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Measles….

20 May

MEASLES

We have all been reading about the recent epidemic in Swansea arisen from the poor uptake of the MMR vaccine.

The leap in the number of confirmed cases can mostly be attributed to the proportion of unprotected 10 to 16-year-olds who missed out on vaccination in the late 1990s and early years of 2000 when fears about the discredited link between autism and the vaccine was widespread, according to public health experts.

Measles cases in the Swansea epidemic have risen by 20 in the last week to 1,094 as health chiefs warn the uptake of MMR is too low to eliminate the disease in Wales.

Public Health Wales (PHW) continues to warn that the outbreak may spread.

It said 95% uptake of MMR would prevent further outbreaks.

But vaccination rates remained low in Wales, especially among those aged 10 to 18 who are hardest hit.

In total, 1,257 people across Wales have now contracted the disease since last November, as the latest figures were released.

PHW said more than 43,000 non-routine MMR vaccines had been given since the outbreak began.

“In 2011 we had only 19 cases of measles in Wales all year and that should be compared with the 20 new cases we have seen since the end of the last week alone.”

In 2011, the World Health Organization (WHO) estimated that there were about 158,000 deaths caused by measles – about 430 deaths every day. Mortality in developed countries is about 1 in 1,000 cases (1%). In populations with high levels of malnutrition and a lack of adequate healthcare, mortality can be as high as 10%.

In cases with complications, the rate may rise to 20–30%.
According to the 2011 United Nations Millennium Development Goals report, “the combination of increased immunization coverage and the opportunity for second-dose immunizations led to a 78% drop in measles deaths worldwide. These averted deaths represent one quarter of the decline in mortality from all causes among children under five.”

Even in countries where vaccination has been introduced, rates may remain high. In Ireland, vaccination was introduced in 1985. There were 99,903 cases that year. Within two years, the number of cases had fallen to 201, but this fall was not sustained.

Measles is a leading cause of vaccine-preventable childhood mortality.

Worldwide, the fatality rate has been significantly reduced by a vaccination campaign led by partners in the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the WHO.

Globally, measles fell 60% from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Estimates for 2008 indicate deaths fell further to 164,000 globally, with 77% of the remaining measles deaths in 2008 occurring within the Southeast Asian region.

Measles is an endemic disease, meaning it has been continually present in a community, and many people develop resistance. In populations not exposed to measles, exposure to the new disease can be devastating.

In 1529, a measles outbreak in Cuba killed two-thirds of the natives who had previously survived smallpox. Two years later, measles was responsible for the deaths of half the population of Honduras, and had ravaged Mexico, Central America, and the Inca civilization.

In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide.

During the 1850s, measles killed a fifth of Hawaii’s people.[62] In 1875, measles killed over 40,000 Fijians, approximately one-third of the population. In the 19th century, the disease decimated the Andamanese population.
In 1954, the virus causing the disease was isolated from an 11-year old boy from the United States, David Edmonston, and adapted and propagated on chick embryo tissue culture. To date, 21 strains of the measles virus have been identified.
While at Merck, Maurice Hilleman developed the first successful vaccine. Licensed vaccines to prevent the disease became available in 1963.An improved measles vaccine became available in 1968.

On a personal level several experiences in my life as a doctor in the UK and in Africa and a mother of three children I value the importance of vaccination.

I distinctly remember talking to my Mathematics teacher when I was in the 6th form at school and knowing I was wanting to study Medicine she told me about her 7 year old daughter who was in an institution as she had contracted Measles and was now severely brain damaged following encephalitis, a rare and very serious complication of measles.
It had an impression on me and over 20 years later, when I had the choice to vaccinate my own children there was no hesitation but at that time only a single injection was available ( MMR was not available) and only about 66% protection.
Unfortunately, my son was one of the 33% who was not protected after the single injection and he contracted Measles caught from a child who had a mild infection but not immunised and he had to be hospitalised.
Later all my children and husband contracted Mumps and they were all unwell , my son and husband had the complication of orchitis (inflammation of the testicles) and my eldest daughter had a mild encephalitis. Fortunately, they all recovered but it was a very stressful time, so that when the MMR was introduced I felt totally committed to encouraging mothers to have their infants immunized and was never convinced of the association with autism or bowel disease.

Furthermore, I had spent time in Nigeria where Measles is a significant cause of death in infants as well as my first hand experience of seeing children with serious complications or death, in all other diseases for which we now vaccinate infants.

I consider it is ethically unacceptable to tolerate any serious complication, or death, from measles or any other disease when an effective vaccine is available.

We vaccinate for the following reasons:-

1) the protection of the individual child to protect them from a disease which could lead to serious complications or death.
2) as part of creating a herd immunity to protect other individuals who are more vulnerable ( children and adults treated for cancer or who are immuno-suppressed for other reasons) and as part of the worldwide programme to eradication of these diseases.

Due to vaccinations, we no longer see smallpox, and poliomyelitis is heading towards eradication. No wonder vaccination is considered a modern miracle.
Vaccination is one of the greatest breakthroughs in modern medicine. No other medical intervention has done more to save lives and improve quality of life.
Hopefully we will never see what my first practice nurse told me how she had nursed rows of children in iron lungs due to the affliction of Poliomyelitis – a scene shown below. When I first joined the practice I regularly saw a patient who had survived this experience as a child and still had assisted respiration machine for the nights and was unable to walk – he attended surgery by mobility car and then transferred to a wheelchair to attended and had kept down a full-time job.

image

http://www.nhs.uk/Conditions/vaccinations/Pages/vaccination-saves-lives.aspx

ARE YOUR CHILDREN UP TO DATE WITH THE MMR?

We are running a catch up programme in Ealing for 10-16 year olds and any other children who for whatever reason missed out on this important vaccination . Hopefully, by encouraging as many people as possible to participate in this programme, we will progress to eliminate these diseases and save lives.

FUTURE VACCINATION PROGRAMMES

In September 2013 the following will be introduced:-

ROTAVIRUS VACCINE
Rotavirus is a highly infectious stomach bug that causes around 140,000 diarrhoea cases a year in under-fives in this country. It leads to hospital stays for nearly 1 in 10 of those who get it and 3-4 deaths annually.
The vaccine will be given to infants under the age of four months.
It is estimated that the vaccine will halve the number of vomiting and diarrhoea cases caused by rotavirus and there could be 90% fewer hospital stays as a result.
The vaccine, Rotarix, is already used routinely to vaccinate children in the US and several other countries. In the US, rotavirus-related hospital admissions have fallen by as much as 86% since the vaccine was introduced.
It will be administered as a 2 dose oral vaccine.

SHINGLES
Shingles is caused by the same virus as chickenpox, herpes varicella zoster and occurs when the dormant virus is activated.

The illness affects the nerves and skin. In severe cases it can cause complications such as hearing loss or brain swelling.

People in their 70s across the UK will be offered a vaccine against shingles from this September.

Experts have been recommending routine immunization against the disease, which causes a painful rash, for some years.

The government-led programme will target 70, 78 and 79-year-olds in the first instance and should prevent tens of thousands of cases a year.

Elderly people are at greatest risk and vaccination should prevent nearly half of cases in the over-70s.

Written by Dr Jacqueline Bayer

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