As late as the 1950s, and before a vaccine was developed, parents were encouraged to expose their children to diseases like measles, mumps, and chicken pox to develop immunity. With the marketing of an effective vaccine to protect people from these diseases, such thinking was rendered moot. Building on the momentum of success achieved with the oral polio vaccine, a number of live attenuated vaccines were being developed. The most significant of these at the time was the measles-mumps-rubella (MMR) vaccine.

For hundreds of years, measles was so ubiquitous it was thought to be a natural episode of childhood. It was not until the 14th century that the word “measles” was used, stemming from the word “miser,” which was used to refer to the wretchedness of lepers.[18] Before the development of an effective vaccine, measles was one of the most common childhood diseases in America. Characterized by fever and a rash, measles is a serious disease that is highly contagious and can lead to death; but recovery confers a lifelong immunity. Interestingly, women who have been vaccinated but who never had the disease do not have natural maternal measles antibodies to pass on to their babies, which mean that most babies born in America are vulnerable to getting this disease.

Mumps, a viral disease, used to be common in childhood. Discovery of the mumps virus in 1934 helped researchers gain a better understanding of the symptoms and how this disease is transmitted. Characterized by fever, headache, and inflammation of the salivary glands (making the cheeks swell, producing the signature sign of the disease), this disease rarely leads to death. Recovery confers lifelong immunity.

Rubella (German measles) is considered a mild childhood disease characterized by a pink rash. While similar to measles, the rubella virus is comparatively benign and less infectious. Recovery usually confers lifelong immunity although repeat cases can occur, albeit rarely. Should a pregnant woman get rubella in the first trimester of pregnancy, there is a greater chance of giving birth to a baby with birth defects.

A measles vaccine was licensed in 1963, and a rubella vaccine was licensed in 1969, and the trivalent MMR vaccine was licensed in 1971. Protection is estimated to last for up to 11 years. Despite the availability of the vaccine, however, around 1 million children, predominantly in resource-poor countries, die every year from measles. Even in the United States, outbreaks occur. For example, a measles outbreak in the 1980s and early 1990s showed that there were a significant number of vaccine failures in older children, teenagers, and adults, especially among those who had been vaccinated before 15 months of age. As such, the government recommended that a second MMR booster be given either before a child enters kindergarten or before entering junior high school. Almost all who get the vaccine have no serious adverse reactions from it.

As is often the case, the risks of the vaccine are usually smaller than the risks from the diseases. However, in the mid-1990s, reports of an association between autism and the MMR vaccine were published. There was speculation that the MMR vaccination could cause autism in some children. This finding alarmed both the lay public and the scientific community. Parents refused to have their children immunized, and the IOM was asked to investigate this link (see “Protesting Vaccines: Fact or Myth”).

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Tony Rosen, MPH, MD
Tony Rosen, Division of Geriatric Medicine and Gerontology, Weill Cornell Medical College, Cornell University, New York, New York;

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REFERENCES

1. Barquest N, Domingo P. Smallpox: the triumph over the most terrible of the ministers of death. Ann Internal Med. 1997;127:627.
2. US Centers for Disease Control and Prevention. Ten great public health achievements in the twentieth century, 1900-1999.
3.   Parker AA. Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States. New Engl J Med. 2006;355:1184.
4. Okonek BAM, Peters PM. Vaccines: how and why
5. Baxby D. Vaccination: Jenner’s Legacy. Berkeley, UK: Jenner Educational Trust; 1994. 6. Parish HJ. A History of Immunization. Edinburgh, UK: Livingstone; 1965.
6. Gross CP, Sepkowitz K. The myth of the medical breakthrough: smallpox, vaccination, and Jenner reconsidered. Int J Infect Dis. 1998;3:54-60.
7. Salmon DA,  et al.  Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future. Lancet. 2006;367(9508):436-442.

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