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NINETY-EIGHT COUNTRIES around the world experienced an increase in measles cases last year, including Ireland.
There were 77 reported cases here in 2018, based on provisional figures, up from 25 in 2017.
To date in 2019, there have been 28 reported cases – 15 of which have been confirmed and the rest are probable or possible.
People of all ages have been affected, but most cases relate to children under the age of four. Two outbreaks have been confirmed so far this year – in Donegal and north Dublin.
The increase in cases, both in Ireland and abroad, is examined in the latest edition of TheJournal.ie‘s The Explainer podcast which was released earlier today.
https://soundcloud.com/the-explainer-podcast/why-has-there-been-a-208-rise-in-measles-cases-in-ireland
Measles is a highly infectious illness and spreads very easily. The uptake rate for the MMR (measles, mumps and rubella) vaccine is quite high in Ireland – about 92% – but this has varied over the years.
The HSE’s goal is to reach a rate of at least 95%, the level needed for herd immunity – whereby people who can’t be vaccinated for health reasons rely on those around them being vaccinated to prevent the spread of conditions such as measles.
Speaking to TheJournal.ie, Dr Mary Ward, who works in the Public Health section of HSE East, said the single biggest risk factor in terms of getting measles is not being vaccinated or not receiving both doses of the vaccine.
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 biggest risk is people who haven’t had their two MMRs, definitely. We’re most concerned about school-going children who don’t have the MMR,” Ward told us.
She said herd immunity is vital to protect “vulnerable” people who cannot be vaccinated or babies who are too young to be vaccinated.
You should get vaccinated to protect yourself and protect those who can’t take the vaccine. In any school, there could be a child who is undergoing chemotherapy, for example – they’re relying on you to be vaccinated to protect them.
Speaking about this on The Explainer, cancer researcher Dr David Robert Grimes noted that a lot of patients with cancer are “immunocompromised” – meaning their immune system “has been modulated or augmented otherwise by the medicines they’re on”.
He said there are “heartbreaking stories, particularly of paediatric cancer patients succumbing to this illness” because they were exposed to an unvaccinated measles carrier.
Some of the reluctance by parents to vaccinate their children stems from an erroneous claim that linked the MMR vaccine to autism and other conditions. This claim can be traced back to a 1998 study by former British doctor Andrew Wakefield which was later retracted and debunked.
Ward said dealing with misinformation spread by the anti-vaccine movement is a “constant battle”. Her advice in this regard is straightforward: “Don’t listen to people who are not medically qualified or don’t have a medical background.”
Pregnant women and rubella
Also on the podcast, broadcaster and former GP Dr Ciara Kelly noted that while measles is the most talked about condition the MMR vaccine protects against, it protects people against mumps and rubella as well.
She noted that rubella, also known as German measles, is “a mild childhood illness”. However, it can have very serious consequences for pregnant women.
If your six-year-old gets rubella, they’ll be fine. If they give it to a pregnant non-immune woman it is teratogenic – it damages a foetus.
Kelly said if a woman contracts rubella while pregnant, there is “a very high risk” of their baby “being born blind or deaf or with other sorts of neurological conditions”.
Mandatory vaccination
Vaccinating children against conditions such as measles is mandatory in a number of countries. During the week, Italy’s government reinstated a law banning children from attending crèches and nursery schools if they have not been vaccinated.
The law makes it compulsory for children in pre-school education to be vaccinated against 10 diseases, including measles, tetanus and polio. Parents in Italy, as in a number of other countries, face fines for not vaccinating their children.
In a number of US states, every student entering or attending a public or private school has to be vaccinated against a range of conditions, including measles, mumps and rubella. However, there are medical, religious and personal exemptions to the law.
Some states are currently looking into getting rid of the personal exemption – California did this back in 2015 after an outbreak of measles which began at Disneyland subsequently spread to other parts of the US and Canada.
Australia is known for taking a particular tough stance in relation to non-vaccination under rules sometimes referred to as ‘no jab, no play’.
Parents face large fines and could lose up to $15,000 (over €9,000) in benefits if they don’t vaccinate their children. And schools and daycare centres face larger fines if they allow a child who isn’t vaccinated to attend.
Ward said there are “pluses and minuses” to mandatory vaccination, describing it as “a road that hasn’t been explored” in Ireland.
She said the HSE instead focuses on providing people with accurate information so they can make informed decisions about vaccinations. She added that many of the childcare facilities the HSE works with already request that children who attended their facilities are vaccinated.
