The occurrence of arthralgia has been documented since the first studies about the rubella vaccination [1-10]. Based on these studies, the Institute of Medicine states: "The committee concludes that a causal connection exists between the RA 27/3 rubella vaccination strain and incidents of chronic arthritis in women." "Thompson et al. report in 1973 on eleven children with recurrent arthritis which lasted at least for 36 months after vaccination with HPV 77; other cases of potential arthritis have since then reported, some with the RA 27/3 strain." [12].

Arthralgia and arthritic affections occur frequently in connection with diseases for which auto-immune reactions are responsible. Examples are Lupus erythematosus, scleroderma, Sharp-syndrome, polymyositis [23], or rheumatoid arthritis.

It would be advisable to study the connection between activation of the immune system and auto-immune diseases, since the number of diseases in this class is large and grows steadily with our increase in knowledge of their pathophysiology: Thyroiditis Hashimoto, primary myxedema, pernicious anemia, auto-immune atrophic gastritis, Morbus Addison, premature menopause, Goodpasture syndrome, myasthenia gravis, sterility in men, Pemphigus vulgaris, sympathetic ophthalmia, multiple sclerosis, auto-immune hemolytic anemia, primary biliary cirrhosis, ulcerative colitis, Sjogren syndrome, and so forth.

We know that immunizations can lead to a deterioration in existing auto-immune diseases [23]. The symptoms which the body exhibits in these cases, because of its specific predisposition, are an indication of a weakness in the regulatory system and are usually overlooked in the "still" healthy person, yet probably present nonetheless (Harris Coulter refers to these cases as "cracked eggs"). "It is generally advisable to abstain from active immunization with live vaccines in the cases of patients with auto-immune diseases or chronic inflammatory processes and vaccinate only in special circumstances and in the presence of strong indications." [23] Further: "It is not aberrant to assume that immunizations, being a considerable interference with the regulation of the immunologic network, can influence the progression of vasculitic illnesses." [23]

Even direct side effects are known: "Ten of 1000,000 vaccinated Americans developed auto-immune post-vaccinal encephalitis or peripheral neuritis (Guillain-Barre syndrome) one or two weeks after immunization with attenuated influenza vaccine." [64].

However, it has been difficult to prove that immunizations are actively involved in the emergence of auto-immune diseases, because these illnesses develop after a considerable latency period. Furthermore, studies, particularly predictive ones, are very involved and have not been carried out to date.

Patho-Mechanism

It is the right time to launch these important studies, since a patho-mechanism which might be involved in causing such auto-immune diseases has been known for a long time: the cross-reaction between foreign pathogenes (or vaccines), and body chemistry and tissues, so-called molecular mimicry [59]. One can imagine such a relationship between body tissues and foreign matter on three planes: [58]:

1. Between two types of cells, tissues, or micro organisms (e.g., bacteria or viruses), if they use a similar or identical kind of molecule in their structure.

2. Between two antigen molecules if, on their surface, they have not only different but also identical determinants (i.e., mutually recognizable sites).

3. Between two determinants, if they are sufficiently similar to react with the same antibody. In this case the group homologue to the antibody will react strongly while the differently configured determinant will yield a weaker reaction.

All these possibilities apply to vaccines or their constituents. If one introduces antigens into the body (e.g., through vaccination) which have similar structural groups as some body tissue, even if the similarity is only partial, the production of antibodies in the sense of an auto-immune reaction is possible. A well known medical example for this process is the cross reactivity between poly-saccharides of the cell membrane of beta-hemolytic streptococci and the human cortical valve during rheumatic fever. In this case, damage to the valve can occur by means of antibody production.

One may remark that the natural infections can trigger auto-immune reactions, too. However, the vaccination-induced infection differs from the natural one in three important ways, and therefore possesses a different antigen makeup from the latter:

1. The pathway of infection is different from the natural disease (i.e., direct confrontation with the antigen by intramuscular injection).

2. The time of infection is determined by the time of vaccination (e.g., all children in the third month), not by the susceptibility of the body or the "random" contact with the virus (readiness of the immune system).

3. The vaccine is an artificial product with additives which modify the action of the pathogen (modified antigen makeup).

For these reasons, vaccination and natural disease are difficult to compare with respect to their risk potential. Both harbor their own risks.

One other point should not be neglected: It is possible to develop tolerance to certain antigens, the exact opposite of what has been described so far [27]. This principle is exploited by desensitization techniques used therapeutically against hay fever and allergic asthma: the patient is injected with small doses of the allergen (pollen, dust mites, etc.) in order to make them adapt to it.

