuppression. Measles immunoglobulin may reduce the risk of infection and complications of measles.148 However, it is important to note that the use of measles immunoglobulin has been linked to degenerative diseases of cartilage and bone, sebaceous skin diseases, immunoreactive diseases, and tumors.149

Antiviral agents such as ribavirin and interferon have also been used to treat measles in immunocompromised individuals, although there are outstanding questions about clinical efficacy.150 151

What is Measles vaccine?

Measles vaccine is a weakened (attenuated) form of the live measles virus. Currently, there are 2 available vaccines for use in the U.S.: Merck's MMRII, which contains Measles, Mumps and Rubella Vaccine, Live;152 and Merck's Proquad (MMRV), which contains Measles, Mumps, Rubella and Varicella, Live. 153

Merck’s MMRII, is licensed and recommended for individuals aged 12 months or older. It is a live attenuated virus vaccine propagated in chick embryo cells and cultured with Jeryl Lynn live attenuated virus mumps and Meruvax II, a live attenuated rubella virus vaccine propagated in WI-38 human diploid lung fibroblasts.154 The WI-38 human diploid cell line was derived from the lung tissue of a three-month human female embryo.155 The growth medium used was salt solution and 10 percent calf (bovine) serum.156

Merck's ProQuad, is licensed and recommended for individuals aged 12 months to 12 years of age. ProQuad (Measles, Mumps, Rubella and Varicella Virus Vaccine Live) is a combined, attenuated, live virus vaccine containing measles, mumps, rubella, and varicella viruses. ProQuad is a sterile lyophilized preparation of the components of M-M-R II (Measles, Mumps, and Rubella Virus Vaccine Live): Measles Virus Vaccine Live, and Varicella Virus Vaccine Live (Oka/Merck), the Oka/Merck strain of varicella-zoster virus propagated in MRC-5 cells. MRC-5 cells are derived from a cell line that was developed in 1966 from lung tissue taken from a 14 week aborted fetus and contains viral antigens.157

The growth medium for measles and mumps for both MMRII158 and ProQuad159 is a buffered salt solution containing vitamins and amino acids and supplemented with fetal bovine serum containing sucrose, phosphate, glutamate, and recombinant human albumin, and neomycin. The growth medium for rubella is a buffered salt solution containing vitamins and amino acids and supplemented with fetal bovine serum containing recombinant human albumin and neomycin. Sorbitol and hydrolyzed gelatin stabilizer are added to the individual virus harvests. In the ProQuad vaccine,160 the Oka/Merck strain of the live attenuated varicella virus, initially obtained from a child with wild-type varicella, introduced into human embryonic lung cell cultures, adapted to and propagated in embryonic guinea pig cell cultures and finally propagated in human diploid cell cultures (WI-38) is added to the MMRII component.

According to Merck, both MMRII and ProQuad vaccines are screened for adventitious agents. Each dose of MMRII contains sorbitol, sodium phosphate, sucrose, sodium chloride, hydrolyzed gelatin, recombinant human albumin, fetal bovine serum, other buffer and media ingredients and neomycin.161 Each dose of ProQuad contains sucrose, hydrolyzed gelatin, sorbitol, MSG, sodium phosphate, human albumin, sodium bicarbonate, potassium phosphate and chloride, neomycin, bovine calf serum, chick embryo cell culture, WI-38 human diploid lung fibroblasts and MRC-5 cells.162 163

The MMRII vaccine product information insert states that the MMRII vaccine should be given one month before or one month after any other live viral vaccines.164 The ProQuad vaccine product information insert states that one month should lapse between administration of ProQuad and another measles containing vaccine such as MMRII and at least three months should lapse between ProQuad and any varicella containing vaccine.165

Currently, the CDC recommends that children receive two doses of a measles containing vaccine, with the first dose between the ages 12-15 months, and the second dose between the ages 4-6 years.166 The CDC also recommends that individuals born after 1957 and have no laboratory evidence of immunity or documentation of vaccination should receive at least one dose of MMR vaccine.167 Two doses of MMR vaccine are also recommended for healthcare personnel, students entering college and other post-high school educational institutions, as well as international travelers.168

The CDC also recommends MMR vaccination for infants between 6 and 12 months of age who may be traveling internationally.169 However, both ProQuad170 and MMRII171 have been FDA approved only for use in for children older than 12 months of age. The MMRII vaccine product insert states that effectiveness and safety of administration of MMRII has not been established in children between the ages of 6 and 12 months of age and if administered to this population, antibodies may not develop. According to the CDC, an infant vaccinated prior to 12 months of age would still require two additional doses of MMR vaccine.172

What is the history of Measles vaccine use in America?

Two measles vaccines were first licensed in 1963, both containing the Edmonston B measles strain isolated by John Enders in 1954. Rubeovax, a live attenuated vaccine, was manufactured by Merck while Pfizer-Vax Measles-K, an inactivated (killed) virus vaccine, was manufactured by Pfizer.173

At the time of vaccine approval, a single dose of the live attenuated Rubeovax was reported to be 95 percent effective at preventing measles, and protection from measles infection lasted at least 3 years and eight months. However, 30 to 40 percent of children who received Rubeovax experienced fever of 103 degrees or higher beginning on or around the sixth day following vaccination, lasting between 2 to 5 days. 30 to 60 percent of individuals who received Rubeovax also developed a “modified measles rash”.174 Due to the high number of side effects, public health officials and Merck officials recommended that Rubeovax be administered in conjunction with measles immune globulin, as co-administration significantly reduced reactions from the vaccine.175 176

Pfizer-Vax Measles–K, Pfizer’s inactivated measles virus vaccine given in a series of 3 vaccines at one month intervals, was much less reactive, however, the vaccine offered limited effectiveness against the disease. In fact, the majority of children who received the vaccine had no detectable levels of measles antibodies one year later.177 By 1965, reports of a new and abnormal measles-like illness began to surface in children previously vaccinated with inactivated measles virus vaccine and exposed to measles. Symptoms of atypical measles included rash, swelling, fever, pneumonia, and pleural effusion.178 Pfizer’s inactivated vaccine was taken off the market in 1968.179

Prior to 1963, as a result of the highly reactive nature of the live measles virus, Enders, had made the Edmonston measles strain available for other researchers to work with to encourage them to further attenuate the virus for vaccine use.180 As a result, additional live attenuated measles vaccines using the Edmonston B measles strain also became available in 1963, including M-Vac, manufactured by Lederle Pharmaceuticals, and other generic measles vaccines manufactured by various pharmaceutical companies including Parke Davis, Eli Lilly, and more. Pfizer also introduced Pfizer-Vax Measles-L, a live attenuated measles vaccine, in 1965. However, by 1975, all early approved measles vaccines had been discontinued and replaced with two newer, and more attenuated vaccines.181

These two further attenuated live measles vaccines were developed for use in the mid-1960’s as a result of the numerous unwanted side effects related to the earlier live vaccines. Lirugen, manufactured by Pitman Moore-Dow, was developed from the Schwarz strain of measles, a strain derived from further attenuating the Edmonston A strain.182 This vaccine was approved for use in 1965 but discontinued in the United States by 1976.183 The Schwarz strain remains in use outside of the United States. Merck further attenuated the Edmonston B strain and in 1968, its Attenuvax live attenuated vaccine, using the Moraten measle strain, was approved for use in the United States.184 Attenuvax is currently the measles vaccine found in Merck’s Measles, Mumps, and Rubella combination vaccine, MMRII,185 as well as Merck’s Measles, Mumps, Rubella, and Varicella vaccine, ProQuad.186

In 1967, public health officials announced that measles could be eradicated from the United States within a few months, with the introduction and use of measles vaccines.187 However, mass vaccination of infants beginning at approximately one year of age and the push for all children entering school to receive a dose of measles vaccine, did not result in measles eradication and outbreaks continued to occur in highly vaccinated populations.188 189 By 1971, public health officials noted that measles outbreaks were on the rise, and blamed the increasing number of measles cases on unvaccinated populations as well as the lack of legislation in many states to require measles vaccination as a condition of school entry. Public health officials acknowledged that vaccine failure played a role in outbreaks, and blamed failure on several factors including early vaccination prior to 9 months of age, the use of measles gamma globulin, improper vaccine handling and storage, as well as the 3 to 5 percent failure rate of the vaccine. The goal of measles eradication in the United States was no longer considered to be something that could be achieved quickly, and possibly not something achievable after all.190

Measles outbreaks continued to occur throughout the 1970’s and 1980’s, mainly affecting pre-school and school aged children.191 Despite the continued outbreaks, in 1979, public health officials launched an effort to eradicate measles in the United States through vaccination, by October 1st, 1982.192 In 1982, there were a record low 1,697 reported cases of measles in the United States193 and while public health officials conceded that they did not meet their goal, they publicly stated eradication to be “right around the corner”.194 Measles cases decreased again to 1,497 in 1983, before resurging to a reported 2,534 cases in 1984.195 By 1985, there were 2,813 reported measles cases, with 44 percent of cases occurring in children who were appropriately vaccinated with measles vaccine.196

In 1989, another resurgence of measles occurred and by the end of the year, 18,193 cases of measles were reported to the CDC,197 with over 40 percent of cases occurring in fully vaccinated individuals.198 The CDC blamed the outbreaks on both the failure of implementing vaccine programs, particularly those aimed at vaccinating preschool children, as well as on vaccine failure. While blaming the measles outbreaks on vaccine failure, the CDC continued to report a 95 percent measles vaccine effectiveness rate, all while denying that vaccine induced immunity was waning. However, in 1989, the CDC’s Advisory Committee on Immunization Practices (ACIP) updated its measles vaccine recommendations, recommending that all children receive 2 doses of MMR vaccine prior to school entry, with the first dose of at 15 months, and the second dose at 4 to 6 years of age, prior to Kindergarten or first grade.199

As well, in 1989, the CDC also sponsored a study involving the use of two separate measles vaccines that targeted minority children living in the Los Angeles area. One of the two measles vaccines used in the study was an experimental, unlicensed vaccine, however, this information was not disclosed to parents. 200 The experimental vaccine was a high dose measles vaccine aimed at overwhelming the natural maternal antibodies that protect infants from infection during the first year of life. The presence of maternal antibodies at time of vaccination can lead to vaccine failure and the risk of measles infection later in life.  This experimental measles vaccine was in use outside of the country, however, by 1990, studies noting a higher death rate in female children receiving the vaccine began to appear in medical journals. The Los Angeles study was halted in 1991, however the public was not informed of the use of the experimental vaccine until 1996. While the CDC claims that no vaccine injuries resulted from the use of this unlicensed vaccine, one child that took part in the study died of a bacterial infection. The CDC, however, maintains that the death was not related to vaccination. 201

