Sixty years after BMJ told us Measles was a “mild infection”, what changed?

Richard and Joey; Jan/ Feb 1959 41,00 cases of Measles reported

In January February 1959 there was a measles epidemic in the UK, 41,000 cases. No one died according to the British Medical Journal and there were very few complications associated with the infection. My best friend Joey and I avoided catching it in that epidemic even though our parents tried, as it was believed and supported by medical opinion that measles infection strengthened ones immune system. It was also easier to have measles as a child.

It was 1964 before I contracted measles as did all my friends and my sister. By then, I was living with my Granny in Carrick on Suir, Ireland. The school was closed for a week, Dr O Brien was busy, he come over to check on me and Eleanor. I had a rash on my body, a temperature for a few days and did not like bright light. I remember all the visitors from parents with children who had not had measles. Measles is the most infectious virus knows to man and if your immune system does not have antibodies to resist it, you will be infected no matter how healthy you are.

Richard & Eleanor back to school after measles 1964

How your body copes with the measles infection does depend on your state of health and after a week off, we were all back at school without any problems as were all the other children at our school. The picture was taken the day we went back, I remember it well because a boy split his head on the railings in the playground and had to be taken to the hospital. My parents did not travel back to visit us while we were ill, they were not unduly concerned about the infection, which was seen as a “normal childhood infection” much the way chickenpox is today. This is how measles was viewed and portrayed on TV when I was a child  a mild infection with comical implications.

So what has changed that after a measles outbreak in the US in 2019 which  infected only 700 people, caused such mass hysteria, that politicians are considering introducing “mandatory Vaccination” again. Smallpox vaccination were compulsory in UK until the Vaccination Act, 1907  was passed. Under this law, parents escaped penalties for the non-vaccination of children if within four months from the birth they made a statutory declaration that they confidently believed that vaccination would be prejudicial to the health of the child. There is no doubt vaccines reduce the incidence of infection in a community, how that vaccine will affect the well being of each individual child in that community is not known and there lies the problem for parents. 

In a communist country like Cuba where “community” takes precedence over the individual, I can understand the desire to embrace vaccination programmes. For Matt Hancock a conservative minister to suggest it in a country, where tax cuts mean, take precedence over health services and economic growth is more important than the exponential rise in type 2 diabetes, or the thousands are killed by air pollution every year, is harder to understand. There were 966 cases of Measles in the UK last year and no one died or suffered serious complications.

Poland does have mandatory vaccinations, it was part of the former Soviet Union guided public health system. The early years of the Soviet regime witnessed some of the worst epidemics in Russia history, which predominantly damaged the poor. In response, Lenin would write in 1920: “All of our determination and experience must apply to combating epidemics. Mass vaccination campaigns emerged in the Soviet Union, as the political leadership, used immunization programs to redefine political legitimacy and state authority. In a society in which public well-being, especially regarding diet and housing, often mattered little, the Soviet government mounted repeated vaccination campaigns that were often carried out in a highly coercive manner.

The reaction to this latest measles outbreak is not that different from the outbreak in 2015 where there were 175 cases and the authorities managed to link one death to the virus, even though the individual did not develop signs and symptoms of measles. She had underlying health problems and had been vaccinated against measles as a child. If a child dies after receiving a vaccine, the cause of death is usually described as a coincidence or if the baby was asleep “sudden Infant death syndrome”? If they had measles its the measles that killed them rather than an inability to deal with a viral infection.

The change in attitude towards measles in the medical literature seems to have started in the 60s after the first trial of a live attenuated measles vaccine was undertaken by David Morley. In 1961 The British Medical Journal began reporting there were 98 “associated” deaths in the 1959 epidemic and how a vaccine was in development.  A vaccine was developed for use in 1963 and by 1964 the reporting of the virus in medical journals changed dramatically and from no complications, the British Medical Journal was reporting, a serious complication in one of every 15 cases and deaths associated with measles infection.

To put this in context its necessary to look at the history of measles and remember that for thousands of years humans have evolved being exposed to measles infection, which was shown to be deadly to many when introduced to indigenous people for vaccine experiments in 1968 Measles has been blamed, in part, for decimating native populations of the Americas as Europeans explored the New World. The process of “natural selection”, means humans adapted and became better able to tolerate the infection over time.

