Worldwide increase in Measles cases

26th Jul 2019
Worldwide increase in Measles cases

A Salvadoran nurse vaccinates a baby (Photo: Sgt Kim Browne/US Army CC)

Measles is a highly infectious viral disease, once prevalent throughout the world, but thanks to improvements in healthcare and the introduction of vaccines there has been a significant decline in cases over the past several decades and it had become rare in many countries.

However, despite our efforts to eradicate measles, the World Health Organisation has reported that in the first three months of 2019 the number of measles cases worldwide has quadrupled compared with the same time last year. So why have we seen such a rise in this preventable disease?

Measles was once a common childhood disease and whilst most people will recover it can sometimes lead to serious health complications, including infections of the lungs and brain, which can be fatal and it was responsible for many deaths worldwide.

Following a radical fall in measles cases after the introduction of vaccinations it had been hoped this disease would be more or less eradicated in some countries; however, there has been a steady rise in the number of reported measles cases in recent years – although it is still below historic levels (pre-vaccination).

Reported cases rose by 31 per cent in 2017 compared to 2016, with around 110,000 deaths worldwide. According to UNICEF, 98 countries saw an increase in measles cases in 2018.

In the UK measles cases have seen an increase in recent years. In 1967, the year before the measles vaccine was introduced in England and Wales, there were almost half a million reported cases and 99 deaths.

By 1998, this had fallen to an all-time low of 56 non-fatal cases, however, between January and October 2018, 900 cases were reported.

There has been a global increase in measles cases, although actual numbers are hard to define as many cases remain unreported. According to the World Health Organisation, Africa had the most dramatic rise – up 700 per cent.

Ukraine, Madagascar and India have been worst affected by the disease, with tens of thousands of reported cases per million people. Outbreaks with several young children deaths have also hit Brazil, Pakistan and Yemen. Even countries like the US and Thailand, who have high levels of vaccination coverage, have seen a spike in cases.

In total, some 170 countries reported 112,163 measles cases to the World Health Organisation, in comparison to 28,124 cases across 163 countries during the same period in 2018 – a fourfold increase. A fall in uptake of the measles vaccine has resulted in a global rise.

According to the United Nations, the global coverage of the first immunisation stage has ‘stalled’ at 85 per cent, short of the 95 per cent needed to prevent outbreaks. The reason behind the fall in vaccinations is due to poverty and civil unrest in some countries and mistrust in vaccines in others (so-called anti-vaxxers). In poorer countries implementing vaccination programmes and reaching more remote communities can be challenging, meaning fewer people are vaccinated and a larger portion of the population is left vulnerable to the virus.

This means outbreaks can occur – such as those in the Democratic Republic of the Congo, Kyrgyzstan and Madagascar. In other countries war, civil unrest and economic problems can lead to a collapse of the healthcare system and vaccination levels fall – such as in the Ukraine, Yemen and Venezuela. Another reason for a fall in vaccinations is a decline in public trust in the vaccines.

In recent years there has been a growing movement of so-called anti-vaxxers who are refusing to have their children vaccinated due to health and safety fears and mistrust in large pharmaceutical companies and Government. In the late 1990s there was a controversy linked to the MMR (measles, mumps and rubella) vaccine and a possible link to autism, which was proposed by the British doctor Andrew Wakefield, this has since been discredited by the medical profession, who point to the fact that millions of children worldwide have now received the MMR jab and no link has been proved.

However, it had a significant effect on the uptake of the MMR vaccine and in 2004 the uptake of the first dose of MMR fell to 80 per cent in England, well below the 95 per cent recommended to provide so-called ‘herd’ immunity, which means enough of the population is vaccinated to make an outbreak unlikely.

Uptake of the MMR has now recovered to over 90 per cent. However, the anti-vaccination movement has become influential on social media and online and as a result, many people in countries that have an effective vaccine regime are choosing not to vaccinate their children. The reduction in MMR vaccinations since the 2000s means there is a group of young people who are not protected from the measles virus and outbreaks can occur. In addition, some children will have received the first dose of MMR but not the second pre-school booster dose and could be vulnerable to getting the disease. In a bid to tackle the low uptake in vaccines, some countries are taking a firm stand to get parents to immunise their children.

Last month Italy banned children under six from attending schools unless they had received vaccines for chickenpox, measles and other illnesses. After outbreaks in New York, a public health emergency was declared, ordering all residents to be vaccinated or face a fine. Introduction of such measures is controversial, and many parents are uncomfortable with being dictated to by the state in this way.

Other initiatives such as checking vaccination status on entry to the nursery and then to school have been proposed to act as a useful reminder to parents and reinforce the importance of vaccinations.However other initiatives have tried to make vaccinations more accessible to parents. Following a measles outbreak, the London borough of Hackney introduced a “spotty bus” – a mobile immunisation unit that toured the neighbourhood and parked in school playgrounds and supermarket car parks offering vaccinations for those who needed them, vaccinating almost 1,000 children whose parents simply needed easier access to immunisation services.

Making the vaccination service more accessible for parents is an approach that health officials think might increase vaccination rates.

Given that measles is very contagious, health officials say that vaccination is the best way to ensure measles outbreaks do not occur. Efforts are needed to ensure vaccination programmes are implemented and children who have missed the vaccination are identified and immunised. In the UK if you have not received the MMR or did not receive the second dose, you can talk to your GP about getting the MMR vaccine.This can be especially important for students going off to university, where large numbers of possibly unvaccinated young people will be in close contact and mumps and measles outbreaks can occur.

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