In 1998, concerns over safety of the combination measles-mumps-rubella vaccine surfaced following a published case study on 12 previously healthy children who developed severe gastrointestinal disorders after MMR vaccination.202 Eight of the twelve children involved in the study also developed autism, with parents and personal physicians reporting that symptoms began soon after receiving the MMR vaccine. As well, the 13 physicians involved in the study also reported that they had investigated over 40 similar cases. While these researchers were not claiming that the MMR vaccine was responsible for causing the reported gastrointestinal health problems, they urged that more research be done on the subject.203

Following publication, scientists involved in the study, including lead author Dr. Andrew Wakefield, became subject of an enormous backlash from public health officials and vaccine policymakers, in attempt to discredit the study.204 By the late 2000’s, Wakefield and two contributing researchers, Dr. John Walker-Smith and Dr. Simon Murch, became the subjects of disciplinary action from the United Kingdom’s General Medical Council (GMC) over misconduct claims in association with the study. In May 2010, Wakefield and Walker-Smith both lost their medical licenses, having been found guilty of misconduct by the GMC.205 Walker-Smith appealed the verdict and in 2012, a U.K. high court reversed the decision, with the presiding judge criticizing the GMC’s disciplinary panel’s decision, stated that "It would be a misfortune if this were to happen again."206 Since the publication of Wakefield et al’s controversial case study, independent researchers have replicated the findings.207 Yet, despite this additional scientific literature, Wakefield continues to be demonized by the press and medical community.208 209

In August 2014, William Thompson, a senior scientist at the CDC, came forward with allegations that CDC researchers purposely omitted data that would show a link between the MMR vaccine and autism among African American boys.210 According to Thompson, researchers involved in the 2004 study went as far as destroying data that would demonstrate an association between autism and the MMR vaccine. After these allegations came to light, Florida Senator Bill Posey called for an investigation of the CDC scientists involved in the study to determine whether fraud had been committed in an attempt to cover up a link between the MMR vaccine and autism. 211 The cover-up of the autism-MMR link by the CDC became the subject of Vaxxed: From Cover-Up to Catastrophe, a documentary that had been scheduled to make its debut at New York City’s Tribeca Film Festival in April of 2016. However following an onslaught of media attacks against the film, the documentary was dropped from the festival’s lineup,212 213 and debuted instead at Manhattan’s Angelika Film Center in April of 2016.214 Government officials have yet to investigate the allegations brought forward by Thompson against his fellow CDC scientists.

In early January of 2015, the CDC began investigating an outbreak of measles linked to the Disneyland theme park resort in California. In a statement released on January 23, 2015, the CDC announced that 51 confirmed cases of measles had been linked to the outbreak and encouraged vaccination against measles.215 The measles cases linked to Disneyland set off a media frenzy, and hundreds of measles outbreak news stories followed, with many reports blaming and vilifying the parents of unvaccinated children.216 As a result of the outbreak, several state legislators began introducing vaccine legislation, with bills aimed at eliminating or severely restricting religious and conscientious/philosophical vaccine exemptions. Vaccine choice advocates were extremely successful in defeating many of the restrictive vaccine bills, however, California lost its personal belief exemption and Vermont lost its philosophical exemption, but retained its religious vaccine exemption.217 In 2015, there were only 188 reported cases of measles in the United States, 218 with 147 cases linked to the outbreak in California,219 which was a 72 percent decrease in measles cases from one year earlier.220

Currently, the CDC’s Advisory Committee on Immunization Practices continues to recommend that all children receive 2 doses of MMR vaccine, with the first dose administered between 12 and 15 months of age, and the second dose administered between 4 and 6 years of age, prior to entering kindergarten or first grade.221

Measles vaccination rates remain high in the U.S. with the CDC currently reporting that 94 percent of children entering kindergarten222 and more than 92% of high school students have received two doses of MMR vaccine. 223

How effective is Measles vaccine?

The CDC estimates that measles antibodies develop in approximately 95 percent of children vaccinated at 12 months and 98 percent of children vaccinated at 15 months or older. It is estimated that about 2-5 percent of children, who receive the vaccine at 12 months of age or younger or who only get one dose of MMR, fail to be protected. A second dose or MMR is thought to stimulate a protective immune response in about 99 percent of vaccine recipients.224

Following the introduction of the measles vaccine in 1963, until December of 1989, public health officials recommended only one dose of measles vaccine for all children. However, by 1989, following multiple outbreaks, including several occurring in fully vaccinated populations,225 226   the CDC’s Advisory Committee on Immunization Practices (ACIP) updated its measles vaccination recommendation, and recommended that a second dose of a measles vaccine, preferably the MMR vaccine, be administered to all children prior to school entry.227

Currently the CDC states that vaccine-induced immunity “appears to be long-term and probably lifelong in most persons”228 however, studies have shown that vaccine failure due to waning immunity can occur.229 230 231 In 2015, infectious disease experts reported that approximately 1 in 10 measles vaccinated individuals may be at risk of measles due to vaccine waning.232 In 2011, news reports from India publicly stated that only 1 child in 5 vaccinated for measles was actually protected from getting the disease, even after being fully vaccinated.233 Measles vaccine acquired immunity is reported to wane in at least 5 percent of cases, within 10 to 15 years after vaccination.234 235 236  Outbreaks of measles can still occur in highly vaccinated populations. In 2017, an outbreak of measles occurred among young soldiers in Israel. The primary patient involved in the outbreak had documentation of having received three doses of measles vaccine and the additional eight cases of measles were found to have occurred in persons who reported having, or provided documentation of having, at least 2 doses of a measles containing vaccine.237

The use of a third MMR vaccine dose to boost low measles vaccine induced antibodies also does not appear to be effective. A recent study found that administering an additional dose of MMR vaccine in an attempt to boost antibodies in persons in persons found to have low vaccine induced measles antibodies was ineffective, leaving this particular population at risk for developing measles infection.238

According to the Merck product information insert, there is some evidence that if infants born to mothers, who have experienced natural measles infection, are vaccinated at less than one year of age, they may not develop long lasting vaccine acquired antibodies because natural maternal antibodies interfere with vaccine induced antibodies.239 Research on maternal antibodies has also found that infants born to mothers who were vaccinated against measles had lower levels of maternal antibodies and lost them sooner in comparison to infants born to mothers who had developed natural immunity from prior infection. As a result, babies born to vaccinated mothers may be at a greater risk of developing measles due to the poor quality and short duration of maternal antibodies.240 241 

The number of vaccinated people infected with measles and who show few or no symptoms but transmit measles to others is also unknown as vaccinated individuals are not routinely surveyed to determine whether they are experiencing asymptomatic or atypical measles and transmitting it to other. 242 243 As well, researchers have found that exposure to natural measles to be necessary for the maintenance of protective antibodies in vaccinated persons.244 

Can Measles vaccine cause injury & death?

The Centers for Disease Control (CDC) report minor side effects from the MMR-V and MMR vaccines to include low-grade fever, injection site redness or rash, pain at the injection site, and facial swelling. Moderate side effects include a full body rash, temporary low platelet count, temporary stiffness and pain the joints and seizures, and seizures. 245 246 MMR-V, however, has been noted to have a higher risk of seizures than separate administrations of MMR and varicella vaccines, especially when given as the first dose of the series.247   Rare serious side effects of both MMR-V and MMR include brain damage, coma, chronic seizure disorder, lowered level of consciousness and loss of hearing.248 249

Serious complications reported by Merck in the ProQuad(MMR-V) product insert during vaccine post-marketing surveillance include250:

  • measles;
  • atypical measles;
  • vaccine strain varicella;
  • varicella-like rash;
  • herpes zoster;
  • herpes simplex;
  • pneumonia and respiratory infection;
  • pneumonitis;
  • bronchitis;
  • epididymitis;
  • cellulitis;
  • skin infection;
  • subacute sclerosing panencephalitis;
  • aseptic meningitis;
  • thrombocytopenia;
  • aplastic anemia (anemia due to the bone marrow’s inability to produce platelets, red and white blood cells);
  • lymphadenitis (inflammation of the lymph nodes);
  • anaphylaxis including related symptoms of peripheral, angioneurotic and facial emema;
  • agitation;
  • ocular palsies;
  • necrotizing retinitis (inflammation of the eye);
  • nerve deafness;
  • optic and retrobulbar neuritis (inflammation of the optic nerve);
  • Bell’s palsy (sudden but temporary weakness of one half of the face);
  • cerebrovascular accident (stroke);
  • acute disseminated encephalomyelitis;
  • measles inclusion body encephalitis;
  • transverse myelitis;
  • encephalopathy;
  • Guillain-Barré syndrome;
  • syncope (fainting);
  • tremor;
  • dizziness;
  • paraesthesia;
  • febrile seizure;
  • afebrile seizures or convulsions;
  • polyneuropathy (dysfunction of numerous peripheral nerves of the body);
  • Stevens-Johnson syndrome;
  • Henoch-Schönlein purpura;
  • acute hemorrhagic edema of infancy;
  • erythema multiforme;
  • panniculitis;
  • arthritis;
  • death

A 2014 published study on the MMR-V vaccine in Canada determined that the risk of febrile seizures to be double in children receiving the MMR-V vaccine when compared to those receiving the MMR and varicella vaccines separately.251 A 2015 meta-analysis found a two-fold increase in febrile seizures between 5 and 12 days or 7 and 10 days following MMR-V vaccination in children between the ages of 10 and 24 months.252

MMR-V vaccine contains albumin, a human blood derivative, and as a result, a theoretical risk of contamination with Creutzfeldt-Jakob disease (CJD) exists. Merck states that no cases of transmission of CJD or other viral diseases have been identified and virus pools, cells, bovine serum, and human albumin used in vaccine manufacturing are all tested to assure the final product is free of potentially harmful agents.

