On 20 August 2018, the World Health Organisation released a press release which stated that “Over 41,000 children and adults in the WHO European Region have been infected with measles in the first 6 months of 2018. The total number for this period far exceeds the 12-month totals reported for every other year this decade.” The WHO European Region is made up of 53 countries. 71% of these cases came from 3 countries: Romania, Italy and Ukraine. However, over the past few years, the amount of cases which have been highlighted in Ireland have been increasing and this is a worrying trend. For me as a parent, a chronic worrier and someone who lives with an invisible autoimmune issue, these figures absolutely terrify me.
Measles is an illness which by all accounts SHOULD be extinct. We’ve been vaccinating against it on a worldwide scale since 1971. Doctors have been giving two doses as standard since the late 1980s. By the end of 2017, 85% of children had received one dose of measles vaccine by their second birthday, and 167 countries had included a second dose as part of routine immunisation and 67% of children received two doses of measles vaccine according to national immunisation schedules. So why are we still in a position where not only are children catching this disease but dying from it? It looks like the answer is lying in reduced vaccination rates and in parents choosing to not vaccinate their children.
I do not say this in a sanctimonious way, I do not wish to tell ANYONE that my way of parenting is the best way of parenting, by any stretch of the imagination. However, when it comes to vaccinations against diseases which put not just your child in danger, then it becomes past a conversation about parenting styles and more about protecting the community as well as protecting your own child. I believe that if a child is medically considered fit to be vaccinated (ie not allergic to ingredients or against medical advice), then that child should be vaccinated against these diseases which have potentially life changing and threatening effects.
What Are Measles?
Measles (AKA rubeola) is a highly infectious viral illness. The measles virus is contained in the millions of tiny droplets that come out of the nose and mouth when an infected person coughs or sneezes. This means that you can catch measles by breathing in these droplets or, if the droplets have settled on a surface, by touching the surface and then placing your hands near your nose or mouth.
Measles symptoms appear around 10-14 days after exposure to the virus. They typically include:
- Fever
- Dry cough
- Runny nose
- Sore throat
- Inflamed eyes (conjunctivitis)
- Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek. This is also called Koplik’s spots
- A skin rash made up of large, flat blotches that often flow into one another
Less common complications of measles are:
- meningitis,
- pneumonia (lung infection), signs of which are fast, difficult breathing, chest pain and deteriorating condition,
- hepatitis (liver infection),
- encephalitis (inflammation of the brain), which can be fatal, so watch for drowsiness, headache and vomiting,
- low platelet count, known medically as thrombocytopenia, which affects the blood’s ability to clot,
- bronchitis and croup (infection of the airways), characterised by a hacking or barking cough, and
- squint, if the virus affects the nerves and muscles of the eye.
These complications are more common in children under the age of five or in adults over the age of twenty.
The infection occurs in sequential stages over a period of two to three weeks.
- Infection and incubation. For the first 10-14 days after you’re infected, the measles virus incubates. You have no signs or symptoms of measles during this time.
- Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This relatively mild illness may last two or three days.
- Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first. Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. At the same time, the fever rises sharply, often as high as 40 to 41 degrees celcius. The measles rash gradually recedes, fading first from the face and last from the thighs and feet.
- Communicable period. A person with measles can spread the virus to others for about 8 days, starting 4 days before the rash appears and ending when the rash has been present for four days.
For a look at what it’s actually like to go through your child(ren) having measles, Kellie from My Little Babóg has written this piece which I think every parent should read.
Why Should We Vaccinate Against Measles?
The measles virus is exceptionally contagious and spreads easily among susceptible individuals. About 90 percent of susceptible people who are exposed to someone with the virus will be infected. To prevent outbreaks, at least 95% immunisation coverage with 2 doses of measles-containing vaccine is needed every year in every community, as well as efforts to reach children, adolescents and adults who missed routine vaccination in the past.
What is The MMR Vaccine?
MMR is a safe and effective combined vaccine that protects against 3 separate illnesses – measles, mumps and rubella (German measles) – in a single injection. The full course of MMR vaccination requires 2 doses. No country in the world recommends MMR vaccine to be given as three separate injections.
MMR vaccine was introduced in 1988. In the Irish system, the MMR is given at 12 months of age by a GP, followed by a second dose of the vaccine at age 4-5 years, either through the school system or by a local GP.
