Open Letter: Global Vaccination Summit 2019

https://ec.europa.eu/health/vaccination/ev_20190912_en

Last week on the news in Australia: vaccinated persons got measles by waning immunity. See:
https://twitter.com/sunriseon7/status/1143245255954726912

https://7news.com.au/news/public-health/measles-spike-raises-fears-that-virus-has-evolved-and-vaccine-is-not-providing-immunity-c-182822

The reporter in Sunrise on 7 mentioned a possible third vaccination, however Fiebelkorn 2016 (2016, PMC5729920) and Modrof et al (2017, PMID: 28968738) found that a third measles-vaccination has no or little effect.

CNN reported on 10 June 2019 that researchers found that most whooping cough cases, 82%, occurred in children who were fully vaccinated or over-vaccinated.

https://thehighwire.com/study-82-of-whooping-cough-cases-occur-in-fully-over-vaccinated/

In the WHO position paper on measles of April 2017 is written that evidence indicates that a single dose of correctly administered measles vaccine which results in seroconversion will afford lifelong protection for most healthy individuals. The position paper summarizes essential background information and reflects policy recommendation of the WHO to the Member States. See:

https://www.who.int/immunization/policy/en/

How is it possible that the WHO adheres to the view that measles vaccination induces lifelong immunity? Why are studies, indicating that the measles vaccine does NOT induce lifelong protection, NOT mentioned in the WHO Position Paper and the Grading of Evidence of April 2017?

Several studies, published in this century, have indicated that the measles vaccine does NOT provide lifelong protection. No lifelong protection due to primary and secondary vaccine failure means that the population immunity will be much less than 95%, even if 100% of the population would be vaccinated. That means that 95%  population immunity and herd immunity by vaccination are unattainable goals. However, nearly the whole world makes policy for 95% population immunity, recommended by the WHO, while believing in lifelong protection, because the WHO wrote that in their position paper. See this article for the statement that more than 95% of every population needs to be immune to ensure community protection against measles for everyone:

https://apps.who.int/iris/bitstream/handle/10665/255149/WER9217.pdf;jsessionid=C177BC90A5E7C90F6A27E129087EED23?sequence=1

Sentence in position paper April 2017 WHO: Even in countries where measles is no longer endemic, antibodies to measles virus persist for decades (reference to Strebel PM et al. (2017), Davidkin et al (2008) and Dine et al (2004)). 

Davidkin and colleagues did NOT find that antibodies to measles virus persist for decades, at least not in a part of the two groups in the study. Davidkin was the senior autor of the study of Kontio et al (2012, PMID: 22966129). They wrote about the same groups of persons as were studied in the article published in 2008, referred to in the WHO position paper. They found that:

15.5% of vaccinated persons in the youngest group had no measurable antibodies in 2007, 20 years after the second MMR

10.4% of vaccinated persons in the oldest group had no measurable antibodies in 2007, 20 years after the second MMR

In both groups 100% was seropositive 8 years after the second dose was administered (see Davidkin et al (1998, PMID: 9796064)). The authors don’t mention the percentages of being low seropositive in 2007, so the percentages of potentially susceptibility to measles are even higher. It is to be expected that the percentages become higher more than 20 years after the second MMR, because they found that vaccine-induced antibodies declined after the second dose (see figure 3 in Davidkin et al, 2010, PMID: 20822347).

Dine and colleagues (2004, PMID: 15106101) determined the presence and titer of measles antibody in 1997-1999 of participants of a vaccine study in 1971, with documentation of antibody 1-7 years after vaccination. However, between 1971 and 1997-1999 boosting from wild-type virus was common. The situation in this century is different. LeBaron and colleagues (2007, PMID: 17339511) wrote: “Many studies have suggested that vaccine-induced immunity is persistent, perhaps even lifelong, but most were performed in an era when boosting from wild-type virus was common.” They referred to the study of Dine et al (2004, PMID: 15106101) at the end of this sentence.

LeBaron and colleagues (2007, PMID: 17339511) wrote  that their results suggested that:

33% of vaccinated persons in the study would be potentially susceptible to measles by 20 years after the second MMR-vaccination (see figure 3). The antibody level of measles declined in the 10 years after the second MMR-vaccination in kindergarten and in the 5 years after the second MMR-vaccination in middle school (see figure 2 in their article).

STUDIES ABOUT SEROPREVALENCE IN VACCINATED PERSONS

Smetana and colleagues (2017, PMC5234812):

31.2% of vaccinated persons did have less than 150 mIU/nl IgG antibodies against measles in the age group 30-39

15.5% of vaccinated persons did have less than 150 mIU/nl IgG antibodies against measles in the age group 18-29

Levine et al (2015, PMC4514436):

14.3% of 439 vaccinated persons, aged 18-19 years, was not seropositive for measles antibodies in Israel (5.9% of 439 persons was negative and 8.4% was equivocal).

Zhang et al (2019, PMID: 31116635):

27.1% was not seropositive in the age group 30-34

25.35% was not seropositive in the age group 35-39

Kontio and colleagues (2012, PMID: 22966129):

18% of vaccinated persons aged 10-11 years had no measurable measles IgG antibodies (4%) or were low positive (14%)

Haralambieya and colleagues (2011, PMC3117252):

8.9% of 763 vaccinated persons aged 11-22 years, median time since last MMR immunization to sampling 7.4 years, had less than 120 mIU/ml antibodies against measles.