Serious complications reported by Merck in the MMRII product insert during vaccine post-marketing surveillance include:253

  • brain inflammation (encephalitis) and encephalopathy (chronic brain dysfunction);
  • panniculitis (inflammation of the fat layer under the skin);
  • atypical measles;
  • syncope (sudden loss of consciousness, fainting);
  • vasculitis (inflammation of the blood vessels);
  • pancreatitis (inflammation of the pancreas);
  • diabetes mellitus;
  • thrombocytopenia  purpura (blood disorder);
  • Henoch-Schönlein purpura (inflammation and bleeding in the small blood vessels);
  • acute hemorrhagic edema of infancy (rare vasculitis of the skin’s small vessels occurring in infants);
  • leukocytosis (high white blood cell count);
  • anaphylaxis (shock);
  • bronchial spasms;
  • pneumonia;
  • pneumonitis(inflammation of the lung tissues);
  • arthritis and arthralgia (joint pain);
  • myalgia (muscle pain);
  • polyneuritis (inflammation of several nerves simultaneously);
  • measles inclusion body encephalitis (disease affecting the brain of immunocompromised persons);
  • subacute sclerosing panencephalitis (fatal progressive brain disorder caused by exposure to the measles virus);
  • Guillain-Barre Syndrome (GBS)(disease where the body’s immune system attacks the nerves);
  • acute disseminated encephalomyelitis (ADEM) (brief widespread inflammation of the nerve’s protective covering);
  • transverse myelitis (inflammation of the spinal cord);
  • aseptic meningitis;
  • erythema multiforme (skin disorder from an allergic reaction or infection);
  • urticarial rash (hives, itching from an allergic reaction);
  • measles-like rash;
  • Stevens-Johnson syndrome (severe reaction causing the skin and mucous membranes to blister, die, and shed);
  • nerve deafness (hearing loss from damage to the inner ear);
  • otitis media (ear infection);
  • retinitis (inflammation of the retina of the eye);
  • optic neuritis (inflammation of the optic nerve);
  • conjunctivitis (pink eye);
  • ocular palsies (dysfunction of the ocular nerve);
  • epididymitis (inflammation of the epididymis);
  • paresthesia (burning or prickling of the skin);
  • death.

In the comprehensive report evaluating scientific evidence, Adverse Effects of Vaccines: Evidence and Causality254, published in 2012 by the Institute of Medicine (IOM), 30 reported vaccine adverse events following the Measles, Mumps, and Rubella (MMR) vaccine were evaluated by a physician committee.255 These adverse events included measles inclusion body encephalitis, febrile seizures, arthritis, meningitis, Guillain Barre Syndrome, autism, diabetes mellitus, optic neuritis, transverse myelitis and more.

In 23 of the 30 measles, mumps, and rubella (MMR) vaccine-related adverse events evaluated, the IOM committee concluded that there was inadequate evidence to support or reject a causal relationship between the MMR vaccine and the reported adverse event, primarily because there was either an absence of methodologically sound published studies or too few quality studies to make a determination.256 The IOM committee, however, concluded that the scientific evidence “convincingly supports” a causal relationship between febrile seizures, anaphylaxis, and measles inclusion body encephalitis in immunocompromised individuals and the MMR vaccine and favored acceptance of a causal relationship between transient arthralgia in both children and women and the MMR vaccine.257 The IOM committee also concluded that it favored rejection of a causal association between both autism and the MMR vaccine and Type 1 diabetes and the MMR vaccine, however, both of these conclusions were made following the review of only five epidemiological studies.258

In 2012, the Cochrane Collaborative examined 57 studies and clinical trials involving approximately 14.7 million children who had received the MMR vaccine. 259 While the study authors stated that they were not able to detect a “significant” association between MMR vaccine and autism, asthma, leukemia, hay fever, type I diabetes, gait disturbance, Crohn’s disease, demyelinating diseases or bacterial or viral infections, they reported that:

“The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.”260

As of November 30, 2018, there have been more than 93,179 reports of measles vaccine reactions, hospitalizations, injuries and deaths following measles vaccinations made to the federal Vaccine Adverse Events Reporting System (VAERS), including 459 related deaths, 6,936 hospitalizations, and 1,748 related disabilities. However, the numbers of vaccine-related injuries and deaths reported to VAERS may not reflect the true number of serious health problems that occur develop after MMR vaccination.

Even though the National Childhood Vaccine Injury Act of 1986 legally required pediatricians and other vaccine providers to report serious health problems following vaccination to federal health agencies (VAERS), many doctors and other medical workers giving vaccines to children and adults fail to report vaccine-related health problem to VAERS. There is evidence that only between one and 10 percent of serious health problems that occur after use of prescription drugs or vaccines in the U.S. are ever reported to federal health officials, who are responsible for regulating the safety of drugs and vaccines and issue national vaccine policy recommendations.261,262,263,264 265

As of January 2, 2019, there have been 1,258 claims filed so far in the federal Vaccine Injury Compensation Program (VICP) for 82 deaths and 1,176 injuries that occurred after measles vaccination. Of that number, the U.S. Court of Claims administering the VICP has compensated 483 children and adults, who have filed claims for measles vaccine injury.266

One example of an MMR vaccine injury claim awarded compensation in the VICP is the case of O.R. On February 13, 2013, O.R. received the MMR, Haemophilus Influenzae type B, Pneumococcal (Prevnar 13), Hepatitis A, and Varicella vaccines. That evening, following vaccination, she became feverish and irritable prompting her mother to contact the doctor. The doctor advised O.R.’s mom to administer Benadryl and Tylenol for her symptoms. The fever persisted for several days and was followed by a severe seizure resulting in cardiac and respiratory arrest. The cardiac arrest and seizures caused O.R. to develop encephalopathy, kidney failure, severe brain injury, low muscle tone and cortical vision impairment. After several months of inpatient hospitalization, O.R. was discharged home with 24-hour supervised medical care.267 On November 20, 2017, the court conceded that the MMR vaccine caused her encephalopathy and O.R. was awarded a $101 million dollar settlement to cover medical expenses for the rest of her life.268 269

In 1998, public health officials and attorneys associated with the federal Vaccine Injury Compensation Program published a review in Pediatrics in regards to the medical records of 48 children ages 10 to 49 months, who received a measles vaccine or combination MMR vaccine between 1970 and 1993 and developed encephalopathy after vaccination. The children either died or were left with permanent brain dysfunction, including mental regression and retardation, chronic seizures, motor and sensory deficits and movement disorders. The study authors concluded that:

“The onset of neurologic signs or symptoms occurred with a nonrandom, statistically significant distribution of cases on days 8 and 9. No cases were identified after the administration of monovalent mumps or rubella vaccine. This clustering suggests that a causal relationship between measles vaccine and encephalopathy may exist as a rare complication of measles vaccination.”270

Nearly two decades earlier, in 1981, a report of the National Childhood Encephalopathy Study was published in Britain that concluded:

“The risk of a serious neurological disorder within 14 days after measles vaccine in previously normal children irrespective of eventual clinical outcome is 1 in 87,000 immunizations.”271

However, a 2007 study conducted in Britain concluded “We can estimate the vaccine-attributable risk of serious neurologic disease after the first dose of MMR vaccine as 1 in 365,000 doses.272 

As well, published studies have shown that the MMR vaccine components or excipients, particularly egg antigens and porcine or bovine gelatin, can trigger both immediate and delayed anaphylactic reactions.273 274

In Guinea-Bissau, Dr. Peter Aaby has studied and administered vaccines to thousands of children for more than three decades and has published research on vaccine safety and effectiveness, including research on measles and measles vaccine.275 He found that there can be marked differences in the way that boys and girls respond to vaccines and noted an increased risk of mortality in girls who received DTP and measles vaccines at the same time.276 He also found that fatality rates were increased for children ages 6 months to 17 months old, if they had received the DTP vaccine simultaneously with or after receiving measles vaccine.277 

In 1995, Swiss researchers discovered the presence of the reverse transcriptase (RT) enzyme in the live measles and mumps vaccine, and traced it back to the cells of the chickens used to create the vaccine.278 Reverse transcriptase is responsible for copying RNA into DNA and its activity is associated with the presence of retroviruses, a class of viruses that has the ability to permanently alter the genes of the cells they infect. While the World Health Organization (WHO) and the CDC reviewed the findings, they were also quick to dismiss them, with the CDC publicly stating that “we are not investigating a situation in which there has been any adverse reaction at all."279 Independent researchers have expressed concerns that the use of animal tissues for the production of human vaccines such as the live MMR vaccine may facilitate the transfer of viral infection from animals into man causing as yet undetected and unevaluated negative health effects on humans.280

The first evidence of persistent measles virus infection of the intestine after measles vaccination was discovered in 1995 by British researchers.281  In 1998, an association between live virus measles vaccine, inflammatory bowel disease (IBD) and regressive autism was hypothesized by gastroenterologist Dr. Andrew Wakefield and other physicians at Royal Free Hospital after they detected the presence of measles virus in the intestines of children suffering with Crohn’s disease and autism. The paper,  published in The Lancet, suggested MMR vaccine may be associated with development of regressive autism in previously healthy children, was immediately met with intense anger and criticism from public health officials and medical trade associations.282

Hans Asperger had observed a high rate of gastrointestinal (celiac) disease in children diagnosed with autism,283 and these observations prompted Wakefield and his colleagues to further examine this association. After studying children who were suffering from inflammatory bowel disease and were receiving treatment at Royal Free Hospital in the United Kingdom, the researchers hypothesized that a persistent viral infection, either from natural measles disease or live virus measles vaccine, could cause chronic inflammation in the bowel and damage to the central nervous system in some children. However, in their paper they emphasized that they had not proven a cause and effect relationship between autism, MMR vaccine and non-specific colitis, which they described as “autistic ileal-lymphoid-nodular hyperplasia,” but rather called for more studies to explore the potential relationship.284 Additional independent studies on this subject have also reported the presence of measles virus in association with gastrointestinal disorders, such as enterocolitis and chronic intestinal inflammation.285 286

Today, the majority of doctors and health officials reject the suggestion that MMR vaccine is associated with the development of autism in children.287 However, privately funded research continues to investigate the potential association between vaccines, including MMR vaccine, and the development of autism, inflammatory bowel disease and other kinds of brain and immune system dysfunction in previously healthy children. 

