Study shows how toxic RFK Jr.’s change to measles vaccine is for US toddlers
Study shows how toxic RFK Jr.’s change to measles vaccine is for US toddlers
研究显示小罗伯特·肯尼迪对麻疹疫苗的调整对美国幼儿危害巨大
With no new data or clear reasoning, a panel of advisors hand-selected by anti-vaccine Health Secretary Robert F. Kennedy Jr. voted last September to strip federal recommendations for a combination shot against measles, mumps, rubella, and varicella (chickenpox). An analysis published today by independent researchers does the work the advisors neglected to do before the vote and, in turn, shows how harmful the decision is to vulnerable US toddlers.
在没有任何新数据或明确理由的情况下，由反疫苗倾向的卫生部长小罗伯特·F·肯尼迪（Robert F. Kennedy Jr.）亲自挑选的顾问小组于去年9月投票，取消了联邦政府对麻疹、腮腺炎、风疹和水痘（MMRV）联合疫苗的推荐。独立研究人员今日发表的一项分析报告，补齐了顾问们在投票前未尽的职责，并由此揭示了这一决定对美国弱势幼儿造成的巨大危害。
The decision last fall followed clumsy discussion by Kennedy’s dubiously qualified advisors, who make up the Advisory Committee on Immunization Practices (ACIP) for the Centers for Disease Control and Prevention. Most noticeably, their unprompted review of the MMRV vaccine did not include a standard decision-making framework ACIP has historically used to comprehensively evaluate what the change would mean for US children in practice—including basic questions, such as which children would be affected.
去年秋天的这一决定，源于肯尼迪那些资质存疑的顾问们进行的拙劣讨论。这些顾问组成了美国疾病控制与预防中心（CDC）的免疫实践咨询委员会（ACIP）。最引人注目的是，他们对MMRV疫苗进行的未经请求的审查，并未包含ACIP历史上用于全面评估政策变更对美国儿童实际影响的标准决策框架——这甚至忽略了诸如“哪些儿童会受到影响”这类基本问题。
Still, the decision meant that private health insurance providers would no longer be required to cover the vaccine, called MMRV. It also meant the shot would no longer be available through a federal program that provides vaccines to about half of American children, mostly from low-income families.
尽管如此，这一决定意味着私人健康保险提供商将不再被要求承保这种名为MMRV的疫苗。这也意味着，该疫苗将不再通过一项联邦计划提供，而该计划此前为约半数美国儿童（主要是低收入家庭儿童）提供疫苗接种。
The study published today in JAMA Network Open set out to assess who was using MMRV before the change. It was done by researchers in Washington state, who examined the use of MMRV between 2015 and 2025 in King County, which encompasses Seattle. Reviewing immunization records of over 200,000 toddlers and young children ages 12 to 47 months, they found that a little over 31,000 children got the MMRV in that time period, about 15 percent.
今日发表在《美国医学会杂志·网络开放版》（JAMA Network Open）上的这项研究，旨在评估政策变更前谁在使用MMRV疫苗。该研究由华盛顿州的研究人员完成，他们调查了2015年至2025年间金县（King County，包含西雅图市）的MMRV使用情况。通过审查超过20万名12至47个月大的幼儿和儿童的免疫记录，他们发现该时期内有超过3.1万名儿童接种了MMRV，约占总数的15%。
MMRV vs. MMR+V
MMRV 与 MMR+V 的对比
This matches what was already known about the vaccine’s use—about 15 percent of kids nationwide get the shot, a small percentage. Most children instead receive a measles, mumps, and rubella shot (MMR) and a separate vaccine against varicella (chickenpox). Usually, the two vaccines are given at the same time, and the co-administration is abbreviated as MMR+V.
这与此前已知的疫苗使用情况相符——全国约有15%的儿童接种该疫苗，比例较小。大多数儿童接种的是麻疹、腮腺炎和风疹联合疫苗（MMR），以及单独的水痘疫苗。通常，这两种疫苗会同时接种，这种联合接种方式简称为MMR+V。
The reason the majority of kids get MMR+V is because it’s preferred over the single shot based on past data. MMRV earned approval from the Food and Drug Administration in 2005, but after a few years, it became clear that there was a slightly increased risk of febrile seizures when it is given as a first of two doses in toddlers 12 to 15 months (there was no increased risk for the second recommended dose, given at 4 to 6 years).
大多数儿童接种MMR+V的原因是，基于过往数据，它比单针疫苗更受推荐。MMRV于2005年获得美国食品药品监督管理局（FDA）批准，但几年后人们发现，当12至15个月大的幼儿接种两剂中的第一剂时，出现热性惊厥的风险略有增加（在4至6岁接种的第二剂推荐剂量中，并未发现风险增加）。
That increase is slight—there were 7 to 8.5 seizure cases for every 10,000 first-dose MMRV vaccinations, compared to 3.2 to 4.2 in 10,000 first-dose MMR + V vaccinations, analyses found. That difference works out to an extra one febrile seizure per 2,300 to 2,600 children. And febrile seizures are generally harmless—however alarming they may be for a parent to observe.
