23rd September 2019 by Joanne Redfern
In July the World Health Organization (WHO) announced that Sri Lanka had eliminated measles. The country’s last indigenous case was over three years ago, which means, apart from the occasional imported case, it is now officially free of the disease. It’s great news for Sri Lanka, but it makes me wonder – why is Europe lagging behind?
In the first five months of this year alone, Europe reported over 80,000 measles cases and 31 measles-related deaths. It’s a huge jump from the 5,300 cases reported in the whole of 2016, and has prompted the WHO to activate a grade 2 emergency response.
CDC/NIP/Barbara Rice [Public domain]
Yes! Measles is one of the world’s most contagious diseases, causing cold-like symptoms, fever and a blotchy rash. Most people recover in about a week, but in some – particularly babies, adults and undernourished or immunocompromised children – serious complications arise, including blindness, severe diarrhoea and pneumonia. According to the NHS, 1 in 5,000 people with measles die. Measles is also risky during pregnancy and can lead to miscarriage, or premature or still births.
All European countries routinely vaccinate against measles. Here in the UK, the measles, mumps and rubella vaccine (commonly known as MMR) is given as part of the childhood vaccination programme. Children receive two doses, both before school age, giving them long-lasting protection against the three diseases.
In 2018, coverage for the second dose of the measles vaccine in Europe was 91%. Although this is a record high, it is neither enough nor uniform enough across all countries to prevent the virus spreading.
A paper published in 1998 linked the MMR vaccine to autism and inflammatory bowel disease. The paper was subsequently retracted, but confidence in the vaccine had dropped, with uptake rates in the UK falling to 79% in 2003. Some European countries have suffered from challenges with vaccine supply, storage and handling, or changes to their healthcare systems. And in the Ukraine, the conflict with Russia may have contributed to the sharp decrease in vaccination rates. Other reasons for children not being vaccinated include illness during vaccination time, access and general safety concerns. Awareness must also play a part: if more parents knew about measle’s potentially deadly risks, would they be lax about vaccinating their children?
Persistance. Sri Lanka has consistently achieved over 95% coverage with both the first and second doses of the measles vaccine included in its childhood immunisation programme. Although this coverage doesn’t seem much higher than Europe’s 91%, the difference is critical for achieving so‑called herd or community immunity. And when Sri Lanka’s health officials have identified gaps in immunisation, the government has organised mass vaccination campaigns to ‘top up’ the immunity.
WHO’s grade 2 emergency response should hopefully make a difference through increased awareness and additional human and financial resources. WHO has prioritised four countries – Israel, Romania, Serbia and Ukraine – but every country needs to join the concerted effort to identify un- or under-vaccinated individuals and bring measles under control.