In 340, Chinese alchemist Ko Hung described the difference between smallpox and measles; a Christian priest, Ahrun, did the same in Egypt about 300 years later. In 910, the Persian physician Rhazes published the most widely celebrated early diagnoses of the two diseases.

In 1492: Christopher Columbus and his fellow European explorers arrived in the Americas, bringing a raft of deadly diseases including measles with them. Native Americans had no natural immunity to many of these diseases. Measles, smallpox, whooping cough, chicken pox, bubonic plague, typhus and malaria. Already dangerous and often deadly in Europe became even more efficient killers in the New World. By some estimates, the Native American population plunged by as much as 95% over the next 150 years due to disease.

1824-48: As was the case with many diseases, measles’ risk to Pacific Islanders was particularly dangerous in the 19th century as traders and travelers crisscrossed the globe. In 1824, Hawaii’s King Kamehameha II and Queen Kamamalu traveled to London to meet King George IV, but instead swiftly contracted measles and both died within a month. The virus, struck Hawaii in 1848, killing up to a third of the native population. In 1875 The HMS Dido brought measles to Fiji, killing 20,000 people up to a third of the island’s natives.

In 1912 the United States government required physicians to start reporting measles cases, which gave researchers a precise grasp of the disease’s widespread impact inside the country. Almost all people caught measles at some point in their life – mostly when young – and the outcome could be deadly.  A study in the U.S. from 1912 to 1916 found 26 deaths for every 1,000 measles cases. However as the graph below demonstrates, improved living standards meant mortality rates associated with measles had reduced dramatically by the time the vaccine was first used in 1963. A similar decline happened with all infectious diseases including scarlet fever, which is very rare in 2019 and there is no vaccine for scarlet fever.

Deaths from measles in UK were very rare after WW2

Br Med J 1959;1:351.2 (Published 07 February 1959)

Editorial BMJ February 1959

In the first three weeks of this year about 41,000 cases of measles were recorded in England and Wales. This is well above the corresponding figures of the last two years – namely, about 9,000 in 1958 and 28,000 in 1957 – though it is below the highest levels reached in the last nine years. To give some idea of the main features of the disease as it appears today and of how it is best treated, we invited some general practitioners to write short reports on the cases they have seen in their practices recently.

These appear at p.380. It is interesting to note, first, that the distribution of the disease is rather patchy at present. It has not yet reached the areas where two of these doctors practice (in South Scotland and Cornwall), and other areas are known to be free of the disease so far. On the other hand, in Kent it is reported to have arrived in time to put the children to bed over Christmas. These writers agree that measles is nowadays normally a mild infection, and they rarely have occasion to give prophylactic gamma globulin. As to the treatment of the disease and its complications, the emphasis naturally varies from one practice to another. Amount of bed-rest, when to administer a sulphonamide or antibiotic, the use of analgesics and linctuses – all these may still be debatable problems in the treatment of what is said to be the commonest disease in the world. But there is probably much in the opinion which one of the writers expresses: “It is the frequent visiting by the interested clinician and not the therapy which produces the good results.”

REPORTS FROM GPs  Page 380                                                      (link to this page) Br Med J 1959;1:380 (Published 07 February 1959)

Dr G.L Watson (Peaslake, Surrey) writes:

Measles was introduced just before Christmas by a child from Petworth …….

Treatment of Attack. – No drugs are given for either the fever or the cough; if pressed, I dispense mist. salin. B.N.F. as a placebo. Glutethimide 125 mg. may be given in the afternoon if the child is restless when the rash develops; 250 mg. in single or divided doses at bedtime ensures a good night’s sleep in spite of coughing. I encourage a warm humid atmosphere in the room by various methods: some electric fires and most electric toasters allow an open pan of water to rest on top; an electric kettle blows off too much steam to be kept on for more than short periods. Parents, conscious of the need to darken the room and to forbid reading, …………They are allowed up when the rash fades from the abdomen-usually the fourth or fifth day-and may go outside on the next fine day. Apart from fruit to eat, solid food is avoided on the day the rash is appearing; fruit drinks or soups are all they appear to want.

Complications. – So far few complications have arisen. Four cases of otitis media occurred in the first 25 children, but only one had pain. No case of pneumonia has occurred, but one child had grossly abnormal signs in the chest for a few days after the fever subsided, uninfluenced by oral penicillin. One girl had a tear-duct infection and another an undue blepharitis. Of three adult males with the disease, two have been more severely affected than any of the children.