How Does the MMR Work?
The vaccine triggers the immune system to produce antibodies against measles, mumps and rubella, as though your body had been infected with them. Antibodies are proteins that are produced by the body to neutralise or destroy disease-carrying organisms and toxins.
This also teaches your immune system how to produce the appropriate antibodies quickly.
This video gives a bit of a rundown on how vaccines in general work and may be much easier than a block of text to understand!
What About Adverse Reactions?
As with any medication or vaccinations, adverse reactions are a possibility with the MMR vaccine.
After getting the vaccine, there may be discomfort, redness or swelling at the injection site. Children may be irritable and have a fever. If this happens, you can give them paracetamol or ibuprofen as well as plenty of fluids. Keep an eye on their temperature. It might also be a bit uncomfortable if clothes are rubbing against the injection site.
After 6-10 days 1 in 20 children may get “mini measles” with a rash and fever. About 1 child in 100 may get “mini-mumps” with swelling in the jaw area in the third week after vaccination. These are not contagious. Children usually recover from these side effects in 1-2 days.
In rare cases, a child may get a small rash of bruise-like spots about 2 weeks after the injection. This side effect, linked to the rubella vaccine, is known as idiopathic thrombocytopenic purpura (ITP). It has been estimated that ITP develops in less than one in every 22,000 doses of the MMR vaccine. There is a greater risk of developing the condition from the diseases that the vaccine prevents. ITP usually gets better on its own, but, as with any rash, seek advice from your doctor ASAP.
In very rare cases, children can have severe allergic reactions straight after an immunisation. This happens in about one in 100,000 immunisations for MMR. Medical staff who give immunisations are trained to deal with allergic reactions to vaccines.
The table below shows the most common side effects from the vaccine, and the levels of same effects seen caused by the disease itself. (Health Protection Surveillance Centre)
People who have been recently immunised cannot infect others with the viruses contained in the MMR vaccine.
The Andrew Wakefield Scandal And Links To Autism
Andrew Wakefield published a study in The Lancet in 1998 linking the MMR vaccine to autism. His initial study appeared to show a link between the MMR vaccine and autism and bowel disease. However, his research was not carried out correctly and has since been discredited. It used a sample size of just 12 individuals. Later it was discovered to be funded by lawyers who had been engaged by parents in lawsuits against vaccine-producing companies. This study was far from unbiased or complete.
Extensive research into the MMR vaccine, involving thousands of children, was carried out in the UK, the USA, Sweden and Finland. This research showed that there is no link between MMR and autism. One study looked at every child born in Denmark from 1991 to 1998. During that time, 82% of children born in Denmark received the MMR vaccine. The researchers looked at the records of over half a million children and found the risk of autism was the same in immunised children as in children who had not been immunised. In 2010 Andrew Wakefield’s name was removed from the medical register after his research was discredited. Experts from around the world, including the World Health Organisation, agree that there is no link between MMR and autism.
Isn’t Three Viruses Too Much For Their Little Bodies To Handle? Why Not Separate Them?
Single vaccines in place of MMR put children and their families at increased and unnecessary risk. Generally, it is considered that the mother’s immunity will cover her child for only up to 12 months against measles, mumps and rubella, and some evidence is showing that the timescale for measles is even less than that. In spreading the vaccines, it would increase the risk of a child contracting one of the diseases while waiting for a time period between vaccines. It would also increase the number of vaccines the child needs to six instead of the current two. The combined vaccine is safer as it reduces the risk of the children being infected with the diseases whilst waiting for full immunisation cover.
What About Herd Immunity? Won’t That Keep Kids Safe?
Herd immunity (otherwise known as Community Immunity) keeps a certain level of the community safe. However, to do this, it requires for the vast majority of the community to be vaccinated. Germs can travel quickly through a community and make a lot of people sick, which can lead to an outbreak. When enough people are vaccinated against a certain disease, the germs can’t travel as easily from person to person. This means that the entire community is less likely to get the disease.
That means even people who can’t get vaccinated will have some protection from getting sick. And if a person does get sick, there’s less chance of an outbreak because it’s harder for the disease to spread. Eventually, the disease becomes rare — and sometimes, it’s wiped out altogether.