In a similar manner, the body may develop a tolerance for things which it would normally eliminate due to their harmful nature. Along these lines one could imagine a weakening of the immune response against certain pathogens, e.g., cancer cells:

"A derailment of the immune system may be responsible for the development of various tumors." [60] "Animal experiments have shown that the fetus, with its immature immune system, can develop a tolerance by exposing it to antigenes." [61] However, the exact time when the immune system has matured fully is unknown, and "other factors like age, genetic background, and nutritional status" [27] are also relevant to the induction of a tolerance. Furthermore, the exact mechanisms leading to a antigen tolerance are still mostly in the dark. Therefore, according to current understanding, there exists a possibility to develop a tolerance for surface antigens of tumor cells induced by vaccines exhibiting a cross-reaction with tumor antigens. As a consequence, tumor cells would not be effectively recognized by the immune system and hence also not fully eliminated.

Especially when one thinks about the diptheria-tetanus-pertussis (DTP) immunization, which is given in the third month, such reactions seem possible. We don't yet fully understand the highly sensitive interplay between fight and tolerance in our immune system. What consequences our interference from outside bears is impossible to predict. Further study is sorely needed in this area since we know of numerous other mechanisms involved in the development of auto-immune diseases (e.g., formation of immune complexes after infection following vaccination [64], etc.).

Purity of Vaccines

Another important issue is the purity of the vaccine. As described above, several vaccines (MMR, polio) are produced by attenuation in living organisms or cell cultures (kidney-cell cultures of monkeys). Despite the utmost cleanliness strived for, it is technologically impossible to exclude all possible risks of contamination entirely.

One such risk is, for example, the infestation of the sample by various viruses (slow virus, BSE, retro-viruses, onco-viruses, etc.) or mycoplasms, all of which are difficult or impossible to detect because of their specific properties. "Virus contaminated cell cultures are a significant problem of the bio-industry." [28] In addition, the latency period of diseases caused by these contaminants is sufficiently long so that a causal connection is almost impossible to detect.

Live vaccines possess a higher risk of contamination with micro-organisms than other vaccines. Ontogenetic viruses are, for example, present in mammalian cell strains used in vaccine production. [64]

Live vaccines attenuated by conventional procedures are commonly carriers of unknown genetic modifications. Particularly when these modifications are only minor, like localized mutations, the danger of back mutation into a pathogenetic virus is possible. The difference, for example, between the Sabin strain and one of the virulent poliomyelitis strains is only the addition of one nucleotide. The mutation into neuro-virulent strains occurred with rabies vaccines and Sabin-polio strains (oral vaccination) of types 2 and 3 [64]. Another drawback of live vaccines lies in their possibility of complementation or recombination with closely related wild strains or vaccine strains. The likelihood and possible consequences of this are wholly unknown.

The Kinman article (Reference 64) poses important thoughts to the issue of vaccination risks.

Because vaccines are applied million-fold on entire populations, overlooked viral contaminations, back mutations, new mutations of the attenuated vaccine, or insufficient attenuation of the pathogen may have dramatic consequences for a large number of people. [30] Big immunization accidents happen not infrequently. Here are a few examples taken from the history of medicine: 102 people contracted encephalitis and 17 died 1944 in Brazzaville due to a yellow fever vaccination. A yellow fever vaccination contaminated with hepatitis virus was conducted in the US in 1942. The consequence was 28,585 cases of hepatitis and 62 deaths. In 1955, the so-called Cutter incidence: 250 cases of polio and 10 deaths were reported, due to active pathogens in the vaccine. 1960 in Berlin, within four weeks there were 25 cases of paralytic poliomyelitis reported, after using an insufficiently attenuated vaccine. [56] Again in 1988-92 there was an increase in encephalitis cases after MMR vaccination.

Undesirable reactions to vaccinations are often the consequence of toxic substances in the vaccine,

of contaminants which are not antigens and have been introduced in the preparation of the vaccine (like, e.g., substances used in cell cultures on which the vaccine virus grows, or insufficiently purified bacteriological antigens), or in-vivo replications of the viral or bacterial organisms. Hypersensitivity reactions may conceivably be due to additives to the vaccine; like, for example, neomycin in the MMR-vaccine or the mercury contained in Thimerosal, a preservative used in the DTP-vaccine. [25].

Considering that there are more unknowns than knowns in this vast field, with all imaginable cross-reactions, gene transfers, etc., it is justifiable to liken the introduction of substances which have been cultivated on living organisms into the human body to a game of lottery. At no time do we know exactly what has been injected nor the consequences arising therefrom.