Ireland’s measles outbreak worsened by fall in vaccinations

Measles. What’s the big deal? Sure it’s just a few spots and a temperature, like chicken pox, which we don’t vaccinate against, right? No. Measles is not a minor illness, and can lead to serious complications or death in severe cases, but this message is still not getting through, public health experts say.

More than 65 cases of measles have now been reported to the HSE this year, as the latest outbreak shows little sign of abating. About 40 of these cases have been laboratory confirmed while the remainder are “likely and probable cases”, says Dr Kevin Kelleher, assistant national director for public health at the HSE.

It is probable that all three clusters could have developed from just one case

There have been three outbreak clusters of measles this year to date – one in Limerick, two in Dublin, with a small number of individual cases in the west and southeast.

It is probable that all three clusters could have developed from just one case, if someone was infected while visiting a country outside Europe and flew back to Ireland, Kelleher says.

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The high number of teenagers and adults affected by the current outbreak is of particular concern to the HSE. “Ten-30 per cent of the population under the age of 40 is not vaccinated,” so there are many vulnerable people out there, Kelleher points out.

So why are so many people in this age group still unvaccinated for measles?

Before the introduction of the measles vaccine in 1963 and widespread vaccination programmes, an estimated 2.6 million people died each year of the disease, according to the World Health Organisation. Even in the 1970s an average of seven children a year died from measles in Ireland.

Uptake rates

Smallpox has been eradicated because of vaccination, and it was expected that measles would eventually go the same way – but a scare about the vaccine in the late 1990s hit uptake rates in many countries and cases started to rise again.

In 2000, there was a major measles outbreak of over 1,600 cases in the Dublin area, with three deaths, following a large drop in vaccine rates.

This was largely down to the panic caused by Dr Andrew Wakefield’s now debunked and discredited research claims in 1998 that the MMR – measles, mumps and rubella – vaccine was linked to the development of autism.

A rate of 95% is needed to ensure herd immunity and protect those who cannot be vaccinated

A legacy of Wakefield’s false claims is that while MMR vaccine uptake has returned to high levels in Ireland, there is a large proportion of adolescents and adults who were not vaccinated or only have one dose of the MMR vaccine, and are now at risk of infection.

The majority of those in the current measles outbreak have been aged between 15 and 40 years and almost all were unvaccinated.

Furthermore, while MMR vaccination rates in Ireland are currently very high, at 92 per cent on average at 12 months, a rate of 95 per cent is needed to ensure herd immunity and protect those who cannot be vaccinated. In addition, some parts of the country, including parts of west Cork and north Dublin, have lower uptake rates.

“Quite simply, if we don’t achieve the uptake we need, we are going to have more outbreaks,” Dr Ann Hogan, a community health doctor in Limerick and past president of the Irish Medical Organisation says. “If everyone had the required two doses of MMR then 99 per cent of the population would be protected against measles. We are finding it very hard to get to that last few per cent to be vaccinated.”

A free public MMR vaccination clinic was held in Limerick in recent weeks. And for the duration of this outbreak the MMR vaccination is available free of charge to the public from GPs locally.

Measles is highly contagious, more so than flu or TB, says Kelleher. It is spread through coughing and sneezing. When one person has measles, 90 per cent of the people they come into close contact with will become infected, if they are not already immune.

Contamination

However, people seem either unaware of this or aren’t bothered about contamination, he says. Many of those infected with measles continue to mix with others, even travelling in planes and other vehicles where the disease spreads more rapidly still.

People with measles should stay at home and avoid work or school. They should contact their GP and avoid hospital emergency departments unless absolutely necessary, Kelleher says.

It is not just Ireland that is affected. Europe is currently in the grip of a widespread measles outbreak, with a four-fold increase in measles cases from 2016 to 2017. Since the beginning of 2016, at least 57 deaths due to the disease have been reported in the EU.

Measles’ continued spread in Europe is due to suboptimal vaccination coverage.

The highest incidence of measles cases in Europe is being reported in infants below one year of age; those most at risk of severe complications and death, and too young to have received the first dose of the vaccine.

A number of European health bodies have called for urgent action on the issue, and a European Commission roadmap for strengthened co-operation against vaccine-preventable diseases is being promoted during the current European Immunisation Week 2018, which ends on April 29th.

Vaccine hesitancy is one of the biggest challenges in trying to eradicate measles and other vaccine-preventable infectious diseases in this era, says Kelleher. People have forgotten the once common long-term health complications and deaths caused by vaccine-preventable diseases such as measles, polio, TB and smallpox, and are now complacent and sometimes suspicious about vaccines.

While vaccination is not mandatory in Ireland, Kelleher suggests we become more aware of those who are not vaccinated and question them as to their reasons.

Measles: highly contagious, highly dangerous

– Measles is a viral illness that is spread through direct contact and through the air. It is highly contagious. One case of measles can infect 15-20 unvaccinated people.

– Symptoms include high fever, cough, runny nose, red eyes, and a rash that starts on the head and spreads.

– Measles can lead to serious complications such as pneumonia, inflammation of the brain and blindness and can, in rare cases, lead to a fatal disease of the brain that develops years after the infection.

– The mortality rate from measles infection is 1-2 per 1,000 cases. The hospitalisation rate is one in ten, while one in 100 cases end up in intensive care.

Those most at risk of catching measles are those who are not fully vaccinated with two doses of MMR vaccine such as babies younger than 12 months, and those with weakened immune systems.

– Anyone who thinks they have contracted measles should stay at home and phone their GP or local Department of Public Health for assistance.

Source: HSE