Protecting Your Family Against Measles Outbreaks
Measles causes the most vaccine-preventable deaths of any disease, but for many parents there remains a concern around measles and vaccination.
Worldwide, measles affects about 20 million people a year, primarily in the developing areas of Africa and Asia. It resulted in approximately 73,000 deaths in 2014, down from 545,000 deaths in 1990. Before immunization in the United States, between three and four million cases occurred each year! However, with the introduction of widespread vaccination, the disease was eliminated from the United States by 2016.
Measles Outbreak in Europe
Recently, there has been a surge in the number of cases of measles across Europe, with particularly large outbreaks documented in Romania and Italy. There have also been reported cases in Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Iceland, Portugal, Slovakia, Spain and Sweden. Worryingly, there have been reported deaths from measles in Romania and Portugal. The European Centre for Disease Prevention and Control (ECDC) has reported that there were over 1,500 cases of measles in 14 European countries in January-February of this year, more than double that of the first two months in 2016. Of particular concern is outbreaks in older age groups as well as in children. One in three cases of measles in Europe in 2015 and 2016 was in adults over 20 years of age. ‘An accumulation of unvaccinated individuals’ is thought to be at blame for this rise and the EU’s health commissioner, Vytenis Andriukaitis, has warned that “It is unacceptable to hear that children and adults are dying from disease where safe and cost-effective vaccines are available.” There are a number of reasons why vaccination coverage has waned in some regions. In some countries, like Ukraine for example, there have been supply and procurement issues. Then, there is vaccine hesitancy; some people are fearful of vaccination.
Children holidaying in any of the affected countries are at increased risk of contracting this highly contagious illness. Parents are now being advised to vaccinate their children against measles before taking them on their summer holidays.
So what exactly is measles?
Well, measles is an illness caused by a virus which is easily transmitted by airborne respiratory droplets (air we breathe out), or by direct contact with nasal and throat secretions of an infected individuals. It’s very contagious. Approximately 90pc of non-immune, largely unvaccinated, people who are exposed to an infected individual will get measles. The first symptoms, usually fever, runny nose and inflammation of the eyes, appear 7-21 days after exposure to the virus. A rash usually appears about 4 days after the beginning of the first symptoms. The rash starts on the back of the ears and, after a few hours, spreads to the head and neck before spreading to cover most of the body, lasting about 8 days. Those with the illness are infectious from 4 days before to four days after the rash appears.
Complications from measles are relatively common. These can range from mild complications such as diarrhoea and middle ear infections to more serious complications such as pneumonia, acute brain inflammation (encephalitis) and corneal ulceration. The most feared complication is Subacute sclerosing panencephalitis (SSPE). This is a rare and ultimately fatal progressive degenerative disorder of the brain that can develop many years after initial infection with the measles virus. People at high risk for complications include: infants and children aged <5 years, adults aged >20 years, pregnant women, and people with compromised immune systems, such as those with leukaemia or HIV infection. Complications are usually more severe in adults.
How to Prevent Measles
To reiterate my earlier point, measles is preventable by vaccination. Two doses of measles containing vaccine is considered to be necessary to ensure sufficient lifelong immunity. The European disease watchdog reports that measles continues to spread across Europe because the vaccination coverage in many countries is suboptimal. To protect agains measles it is recommended at least 95% of the population are vaccinated against it. Many countries are struggling to achieve this.
You can protect your children by ensuring they are vaccinated on time as recommended by the national immunisation schedule. The first dose of the MMR is given at 12-13 months of age and the second dose is given at pre-school age. Parents can consider getting an early MMR (between 6-11months) if their child is visiting an outbreak affected area, but this early dose does not replace the first dose given at 12-13months of age. Although the second dose is usually given with the pre-school boosters, it can be given any time from three months from the first dose. For older children who are not vaccinated with two doses of MMR, speak to your GP so they can start getting protection before travel. For adults who never had measles or measles containing vaccine, speak to your GP to see whether you should get the vaccine.
Dr Vanessa Ni Churrain