Another issue in terms of spreading the condition is travel – both people coming into Ireland and Irish people unknowingly contracting measles while abroad and bringing it back when they come home.
Ward noted that people with measles may not display symptoms for about four days, stating: “Everyone doesn’t go around with a big, red, blotchy face.
You could be sitting in the airport and be beside someone who is coughing, they may have measles; 10 days later you have it. It’s very difficult to control.
On The Explainer, Kelly also discussed how “aggressive” measles is, noting: “We’re in major trouble because you will see it spread like wildfire and that’s the difficulty … Measles happens to be particularly contagious.”
The global picture
A Unicef report released last month noted that 98 countries around the world reported an increase in measles cases in 2018.
The World Health Organization 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.
The countries with the highest jumps in the number of cases reported last year were Ukraine, the Philippines and Brazil.
In Ukraine, there were over 35,000 cases in 2018 – a huge jump from 4,782 in 2017. This figure could well be topped in 2019 – the Ukrainian government said over 24,000 people were infected in January and February alone. At least 30 people have died in the country from measles since 2017.
Authorities believe anti-vaccine sentiment is partly to blame as well as shortages of vaccine supplies and cuts to health services amid an economic slowdown worsened by the ongoing conflict with Russia.
In the Philippines, there were 15,600 cases last year – up from 2,400 in 2017. This year looks set to be even worse – there have been 12,700 cases and over 200 deaths to date in 2019.
The jump in cases is partially due to fewer people getting vaccinated – in general and against measles – because of a number of children experiencing severe side-effects and some reportedly dying after receiving an anti-dengue vaccine, the makers of which are now being sued by the Philippine government.
Turning to Brazil, there were more than 10,200 cases last year, but none in 2017. The vast majority of cases have been reported in Amazonas state, which borders Venezuela; and about two-thirds of the confirmed cases involve people from Venezuela – a country obviously currently going through huge upheaval.
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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Attendance at schools, creches and playgrounds should be barred to un-vaccinated children.
Child benefit should also be conditional on vaccination.
@Josh Hanners: as should child benefit payments,
@Barry Somers: stopping child benefit hits the poor hardest. Basically, such a penalty is saying if you are wealthy, don’t worry about vaccinations. If you are poor, we’ll make you even poorer. Considering vaccine uptake rates are generally highest among the poor and the very wealthy, such a scheme could be seen as divisive and only serve to reinforce the idea that the elite is trying to wipe out lower classes, absurd as it sounds. In other words, such a penalty might serve to only fuel the anti-vaxxers and become self-defeating. The original suggestion about requiring vaccines to enter schools, creches, etc is a far better solution.
@Josh Hanners: If a child is vaccinated, how are the unvaccinated a risk, if the vaccinations are effective?
PLEASE get the MMR for your child.
Measles can kill, or almost worse, leave serious neurological complications. Look up SSPE (Sub-acute Sclerosing Pan Encephalitis), it will
put all other childhood problems in the ha’penny (remember them?) place.
@Muiris de Bhulbh: I absolutely agree. To the anti-vaxxers, Google Search a picture of a kid with Measles. Look at it a while and ask yourself, are you are willing to risk that to your own child or others?. To those who think it’s acceptable, there’s something wrong with your moral compass.
@tottkingham: well put!! People who don’t get their children vaccinated are gambling with the health and well being of those who cannot get vaccinated.
@tottkingham:
136,000 deaths from measles last year, but still some anti-vaxxer idiots say things like “what’s wrong with a dose of measles anyway, we all had it as kids and it never did us any harm”….
@The Great Unwashed:
And right on cue here’s one of them further down this thread…
Vaccines are possibly one of humanities greatest inventions that have saved the lives of countless millions. Now we have people refusing their children their protection based on random sites on the Internet. It really makes me so sad and so angry!
@The Bob: the fact that these refusals are merely a product of fear mongering is irrelevant to the uptake figures.
It’s a mass, fear based response, which makes it a real problem that the state has to deal with. The state has to be the pragmatic party here.
If 20% of mothers are afraid to give multiple vaccine doses to their kids, the state should offer a single dose option, charge a few euro if necessary.
As I said in the earlier article about this, Fear is a powerful motivation, it does not have to be rational to be a real thing. The shaming approach may feel satisfying , but unlikely to overcome that fear.