Dr. R. E. HOPE SIMPSON (Cirencester, Glos) writes:

We make no attempt to prevent the spread of measles, and would only use gamma globulin to mitigate the severity of the disease in the case of the exposure of a susceptible adult or child who is already severely debilitated. Bed rest, for seven days for moderate and severe cases and of five to six days in mild cases, seems to cut down the incidence of such complications as secondary bacterial otitis media and bronchopneumonia.

Page 381

British Medical Journal
February 1958 page 381

Dr. JOHN FRY (Beckenham, Kent) wrote : The expected biennial epidemic of measles appeared in this region in early December, 1958, just in time to put many youngsters to bed over Christmas. To date there have been close on 150 cases in the practice, and the numbers are now steadily decreasing. Like previous epidemics, the primary cases have been chiefly in the 5- and 6-year-olds, with secondary cases in their younger siblings. No special features have been noted in this relatively mild epidemic. It has been mild because complications have occurred in only four children. One little girl aged 2 suffered from a lobular pneumonia, and three others developed acute otitis media following their measles. In the majority of children the whole episode has been well and truly over in a week, from the prodromal phase to the disappearance of the rash, and many mothers have remarked ”how much good the attack has done their children,” as they seem so much better after the measles.

A family doctor’s approach to the management of measles is essentially a personal and individual matter, based on the personal experiences of the doctor and the individual character and background of the child and the family.

In this practice measles is considered as a relatively mild and inevitable childhood ailment that is best encountered any time from 3 to 7 years of age. Over the past 10 years there have been few serious complications at any age, and all children have made complete recoveries. As a result of this reasoning, no special attempts have been made at prevention even in young infants in whom the disease has not been found to be especially serious.

In Scotland Dr M Mc Gregor reported that this outbreak had not effect them. However outbreaks in 1950/53 and 55 had been mild with “no serious complications beyond otitis media.

The reporting of measles in medical journals change dramatically in 1963 after John Enders and colleagues transformed their Edmonston-B strain of measles virus into a vaccine and licensed it in the United States. The vaccine was announced in the September 1963 edition of the British Medical Journal  The article states in the second paragraph on page 760 “There is no doubt that an effective vaccine is needed for children who are especially liable to develop sever measles (children in underdeveloped countries). But the need or desire for a vaccine for the general population of Great Britain is much less certain. Measles is now a mild disease and many parents and doctors may feel that no protection against it is required. 

The risk of encephalitis in UK was estimated at one in a thousand. The article goes on to state that “nutrition and living standards played a part in determining the mildness of measles, compared to developing countries. The article warned that by preventing measles using vaccines and eliminating natural immunity you create the risk of mutated strains could result and cause epidemics sometime in the future. 

In July 1964 The British Medical Journal made references to the 1963 article and the lack of urgency for a measles vaccination in the UK. They published a study of “Frequency of Complications of Measles” from the 1963 epidemic. Now GPs are reporting serious complications, in one out of every fifteen patients and 12 deaths out of 53,000 cases of measles. The “discussion” opens with the comment; “The results of this investigation show that serious complications of measles are commoner than is generally supposed and cannot be ignored in any assessment of the need for universal vaccination”. The study states “the results reflect complication rates under the present conditions of medical practice, and on these grounds, measles can scarcely be regarded as a mere inconvenience. Moreover, measles is an unpleasant disease that imposes considerable discomfort on nearly every child at some time, as well as a burden of anxiety and work on parents and doctors”.

In 1967 a campaign was launched to eliminate measles from the United States, supported by President Lyndon Johnson “To those who ask me ‘Why do you wish to eradicate measles?’” wrote Alexander Langmuir, chief epidemiologist at the Centers for Disease Control and Prevention from 1949 to 1970,

I reply with the same answer that Hillary used when asked why he wished to climb Mt. Everest. He said “Because it is there.” To this may be added, “… and it can be done.”

