NINETY-EIGHT COUNTRIES around the world experienced an increase in measles cases last year, including Ireland.
There were 77 reported cases here in 2018, based on provisional figures, up from 25 in 2017.
To date in 2019, there have been 28 reported cases – 15 of which have been confirmed and the rest are probable or possible.
People of all ages have been affected, but most cases relate to children under the age of four. Two outbreaks have been confirmed so far this year – in Donegal and north Dublin.
The increase in cases, both in Ireland and abroad, is examined in the latest edition of TheJournal.ie‘s The Explainer podcast which was released earlier today.
The Explainer / SoundCloud
Measles is a highly infectious illness and spreads very easily. The uptake rate for the MMR (measles, mumps and rubella) vaccine is quite high in Ireland – about 92% – but this has varied over the years.
The HSE’s goal is to reach a rate of at least 95%, the level needed for herd immunity – whereby people who can’t be vaccinated for health reasons rely on those around them being vaccinated to prevent the spread of conditions such as measles.
Speaking to TheJournal.ie, Dr Mary Ward, who works in the Public Health section of HSE East, said the single biggest risk factor in terms of getting measles is not being vaccinated or not receiving both doses of the vaccine.
All children are entitled to, and advised to, get the MMR vaccine at the age of 12 months. They are supposed to get a second dose when four or five (in junior infants). Adults who are not sure if they received the vaccine as a child are advised to contact their GP to check and discuss getting a booster if needed.
“The biggest risk is people who haven’t had their two MMRs, definitely. We’re most concerned about school-going children who don’t have the MMR,” Ward told us.
She said herd immunity is vital to protect “vulnerable” people who cannot be vaccinated or babies who are too young to be vaccinated.
You should get vaccinated to protect yourself and protect those who can’t take the vaccine. In any school, there could be a child who is undergoing chemotherapy, for example – they’re relying on you to be vaccinated to protect them.
Speaking about this on The Explainer, cancer researcher Dr David Robert Grimes noted that a lot of patients with cancer are “immunocompromised” – meaning their immune system “has been modulated or augmented otherwise by the medicines they’re on”.
He said there are “heartbreaking stories, particularly of paediatric cancer patients succumbing to this illness” because they were exposed to an unvaccinated measles carrier.
Some of the reluctance by parents to vaccinate their children stems from an erroneous claim that linked the MMR vaccine to autism and other conditions. This claim can be traced back to a 1998 study by former British doctor Andrew Wakefield which was later retracted and debunked.
Ward said dealing with misinformation spread by the anti-vaccine movement is a “constant battle”. Her advice in this regard is straightforward: “Don’t listen to people who are not medically qualified or don’t have a medical background.”
Pregnant women and rubella
Also on the podcast, broadcaster and former GP Dr Ciara Kelly noted that while measles is the most talked about condition the MMR vaccine protects against, it protects people against mumps and rubella as well.
She noted that rubella, also known as German measles, is “a mild childhood illness”. However, it can have very serious consequences for pregnant women.
If your six-year-old gets rubella, they’ll be fine. If they give it to a pregnant non-immune woman it is teratogenic – it damages a foetus.
Kelly said if a woman contracts rubella while pregnant, there is “a very high risk” of their baby “being born blind or deaf or with other sorts of neurological conditions”.
Mandatory vaccination
Vaccinating children against conditions such as measles is mandatory in a number of countries. During the week, Italy’s government reinstated a law banning children from attending crèches and nursery schools if they have not been vaccinated.
The law makes it compulsory for children in pre-school education to be vaccinated against 10 diseases, including measles, tetanus and polio. Parents in Italy, as in a number of other countries, face fines for not vaccinating their children.
In a number of US states, every student entering or attending a public or private school has to be vaccinated against a range of conditions, including measles, mumps and rubella. However, there are medical, religious and personal exemptions to the law.
Some states are currently looking into getting rid of the personal exemption – California did this back in 2015 after an outbreak of measles which began at Disneyland subsequently spread to other parts of the US and Canada.
Australia is known for taking a particular tough stance in relation to non-vaccination under rules sometimes referred to as ‘no jab, no play’.
Parents face large fines and could lose up to $15,000 (over €9,000) in benefits if they don’t vaccinate their children. And schools and daycare centres face larger fines if they allow a child who isn’t vaccinated to attend.
Ward said there are “pluses and minuses” to mandatory vaccination, describing it as “a road that hasn’t been explored” in Ireland.
She said the HSE instead focuses on providing people with accurate information so they can make informed decisions about vaccinations. She added that many of the childcare facilities the HSE works with already request that children who attended their facilities are vaccinated.
Another issue in terms of spreading the condition is travel – both people coming into Ireland and Irish people unknowingly contracting measles while abroad and bringing it back when they come home.
Ward noted that people with measles may not display symptoms for about four days, stating: “Everyone doesn’t go around with a big, red, blotchy face.
You could be sitting in the airport and be beside someone who is coughing, they may have measles; 10 days later you have it. It’s very difficult to control.
On The Explainer, Kelly also discussed how “aggressive” measles is, noting: “We’re in major trouble because you will see it spread like wildfire and that’s the difficulty … Measles happens to be particularly contagious.”
The global picture
A Unicef report released last month noted that 98 countries around the world reported an increase in measles cases in 2018.
The World Health Organization said cases worldwide soared by nearly 50% in 2018, killing around 136,000 people. There were at least 72 measles-related deaths in Europe in 2018, up from 42 in 2017, but none in Ireland.
The countries with the highest jumps in the number of cases reported last year were Ukraine, the Philippines and Brazil.
In Ukraine, there were over 35,000 cases in 2018 – a huge jump from 4,782 in 2017. This figure could well be topped in 2019 – the Ukrainian government said over 24,000 people were infected in January and February alone. At least 30 people have died in the country from measles since 2017.
Authorities believe anti-vaccine sentiment is partly to blame as well as shortages of vaccine supplies and cuts to health services amid an economic slowdown worsened by the ongoing conflict with Russia.
In the Philippines, there were 15,600 cases last year – up from 2,400 in 2017. This year looks set to be even worse – there have been 12,700 cases and over 200 deaths to date in 2019.
The jump in cases is partially due to fewer people getting vaccinated – in general and against measles – because of a number of children experiencing severe side-effects and some reportedly dying after receiving an anti-dengue vaccine, the makers of which are now being sued by the Philippine government.
Turning to Brazil, there were more than 10,200 cases last year, but none in 2017. The vast majority of cases have been reported in Amazonas state, which borders Venezuela; and about two-thirds of the confirmed cases involve people from Venezuela – a country obviously currently going through huge upheaval.
What are the symptoms of measles?
Measles can cause chest infections, fits (seizures), ear infections, swelling of the brain and/or damage to the brain.
The Department of Health gives the following advice in relation to the MMR vaccine:
What advice does the HSE give to people who think they might have measles?
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