Decades of measles vaccination gaps finally take their toll

The World Health Organization (WHO) confirmed today that the UK, along with Albania, Czechia and Greece, has lost its measles elimination status after several years of steady progress toward elimination of measles in the WHO European Region.

It called the situation concerning and said that if high immunisation coverage is not achieved and sustained in every community both children and adults will suffer unnecessarily and some will tragically die.

Measles is one of the world’s most contagious diseases, with the potential to be extremely severe. Even in high-income countries, WHO figures show that complications result in hospitalisation in up to a quarter of cases, and can lead to lifelong disability, from brain damage and blindness to hearing loss.

The US Centers for Disease Control and Prevention this week also announced that measles outbreaks have led to the highest number of cases reported in the country since it was declared eliminated in 2000.

This is the same disease that can be safely and effectively prevented through two doses of the Measles, Mumps and Rubella (MMR) vaccine. 

Why is measles returning?

Many blame the anti-vaccination movement that is still strong despite it being 20 years since the controversial paper by Andrew Wakefield was published in The Lancet.

The study investigated 12 children, consecutively referred to the department of paediatric gastroenterology with a history of a pervasive developmental disorder with loss of acquired skills and intestinal symptoms and it suggested a casual relationship between development regression and the MMR vaccine.

As a result, rates of uptake of the MMR vaccine fell sharply in the early 2000s falling from 90% to 79% in January 2003.

The Lancet partially retracted the paper in 2004 and fully retracted it in 2010, and coverage consequently improved, reaching 93% in 2013-14.

In 2017, the UK achieved WHO measles elimination status, but coverage for the MMR vaccine for children reaching their second birthday fell to 91.2% in England. It was the fourth consecutive year that MMR coverage had decreased and the chief executive of NHS England warned that vaccination deniers were gaining traction on social media, and may be contributing to the decline.

Measles is a global issue

Another factor in the jump of UK measles cases according to Professor Heidi Larson, director of the London School of Hygiene & Tropical Medicine, is the extraordinary prevalence of the disease in the rest of Europe and across the world, increasing the risk of people being infected and bringing it home.

In the first six months of 2019, reported measles cases globally were almost three times as many as the same time last year with 230 cases of measles being reported in the UK during first quarter of 2019.

Global coverage with the first dose of measles vaccine has stalled at 85%. This is still short of the 95% needed to prevent outbreaks, and leaves many people, in many communities, at risk. Second dose coverage, while increasing, stands at 67%.

Larson added: €œWe only achieved measles-free status three years ago and that took a lot of hard work. Now we have to start again.€ 

The Department for Health and Social Care €“ working with Public Health England and NHS England €“ will be delivering a comprehensive strategy to address the issue in the Autumn. This includes strengthening the role of local immunisation coordinators €“ healthcare professionals that promote vaccines particularly with hard-to-reach families.

It also plans to call a summit of social media companies to discuss how they can play their part in promoting accurate information about vaccination.

What are the symptoms of measles?

If measles is suspected, it is important to reduce the risk of spreading the infection to other people. Signs and symptoms appear around 10 to 14 days after exposure to the virus and 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 €” also called Koplik’s spots
• A skin rash made up of large, flat blotches that often flow into one another.

Role of primary care in halting measles outbreak

GPs and primary care staff have a huge role to play in promoting a €˜catch up’ vaccination programmes for MMR for 10-11 year olds, as well as all those 5-25 year olds who have not had two doses of the jab.

RCGP chair Professor Helen Stokes-Lampard said: “People who were not vaccinated as children need to understand that it is not too late to have their MMR jab and we would urge them to do so.

“We welcome that the government is addressing the falling take-up of childhood vaccinations seriously – and are particularly pleased to see that they are involving social media companies in their strategy given the deeply concerning and misleading school of thought, especially prevalent online and across social media, that casts doubt over the safety and effectiveness of vaccines.”