There is a rare but cruel complication of measles: subacute sclerosing panencephalitis (SSPE), a progressive neurological disorder of children and young adults that affects the central nervous system (CNS).
Mischa, a 14 year old German boy, has just died of SSPE. He was infected with measles in 2000, at the age of 5 months, by an 11 year old boy whose parents had refused vaccination. The infection was passed at a pediatrian's office. The older child also infected five other children; one of them, a girl named Natalie, also developed SSPE and died in 2011.
Thanks to relatively high vaccination uptake of the Measles-Mumps-Rubella (MMR) vaccine, SSPE has become rare in the US, with fewer than 10 cases reported annually.
Analysis of data from an outbreak of measles in the United States during 1989-1991 suggests a rate of 4-11 cases of SSPE per 100,000 cases of measles. A risk factor for developing this disease is measles infection at an early age. Studies in the United Kingdom indicate that 18 out of every 100,000 people who get measles when they are less than a year old will develop SSPE. This is compared to 1.1 per 100,000 in those infected after 5 years of age. On average, the symptoms of SSPE begin 7 to 10 years after measles infection, but they can appear anytime from 1 month to 27 years after infection.
Most youngsters with SSPE have a history of measles infection at an early age, usually younger than 2 years, followed by a latent period of 6 to 8 years before neurological symptoms begin. Despite the long interval between the measles infection and the onset of SSPE, researchers think that the infection of the brain occurs soon after the primary bout with measles and progresses slowly.....There is progressive deterioration to a comatose state, and then to a persistent vegetative state. Death is usually the result of fever, heart failure, or the brain's inability to continue controlling the autonomic nervous system.
The blogging duo at Just the Vax have been covering SSPE for years:
Just the Vax's Coverage of SSPE cases in Europe
- April 23 2009 Medical Care for Unvaccinated Children
- January 28 2010 GMC ruling on Andrew Wakefield in and a reminder why MMR is important
- October 20, 2011 So predictable - so sad, Natalie dies of SSPE
- November 7 2011 And another SSPE case: Angelina is dying
- May 23 2012 Measles in Europe: personal stories about coma, SSPE
- September 12 2012 Olmsted Can't Find SSPE Either
- June 13 2013 Mischa is Dead
German-language reports
There's been a claim that the measles vaccine can and has caused SSPE. This claim is false.
"6.4. Only wild-type virus sequences have been found in SSPE
The description of specific clades and genotypes of MV has allowed the evaluation of mutations found in the MV RNA sequences from SSPE brain material against wild-type (clades B–G) viruses. All the vaccine viruses are derived from the Edmonston strain (clade A) but no clade A virus has been found in SSPE brain material. The sequences found in SSPE brain are related to the wild-type viruses circulating at the time of initial infection of the child and not to those circulating at the time of onset of symptoms. Hence, the virus which initially infected the child, appears to persist and SSPE is not due to a super-infection by viruses circulating during the onset of symptoms (Jin et al., 2002) (Rima et al., 1995); Rota, personal communication). To the best of the authors’ knowledge no vaccine virus, genotype A, sequences have been obtained from SSPE cases. SSPE has been vastly reduced in incidence after successful control of measles by vaccination (Dyken et al., 1989). In contrast, vaccine strains have been identified in MV infections in immuno-compromised patients who died from MIBE (Bitnun et al., 1999) and giant cell pneumonia (Mawhinney et al., 1971)."
http://www.ncbi.nlm.nih.gov/pubmed/15893837
(thank you Catherina Becker for the link)
Posted by: Liz Ditz | Friday, June 14, 2013 at 09:59 AM
Subacute Sclerosing Panencephalitis: More Cases of This Fatal Disease Are Prevented by Measles Immunization than Was Previously Recognized
Results ... The estimated risk of developing SSPE was 10-fold higher than the previous estimate reported for the United States in 1982
Conclusions Vaccination against measles prevents more cases of SSPE than was originally estimated
(again, H/T Catherina Becker)
Posted by: Liz Ditz | Friday, June 14, 2013 at 10:02 AM
It was not until the 1960s that they even connected SSPE to measles. There was no explanation why a healthy child would just start deteriorating.
Then the measles vaccine came along, and some thought it contributed. It would be hard to make a connection because it manifests years after the measles infection. But it turns out as more and more kids got vaccinated, there were fewer cases of SSPE.
Posted by: Chris | Friday, June 14, 2013 at 10:22 AM