Measles, Mumps, and Rubella Vaccines

 

Norman Rockwell Print, Mumps (Boy in Auto), ca 1972. Norman Rockwell created this work for a Merck advertisement celebrating the impact of the mumps vaccine on American culture. The image of a family having to cancel their vacation when the young son comes down with the mumps pointed to how, thanks to the vaccine, mumps was no longer an unavoidable part of childhood. Childhood vaccination had replaced mumps as an American tradition.

One of the standard childhood vaccinations in the United States is the MMR vaccine, which produces immunity against measles, mumps, and rubella. These three infectious diseases have several things in common. They are all caused by viruses that can spread through coughing and sneezing. Individuals infected with measles, mumps, or rubella are contagious for several days before they show the classic outward signs—rash or swelling—of infection. Finally, many Americans once considered these diseases to be part of a normal childhood—their danger was underestimated.

We now know that two of these illnesses, measles and rubella, can be very dangerous. Far from being a harmless rite of childhood, they are responsible for hundreds of thousands of fetal and child deaths each year. The third illness, mumps, is far less perilous but can have serious (and occasionally permanent) complications.

Although we now protect against all three diseases with one combined vaccine, in the past each disease required its own course of vaccinations. The museum’s collections include objects that document the development of each of these vaccines.

Measles is an exceptionally contagious disease. The Centers for Disease Control (CDC) reports that 90% of all non-immune people who come in contact with an infected person will also become infected. In fact, the virus can remain alive and airborne for two hours after an infected person has left a room.

Measles can cause ear infections and hearing loss, pneumonia, and swelling of the brain. Children are the most susceptible to severe complications: 1-2 children die for every 1,000 that contract the disease, even if they are under hospital care. That death rate may not seem high—except when one considers the 90% infection rate, which meant that, before a vaccine, almost all children contracted measles by their fifteenth year.

Before a vaccine was developed, quarantining the sick remained the best strategy for curtailing the quick spread of measles. The museum’s collections contain several examples of quarantine signs used in the struggle to contain measles.

The announcement of a measles vaccine brought hope and relief to public health organizations. In 1963, pharmaceutical companies produced the first measles vaccines based on a vaccine created in the laboratory of Dr. John Enders at Boston Children’s Hospital.

 

Gamma globulin vial, ca 1947. Gamma globulin was originally used as a serum therapy—injections were given in an attempt to prevent or mitigate measles infection. Later, in 1963, gamma globulin was administered alongside the measles vaccine to alleviate the side effects of the vaccine.

A live virus vaccine proved the most effective, but it caused side effects such as fever and rashes. The vaccine, developed by Dr. Maurice Hilleman, director of vaccine research at Merck & Co., relied upon a concurrent injection of gamma globulin (an antibody-packed serum), thereby making the vaccine both safe and potent. Hilleman continued working to further attenuate (weaken) the measles strain, and eventually created a vaccine that could be administered without gamma globulin. His measles vaccine was distributed in 1968 and is still in use today.

Vaccination campaigns drastically reduced the spread of measles in America. However, the disease proved surprisingly difficult to eradicate. Vaccination programs were hindered by a misperception about measles—parents and some physicians continued to underestimate the danger of the disease.

Measles was finally eliminated from the United States in 2000—but it is back. Unvaccinated U.S. residents contract the disease during foreign travel or from foreign visitors, and the disease then quickly spreads to other unvaccinated people within a community. Since 2008, serious outbreaks of measles have occurred among Americans.

The characteristic calling card of mumps, a swollen jaw and cheeks, is often comically depicted in American culture. Most people who contract the disease recover fully from the fever, swelling, and aches that usually attend it, while some infected people never experience these symptoms.

The complications of mumps are less comical: inflammation of the testicles, ovaries, brain, and the tissue around the brain and spinal cord, as well as deafness. Adults are often subject to more serious complications than are children. However, before a vaccine was available in the U.S., mumps was a significant cause of acquired deafness in childhood.

The mumps vaccine has an unusual history. When vaccine researcher Dr. Maurice Hilleman’s five year-old daughter, Jeryl Lynn, came down with mumps, he collected a sample of the virus from her. After attenuating the virus strain, he created a live virus vaccine that he thought would prove both safe and effective. Clinical trials of the vaccine followed, with Dr. Hilleman’s younger daughter Kirsten participating in one of them.

Rubella (German measles) presents a unique challenge in the history of vaccination in America. The rubella vaccine is not primarily meant to protect the children who receive it—it is meant to protect all unborn children within the same family or community.

Rubella was not understood to be a highly dangerous disease until 1941. In that year, Australian ophthalmologist Norman Gregg discovered a correlation between mothers who had been infected with rubella during pregnancy and infants who were born with cataracts.

Researchers soon realized that women exposed to rubella in early pregnancy are at high risk for miscarriages and still births. Furthermore, surviving infants could be born with visual and hearing impairments, heart defects, neurological damage, and other lifelong disabilities. This condition is known as congenital rubella syndrome (CRS). According to the CDC, a “woman infected with rubella during the first 3 months of pregnancy has up to a 90% chance of giving birth to a baby with CRS.”

The importance of preventing rubella came into focus after the U.S. rubella epidemic of 1964–65, which resulted in an estimated 20,000 cases of CRS, plus another 20,000 fetal deaths. Following this outbreak, American scientists prioritized the production of an effective vaccine and in 1969, three vaccines – Meruvax, Rubelogen, and Cendevax – were released.

Dr. Stanley Plotkin of Philadelphia’s Wistar Institute developed yet another rubella vaccine strain, one that proved superior to all others. In 1979, licensed as Meruvax II, it became the sole rubella vaccine available in the U.S.

Rubella vaccination programs have been very effective—the CDC reports that rubella was eliminated from the United States in 2004. Nevertheless, to prevent a resurgence of rubella, high vaccination rates for children and women of childbearing age must be maintained.

Internationally, rubella remains a threat. The CDC estimates that 110,000 babies are born each year with congenital rubella syndrome, largely in Southeast Asia and Africa.

In the United States, measles, mumps, and rubella are now prevented by a single combined vaccine, known as MMR (measles, mumps, rubella). The combined vaccine was developed by Dr. Maurice Hilleman in 1971. In 1979 it was modified, substituting Dr. Stanley Plotkin’s more effective rubella vaccine.

The combined vaccine is more convenient for patients, and this convenience actually saves lives. Fewer injections translate as fewer missed doses, and therefore more protection in a shorter time. The MMR vaccine has saved millions of lives worldwide.