Poethko-Müller et al (2012, PMC3412821):

8.4% of persons aged 0-17 years, who received two doses measles vaccine more than 6 years earlier, did have less than 150 mIU/ml antibodies against measles (see table 4). Table 4 shows that seronegativity increased for children who received two doses; from 2.7% (0-2 years since last vaccination) to 4.5% (3-6 years since last vaccination) to 8.7% (more than 6 years since last vaccination). The increasing seronegativity in this study indicates that secondary vaccine failure takes place.

Primary vaccine failure is 3% after two doses of the measles vaccine, according to the CDC:

https://www.cdc.gov/vaccines/vpd/mmr/public/index.html

Next sentence in position paper April 2017 WHO: Studies using IgG avidity measurements to separate primary vaccination failures from secondary vaccination failures suggest that secondary failures may occur at least occasionally due to waning immunity (reference to Paunio et al (2003), Pannuti et al (2004) and Grading of scientific evidence). 

Indeed, Paunio et al (2000, PMC2810910) and Pannuti and colleagues (2004, PMC321355) found that people contracted measles due to secondary vaccine failure. Pannuti found that among the 52 measles patients with documented vaccination, 27 (51.9%) showed a secondary immune response, thereby constituting a secondary vaccine failure. Besides Paunio et al and Pannuti et al, Atraheuskaya et al (2008, PMID 18343536)and Hamkar et al (2006, PMID: 17333822) also found, based on IgG avidity testing, that vaccinated persons contracted measles due to seconday vaccine failure. Atraheuskaya et al (2008, PMID 18343536) found that half of the vaccinated measles patients demonstrated evidence of secondary vaccine failure. Hamkar et al (2006, PMID: 17333822) found that of 244 patients with documented vaccination, 24.2% showed a secondary immune response, thereby indicating a secondary vaccine failure.

In the Grading of Scientific Evidence of the duration of protection following measles immunization, belonging to the WHO Position Paper on measles of April 2017, 11 studies are mentioned. 10 of the 11 were published in the previous century. Only one is from this century. See: https://www.who.int/immunization/measles_grad_duration.pdf

As mentioned, LeBaron (2007, PMID: 17339511) wrote that many studies have suggested that vaccine-induced immunity is persistent, perhaps even lifelong, but most were performed in an era when boosting from wild-type virus was common.

Poland et al  (PMC3905323) wrote already in 2012 that due to, amongst other things, primary and secundary vaccine failure sustained elimination of measles, much less eradication, are unlikely.

Next sentence in position paper April 2017 WHO: However, declining immunity does not appear to play a major role in measles virus transmission. 

Studies indicate that declining immunity DOES play a (major) role in measles virus transmission.

PROVEN SPREADING OF MEASLES BY VACCINATED PERSONS DUE TO SECONDARY VACCINE FAILURE OF MEASLES VACCINE

Rosen et al (2014, PMID: 24585562) reported measles transmission from a twice-vaccinated individual with documented secondary vaccine failure.

Gibney et al (2019, PMID: 31056637) found that 13 of the 190 measles patients had waning immunity. Onward transmission from one waning immunity case to two infant household contacts too young for vaccination was documented.

SUSPECTED SPREADING OF MEASLES BY VACCINATED PERSONS DUE TO SECONDARY VACCINE FAILURE OF MEASLES VACCINE

De Serres et al (2013, PMID: 23264672) showed  in table 3 that 53 of 110 measles cases in a high school in Canada had received two vaccine doses. The authors wrote that, on balance, secondary vaccine failure seemed the most plausible explanation for adolescent susceptibility.

Ma et al (2016, PMID 26589518) showed measles transmission in China among persons with prior evidence of immunity. The wrote that secondary vaccine failure may have played an important role in measles transmission.

Currently, many unvaccinated persons above 50 years of age still have lifelong immunity because they experienced natural measles infection when they were young. However, the more people in the population are vaccinated, the larger the group with primary and secondary vaccine failure will be. As mentioned above, scientific studies found that a third vaccination has no or little effect.

– Fiebelkorn (2016, PMC5729920) found that most subjects were seropositive pre-MMR3 and very few had a secondary immune response post-MMR3. For the 24 subjects with low or negative baseline measles vaccine antibody concentrations, 18 (75%) moved into medium or high categories at 1 month, of whom, 12 (67%) remained medium or high at 1 year. In other words, 25% stayed low or negative and 33% was again low or negative after one year.

– Modrof et al (2017, PMID: 28968738) found that  revaccination-induced titer increases were only about 2-fold and short-lived.

Besides primary and secondary vaccine failure of the measles vaccine, Muñoz-Alía (2017, PMC5432853) found that D4.2 subgenotype viruses showed a trend toward diminished susceptibility to neutralization by human sera pooled from approximately 60 to 80 North American donors.

Did you know that people can get measles from the vaccine and excrete the measles vaccine virus? According to Roy et al (2017, PMC5328441) 5% of recipients of the measles vaccine experience rash and fever. They wrote in their article that 73 of the 194 measles virus sequences obtained in the United States in 2015, were identified as vaccine sequences. Kaic and colleagues (2010, PMID: 20822734) and Murti and colleagues (2013, PMID: 24330942) wrote about vaccine-associated measles and excretion of the measles vaccine virus.

Please find below: