THE HSE HAS warned a measles outbreak “could happen in Ireland” and urged parents to ensure children are immunised before travelling this summer, amid vaccine uptake below the level required for herd immunity.

Doctors here say public understanding of the danger of the highly contagious disease must be improved, as uptake of the measles, mumps and rubella (MMR) jab falters.

The Chief Medical Officer said this weekend that she is “very worried about measles in our population”. 

Professor Breda Smyth said: “There has been a significant increase in the number of measles cases this year in Europe in the first six months.

“If I was travelling to Europe with my children this year, it’s really important that my child would be protected against measles.”

Uptake of the first MMR dose – recommended for babies at 12 months – was 89.2% in the first quarter of this year, three percentage points lower than before the pandemic. 

Uptake of the second dose in junior infants has also dropped three points to 88%. The HSE’s target is 95% immunisation, the level recommended by the World Health Organization to ensure community-wide protection.

Rise in cases in UK

Last week, the UK Health Security Agency (UKHSA) warned that London was at risk of a measles outbreak that could cause tens of thousands of cases, due to low vaccination rates over several years. 

There were 128 cases of measles in the first six months of the year in the UK, up from 54 in the whole of 2022. Two thirds of the cases were in London, where in some areas vaccination is as low as 69.5% and has been low for several years, the UKHSA said.

The HSE said this weekend: “There have been no confirmed cases of measles reported in Ireland to date in 2023. However, we have seen a rise in cases in London which could happen in Ireland.” 

“Measles is a highly infectious disease. One infected person can spread the disease to 12 or more people who are not immune or not vaccinated.”

It added that parents should check that children are up to date with their vaccines before travelling this summer. 

‘People are refusing’

Ilona Duffy, a GP in Monaghan, said, when it comes to childhood immunisations: “We are struggling with people in general since Covid.” 

“We are having to contact more and more mums. People are refusing certain ones, for example the rotavirus.

“The MMR has always been a challenge, partly because of the damage done by Andrew Wakefield. We are still paying the price for that. People will still say they are worried about autism,” Duffy said.

“What do we do? It is about education and reminding people about how serious these diseases are. People don’t know someone who has had a bad reaction to childhood illnesses.”

Wakefield authored a paper, published in The Lancet in 1998, which falsely linked the MMR vaccine with autism. Wakefield was struck off in 2010 and the journal fully retracted the paper, which had already been widely discredited in 2004. 

Data from the Health Protection Surveillance Centre shows uptake of the MMR varies across the country. Among the areas with the lowest uptake were Donegal, where the rate was 80.1% of babies in the first quarter of this year, and Cavan/Monaghan with a rate of 84.2%. 

The MMR vaccine protects your child against measles. I'm concerned about MMR vaccination levels in Ireland given the rising number of cases across Europe. See https://t.co/Jx6jBHB6ez for details on the vaccine and find out more at https://t.co/YheFJohvSR pic.twitter.com/ZdR3vau3RK

— Chief Medical Officer (@CMOIreland) July 23, 2023

 DCU Professor Christine Loscher, an expert in immunology, said attitudes to vaccinations may have shifted during the pandemic. She noted that the Covid vaccine was “one of the first times people considered whether to get” a particular vaccine, and this attitude may be spilling over to childhood immunisations.

With measles cases much lower during the pandemic – due to pandemic restrictions – some parents may have incorrectly concluded that their child did not need the MMR.

Loscher said a public information campaign was needed to improve the public’s understanding of the risks of measles, which can have serious complications, particularly for babies and children under the age of 5, and for children with weakened immune systems. The most serious complications can include pneumonia and inflammation of the brain.

Loscher said: “Lots of people think of all childhood illnesses being in the same category as chickenpox. Measles is one of the most contagious diseases ever. There needs to be a campaign for people to understand the benefits of vaccination.”

She added that any public information campaign must explain that with an increasing proportion of children across the country unvaccinated, all unvaccinated children – including those who missed their vaccines five or 10 years ago – are now at increased risk in a potential outbreak.

John Fitzsimons, a consultant paediatrician at Temple Street Children’s Hospital, said he believed most vaccine hesitancy was “due to people not appreciating the importance of getting the vaccine and therefore not taking the time or effort to organise [it].”

“Vaccination is always a victim of its own success because people can’t see or remember what the illness was like,” Fitzsimons explained.

Duffy said the health service could be more proactive in offering “catch up” vaccinations to those who are not immunised, including people who have moved to Ireland. This could include making information more easily available in more languages.

She also suggested that Ireland may need consider more stringent measures such as making immunisation a requirement to access publicly funded childcare. While some facilities ask parents to confirm that children are up to date with immunisations there is no requirement to do so.

The HSE said: “If any child has missed their MMR vaccine they should be vaccinated as soon as possible and if they are not sure they can check with their doctor.”

Marginalised children

Last month, doctors working with refugee and migrant children in Ireland told the Oireachtas committee on children about barriers to the children being immunised.

The committee heard that public health nurses were not told when migrant families were being moved into or out of an area, while access to language interpretation also represented a barrier.

The committee heard that vaccination rates among migrant children were lower, yet there was no formal catch-up programme nationally. One consultant paediatrician working with marginalised migrant children said staff shortages meant many of those she met at her clinic had no public health nurse. 

The Irish Nurses and Midwives Organisation told The Journal there was a shortfall of 600 public health nurses, who “play a vital role in children’s development and health”. It said the greater Dublin area was the worst affected.

“There are significant backlogs in regard to child health which was greatly impacted by Covid-19,” the INMO said.