By ignoring alternative routes in hope of winning a ‘talk to the wall’ argument, or to save a paltry quid, the state is contributing to the risk that the rest of us face here.
It can be sorted in a week. All parents produce copies of vaccinations to crèches,pre schools, primary schools and secondary schools. If you don’t have them, kids don’t go to school. Sumples!!!
@Niall Donnelly:
You already have to produce your dog’s vaccination certs before you can put them in the kennels, in order to protect the other dogs. Not really sure why innocent kids shouldn’t get equal protection.
@Niall Donnelly: nothing in Ireland is simple, most if not all parents who have fully vaccinated their children will have the evidence you mention. There has been no need to retain it and highly unlikely GPs have this all recorded and readily available either. We do need to find a way to enforce this quickly though, can’t believe people expose themselves and others by not getting their kids vaccinated
Anti vax types are morons.
@DJ François: Not very helpful. In fairness these people believe they’re doing the best they can for their children, that’s pretty much what all of us want for our kids. They may be somewhat guilty of accepting bad advice or being misguided, if you’re going to insult those who’ve done that you’ll be quickly out of breath.
The important thing here is to get the message across that vaccines work, they’ve been working successfully for hundreds of years. The anti vaccine movement is not only based upon a lie and completely fraudulent but the person who founded it, Andrew Wakefield, set out to do so for his own gain. He has now moved on to claiming the vaccines themselves are harmful, despite a British Court ruling determining there is absolutely no basis for this. Sadly, much of the so-called evidence found online and responsible for so many deaths can still be attributed to this man.
@Arch Angel: Anyway, anti vax types are morons.
@Arch Angel: As a medical professional he added a veneer of respectability to the whole movement and was the first to attribute Autism to vaccination, which is utter nonsense seeing as Autism is a genetic disease present from birth (it just doesn’t become apparent until children fail to meet their milestones) which great, ignorant masses jumped on. This man has been responsible for so many deaths he should be charged with crimes against humanity.
Many people pretending to know a lot about vaccination. Telling others what to do, unsubstantially accusing etc.. Then please tell – who carries responsibility in cases when child dies or get serious complications after vaccination?!
@Katy Ekaterina:
Who carries responsibility if a child dies from measles or cervical cancer, which are easily preventable with a simple vaccination?
@Katy Ekaterina: One in several million odds usually associated with an underlying health issue versus 1/5 hospitalised or 1/2,000 dying horribly. Anti-vaxx parents are the most selfish people on the planet as far as I’m concerned, despite enjoying good health due to themselves being vaccinated they choose to risk the lives of not only their own children but everyone else’s because they “know better”
Anti-vaxxers should have their kids taken off them immediately as they’re clearly awful parents who are unable to act in their child’s best interests.
@Mark Brown: tell us how you really feel….
@Sharon Moore: Thought I did, no?
“people who can’t be vaccinated for health reasons”… Actually no doctor can tell you in advance wether your one year old child will die from anaphylactic shock or get serious complications after vaccination. Even when temperature go up after vaccination they already protecting themselves by declaring that this is not from vaccines.
@Katy Ekaterina: There’s more chance of being killed in a car accident on the way to the doctor.
@Katy Ekaterina: the reason even adults with the flu shot are asked to remain for 15 minutes after a shot is that if medical complications arise a medical professional is in close proximity who knows exactly what has been given can deal with it.
Can you provide even one verifiable source for a patient dying of anaphylaxis when these precautions are observed?
Who was in charge of the Coombe when Dr. Wakefield did the testing to support his wild theory? They should be held to account for their part in creating one of the most monumental crises in modern medicine.
Any parent having doubts about vaccines should read the history of the toils endured by the unsung hero, Maurice Hilleman.
https://www.bookdepository.com/Vaccinated-Dr-Paul-A-Offit/9780061227967?redirected=true&utm_medium=Google&utm_campaign=Base2&utm_source=IE&utm_content=Vaccinated&selectCurrency=EUR&w=AFFPAU99XNK0D9A80386&pdg=pla-308360991107:kwd-308360991107:cmp-711096402:adg-39922123827:crv-163909984731:pid-9780061227967:dev-m&gclid=EAIaIQobChMIxJLnhIiK4QIV6rztCh0-5QHLEAQYASABEgJzoPD_BwE
Diversity of illness is our strength.
This is happening because the supply of morons is apparently endless. Even with a disease that can be essentially eradicated, we have enough morons to bring it back.
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