The MMRII and the ProQuad (MMR-V) product inserts report the following:

  • Measles inclusion body encephalitis, pneumonitis, and death have occurred in severely immunocompromised individuals who were inadvertently vaccinated. Disseminated mumps and rubella infections have also been reported in this population.
  • Subacute sclerosing panencephalitis (SSPE) has been reported in children without a history of wild-type measles infection, however, these children were documented to have received measles vaccine. The vaccine product insert speculates that some cases may have either resulted from measles vaccination or from a possible unrecognized case of measles in the first year of life.
  • In the majority of susceptible individuals, small amounts of the live attenuated rubella virus have been excreted from the throat or nose 7 to 28 days following vaccination. According to the vaccine product insert, no evidence has confirmed that the rubella virus can be transmitted to susceptible individuals who come into contact with vaccinated persons. Transmission through close personal contact have been accepted as being theoretically possible but it is not considered a significant risk.
  • Transmission of the rubella vaccine virus through breast milk has been noted and postpartum women vaccinated with a live attenuated rubella vaccine may transmit the virus to their breast-fed infants. In one study, several infants were found to have serological evidence of rubella infection without severe disease, however, one infant was noted to have a mild illness found to be typical of rubella.
  • Vaccine product inserts for MMR and MMR-V deny any reports of transmission of live attenuated mumps or measles viruses from persons vaccinated and susceptible close contacts. Measles or mumps vaccine virus secretion in human milk is not known.

In November 2014, the National Vaccine Information Center published a special report The Emerging Risks of Live Virus and Virus Vectored Vaccines: Vaccine Strain Virus Infection, Shedding and Transmission.288  This report reviewed the medical literature for evidence that live virus vaccine strain infection, shedding, and potential for transmission occurs, including measles vaccine strain infection and shedding.

There have been published reports of vaccine strain measles infection with clinical symptoms that are indistinguishable from wild-type measles.289 290  There are also a few reports of measles vaccine strain virus shedding and lab confirmed infection in children following MMR vaccination. In 2002, there was a published report by researchers in France of “a child presenting with fever 8 days after vaccination with a measles-mumps-rubella vaccine. Measles virus was isolated in a throat swab taken 4 days after fever onset. This virus was then further genetically characterized as a vaccine-type virus.” 291

In 2010, Eurosurveillance published a report about the shedding of vaccine strain measles virus in urine and throat secretions of a Croatian child with vaccine-associated rash illness.292 A healthy 14-month old child was given MMR vaccine and eight days later developed macular rash and fever. Lab testing of throat and urine samples between two and four weeks after vaccination tested positive for vaccine strain measles virus. Authors of the report pointed out that when children experience a fever and rash after MMR vaccination, only molecular lab testing can determine whether the symptoms are due to vaccine strain measles virus infection. They stated:

“According to WHO guidelines for measles and rubella elimination, routine discrimination between aetiologies of febrile rash disease is done by virus detection. However, in a patient recently MMR-vaccinated, only molecular techniques can differentiate between wild type measles or rubella infection or vaccine-associated disease. This case report demonstrates that excretion of Schwartz measles virus occurs in vaccinees.”293

In 2012, a report was also published describing a healthy 15-month old child in Canada, who developed irritability, fever, cough, conjunctivitis and rash within seven days of an MMR shot. 294 Blood, urine and throat swab tests confirmed a vaccine strain measles virus infection 12 days after vaccination. Addressing the potential for measles vaccine strain virus transmission to others, the authors stated,

“While the attenuated virus can be detected in clinical specimens following immunization, it is understood that administration of the MMR vaccine to immunocompetent individuals does not carry the risk of secondary transmission to susceptible hosts.”

IMPORTANT NOTE: Even though ACIP says it’s safe to give other viral and bacterial vaccines at the same time as MMR vaccine, Merck’s MMRII product information insert states that other live virus vaccines—such as varicella295 should NOT be given at the same time as MMR vaccine but rather should be administered one month prior or one month after MMR vaccination.296

Who is at highest risk for complications from Measles Vaccine?

According to the MMRII product insert,297 persons most at risk for complications from MMRII vaccine include individuals with both primary and acquired immunodeficiency such as AIDS, dysgammaglobulinemic and hypogammaglobulinemic states, and cellular immune deficiencies. Pneumonitis, measles inclusion body encephalitis, and death have also occurred as a result of being inadvertently vaccinated with a measles containing vaccine.

Persons with thrombocytopenia or history of the condition may also be at greater risk for exacerbation or redevelopment of thrombocytopenia with subsequent doses of MMRII vaccine.

Individuals with a personal history of cerebral injury, personal or family history of seizures, or any other health condition where stress related to fever should be avoided, may also be at greater risk for complications.

As both the live measles and live mumps vaccines are manufactured using chick embryo cell culture, individuals with a history of an immediate reaction, as well as those with anaphylactic and anaphylactoid reactions to eggs may be at greater risk of a reaction from the MMRII vaccine. MMRII contains neomycin and persons who have previously experienced an anaphylactic reaction to either systematic or topical neomycin should not be vaccinated with MMRII due to the risk of reaction and subsequent complications resulting from the reaction.

Merck’s MMR-V (ProQuad) vaccine product insert298 states that children between the ages of 12 and 23 months with no history of vaccination or wild-type infection with measles, mumps, rubella, and varicella have a higher risk of fever and febrile seizure between 5 and 12 days following vaccination with MMR-V in comparison with children who were vaccinated with separate doses of MMRII and Varicella vaccine. Children with a personal or family history of convulsion or a personal history of cerebral illness or medical condition where stress from fever should be avoided may also be at a greater risk of complications from MMR-V.

Individuals most at risk for complications from MMR-V vaccine include persons with both primary and acquired immunodeficiency such as AIDS, dysgammaglobulinemic and hypogammaglobulinemic states, and cellular immune deficiencies. Pneumonitis, measles inclusion body encephalitis, and death have also occurred as a result of being inadvertently vaccinated with a measles containing vaccine. As well, reports of disseminated varicella vaccine virus infection occurring in children with underlying immunodeficiency disorders inadvertently with a varicella-containing vaccine have also been documented.

Who should not get Measles vaccine?

Contraindications to receiving the MMRII vaccine documented in Merck’s product insert include299:

  • Persons who have experienced a severe allergic reaction or anaphylaxis to any MMR vaccine component, including gelatin and neomycin, should not be vaccinated with MMR.
  • Pregnant women should not receive this vaccine, as well as women seeking to become pregnant should avoid become pregnant for 3 months following MMR vaccination.
  • Individuals receiving immunosuppressive therapy. Vaccination with MMR should be delayed for 3 months following the administration of human immune globulin, blood, or plasma.
  • Persons with leukemia, lymphoma, blood dyscrasias and other malignant neoplasms affecting the lymphatic systems or bone marrow.
  • Individuals with febrile respiratory illness or other active febrile infection should avoid MMR vaccine.
  • MMR and other measles-containing vaccines are not recommended for HIV-infected persons with evidence of severe immunosuppression.
  • Persons with a family history of hereditary or congenital immunodeficiency should not be vaccinated with MMR until the immune competence of the recipient has been determined.
  • Individuals with untreated tuberculosis should not be vaccinated with MMR vaccine.

Merck’s MMRII product insert also warns that caution should be taken when administering the vaccine to individuals with a history of cerebral injury, family or personal history of convulsions, or any other condition where stress related to fever should be avoided. As well, a person with thrombocytopenia may exacerbate their condition by receiving the MMR vaccine.

Both live measles and mumps vaccine are manufactured in chick embryo cell culture. Extreme caution should be taken when vaccinating individuals with a history of anaphylaxis or immediate hypersensitivity to eggs and Merck advises careful evaluation of the risks and benefits when considering vaccination in this population.

Rubella vaccine virus has been found in the breast milk of nursing mothers with documentation of its ability to be transferred to infants. Serological evidence of rubella infection and a case of mild clinical illness typical with an acquired rubella infection has also been documented in a nursing infant. As a result of these findings, Merck cautions the use of MMR vaccine in nursing women.

IMPORTANT NOTE: Even though the CDC’s Advisory Committee on Immunization Practices (ACIP) states that Merck’s MMRII vaccine can be administer at the same time as other viral and bacterial vaccines, Merck’s MMRII product information insert states that other live virus vaccines—such as varicella300 should NOT be given at the same time as MMR vaccine but rather should be administered one month prior or one month after MMR vaccination.301

Additionally, Merck’s product insert does not recommend giving MMRII at the same time as DTP (diphtheria, tetanus, and pertussis) and/or OPV (oral poliovirus vaccine) even though the Advisory Committee on Immunization Practices (ACIP) has stated that simultaneous administration of the entire recommended vaccine series is acceptable.302

MMRII vaccine is approved for use in persons 12 months of age and older. Despite recommendations by the CDC’s Advisory Committee on Immunization (ACIP) that children between 6 and 12 months who will be traveling or residing abroad be vaccinated with MMR prior to international travel,303 Merck’s MMRII product insert states that effectiveness and safety have not been established in this population.304 Studies have determined that early vaccination of an infant often results in vaccine failure due to both the infant’s immature immune system response as well as the presence of maternal antibodies that interfere with vaccination. Early vaccination can result in reduced antibodies that persist, despite revaccination. 305

Contraindications to receiving MMR-V (ProQuad) vaccine documented in Merck’s product insert include:306

  • Persons who have experienced a severe allergic reaction or anaphylaxis to any MMR-V vaccine component, including gelatin and neomycin, should not be vaccinated with MMR-V.
  • Febrile illness or active untreated tuberculosis
  • Persons with acquired or primary immunodeficiency status and individuals receiving immunosuppressive therapy. Vaccination with MMR-V should be delayed for 3 months following the administration of human immune globulin, blood, or plasma.
  • Individuals with a family history of hereditary or congenital immunodeficiency.
  • Pregnant women.
  • Persons with leukemia, lymphoma, blood dyscrasias and other malignant neoplasms affecting the lymphatic systems or bone marrow.

Merck’s MMR-V (ProQuad) product insert warns of a higher incidence of fever and febrile seizures in children between the ages of 12 and 23 months following administration of MMR-V in comparison with children who receive separate doses of MMR and varicella vaccines. Caution is advised when administering MMR-V in children with a history of seizures, cerebral injury, or any other medical condition where stress from fever should be avoided.

Both live measles and mumps vaccine are manufactured in chick embryo cell culture. Extreme caution should be taken when vaccinating individuals with a history of anaphylaxis or immediate hypersensitivity to eggs and Merck advises careful evaluation of the risks and benefits when considering vaccination in this population.

Merck’s MMR-V vaccine product insert reports that transmission of varicella vaccine virus may occur between vaccine recipients and susceptible contacts, including high risk individuals, resulting in both the development or non-development of varicella-like rash. As a result, Merck cautions that vaccine recipients should attempt to avoid close contact with high risk individuals. This population includes pregnant women who lack a positive history of illness or vaccination and their newborn infants, any infants born prior to 28 weeks gestation, and any immunocompromised individuals.