Herd/Community immunity protects everyone. But it’s especially important because some people can’t get vaccinated for certain diseases — such as people with some serious allergies and those with weakened or failing immune systems (like people who have cancer, HIV/AIDS, type 1 diabetes, or other health conditions).
Community immunity is also important for the very small group of people who don’t have a strong immune response from vaccines.
What About Reports That Say The Drug Wasn’t Tested Enough Before Giving It To Kids?
The normal procedure for licensing was used for MMR. The vaccine was thoroughly tested before being introduced into the Irish routine immunisation programme in 1988.
How Widespread is Vaccination against Measles Currently, And What Is The Scale Of The Current Problem?
While immunisation coverage with 2 doses of measles-containing vaccine increased from 88% of eligible children in the WHO European Region in 2016 to 90% in 2017, large disparities at the local level persist: some communities report over 95% coverage, and others below 70%.
The figures for Irish vaccination at levels can be seen here. In looking at the figures which are broken down by quarter, we can see a national decline from 93% to 92% over the last 6 years, remaining steady for the last 3 years at 92%. In the breakdown by area, Wicklow has the worst average rate of vaccination for the MMR by the age of 24 months, with just 85% of eligible children vaccinated with the MMR in the last two quarters, part of a steadily decreasing trend in the area. On the other hand, areas in the midlands and the west of Ireland seem to be hitting the targets consistently for vaccination. Those, however, are just the current vaccination figures and do not take into account young adults and adolescents who have not been vaccinated in the years since the Wakefield report which caused mass hysteria over reported dangers of the vaccine. The lack of vaccination around the time of that report’s publication and the years that followed has led to an increased number of secondary-school and college-aged people contracting communicable diseases like measles and mumps which had not been seen before at that age in recent years.
In Ireland in the period between July 2017 and June 2018, Ireland saw a total of 95 cases of measles, 20 cases per million of population. During that same time period the year before, July 2016 to June 2017, this figure was just 15, making up 3.2 cases per million of population. In a single year, it has multiplied 533.333%.
The United Kingdom, our closest neighbour, had 947 cases in the July 2017-June 2018 period, making up 14.46 per million of population. In the year before that, it had 413 cases in total, which was 6.3 per million population, in effect increasing by 129% in a 12 month period.
The “target” for disease control as considered by the WHO is less than 1 per million of population. Only 21 out of 53 countries (51 when you discount those who did not report in 2017/18 and 50 when you discount those who did not report in 2016/17) meet that target in 16/17, and only 8 countries meeting it in 17/18.
The largest surge in cases seems to radiate in Serbia, Ukraine, Italy, Georgia and Greece. Just 7 states out of the European region had effectively eradicated measles in 2017/2018, reporting zero confirmed cases of measles in that time. The Italian Senate has recently voted to remove mandatory vaccinations from their legislation in a time of already startling climbing figures of infection in their country. In contrast, in the USA where the public school system in many states requires full vaccination schedules for access to schools (and vaccines are given free of charge), with a population of 325.7 million (2017 figures) has had a total of 1691 cases since 2010, with 667 of them taking place in a huge outbreak in 2014. It is thought that the majority of those cases came from infected visitors from The Philippines. In Australia, which has a similar “mandatory” policy, where they penalise parents financially and refuse to allow access to public institutions for not vaccinating kids without medical cause, there were 1279 cases between 2010 and 2018 year to date, in a population of 24.13 million people. When you compare this with the YEARLY figures that we are seeing in areas of much smaller population – Ireland has 4.773 million people, which is just over 20% of the population of Australia and just 1.47% of the population of the United States, it is clear that our problems are on a much larger scale.
So, is mandatory vaccination the solution? I don’t believe it is a politically viable option, given the current way that the Irish government functions. There are already policies in place across the Health Service Executive to make vaccinations as easily accessible as possible to patients. Parents are given reminders by text message in some cases, and at checkups with doctors. We do not have a system that allows those doctors to make that choice for the parents, ultimately the choice is up to them. I just hope that in making that choice, they are not making the choice for another child or vulnerable person’s health for them.
Vaccinate your children – give them and the community around them the best chance of good health and avoiding a life-changing or ending disease. Measles is not a childhood illness children should have to get in 2018, and by vaccinating them, it gives them the best possible chance of avoiding its dangers.
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