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'Three children died as a result of measles that year. I remember their eyes'

Consultant paediatrician John Fitzsimons writes about his experiences with measles, and why it’s important to vaccinate.

John Fitzsimons

I HAD MEASLES when I was seven. There was no MMR vaccine available in Ireland at that time.

I was lucky, I wasn’t that sick and I don’t remember much of the experience. 20 years later, I had my second experience of measles and I won’t forget it.

It was January 2000 and I was working as a junior doctor in the Emergency Department at the Children’s University Hospital, Temple Street.

Every day for the first few months of the year, a steady stream of misery arrived; babies, toddlers and older children, covered in a rash, feverish, coughing, some struggling for breath – but what I remember most was their eyes.

Measles causes a painful conjunctivitis, a red discharging inflammation of the eyes. That year at least 1,600 people contracted measles and hundreds of children attended Temple St with the disease.

‘I remember their eyes’

More than 100 children needed to be admitted to hospital and one in 10 of them needed to go the intensive care unit (ICU). Three children died as a result of measles that year. I met some of them, I knew their families. I remember their eyes.

Eighteen years later we are in the midst of another measles outbreak in Europe.

Admittedly, numbers in Ireland are nowhere near as bad as before but the fact is that we don’t have to be here again. Measles is a preventable disease, it’s even possible that we might eradicate it altogether from Ireland, from the world, forever.

Measles immunisation is highly effective: a single dose confers immunity on 93% of individuals with a second dose raising it to 97%.

Because measles is so infectious however, over 95% of the population need to be immunised for all everyone to be safe. Measles immunisation is a team sport.

We are now in a much better place with regard to immunisation uptake rates. Currently the uptake of the MMR immunisation in Ireland is about 92% compared with 79% in 2000.

There is some variation in the most recent national figures with uptakes (per quarter) varying from 84-97% around the country. Unfortunately these rates leave us vulnerable to outbreaks, like the one we are currently experiencing, and diminish the chances of eliminating measles for good any time soon.

‘Personal choices need to be challenged’

There are many reasons why immunisation rates struggle to reach and sustain at the necessary threshold.

Logistical and operational challenges have been addressed and Ireland has an excellent immunisation infrastructure. Globally there needs to be trust in immunisation programmes including ways to detect and respond to possible harm when new vaccines are introduced at scale.

The MMR vaccine has been in use in Ireland since 1985 and there is no evidence that it is associated with autistic spectrum disorder (ASD) or any other medical condition (except the prevention of measles, mumps and rubella), in fact there is good medical evidence to say that it is not.

Trusted medical bodies such as the World Health Organization, the American Academy of Pediatrics and the Royal College of Physicians in Ireland all recommend the use of MMR because it is effective and safe.

Another reason for avoiding MMR has been the concern that children with egg allergy may have an adverse reaction to the vaccine. Years of experience have shown this not to be the case and it is now recommended that children with egg allergy receive their MMR in the community, just like everyone else.

Personal choices need to be challenged too, not just by health professionals but within families and communities as this is where measles will be defeated.

This must be done respectfully as I believe parents always try to make the best decisions for their children. It is essential, however, that misinformation, mythology and scaremongering are exposed and addressed.

Imagine a world without measles.

It’s possible if we want to.

John Fitzsimons is a Consultant Paediatrician at Our Lady of Lourdes Hospital, Drogheda.

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