Merck also advises careful evaluation of the risk and benefits of vaccination with MMR-V in children with thrombocytopenia or history of the blood disorder as no clinical data on the development or exacerbation of this condition exists. Thrombocytopenia has been reported following vaccination with MMRII, measles vaccine, varicella vaccine and again following an addition dose of both measles and MMRII vaccines.

The safety or efficiency of MMR-V has not been determined in children who are infected with human immunodeficiency virus (HIV).

Children between 12 months and 12 years of age who receive MMR-V vaccine should avoid the use of salicylate (aspirin) or salicylate-containing products for 6 weeks following vaccination due to the risk of Reye Syndrome with aspirin and wild-type varicella disease.

MMR-V is approved for use in children 12 months to 12 years of age. Children under the age of 1 year or older than 12 years of age should not receive MMR-V vaccine.

What questions should I ask my doctor about Measles vaccine?

NVIC’s If You Vaccinate, Ask 8! Webpage downloadable brochure suggests asking eight questions before you make a vaccination decision for yourself, or for your child. If you review these questions before your appointment, you will be better prepared to ask your doctor questions.  Also make sure that the nurse or doctor gives you the relevant Vaccine Information Statement (VIS) for the vaccine or vaccines you are considering well ahead of time to allow you to review it before you or your child gets vaccinated. Copies of VIS for each vaccine are also available on the CDC's website and there is a link to the VIS for MMR and MMR-V vaccines on NVIC's “Quick Facts” at the top of this page.

It is also a good idea to read the vaccine manufacturer product insert that can be obtained from your doctor or public health clinic because federal law requires drug companies marketing vaccines to include certain kinds of vaccine benefit, risk and use information in product information inserts that may not be available in other published information. Merck’s MMRII and MMR-V vaccine product inserts are located on the Food and Drug Administration’s website.

Other questions that may be useful to discuss with your doctor before getting the mumps (MMR or MMR-V) vaccine are: 

  • If other vaccines in addition to MMR/MMR-V vaccine are scheduled for my child at this office visit, am I allowed to modify the schedule so fewer vaccines are given at once?
  • What should I do if my child has a high fever or appears very ill after vaccination?
  • What other kinds of reaction symptoms should I call to report after MMR/MMR-V vaccination?
  • If the MMR/MMR-V vaccine doesn’t protect my child, do I have any other options for preventing measles infection?

Under the National Childhood Vaccine Injury Act of 1986, doctors and all vaccine providers are legally required to give you vaccine benefit and risk information before vaccination; record serious health problems following vaccination in the permanent medical record; keep a permanent record of all vaccines given, including the manufacturer’s name and lot number; and report serious health problems, injuries and deaths that follow vaccination to VAERS.

Remember, if you choose to vaccinate, always keep a written record of exactly which shots/vaccines you or your child have received, including the manufacturer’s name and vaccine lot number. Write down and describe in detail any serious health problems that develop after vaccination, and keep vaccination records in a file you can access easily.  

It also is important to be able to recognize a vaccine reaction and seek immediate medical attention if the reaction appears serious, as well as know how to make a vaccine reaction report to federal health officials at the Vaccine Adverse Reporting System (VAERS). NVIC’s Report  Vaccine Reactions—It’s the Law webpage can help you file a vaccine reaction report yourself to VAERS if your doctor fails or refuses to make a report.

NVIC Press Releases, Statements & Commentaries Related to Measles

NVIC Measles Video Playlist

View the collection of video resources within the player below for more information on measles and the measles vaccine.

To view the entire video collection, click the hamburger menu in the upper left corner of the video player above. This will expand a full list of videos. You may also open the video player in full screen mode for optimal display.

 

NVIC Statements & Commentaries

The Vaccine Reaction

Bibliography & Resource Links

Medical Literature 

Media Articles

Other Institutions/Organizations 

Physicians For Informed Consent – Measles

World Health Organization

References

1 CDC Measles (Rubeola) – Transmission of Measles. Mar. 3, 2017

2 CDC Measles (Rubeola) - Complications of Measles. Mar. 3, 2017

3 CDC Measles (Rubeola) – Signs and Symptoms. Feb. 17, 2015

4 CDC Measles – Clinical Features. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

5 CDC Measles – Complications. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

6 D'Souza RM, D'Souza R. Vitamin A for treating measles in children. Cochrane Database Syst Rev. 2002;(1):CD001479.

7 CDC Measles (Rubeola) For Healthcare Professionals – Post-exposure Prophylaxis. May 8, 2018

8 CDC Reported incidence of notifiable diseases in the United States 1962. MMWR Sep. 16, 1963; 11(53): 1-29

9 National Center for Health Statistics. U.S. Vital Statistics Mortality Data. National Vital Statistics System. 

10 CDC. Measles, Mumps and Rubella – Vaccine Use and Strategies for Elimination of Measles, Rubella and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR May 22, 1998; 47(RR-8): 1-57. 

11 Wood DJ, Brunell PA. Measles Control in the United States: Problems of the Past and Challenges for the Future. Clin Microbiol Rev 1995; 8(2): 260-267. 

12 US National Communicable Disease Center Immunization against disease 1966-67 – Measles Vaccine (p. 29-34) Bureau of Disease Prevention and Environmental Control, Atlanta, GA,

13 CDC SUPPLEMENT – Collected Recommendations of the Public Health Service Advisory Committee on Immunization Practices MMWR Oct. 25, 1969; 18(43) : 1-31

14 CDC Summary of Notifiable Infectious Diseases and Conditions — United States, 2015 MMWR Aug. 11, 2017; 64(53);1–143

15 WHO Measles. Sep. 20, 2018

16 FDA Measles, Mumps and Rubella Virus Vaccine, Live. May 16, 2017

17 FDA Measles, Mumps, Rubella and Varicella Virus Vaccine Live. Oct. 23, 2018

18 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Jun. 14, 2013; 62(RR04);1-34

19 CDC MMR (Measles, Mumps, & Rubella) VIS. Feb. 12, 2018

20 CDC MMRV (Measles, Mumps, Rubella & Varicella) VIS. Feb 12, 2018

21 Kang HJ, Han YW, Kim SJ et al. An increasing, potentially measles-susceptible population over time after vaccination in Korea. Vaccine. 2017 Jul 24; 35(33):4126-4132.

22 Hahné SJ, Nic Lochlainn LM, van Burgel ND et al. Measles Outbreak Among Previously Immunized Healthcare Workers, the Netherlands, 2014. J Infect Dis. 2016 Dec 15; 214(12):1980-1986.

23 Rosen JB, Rota JS, Hickman CJ et al. Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Clin Infect Dis. 2014 May; 58(9):1205-10

24 Fiebelkorn AP, Coleman LA, Belongia EA et al. Measles Virus Neutralizing Antibody Response, Cell-Mediated Immunity, and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles, Mumps, and Rubella Vaccine in Young Adults. J Infect Dis. 2016 Apr 1;213(7):1115-23

25 Waaijenborg S, Hahné SJ, Mollema L et al. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. J Infect Dis. 2013 Jul;208(1):10-6

26 Zhao H, Lu P-S, Hu Yali, et al. Low Titers of Measles Antibody in Mothers Whose Infants Suffered from Measles before Eligible Age for Measles Vaccination. Virology 2010, 7:87.

27 CDC Measles – Measles Virus. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

28 CDC Measles (Rubeola) For Healthcare Professionals – Clinical Features. May 8, 2018

29 CDC Measles – Epidemiology Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

30 WHO Measles. Sep. 20, 2018

31 PetMD Distemper in Dogs. No Date

32 CDC Transmission of Measles Mar. 3, 2017

33 Mayo Clinic Measles Sep. 7, 2018

34 CDC Measles – Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

35 Perry RT, Halsey NA. The Clinical Significance of Measles: A Review. J Infect Dis. 2004 May 1;189 Suppl 1:S4-16.

36 Nordqvist, C Understanding the causes of measles MedicalNewsToday May 15, 2017

37 CDC Measles (Rubeola) Complications of Measles. Mar. 3, 2017

38 CDC Measles Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

39 Koenig KL, Alassaf W, Burns MJ Identify-Isolate-Inform: A Tool for Initial Detection and Management of Measles Patients in the Emergency Department West J Emerg Med. 2015 Mar; 16(2): 212–219.

40 Mayo Clinic Measles – Diagnosis Sep. 7, 2018

41 Seward J Suspect Measles and Act Fast. Medscape. Updated Feb. 11, 2015

42 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Jun. 14, 2013; 62(RR04);1-34

43 CDC Measles - Measles Virus Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

44 Perry RT, Halsey NA. The Clinical Significance of Measles: A Review. J Infect Dis. 2004 May 1;189 Suppl 1:S4-16

45 Biellik RJ, Clements CJ. Strategies for Minimizing Nosocomial Measles Transmission. Bulletin of the World Health Organization. Bull World Health Organ. 1997; 75(4): 367–375.

46 van Binnendijk RS, Hahne S, Timen A, et al. Air Travel as a Risk Factor for Introduction of Measles in a Highly Vaccinated Population. Vaccine. 2008 Oct 29; 26(46):5775-7.

47 Biellik RJ, Clements CJ. Strategies for Minimizing Nosocomial Measles Transmission. Bulletin of the World Health Organization. Bull World Health Organ. 1997; 75(4): 367–375.

48 CDC Measles (Rubeola) For Healthcare Professionals – Evidence of Immunity. May 8, 2018

49 Adu FD, Adeniji JA. Measles Antibodies in the Breast Milk of Nursing Mothers. Afr J Med Med Sci. 1995 Dec; 24(4):385-8.

50 Waaijenborg S, Hahné SJ, Mollema L et al. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. J Infect Dis. 2013 Jul;208(1):10-6

51 Zhao H, Lu P-S, Hu Yali, et al. Low Titers of Measles Antibody in Mothers Whose Infants Suffered from Measles before Eligible Age for Measles Vaccination. Virology 2010, 7:87.

52 Modanlou HD A tribute to Zakariya Razi (865 - 925 AD), an Iranian pioneer scholar. Arch Iran Med. 2008 Nov; 11(6):673-7.

53 Plotkin SA. Vaccination against measles in the 18th century. Clin Pediatr (Phila). 1967 May;6(5):312-5.

54 Enders JF Vaccination Against Measles: Francis Home Redivivus Yale J Biol Med. Dec –Feb 1961-2; 34(3-4): 239–260.

55 CDC Measles History Mar. 19, 2018

56 CDC Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998 MMWR April 02, 1999 / 48(12);243-248

57 Ibid

58 CDC Measles – Epidemiology Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

59 WHO Measles. Sep. 20, 2018

60 CDC. Measles, Mumps and Rubella – Vaccine Use and Strategies for Elimination of Measles, Rubella and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR May 22, 1998; 47(RR-8): 1-57. 

61 Wood DJ, Brunell PA. Measles Control in the United States: Problems of the Past and Challenges for the Future. Clin Microbiol Rev 1995; 8(2): 260-267.

62 CDC Reported incidence of notifiable diseases in the United States 1962. MMWR Sep. 16, 1963; 11(53): 1-29

63 National Center for Health Statistics. U.S. Vital Statistics Mortality Data. National Vital Statistics System. 

64 CDC. Measles, Mumps and Rubella – Vaccine Use and Strategies for Elimination of Measles, Rubella and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR May 22, 1998; 47(RR-8): 1-57. 

65 Wood DJ, Brunell PA. Measles Control in the United States: Problems of the Past and Challenges for the Future. Clin Microbiol Rev 1995; 8(2): 260-267. 

66 CDC SUPPLEMENT – Collected Recommendations of the Public Health Service Advisory Committee on Immunization Practices MMWR Oct. 25, 1969; 18(43) : 1-31

67 CDC Measles, Mumps, and Rubella—Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. May 22, 1997; 47(RR-8); 1-57.

68 Grove RD, Hetzel AM. Vital Statistics Rates in the United States 1940-1960 U.S. Public Health Service National Center for Health Statistics 1968.

69 McKinlay JB, McKinlay SM. The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century. MMFQ. Health and Society. Summer 1977. P. 421.

70 Sencer DJ, Dull HB, Langmuir AD Epidemiologic basis for eradication of measles in 1967. Public Health Rep. 1967 Mar; 82(3): 253–256.

71 Baratta RO, Ginter MC, Price MA et al. Measles (rubeola) in previously immunized children. Pediatrics. 1970 Sep; 46(3):397-402.

72 Wood DL, Brunell PA Measles control in the United States: problems of the past and challenges for the future. Clin Microbiol Rev. 1995 Apr; 8(2): 260–267.

73 CDC Reported incidence of notifiable diseases in the United States, 1968 MMWR 17(53): 1-60

74 Hinman AR, Brandling-Bennett AD, Nieburg PI. The opportunity and obligation to eliminate measles from the United States. JAMA. 1979 Sep 14; 242(11):1157-62.

75 CDC Current Trends Measles -- United States, 1982 MMWR Feb. 04, 1983; 32(4);49-51

76 Associated Press U.S. Cases of Measles Are Almost Eradicated. The New York Times. Oct. 3, 1982

77 Hutchins S, Markowitz L, Atkinson W, et al. Measles Outbreaks in the United States, 1987 through 1990. Pediatr Infect Dis J. 1996; 15:31-38.

78 CDC Measles -- United States, 1992 MMWR May 21, 1993; 42(19);378-381

79 CDC Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) MMWR Dec 29, 1989; 38(S-9);1-18

80 Yip FY, Papania MJ, Redd SB. Measles Outbreak Epidemiology in the United States, 1993-2001. J Infect Dis. May 1, 2004; 189 Suppl 1:S54-60.

81 Ibid

82 CDC Measles --- United States, 2000 MMWR Feb. 15, 2002; 51(06);120-3

83 CDC Measles History Mar. 19, 2018

84 CDC Update: Measles—United States, January-July 2008. MMWR. Aug. 22, 2008; 57(33); 893-896.

85 CDC Summary of Notifiable Diseases --- United States, 2009. MMWR. May 13, 2011; 58(53);1-100

86 CDC Summary of Notifiable Diseases — United States, 2010. MMWR. Jun. 1, 2012; 59(53);1-111

87 CDC Summary of Notifiable Diseases — United States, 2011. MMWR. July 5, 2013; 60(53);1-117

88 CDC Summary of Notifiable Infectious Diseases and Conditions — United States, 2014 MMWR. Oct. 14, 2016; 63(54);1-152

89 CDC Measles Cases and Outbreaks. Nov. 15, 2018

90 Ibid

91 NVIC Measles in Disneyland: Third MMR Shot and Vaccine Exemption Ban? Jan 28, 2015

92 NVIC State Vaccine Legislation in America 2015-2017. Oct 25, 2017

93 Roy F, Mendoza L, Hiebert J et al. Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR. J Clin Microbiol. 2017 Mar;55(3):735-743.

94 CDC Measles (Rubeola) Genetic Analysis of Measles Viruses Jun. 5, 2018

95 Tramuto F, Dones P, D Angelo C et al. Post-vaccine measles in a child with concomitant influenza, Sicily, Italy, March 2015. Euro Surveill. 2015 May 21;20(20). pii: 21134.

96 Murti M, Krajden M, Petric M et al. Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013. Euro Surveill. 2013 Dec 5;18(49). pii: 20649.

97 Kaic B, Gjenero-Margan I, Aleraj B, et al. Spotlight on measles 2010: excretion of vaccine strain measles virus in urine and pharyngeal secretions of a child with vaccine associated febrile rash illness, Croatia, March 2010. Euro Surveill. 2010 Sep 2;15(35). pii: 19652.

98 Morfin F, Beguin A, Lina B, et al. Detection of measles vaccine in the throat of a vaccinated child. Vaccine. 2002 Feb 22; 20(11-12):1541-3.

99  Nestibo L, Lee BE, Fonseca K et al. Differentiating the wild from the attenuated during a measles outbreak Paediatr Child Health. 2012 Apr; 17(4): e32–e33.

100 Roy F, Mendoza L, Hiebert J et al. Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR. J Clin Microbiol. 2017 Mar;55(3):735-743.

101 CDC Measles Outbreak — Minnesota April–May 2017 MMWR Jul. 14, 2017 / 66(27);713–717

102 CDC Notifiable Diseases and Mortality Tables MMWR Jan. 5, 2018; 66(52)

103 CDC Measles Cases and Outbreaks. Jan. 10, 2019

104 CDC Measles - Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

105 Sabella C. Measles: Not just a childhood rash Cleve Clin J Med 2010 Mar. 77(3):207-213

106WHO Measles Sep. 20, 2018

107 WHO Measles Sep. 20, 2018

108 CDC Measles Data and Statistics. Feb. 16, 2018

109 Ford D Washington reports first U.S. measles death in 12 years CNN Jul. 2, 2015

110 Perry RT, Halsey NA. The Clinical Significance of Measles: A Review. J Infect Dis. 2004 May 1;189 Suppl 1:S4-16

111 Mayo Clinic Measles Sep. 7, 2018

112 Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Effects of Vaccines: Evidence and Causality. (Evaluating Biological Mechanisms for Adverse Events: Increased Susceptibility). Washington, DC: The National Academies Press. 2012. Chap. 4 (103-238)

113 CDC Measles – Complications. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

114 WHO Measles Sep. 20, 2018

115 CDC Measles (Rubeola). Complications of Measles. Mar. 3, 2017

116 Tesini BL, Subacute Sclerosing Panencephalitis (SSPE) Merck Manual Professional Version. Jan 2018

117 Blumberg RW, Cassady HA. Effect of measles on the nephrotic syndrome. Am J Dis Child. 1947 Feb;73(2):151-66.

118 Rosenblum AH, Lander HB, Fisher RM Measles in the nephrotic syndrome Pediatrics Nov. 1949; 35(5) 574-584

119 Meizlik EH, Carpenter AM Beneficial effect of measles on nephrosis; report of three cases. Am J Dis Child. 1948 Jul;76(1):83-90.

120 Gairdner D A notable case of nephrosis. Arch Dis Child. 1978 May; 53(5): 363–365.

121 Lepore L, Agosti E, Pennesi M, et al. Long-term remission induced by measles infection and followed by immunosuppressive therapy in a case of refractory juvenile rheumatoid arthritis. Pediatr Med Chir. 1988 Mar-Apr;10(2):191-3.

122 Urbach J, Schurr D, Abramov A. Prolonged remission of juvenile rheumatoid arthritis (Still's disease) following measles. Acta Paediatr Scand. 1983 Nov;72(6):917-8.

123 Simpanen E, van Essen R, Isomäki H. Remission of juvenile rheumatoid arthritis (Still's disease) after measles. Lancet. 1977 Nov 5;2(8045):987-8.

124 Chakravarti VS, Lingam S. Measles induced remission of psoriasis. Ann Trop Paediatr. 1986 Dec;6(4):293-4.

125 Sasco AJ, Paffenbarger RS Jr. Measles infection and Parkinson's disease. Am J Epidemiol. 1985 Dec; 122(6):1017-31.

126 Mota HC Infantile Hodgkin's disease: remission after measles. Br Med J. 1973 May 19; 2(5863): 421.

127 WHO Measles. Sep. 20, 2018

128 Biellik RJ, Clements CJ. Strategies for Minimizing Nosocomial Measles Transmission. Bulletin of the World Health Organization. Bull World Health Organ. 1997; 75(4): 367–375.

129 Markowitz LE, Preblud SR, Orenstein WA, et al. Patterns of Transmission in Measles Outbreaks in the United States, 1985-1986. N Engl J Med 1989; 320:75-81.

130 Niewiesk S Maternal Antibodies: Clinical Significance, Mechanism of Interference with Immune Responses, and Possible Vaccination Strategies Front Immunol. 2014; 5: 446.

131 Waaijenborg S, Hahné SJ, Mollema L et al. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. J Infect Dis. 2013 Jul;208(1):10-6

132 Zhao H, Lu P-S, Hu Yali, et al. Low Titers of Measles Antibody in Mothers Whose Infants Suffered from Measles before Eligible Age for Measles Vaccination. Virology 2010, 7:87.

133 Papania M, Baughman AL, Lee S et al. Increased susceptibility to measles in infants in the United States. Pediatrics. 1999 Nov; 104(5):e59.

134 Niewiesk S Maternal Antibodies: Clinical Significance, Mechanism of Interference with Immune Responses, and Possible Vaccination Strategies Front Immunol. 2014; 5: 446.