Call me cynical but it does seem an extraordinary change in observations by GPs, on the basis of having a measles vaccine to try. The graph above shows deaths associated with measles infection had dropped to negligible levels in the UK by the time the vaccine was introduced in 1968, it is a fact infection rates were increasing but our immune systems were coping better because of improved living conditions. I am not disputing that some children do have complications after measles infection, there is evidence of people having encephalitis after being infected, but the vast majority make full recoveries. However, for every example of measles injury, there is an example of a child injured by a vaccine.  Are we seriously expected to believe that this infection is now more dangerous than it was in 1959 despite all the advances in health care, housing and nutrition?

Its not as if the measles vaccine has been without controversy, but researchers have been more enthusiastic about discussing side effects from measles than side effects of the vaccine. There is no doubt that there has been an exponential rise in autism in recent years, there may be very well an association with MMR, however the medical establishment have their tanks parked on this theory and seem to enjoy this discussion. Proving causation is extremely difficult without funds for massive epidemiology studies, better to challenge governments to provide answers on autism, rather than handing them a strawman, that autism could be caused by anything except the MMR vaccine. 

There is no need to bring up Andrew Wakfield or the excellent Vaxxed documentary when you have a history like the MMR vaccine has. The “Urabe” strain of the MMR vaccine was introduced in 1988, three brands were tried on UK children, an experiment to see if the Government could get away with using a cheaper MMR vaccine. Eighty percent of the vaccines used on children were made by Merieux and SmithKline Beecham and contained the Urabe strain. The  MMR II, made by Merck, Sharp and Dohme, containing the ‘Jeryl Lynn’ strain, was more expensive and used 20% of the time.

After four years use it was apparent the Urabe strain was causing many cases of aseptic meningitis. But the medical establishment stuck with the 1964 narrative (rather than the 1959 one) that the risks from measles were preferable than not vaccinating. In  2007 it came out in a “Freedom of Information” request; that the government knew that there were concerns about the vaccine when it was introduced in 1988; minutes of a meeting of the Joint Committee on Vaccination and Immunisation, in May 1990, show that there was “special concern” about “reports from Japan of a high level of meningoencephalitis associated with the administration of MMR”. The UK Government waited another two years before it decided to stop using Urabe MMR in 1992, so keen were they to push on with this vaccine, we know children died but we have no details of numbers  

Last Summer I was invited on “Good Morning Britain” to discuss with Dr Hillary Jones why my children had not been vaccinated. They asked why not and I pointed out that it was normal for children like Hilary Jones and myself to have measles without a problem in the 60s.

That statement always lights up doctors under fifty who are taught measles is a “killer disease” best protection offered by vaccines.  Hilary Jones was no different; Measles killed many he said, but he was not expecting me to produce the page from the British Medical Journal in 1959, he commented: “the reference was a bit old”. I pointed out this was when measles was common in UK and doctors were not seeing deaths and very few complications.  He smoothly shifting the discussion to German Measles (Rubella) another mild infection, which can cause serious damage to fetuses in pregnant mothers who do not have antibodies, from previously being exposed to the infection. The presenter Kate Garaway seemed to think we have better knowledge about the risks of measles in the UK now, when most of the current statistics are based on small outbreaks, or from epidemics in the developing world, where children are often malnourished and don’t even have access to clean water.

It’s amazing how doctors can clearly see the “dangers” of measles now its become quite rare, while having great difficulty seeing the side effects of vaccines which are common, always “safe” but not risk free. This is what happens to clinical observations when the pharmaceutical industry has a vaccine to sell and governments absolve manufacturers of liability for injuries caused by their vaccines. The pharmaceutical industry knows, that many injuries will not be picked up on small trials and surface later on mass use. Compensation costs are prohibitive to manufacturing vaccines, so governments deal with “no Fault” compensation for injuries caused by vaccines. 

The cherry picking of evidence to support particular points of view, the smoke and mirrors, leaves parents none the wiser. The majority acquiesce as they did in Soviet times, others convinced its a social responsibility to vaccinate their children, while multinational companies avoid paying taxes, squirreling profits offshore. A minority continue to question, in the face of growing intimidation.

I never considered myself anti-vaccination, its a parents choice but if the name “Antivaxxer” has been created as a pejorative term to intimidate, I shall wear it as a badge of honor, while doing my best to optimise my children’s health and well being with minimal medical interventions. Here is a balanced measles debate which was on American TV, shame we can’t have similar debates in the UK, rather that the “science is settled” mantra and no need to give a platform to people to question the “science”; PR masquerading as science.

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