CONCERNS HAVE BEEN raised about the possibility of Ireland losing its measles-free status given the recent spike in cases here.
The United Kingdom has lost its measles-free status and, following a drop in vaccine uptake rates, there are fears Ireland could end up in the same position.
Three years after eliminating the disease, the UK has been stripped of its measles-free status by the World Health Organization.
The WHO defines measles elimination as the absence of the illness circulating, high vaccine coverage, and a robust process to identify cases.
In the first quarter of 2019, there were 231 confirmed cases of measles in England and Wales. There were 991 confirmed cases last year, a jump from 284 cases in 2017. Most cases are linked to travel in Europe, where many countries have experienced measles outbreaks.
Ireland has also seen an increase in cases in recent years. The number of cases here tripled from 25 in 2017 to 77 in 2018.
There have been 56 reported cases to date in 2019 – 33 of which have been confirmed.
Most cases in Ireland to date this year were among children, however there were 17 cases among people aged 20-44. Thirty-one cases involved males and 25 cases related to females.
There were 29 reported cases in Northern Ireland in 2018, none of which were confirmed. There have been no confirmed cases in the North to date in 2019.
Measles is a highly infectious illness and spreads very easily, often via coughing or sneezing. Symptoms include a high fever, cough, runny nose and rash (more on that below).
‘Very concerned’
Dr Kevin Kelleher, Assistant National Director of the HSE’s Health Protection section, said Ireland’s measles-free status is at risk.
“We’re very concerned about what’s happening, it’s a significant problem,” Kelleher said, noting the impact travel has on the disease spreading.
We travel a lot, there are constantly Irish people going to Europe on holiday, and people from France, Germany, Italy, Poland, Bulgaria coming to Ireland … It’s very easy for [measles] to come here unfortunately – it’s a big threat.
Measles is now considered to be endemic in a number of countries including France, Bulgaria, Italy and Poland.
Kelleher noted that while there has been an increase in cases in Ireland, it is not considered endemic as “we’re able to show that all cases of measles have either come into Ireland from outside or we can show that what we’ve done is stop them from being transmitted,” adding: “The UK can’t show it is stopping transmission.”
Vaccine rates slipping
All children are entitled to, and advised to, get the MMR vaccine at the age of 12 months. They are supposed to get a second dose when four or five (in junior infants). Adults who are not sure if they received the vaccine as a child are advised to contact their GP to check and discuss getting a booster if needed.
The uptake rate for the MMR vaccine in Ireland is 90.1% – below the HSE’s goal of 95%, the level needed for herd immunity.
“With a number of diseases like measles, if you can get to around 95%, enough people then are covered so it’s very difficult for the disease to spread,” Kelleher said.
He noted that some people haven’t had the vaccine for “valid medical reasons”, such as children who are receiving chemotherapy, and rely on others to be vaccinated so they and the wider population is protected.
Ireland reached an uptake rate of 92% last year but the upward trend we had been experiencing is now being eroded. The 90.1% figure relates to children who were two years old in the first quarter of 2019. Kelleher said the “slight and slow decline” in MMR uptake rates is “absolutely a concern”.
The measles vaccine was introduced in Ireland in 1984 and the MMR vaccine was introduced in 1988. Between 1948 (the earliest available records) and 1984, an average of more than 5,000 cases were reported annually.
The figure has dropped substantially in the last three decades. However, it has fluctuated in recent years. 2015 was an anomaly, for example – there were just two cases of measles – the lowest annual number reported since records began.
On the opposite end of the scale, there was a spike in 2010 – when there were 403 reported cases; up from 162 in 2009. The HSE said this increase was the result of a national measles outbreak that was first identified in August 2009 and continued into May 2010.
The MMR vaccine was also introduced in the UK in 1988. In prior decades, there were hundreds of thousands of measles cases, and many deaths, every year.
Misinformation spreading on social media
Kelleher said misinformation – in particular a long since disproven theory that erroneously links the MMR vaccine to autism – being spread online has had a negative impact on uptake rates.
“There are people out there who still spread myths about measles and autism, despite the fact it has been totally disproven. We’re making lots of efforts to try to counter all that,” he told us.
There is no evidence, absolutely no evidence (that the vaccine is harmful) … The impact of measles can be permanent and dramatic, it’s a really dreadful thing. I’m old enough to have seen people with measles,and very bad side effects – unfortunately I have seen people die, that shouldn’t happen in 2019.
“We want people to protect their children, that’s basically what we’re seeking … It’s dreadful, it’s a preventable disease, it’s totally preventable.”
A Unicef report released earlier this year noted that 98 countries around the world reported an increase in measles cases in 2018. The WHO said cases worldwide soared by nearly 50% in 2018, killing around 136,000 people. There were at least 72 measles-related deaths in Europe in 2018, up from 42 in 2017, but none in Ireland.
More people have died from measles in the Democratic Republic of the Congo than a recent Ebola outbreak, according to Médecins Sans Frontières.
Since January, over 145,000 people have been infected with measles in the DRC and 2,758 have died, the majority of them children. More than 1,800 people have died since an Ebola outbreak began in August 2019.
The countries with the highest jumps in the number of cases reported last year were Ukraine, the Philippines and Brazil. Some people choose to not vaccinate their children for religious reasons – a growing issue in a number of countries including the US.
TheJournal.ie explored the issue in a previous episode of The Explainer podcast:
The Explainer / SoundCloud
What are the symptoms of measles?
Measles can cause chest infections, fits (seizures), ear infections, swelling of the brain and/or damage to the brain.
The Department of Health gives the following advice in relation to the MMR vaccine:
What advice does the HSE give to people who think they might have measles?
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