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The number of reported measles cases in Ireland more than trebled this year

Seven in 10 of the confirmed cases involved people who were not vaccinated.

Image: Shutterstock/TinnaPong

THE NUMBER OF reported measles cases in Ireland more than trebled this year.

There were 85 reported cases as of 17 December, up from just 25 for the whole of 2017.

The majority of these cases – 73 – were confirmed, while 12 were deemed to be probable or possible cases. The last confirmed case was in October.

Seven in 10 of the confirmed cases (51; 69%) involved people who were not vaccinated.

When only taking into consideration confirmed cases among people aged 12 months and older (all of whom are eligible for vaccination as part of the national programme) there were 64 cases, of whom 43 individuals were not vaccinated (67%).

Males accounted for 53 of the confirmed cases, while 32 females were affected. 

Children aged four and under were the group most affected, with 24 cases; there were 13 cases among people aged 15-19 years; and 11 cases among both the 20-24 age group and 35-44 age group. 

measles age Source: HPSC

The HSE released a number of warnings about the condition during the year after a spike in reported cases.

People at increased risk of getting measles are those who are not fully vaccinated with two doses of the MMR (measles, mumps, and rubella) vaccine or who have not had measles in the past. The risk of infection remains for up to 21 days after contact with a case of measles.

The majority of the cases this year involved onward transmission in hospital and community sessions – that is, the condition spreading after a person with measles came into contact with others.

At least five of the 85 cases related to people returning to Ireland after being exposed to a person with measles while abroad.

The rate of measles infections across Europe reached a record high this year – more than 41,000 children and adults were infected with measles in the first six months of 2018, according to the World Health Organization.

There have been 72 measles-related deaths in Europe this year, twice as many as 2017, but none in Ireland.

Here’s a geographical breakdown of where the measles cases occurred here:

  • East: 29
  • Midwest: 33
  • Southeast: 15
  • South: 4
  • West: 3
  • Northeast: 1

There were no confirmed cases in the midlands.

‘Very large outbreak’ 

Dr Suzanne Cotter, Specialist in Public Health Medicine at the Health Protection Surveillance Centre (HPSC), said the worst outbreak originated in the midwest after a person who had been exposed to measles abroad returned to Ireland.

She said this particular case “resulted in a very large outbreak” which spread to the west and southeast following onward transmission in community and healthcare settings.

“Not being vaccinated is the main risk factor,” Cotter said.

shutterstock_531557422-2 Source: Shutterstock/TinnaPong

She said there is “a certain amount of vaccine-hesitancy” among some groups, due in part to misinformation being spread about vaccines.

The Department of Health gives the following advice in relation to the MMR vaccine: 

  • All children should get the MMR vaccine when they are aged 12 months; if any child aged over 12 months has missed this vaccine they should get it now from their GP
  • All children should get a second dose of MMR vaccine when they are four to five years old or in junior infants at school; if any child in senior infants or older has missed this vaccine they should get it now from their GP
  • Adults under 40 years who have not had measles or have not received two doses of MMR vaccine should contact their GP to get the MMR vaccine
  • Adults over 40 years of age may sometimes be at risk and if such adults never had measles nor a measles containing vaccine they should consider getting the MMR vaccine from their GP

In recent years, the uptake rate for the MMR vaccine has remained quite stable – the uptake rate among children aged 24 months was 92% in the second quarter of 2018, unchanged from the same period last year.

Cotter said these figures are “good but not good enough”, adding that the goal is to reach at least 95%.

Don’t know if they got vaccine 

Cotter said many of the adults who contracted measles “assumed they were immune” but “didn’t know if they had measles as child or didn’t know if they had the vaccine”.

“People frequently don’t have their vaccine records, there was no automated system in previous decades,” she said.

Cotter said some people’s parents “chose to delay vaccination years ago and then completely forgot about it”, adding: “Those individuals are really hard to identify.”

She noted that some individuals may have intended to get the vaccine but genuinely forgot and have the attitude of, ‘I’ve survived this long without having measles, do I need to worry about it now?’

Cotter said a minority of people may miss out on getting the vaccine if they “are moving address a lot and miss letters and appointment reminders”, adding that, anecdotally, this seems to be the case with some families who are homeless or at risk of homelessness and have to regularly relocate, meaning they have no stable address.

‘Safe, effective vaccine’

Cotter said measles is a serious condition and advised people to get the vaccine.

“The MMR vaccine is a safe, effective vaccine. It definitely provides protection against measles, which can be a serious disease.

A substantial proportion of individuals with measles were hospitalised this year. It’s not a mild illness and can be quite severe.

If people think they may have measles, they should stay at home and phone their GP for advice.

People who are sick should not attend any congregated settings such as crèche, school, work or religious gatherings until they have recovered from illness.

Measles symptoms include:

  • High fever
  • Cough
  • Runny nose
  • Red eyes
  • Red rash that starts on the head and spreads down the body – this normally starts a few days after onset of illness; the rash consists of flat red or brown blotches, which can flow into each other; it lasts about four to seven days
  • Vomiting, diarrhoea and tummy pain may also happen

Measures to prevent the spread of measles if you think you may have the condition:

  • Do not go to work, school or crèche
  • Stay at home and phone your GP; tell the doctor or nurse that you think you might have measles
  • Stop visitors coming to your home
  • Pregnant women who have been exposed to measles should seek medical advice as soon as possible

Risk of measles from international travel:

There are ongoing outbreaks of measles in multiple countries in Europe and worldwide. Most of the cases in the EU in 2018 were reported from Romania, France, Greece and Italy.

Most people who get measles on holiday do not know they were exposed until they develop disease, the HSE said. Unrecognised exposures to measles have occurred at airports, on planes, at concerts, in shops and in healthcare settings. In 2018, at least 31 deaths associated with measles were reported in EU countries.

Advice for people travelling abroad:

Vaccination remains the most effective measure against infection. Children aged six-11 months who are travelling to other countries and regions where measles outbreaks have been reported are recommended to get the MMR vaccine.

A dose given before 12 months of age does not replace the dose that would normally be given at 12 months of age, the HSE advised.

Older children should be age-appropriately vaccinated. Children who have missed their recommended doses should get the MMR vaccine from their GP.

Adults may be at risk of measles, particularly those under 40 years of age who have never had measles or two doses of a measles vaccine.

Complications of measles:

Measles can cause chest infections, fits (seizures), ear infections, swelling of the brain and/or damage to the brain.

Measles is a notifiable disease and GPs and hospital clinicians should immediately notify public health authorities if they suspect someone has measles.

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About the author:

Órla Ryan

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