分析发现，这种风险增加幅度很小——每1万剂MMRV首剂接种中，约有7至8.5例惊厥病例，而每1万剂MMR+V首剂接种中则为3.2至4.2例。这一差异意味着每2300至2600名儿童中会多出一例热性惊厥。尽管家长看到时会感到惊恐，但热性惊厥通常是无害的。
A febrile seizure is simply a seizure associated with fever, and they can be spurred by almost anything that can cause a fever, such as the flu or an ear infection. In almost every case, children fully recover, with no long-term effects. By age 5, about 5 percent of all children have had such a febrile seizure for one reason or another. Still, given the comparative increase over MMR+V, in 2009, the ACIP of the time combed through the data and decided that MMR+V should be preferred over MMRV. But, MMRV was still considered safe and effective and was left as an option for parents in consultation with their doctors. No new data has changed that view among experts since those times.
热性惊厥仅仅是与发烧相关的惊厥，几乎任何能引起发烧的原因（如流感或耳部感染）都可能诱发。在几乎所有病例中，儿童都能完全康复，且没有长期后遗症。到5岁时，约有5%的儿童因各种原因经历过此类热性惊厥。尽管如此，考虑到其相对于MMR+V的风险增加，2009年当时的ACIP梳理数据后决定，应优先推荐MMR+V而非MMRV。但MMRV仍被认为安全有效，并作为家长与医生协商后的一个选项保留了下来。自那时起，没有任何新数据改变专家们的这一观点。
Vulnerable toddlers
弱势幼儿
Between 2015 and 2025, use of MMRV among children in King County held steady at 15 percent for the decade, despite the ranked recommendation. And that 15 percent had clear demographic characteristics: Children who got an MMRV as a first dose were more likely than other vaccinated children to be in minority racial and ethnic groups. By comparison, significantly more of them were getting a “catch-up dose” after the initial window of 12 to 15 months, getting them instead between 16 and 47 months.
2015年至2025年间，尽管有优先推荐建议，金县儿童的MMRV使用率在十年间一直稳定在15%。这15%的群体具有明确的人口统计学特征：接种MMRV作为首剂的儿童，比其他接种疫苗的儿童更有可能来自少数族裔群体。相比之下，他们中有更多人在12至15个月的初始窗口期后才接种“补种剂量”，即在16至47个月之间接种。
Children getting an MMRV were also more than three times more likely than other vaccinated children to be eligible for a federal program that offers free vaccines to children in low-income families. They were nearly four times more likely to get vaccinated at a safety-net clinic. In all, the researchers concluded, “This population might be at risk of not receiving recommended vaccines if options become limited.”
接种MMRV的儿童有资格享受联邦免费疫苗计划（针对低收入家庭儿童）的可能性，是其他接种疫苗儿童的三倍多。他们在安全网诊所（safety-net clinic）接种疫苗的可能性则高出近四倍。研究人员总结道：“如果选择受限，这一群体可能面临无法接种推荐疫苗的风险。”
In an accompanying commentary piece, health policy experts Elizabeth Cope and Aaron Carroll of the health research nonprofit AcademyHealth blasted Kennedy’s ACIP for making their decision without accounting for analyses like this one. The study’s findings “are not surprising,” they wrote. “Combination vaccines reduce the number of injections and visits and lower cost barriers to series completion. Those benefits matter most to families with the least slack: hourly work, no paid sick leave, and a follow-up visit that may not happen.”
在随附的评论文章中，健康研究非营利组织AcademyHealth的卫生政策专家伊丽莎白·科普（Elizabeth Cope）和亚伦·卡罗尔（Aaron Carroll）猛烈抨击了肯尼迪的ACIP，称其在做出决定时未考虑此类分析。他们写道，该研究的结果“并不令人惊讶”。“联合疫苗减少了注射次数和就诊次数，降低了完成全程接种的成本障碍。这些益处对于那些最缺乏余力的家庭至关重要：他们从事时薪工作，没有带薪病假，且后续复诊可能无法实现。”
The study has the limitation of only examining MMRV use in one county in one state, Cope and Carroll note. But, they said, “If similar patterns exist in less well-resourced settings, the resulting equity implications could be even more pronounced.” The two experts stop short of suggesting Kennedy’s anti-vaccine agenda directly swayed his ACIP members to make this ill-conceived recommendation, saying it can’t be determined from the public record. But “[w]hat can be determined is that multiple structural safeguards, historically intended to preserve ACIP independence, were absent simultaneously,” they write.
科普和卡罗尔指出，该研究仅调查了一个州内一个县的MMRV使用情况，存在局限性。但他们表示：“如果资源较匮乏的地区也存在类似模式，由此产生的公平性影响可能会更加显著。”这两位专家并未直接指出肯尼迪的反疫苗议程直接左右了ACIP成员做出这一考虑不周的建议，称从公开记录中无法断定。但他们写道：“可以确定的是，历史上旨在维护ACIP独立性的多项结构性保障措施，在这次决策中同时失效了。”