135 CDC Measles – Complications. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

136 WHO Measles. Sep. 20, 2018

137 Fox A, Hung TM, Wertheim H, et al. Acute measles encephalitis in partially vaccinated adults. PLoS One. 2013 Aug 13;8(8):e71671

138 CDC Measles (Rubeola) For Healthcare Professionals May 18, 2018

139 Sabella C. Measles: Not just a childhood rash Cleve Clin J Med 2010 Mar. 77(3):207-213

140 CDC Measles – Complications. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

141 Markowitz LE, Preblud SR, Orenstein WA, et al. Patterns of Transmission in Measles Outbreaks in the United States, 1985-1986. N Engl J Med 1989 Jan 12; 320:75-81.

142 Higuera V Measles – How to treat measles Healthline Jul. 21, 2016

143 CDC Measles (Rubeola) For Healthcare Professionals – Treatment May 8, 2018

144 Fawzi WW, Chalmers TC, Herrera MG et al. Vitamin A supplementation and child mortality. A meta-analysis. JAMA. 1993 Feb 17; 269(7):898-903.

145 Huiming Y, Chaomin W, Meng M. Vitamin A for treating measles in children. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001479.

146 CDC Measles (Rubeola) For Healthcare Professionals – Treatment May 8, 2018

147 Frieden TR, Sowell AL, Henning KJ, et al. Vitamin A Levels and Severity of Measles. Am J Dis Child. 1992; 146(2): 182-186

148 CDC Measles (Rubeola) For Healthcare Professionals – Immunoglobulin (IG) as post-exposure prophylaxis May 8, 2018

149 Rønne T Measles virus infection without rash in childhood is related to disease in adult life. Lancet. 1985 Jan 5; 1(8419):1-5.

150 Sabella C. Measles: Not just a childhood rash Cleve Clin J Med 2010 Mar. 77(3):207-213

151 Forni AI, Schluger NW, Roberts RB. Severe Measles Pneumonitis in Adults: Evaluation of Clinical Characteristics and Therapy with Intravenous ribavirin. Clin Infect Dis 1994; 19:454-462

152 FDA Measles, Mumps and Rubella Virus Vaccine, Live May 16, 2017

153 FDA Measles, Mumps, Rubella and Varicella Virus Vaccine Live Oct. 23, 2018

154 FDA Measles, Mumps and Rubella Virus Vaccine, Live May 16, 2017

155 Wadman M. Medical research: Cell Division. Nature  Jul. 2013 498, 422–426

156 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

157 Ibid

158 Ibid

159 FDA PROQUAD. May 16, 2017

160 Ibid

161 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

162 FDA PROQUAD. May 16, 2017

163 CDC Vaccine Excipient & Media Summary. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). Mar. 2018

164 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

165 FDA PROQUAD. May 16, 2017

166 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Jun. 14, 2013; 62(RR04);1-34

167 Ibid

168 Ibid

169 Ibid

170 FDA PROQUAD. May 16, 2017

171 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

172 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Jun. 14, 2013; 62(RR04);1-34

173 Hendriks J, Blume S Measles Vaccination Before the Measles-Mumps-Rubella Vaccine Am J Public Health. 2013 Aug;103(8):1393-401

174 Terry LL The Status of Measles Vaccines - A Technical Report J Natl Med Assoc. 1963 Sep; 55(5): 453–455.

175 Ibid

176 Galambos L, Sewell JE Networks of Innovation: Vaccine Development at Merck, Sharp & Dohme, and Mulford, 1895-1995. Cambridge University Press, 1997.

177 Terry LL The Status of Measles Vaccines - A Technical Report J Natl Med Assoc. 1963 Sep; 55(5): 453–455.

178  Rauh LW, R. Schmidt R Measles immunization with killed virus vaccine. Serum antibody titers and experience with exposure to measles epidemic. 1965. Bull World Health Organ. 2000; 78(2): 226–231.

179 CDC Selected Discontinued U.S. Vaccines Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition

180 Hendriks J, Blume S Measles Vaccination Before the Measles-Mumps-Rubella Vaccine Am J Public Health. 2013 Aug;103(8):1393-401

181 Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Events Associated with Childhood Vaccines (Evidence Bearing on Causality). Washington, DC: The National Academies Press. 1994 Chap. 6. P. 118

182 Ibid

183 CDC Selected Discontinued U.S. Vaccines Epidemiology and Prevention of Vaccine-Preventable Diseases, (The Pink Book) 13th Edition

184 Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Events Associated with Childhood Vaccines (Evidence Bearing on Causality). Washington, DC: The National Academies Press. 1994 Chap. 6. P. 118

185 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

186 FDA Measles, Mumps, Rubella and Varicella Virus Vaccine Live. Oct 23, 2018

187 Sencer DJ, Dull HB, Langmuir AD Epidemiologic basis for eradication of measles in 1967. Public Health Rep. 1967 Mar; 82(3): 253–256.

188 Baratta RO, Ginter MC, Price MA et al. Measles (rubeola) in previously immunized children. Pediatrics. 1970 Sep; 46(3):397-402.

189 Wood DL, Brunell PA Measles control in the United States: problems of the past and challenges for the future. Clin Microbiol Rev. 1995 Apr; 8(2): 260–267.

190 Conrad JL, Wallace R, Witte JJ The epidemiologic rationale for the failure to eradicate measles in the United States. Am J Public Health. 1971 November; 61(11): 2304–2310.

191 Wood DJ, Brunell PA. Measles Control in the United States: Problems of the Past and Challenges for the Future. Clin Microbiol Rev 1995; 8(2): 260-267. 

192 Hinman AR, Brandling-Bennett AD, Nieburg PI. The opportunity and obligation to eliminate measles from the United States. JAMA. 1979 Sep 14; 242(11):1157-62.

193 CDC Current Trends Measles -- United States, 1982 MMWR Feb. 04, 1983; 32(4);49-51

194 Associated Press U.S. Cases of Measles Are Almost Eradicated. The New York Times. Oct. 3, 1982

195 CDC Current Trends Measles -- North America, 1984 MMWR Jun. 21, 1985; 34(24);366-70

196 CDC Measles -- United States, 1985 MMWR Jun. 06, 1986; 35(22);366-70

197 CDC Summary of notifiable diseases, United States, 1989 MMWR October 5, 1990; 42 (53); 1-67

198 CDC Current Trends Measles -- United States, 1989 and First 20 Weeks 1990 MMWR Jun 01, 1990; 39(21);353-355,361-363

199 CDC Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) MMWR Dec 29, 1989; 38(S-9);1-18

200 Cimons M CDC Says It Erred in Measles Study. Los Angeles Times. Jun. 17, 1996

201 Fisher BL. Measles Vaccine Experiments on Minority Children Turn Deadly. NVIC Commentary. June 1996. Vol 2 No 2. Online. 

202 Wakefield AJ, Murch SH, Anthony A et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998 Feb 28;351(9103):637-41. (Retracted)

203 NVIC Research into Vaccines, Autism and Intestinal Disorders Published in the Lancet Press Release. Mar. 3, 1998

204 Ibid

205 Boseley S Andrew Wakefield struck off register by General Medical Council. The Guardian. May. 24, 2010

206 Aston J MMR DOCTOR JOHN WALKER-SMITH WINS HIGH COURT APPEAL. The Independent. Mar. 7, 2012

207 Beck S Scientists fear MMR link to autism. The Daily Mail. May 28, 2006

208 Buncombe A Andrew Wakefield: How a disgraced UK doctor has remade himself in anti-vaxxer Trump’s America. The Independent. May 4 , 2018

209 Blanchard S Discredited doctor Andrew Wakefield who falsely claimed MMR jabs lead to autism is handed 'bad science' award - 20 years after his 'fatally flawed' report was published The Daily Mail. Oct. 16, 2018

210 Attkisson S (Audio) CDC Addresses Allegations on Vaccine-Autism Link Omission. SharylAttkisson.com Aug. 29, 2014

211 Posey B (Transcript) Congressman Wants CDC Investigated for Tampering With MMR Study The Vaccine Reaction. Aug. 1, 2015

212 Cáceres M When the Media Thinks and Concludes for the People. The Vaccine Reaction. Mar. 29, 2016

213 Mercola J Robert De Niro Enters the Vaccine Safety Battle. Mercola.com Apr. 26, 2016

214 Ryzik M Anti-Vaccine Film, Pulled From Tribeca Film Festival, Draws Crowd at Showing. The New York Times. Apr. 1, 2016

215 CDC U.S. Multi-State Measles Outbreak, December 2014-January 2015CDC Health Alert Network Jan. 23, 2015

216 Fisher B Measles in Disneyland: Third MMR Shot and Vaccine Exemption Ban? Jan. 28, 2015

217 NVIC State Vaccine Legislation in America 2015-2017. Oct 25, 2017

218 CDC Summary of Notifiable Infectious Diseases and Conditions — United States, 2015. MMWR. Aug. 11, 2017; 64(53);1–143

219 CDC Measles Cases and Outbreaks. Nov. 15, 2018

220 CDC Summary of Notifiable Infectious Diseases and Conditions — United States, 2014 MMWR. Oct. 14, 2016; 63(54);1-152

221 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Jun. 14, 2013; 62(RR04);1-34

222  CDC. Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year MMWR Oct. 13, 2017; 66(40);1073–1080

223 CDC. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2017 MMWR Aug. 24, 2018; 67(33);909–917

224 CDC Measles – Measles Vaccine Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

225 Gustabson TL, Lievens AW, Brunell PA, et al. Measles Outbreak in a Fully Immunized Secondary-School Population. N Engl J Med. 1987 Mar 26;316(13):771-4.

226 CDC Measles Outbreak among Vaccinated High School Students - Illinois. MMWR  Jun. 22, 1984; 33(24);349-51.

227 CDC Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) MMWR Dec 29, 1989; 38(S-9);1-18

228 Ibid

229 Kang HJ, Han YW, Kim SJ et al. An increasing, potentially measles-susceptible population over time after vaccination in Korea. Vaccine. 2017 Jul 24; 35(33):4126-4132.

230 Hahné SJ, Nic Lochlainn LM, van Burgel ND et al. Measles Outbreak Among Previously Immunized Healthcare Workers, the Netherlands, 2014. J Infect Dis. 2016 Dec 15; 214(12):1980-1986.

231 Rosen JB, Rota JS, Hickman CJ et al. Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Clin Infect Dis. 2014 May; 58(9):1205-10

232 Briggs B. Have You Had Your Measles Shot? Maybe You Need AnotherNBC News Jan. 21, 2015.

233 Chatterjee P. Measles Vaccine Protects Only 1 Out of 5 Children in Delhi: Study. The Indian Express. Oct. 1, 2011.

234 Sabella C. Measles: Not just a childhood rash Cleve Clin J Med 2010 Mar. 77(3):207-213

235 Markowitz LE, Preblud SR, Fine PE, Orenstein WA. Duration of Live Measles Vaccine-Induced Immunity. Pediatr Infect Dis J. 1990; 9:101-110.

