SIX YEARS AFTER the WHO declared that measles had been eliminated in the UK, the country is in the middle of a measles emergency.
The UK Health Security Agency (UKHSA) has declared a national incident as hundreds of children have been infected in recent weeks. The epicentre is in the West Midlands – UKHSA data confirmed 216 measles cases and 103 probable cases since October last year, with 80% of cases in Birmingham and the majority in children under the age of ten.
Unless we act immediately, Ireland will be in exactly the same position in the very near future. Minister for Health, Stephen Donnelly stated on Friday last, that he had received a ‘detailed update’ from the Chief Medical Officer on measles in the context of the UK situation. “I was just discussing it with the Taoiseach and I’m going to be bringing a memo to Government probably in the next two weeks on this,” the minister said.
The two week timeline may be too little too late. Based on the surging situation in the UK and the rapidly approaching school mid-term break on 12 February, the time to get vaccinations into arms in Ireland is right now.
UK health officials predict that up to 3.4 million children under the age of 16 are at risk. There have also been outbreaks in London, Wales, Yorkshire and Leicester.
“We’re at the point where there’s a very large susceptible population of children,” warned Prof Sir Andrew Pollard, chair of the Joint Committee on Vaccination and Immunisation, this week. “To keep measles at bay we need to have 95% of children vaccinated. The NHS figures suggest that we’re at about 85%.”
Unbelievably, as few as half of children are reported to have two doses of measles, mumps, rubella (MMR) vaccine in parts of London with similar low levels also seen in parts of Liverpool, Manchester and Birmingham.
Further afield, the WHO is reporting a nearly 45-fold increase in measles cases in Europe last year. Numbers are still rising and ‘urgent measures’ are needed to prevent further spread. Last year, 42,200 people in Europe were infected with measles compared to 941 during the whole of 2022.
The NHS has launched a Catch Up Campaign for Missed MMR Vaccines. Millions of parents and carers in England are being urged to book their children in for their missed measles, mumps and rubella (MMR) vaccine as part of a major new NHS drive to protect children.
The campaign will see all parents of children aged from six to eleven years contacted- encouraging them to make an appointment with their child’s GP for their missed vaccines.
Additionally, the campaign will target areas with low uptake of the vaccine with health services contacting just over one million people aged 11 to 25 years in London and the West Midlands to invite them to catch up on their missed MMR vaccinations.
Julie Kelly, Head of Public Health at NHS England-North West said the NHS is acting quickly to tackle the spread of measles across the country.
“People who are unvaccinated can get catch-up jabs at MMR pop-ups in schools and other convenient places, while GPs, teachers and trusted community leaders are encouraging groups that are less likely to get their jab to come forward.”
The main difference between Ireland and the UK is that no single case of measles has yet been detected in Ireland this year to date. With MMR vaccination rates at very low levels post-pandemic, now is the time to push forward with an urgent campaign before the inevitable arrival of cases imported into the country that will spread like a tidal wave.
Figures from the Health Protection Surveillance Centre (HPSC) report uptake of the second dose of the MMR vaccine for children in Ireland for 2021/2022 school year at a low of 87%. This figure is down from 91% reported for the 2019/2020 school year and nowhere near the 95% coverage required to prevent outbreaks occurring up and down the country.
Chief Medical Officer Professor Breda Smyth said last week that no county has achieved 95% uptake and in some parts of the country, such as Louth and Meath – uptake rates are below 80%.
“If you are considering travelling (to UK or Europe) I would strongly urge you to ensure that you and/ or your child are protected. It’s never too late to vaccinate.”
Measles is not just a childhood disease and can be serious at any age. If caught during pregnancy, it can be very serious causing stillbirth, miscarriage and low birthweight.
Complications can be potentially life-changing including blindness, deafness and swelling of the brain (encephalitis).
Analysis shows one infected child in a classroom can infect up to nine other unvaccinated children, making it one of the most infectious diseases worldwide — more infectious than Covid-19. One in five children with measles will need to be admitted to hospital for treatment.
Two doses of the MMR vaccine are needed for maximum lifelong protection, with the first dose given at 12 months and a booster dose offered by school vaccination teams when children are in junior infants.
Low vaccine rates post-pandemic emerged because of practical difficulties in accessing vaccination clinics during lockdown but also because of a more sinister factor – the rise of the anti-vaccine movement. In its early years, the movement hinged around a mishmash of organisations that stated the vaccines were unsafe because they contained toxic ingredients and caused autism. A paper in the Lancet (1998) claimed that the MMR vaccine was somehow linked to autism. Despite the article being retracted by the journal’s editors in 2010, by that time the anti-vaccine movement was well on its way.
Prof Peter J Hotez, Professor of Paediatrics and molecular virology and microbiology at Baylor College of Medicine, Texas, states in his book The Deadly Rise of Anti-Science, that anti-science now threatens the future of childhood vaccination programmes.
“Declining vaccination rates and a new ‘low vax’ future will ensure the widespread return of ancient childhood scourges such as measles and polio,” Prof Hotez warns.
A paper in the British Medical Journal in 2022 expressed the concern that immunisation rates will not return to their original levels because of widespread anti-vaccine activities. Covid vaccine hesitancy seems to have impacted confidence in vaccines in general.
“This could bring back childhood illness on a massive scale and reverse hard won gains in global health,” states Prof Hotez.
Our entire vaccination ecosystem has become extremely fragile. Measles is the canary in the coal mine for the return of vaccine-preventable and deadly childhood infectious diseases.
In order to break the chain of transmission and get vaccination rates up quickly to close to the 95% levels required to prevent large-scale outbreaks, catch up campaigns are urgently needed now.
This involves a combination of pop-up clinics across the country combined with comprehensive efforts to contact parents of unvaccinated children. Risks of infection need to be explained along with the availability of a safe and effective vaccine- to prevent another highly infectious agent sweeping the country and creating havoc.
Dr Catherine Conlon is a public health doctor with the HSE.
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