Measles: How has a preventable disease come back from the past?

[ad_1]

Measles is one of the most infectious diseases in the world but, until recently, the number of cases was decreasing. So what has led to recent epidemics?

Rockland County, New York State, declared the state of emergency last week as a result of a severe re-emergence of the preventable virus.

This is not an isolated case, as the United States is already on track to see the highest number of measles cases since 2000, when the disease was officially eliminated.

Other countries, such as Mexico, France and Madagascar, have experienced similar epidemics in communities with immunity gaps.

In most cases, measles is relatively minor, but it can also lead to life-threatening complications such as pneumonia, meningitis and inflammation of the brain.

Although still well below historic levels, the disease has been increasing for several years. Reported cases increased by 31% in 2017 compared to the previous year, resulting in approximately 110,000 deaths worldwide.

According to UNICEF, 98 countries reported an increase in the number of measles cases in 2018, including nearly three quarters in 10 countries.

What happens to vaccinations?

Thanks to successful immunization programs, measles has become rare in many places.

When measles vaccine was widely used in the 1980s, the number of cases dropped significantly, eventually leading some countries to declare that it had been eliminated.

Prior to that, large outbreaks of measles occurred every few years.

For example, in 1967, the year before the introduction of measles vaccine in England and Wales, nearly half a million cases were reported and 99 deaths. In 1998, the number of cases had increased to 56 and had not resulted in death.

So, what explains the alarming recent increases?

A 95% vaccination goal creates "community immunity" in a community to prevent the spread of this highly infectious disease.

All measles outbreaks have taken root in areas where immunity is not sufficient but where the reasons are different from one place to another.

The high-level anti-vaccination movement has become influential in parts of the United States and Europe.

Despite overwhelming scientific evidence for vaccination, "anti-vaxxers" may believe vaccines are useless or dangerous.

They sometimes adopt conspiracy theories around "big pharma" and are wary of the government.

In the United Kingdom, a concern about the safety of the measles, mumps and rubella (MMR) vaccine, as a result of now discredited research, has had a major impact for some time.

In 2004, coverage of first dose MMR fell to 80% in England and 78% in Wales.

Two decades later, the rate of participation in the virus has recovered: more than 90% of two-year-old Britons received the vaccine in 2017-2018.

But many teens and young adults who have not received MMR, because they now catch measles.

We could also see future outbreaks of rubella – German measles – in this age group, a particular concern as they reach the age of procreation.

Rubella is usually a mild disease. It can be catastrophic if it is detected early in pregnancy, causing severe vision, hearing, heart and learning problems in the fetus.

Measles cases in Europe tripled in 2018
"Measles is bad, you have to vaccinate"

Beyond the anti-vaxxeurs

In other countries, the reasons for the decline in vaccination rates are very different.

In Ukraine, for example, public confidence in vaccination was severely shaken in 2008, following the death of a teenager after a measles vaccination, which, although unrelated, led the government to end the immunization. vaccination campaign.

In 2016, in a situation aggravated by political turmoil, corruption in health services and shortage of vaccines, Ukraine has recorded one of the lowest removals of measles vaccines in the world, with only one in three six year old children protected with two doses of vaccine.

Although more than 90% of six-year-olds are now protected, the reservoir of unprotected young people has allowed measles to spread.

The country has become a hot spot for measles, with 54,000 cases in 2018, compared with about 5,000 the previous year.

Immunity levels have also decreased in countries where the health system has collapsed, such as Yemen, which is in full civil war, and Venezuela, which is facing a serious economic crisis.

This may have repercussions on other countries, such as Brazil, which has experienced mass migration from Venezuela.

What is measles?

Measles is a highly infectious virus that spreads in droplets through coughing, sneezing, or direct contact
It can hang in the air or stay on the surfaces for hours
Measles often starts with fever, feeling sick, sore eyes and a cough followed by a rising fever and rash.
In the mildest cases, measles makes children very uncomfortable with a cure in seven to ten days – but complications include ear infections, seizures, diarrhea, pneumonia and diarrhea. Brain inflammation is common.
The disease is more serious in very young children, adults and immunocompromised people
Measles remains a major cause of infant mortality in many low-income countries, although measles vaccine has averted more than 20 million deaths in 2000-2017

How are countries responding to these epidemics?

Some countries are moving towards mandatory vaccination and many others have tightened existing requirements.

Italy and France have expanded the existing requirements by imposing fines and limiting school attendance. And Germany is discussing the need to make measles vaccine mandatory.

In Rockland County, New York, unvaccinated children were banned from public places for 30 days. But it is difficult to see how this could be effectively implemented and there is little evidence that mandatory vaccination is always the best approach.

Those who are determined not to vaccinate will find a way around the system, for example by attending home schooling or paying a fine.

Meanwhile, parents opposed to vaccination may become more resistant if they feel they do not have a choice. A better solution may be the ability to converse with a health professional to address their concerns.