236 Anders JF, Jacobsen RM, Poland GA, et al. Secondary Failure Rates of Measles Vaccines: a Meta-analysis of Published Studies. Pediatr Infect Dis J. 1996 Jan;15(1):62-6.

237 CDC Measles Outbreak in a Highly Vaccinated Population — Israel, July–August 2017. MMWR. Oct. 26, 2018; 67(42);1186–1188

238 Fiebelkorn AP, Coleman LA, Belongia EA et al. Measles Virus Neutralizing Antibody Response, Cell-Mediated Immunity, and Immunoglobulin G Antibody Avidity Before and After Receipt of a Third Dose of Measles, Mumps, and Rubella Vaccine in Young Adults. J Infect Dis. 2016 Apr 1;213(7):1115-23

239 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

240 Waaijenborg S, Hahné SJ, Mollema L et al. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. J Infect Dis. 2013 Jul;208(1):10-6

241 Zhao H, Lu P-S, Hu Yali, et al. Low Titers of Measles Antibody in Mothers Whose Infants Suffered from Measles before Eligible Age for Measles Vaccination. Virology 2010, 7:87.

242 Whittle HC, Aaby P, Samb B et al. Effect of subclinical infection on maintaining immunity against measles in vaccinated children in West Africa. Lancet. 1999 Jan 9; 353(9147):98-102.

243 Mossong J, Muller CP. Modelling Measles Re-Emergence as a Result of Waning of Immunity in Vaccinated Populations. Vaccine. Nov. 7, 2003.  21 (31); 4597-4603.

244 Aaby P, Cisse B, Simondon F, et al.  Waning of Vaccine-Induced Immunity: Is It a Problem in Africa? Am J Epidemiol 1999 Feb. 15;149(4); 304-305

245 CDC MMR (Measles, Mumps, & Rubella) VIS Feb. 12, 2018

246 CDC MMRV (Measles, Mumps, Rubella & Varicella) VIS Feb. 12, 2018

247 CDC Use of Combination Measles, Mumps, Rubella, and Varicella Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. May 7, 2010; 59(RR03);1-12

248 CDC MMR (Measles, Mumps, & Rubella) VIS Feb. 12, 2018

249 CDC MMRV (Measles, Mumps, Rubella & Varicella) VIS Feb. 12, 2018

250 FDA Measles, Mumps, Rubella and Varicella Virus Vaccine Live. Oct 23, 2018

251 MacDonald SE, Dover DC, Simmonds KA, et al. Risk of febrile seizures after first dose of measles–mumps–rubella–varicella vaccine: a population-based cohort study. CMAJ. 2014 Aug 5; 186(11): 824–829.

252 Ma SJ, Xiong YQ, Jiang LN et al. Risk of febrile seizure after measles-mumps-rubella-varicella vaccine: A systematic review and meta-analysis. Vaccine. 2015 Jul 17;33(31):3636-49

253 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

254 Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Effects of Vaccines: Evidence and Causality. (Evaluating Biological Mechanisms for Adverse Events: Increased Susceptibility). Washington, DC: The National Academies Press. 2012

255 Institute of Medicine Committee to Review Adverse Effects of Vaccines. Adverse Effects of Vaccines: Evidence and Causality. (Evaluating Biological Mechanisms for Adverse Events: Increased Susceptibility). Washington, DC: The National Academies Press. 2012. Chap. 4 (103-238)

256 Ibid

257 Ibid

258 Ibid

259 Demicheli V, Rivetti A, et al. (Intervention Review) Vaccines for Measles, Mumps and Rubella in Children. The Cochrane Library 2012, Issue 2.

260 Ibid

261 Kessler DA, the Working Group, Natanblut S, et al. A New Approach to Reporting Medication and Device Adverse Effects and Product Problems. JAMA. 1993;269(21):2765-2768.

262 FDA.gov. Kessler DA. Introducing MEDWatch: A New Approach to Reporting Medication and Device Adverse Effects and Product Problems. Reprint from JAMA. June 9, 1993.

263 Braun M. Vaccine adverse event reporting system (VAERS): usefulness and limitations. Johns Hopkins Bloomberg School of Public Health

264 Rosenthanl S, Chen R. The reporting sensitivities of two passive surveillance systems for vaccine adverse events. Am J Public Health 1995; 85: pp. 1706-9.

265 AHRQ Electronic Support for Public Health–Vaccine Adverse Event Reporting System (ESP:VAERS) Dec 1, 2007-Sep. 30, 2010

266 U.S. Department of Health and Human Services. National Vaccine Injury Compensation Program Data—January 2, 2019. National Vaccine Injury Compensation Program. Jan. 2, 2019

267 MCTlawyers.com $101 Million Dollar Vaccine Injury Award for Encephalopathy from MMR Vaccine. Press Release. Jul. 17, 2018

268 Ibid

269 Office of Special Masters. United States Court of Federal Claims. RAYMOND ROACH, on behalf of O.G.R., a minor child V. Secretary of Health and Human Services. Nov. 20, 2017

270 Weibel RE, Casserta V, Benor DE et al. Acute Encephalopathy Followed by Permanent Brain Injury or Death Associated with Further Attenuated Measles Vaccine: A Review of Claims Submitted to the National Vaccine Injury Compensation Program. Pediatrics 1998; 101(3): 383-387.

271 Alderslade R, Bellman MH, Rawson NSB, Ross EM, Miller DL. The National Childhood Encephalopathy Study: A Report on 1000 Cases of Serious Neurological Disorders in Infants and Young Children from the NCES Research Team. Her Majesty’s Stationery Office 1981.

272 Ward KN, Bryan NJ, Andrew NJ et al. Risk of Serious Neurologic Disease After Immunization of Young Children in Britain and Ireland. Pediatrics 2007; 120(2): 314-321.

273 Lakshman R. MMR Vaccine and Allergy. Arch Dis Child 2000;82:93-95.

274 Bogdanovic, J, Halsey NA, Wood RA, et al. Bovine and Porcine Gelatin Sensitivity in Milk and Meat-Sensitized Children J Allergy Clin Immunol. 2009 Nov; 124(5): 1108–1110.

275 Bandim Health Project Staff – Peter Aaby Oct. 6, 2017

276 Aaby P, Jensen H, Samb B, et al. Differences in Female-Male Mortality after High-Titre Measles Vaccine and Association with Subsequent Vaccination with Diphtheria-Tetanus-Pertussis and Inactivated Poliovirus: Reanalysis of West African Studies. Lancet. 2003;361:2183-8

277 Aaby P, Biai S, Veirum JE, et al. DTP with or after Measles Vaccination Is Associated with Increased In-Hospital Mortality in Guinea-Bissau. Vaccine. Jan. 26, 2007 Jan 26; (25)7: 1265-1269.

278 Böni J, Stalder J, Reigel F et al. Detectionof reverse transcriptase activity in live attenuated virus vaccines. Clin Diagn Virol. 1996 Feb;5(1):43-53.

279 Brown D UNEXPECTED PROTEIN FOUND IN MEASLES-MUMPS VACCINE. The Washington Post. Dec. 9, 1995

280 Fisher B Virus Enzyme Found in MMR Vaccine. The Vaccine Reaction. Nov. 28, 2018

281 Lewin J, Dhillon AP, Sim R et al. Persistent measles virus infection of the intestine: confirmation by immunogold electron microscopy. Gut. 1995 Apr; 36(4):564-9.

282 NVIC. Research Into Vaccines, Autism and Intestinal Disorders Published in The Lancet. Press Release: March 3, 1998.

283 Brown A, Chow D, Murakami S, et al. Possible gastrointestinal symptoms in a subset of children with autism Expert Rev Gastroenterol Hepatol 2010 4(2), 125–127

284 Wakefield AJ, Murch SH, Anthony A, et al Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998 Feb 28; 351(9103):637-41.(Retracted)

285 Ashwood P, Anthony A, Pellicer AA et al.  Intestinal Lymphocyte Populations in Children with Regressive Autism: Evidence for Extensive Mucosal Immunopathology J Clin Immunol. 2003 Nov; 23(6):504-17.

286 Mercola J New Evidence Refutes Fraud Findings in Dr. Wakefield Case Jan. 24, 2012

287 CDC Measles, Mumps, and Rubella (MMR) Vaccine Safety Aug 21, 2018

288 Fisher BL. The Emerging Risks of Live Virus and Virus Vectored Vaccines: Vaccine Strain Virus Infection, Shedding and Transmission. NVIC November 2014.

289 Jenkins GA, Chibo D, Kelly HA et al. What is the cause of a rash after measles-mumps-rubella vaccination? Med J Aust 1999; 171(4): 194-195.

290 Berggren KL, Tharp M, Boyer KM. Vaccine-associated “wild-type” measles. Pediatr Dermatol 2005; 22(2): 130-132.

291 Morfin F, Beguin A, Lina B, et al. Detection of measles vaccine in the throat of a vaccinated child. Vaccine 2002; 20(11-12); 1541-1543.

292  Kaic B, Gjenero-Margan I, Aleraj B et al. Spotlight on Measles 2010: Excretion of Vaccine Strain Measles Virus in Urine and Pharyngeal Secretions of a Child with Vaccine Associated Febrile Rash Illness, Croatia, March 2010. Eurosurveillance 2010 15(35). 

293 Ibid

294 Nestibo L, Lee BE, Fonesca K et al. Differentiating the wild from the attenuated during a measles outbreak. Paediatr Child Health Apr. 2012; 17(4).

295 FDA Varivax Oct. 19, 2018

296 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

297 Ibid

298 FDA Measles, Mumps, Rubella and Varicella Virus Vaccine Live. Oct 23, 2018

299 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

300 FDA Varivax Feb. 17, 2017

301 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

302 Ibid

303 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. June 14, 2013; 62(RR04);1-34

304 FDA Measles, Mumps and Rubella Virus Vaccine, Live  May 16, 2017

305 Niewiesk S Maternal Antibodies: Clinical Significance, Mechanism of Interference with Immune Responses, and Possible Vaccination Strategies Front Immunol. 2014; 5: 446.

306 FDA Measles, Mumps, Rubella and Varicella Virus Vaccine Live. Oct 23, 2018


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