The measles threat is made worse by short mem­o­ries and low vac­ci­na­tion rates

The dan­gers of this ex­tremely con­ta­gious ill­ness are un­der­es­ti­mated by the pub­lic, doc­tors say

The Irish Times - Weekend Review - - NEWS | REVIEW - Priscilla Lynch

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 t hese 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.

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.

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.

Still un­vac­ci­nated

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.

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 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.

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

Measles A highly con­ta­gious ill­ness

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.

Free clinic

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.

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.

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 f or­got­ten t he 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.

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