Monthly Archives: May 2019

Measles – catching your death…

I know about measles. I had it as a child and was pretty unwell with it, confined to a darkened room for over a week with concerns raised for my eyesight among other things. Decades later I still know about measles because I work with patients who have encephalitis because of it, and also families left bereaved by it. It is not the innocuous childhood illness that the uninformed and many opposed to vaccines would have you believe. It is serious and deadly. Measles kills. It’s that simple.

Roald Dahl knew about measles too[1]:

“Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

“Are you feeling all right?” I asked her.

“I feel all sleepy, ” she said.

In an hour, she was unconscious.

In twelve hours she was dead.

The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.

What is measles?

Measles is a highly infectious viral illness. The virus is found in the millions of tiny droplets that come out of our noses and mouths when an infected person coughs or sneezes. You can contract measles by breathing in these droplets or touching surfaces where they might have landed (the virus can survive on surfaces for several hours).

People with measles are infectious from when the symptoms develop until about 4 days after the rash first appears.  It can be very unpleasant to endure even without experiencing any serious complications. Like many other highly infectious illnesses such as smallpox, polio and Hib meningitis, it was until recently, uncommon in the many countries where vaccination programs existed.

Anyone can get measles if they haven’t been vaccinated or haven’t had it before, although it’s most common in young children.

Initial symptoms occur around 10 days after you’re infected, and might include cold-like symptoms, sensitivity to light, sore red eyes, fever, and spots on the inside of your cheeks. A few days later, a reddish-brown rash will appear spreading across the body.

Most people will recover from measles around a week to two weeks after they first became ill however it can lead to serious complications, including life-changing disabilities and death. For example eye disorder, pneumonia, meningitis, encephalitis or even an ultimately fatal brain complication known as subacute sclerosing panencephalitis (SSPE), which can occur several years after the initial measles infection. There may also be other complications in pregnancy if the mother is not vaccinated against the condition.

Measles can however be prevented by having the MMR (measles, mumps and rubella) vaccination given in 2 doses when a child is around 13 months old, and a second dose at 3 years and 4 months. Adults and older children can be vaccinated at any age if they haven’t been fully vaccinated before.

  • 90% of unvaccinated people exposed to measles will become infected.
  • A single person with measles will be able to infect 90 other people who are not immune.
  • Between one and three people in every 1,000 who catch measles will die.

Deadly situation – measles, a once near-eradicated disease is again a public health crisis.

Worldwide, measles is still a major cause of death, especially among children in resource-poor countries. Over the last two decades however vaccination has dramatically reduced the number of deaths from measles.

In 1990 measles killed 872,000 people worldwide, in contrast to 2016 when it is estimated about 90,000 people died of measles, and in 2017 this had risen to 110,000 (300 people dying from measles every day).  It is estimated that over one in 5 of all child deaths averted have been due to measles vaccination. The World Health Organisation (WHO) estimates the first four months of 2019 has already witnessed 112,000 confirmed measles cases.

Since the measles vaccine was introduced in the UK in 1968, Public Health England estimates that 20 million measles cases and 4,500 deaths have been averted in the UK. However in 2018 there were 966 laboratory confirmed measles cases in England – an increase of 400% on 2017 (259 cases).

The MMR vaccine was introduced in the US in 1963 when measles cases were an estimated three to four million. In 2000 the US declared measles eradicated.  So far in the first four months of 2019 626 cases have been confirmed.

Numbers of measles cases are currently high in several European countries. There were over 82,500 measles cases in Europe in 2018 . This is more than three times as many as in 2017, and 15 times as many as in 2016. In 2016 and 2017 there were 49 deaths from measles in Europe, and 2018 saw another 72 deaths.

The increase in measles cases is due to gaps in vaccination coverage according the World Health Organization, with Unicef warning us there are nearly 170 million children worldwide (under the age of 10) unprotected from measles.  Half  a million of these are in the UK and 2.5 million in the US.  In low to middle-income countries the statistics make even bleaker reading.

How did we let this happen?

According to Unicef the current grim global vaccination picture results from a mixture of complacency, misinformation, scepticism about immunisations, and a lack of access to vaccination.

Whilst fear of vaccines is not new (opposition can be traced as far back as the 18thcentury) a significant catalyst for the current vaccine-hesitancy and the more mobilised anti-vaccine movement was the publication of a paper by disgraced doctor Andrew Wakefield in 1998. In the bad science of the paper (he had undisclosed conflicts of interest and his research methods were unethical) he asserted that, in a paper of only 12 (yes 12!) children that the MMR vaccine was responsible for autism-like behaviours. In 2010, over a decade on from its publication, and in large part thanks to a reporter called Brian Deer, The Lancet finally and fully retracted the paper. Wakefield was also struck off as a practicing doctor by the General Medical Council.

As a result, certainly in the UK, a public health scare around the vaccine ensued and it is this that fed much of the vaccine-hesitancy and anti-vax movement we see today. This scare spread across Europe and eventually over the Atlantic and to North America. Further misleading papers and theories emerged suggesting further vaccine-autism links such as mercury poisoning related to a preservative found in some vaccines, aluminium poisoning, and ‘antigenic overload’ (the need to spread out vaccines in order not to overload children’s immune systems).

Of course we must recognise that some people exercise their autonomy and legitimately oppose vaccine due to their personal or religious beliefs.  If vaccination rates provide a herd immunity to diseases like measles, then this means that wider society can accommodate these genuine personal choices.

However it is the anti-vax movement who tend to shout loudly about their misinformed beliefs. Why are their viewpoints not as legitimate and genuine as people who choose not to vaccinate due to their personal or religious beliefs?  Simply because, as Hussain[2]et al (2018) remind us:

 ‘Online anti-vaccination authors…tactics include…skewing science, shifting hypotheses, censoring opposition, attacking critics, claiming to be ‘pro-safe vaccines’ and not ‘anti-vaccine’, claiming that vaccines are toxic or unnatural, and more. Not only are these tactics deceitful and dishonest, they are also very effective on many parents.’

As my own work in narrative medicine recognises the growth of technology and our capacity to share our views and stories digitally is a really positive thing for people.  It can reduce isolation and loneliness as well as help educate and inform us about a myriad of things we otherwise might remain inexperienced or uneducated about.  However this also means that information about medicines and disease has shifted from being the sole province of the medical practitioner and is accessible to the lay-person.  The flip-side of this is that the creation and distribution of fictitious, fake and false information is possible.  A range of studies have been conducted looking at online vaccine and immunisation information, and demonstrated high percentages of opposing vaccination, with these digital footprints often having higher views and ratings than those that were pro-vaccination.

One caveat I will make at this juncture is that some of the proponents of anti-vax misinformation and campaigns affect some of the most vulnerable – parents who have lost children or whose children have life-changing disabilities are led to believe vaccination was the cause.  I have seen and heard from these parents – their loss and distress is palpable and heart-breaking. Along with patients and families affected by the complications of measles, these parents are also victims of an erroneous and misguided movement.

What needs to be done to address this preventable crisis?

People need to call it out.  In the same way they have done recently for issues around gender pay-gaps, sexual harassment, climate change and so on.  That’s why I am writing this blog.  I simply cannot be silent, sit back and watch more people die of a preventable disease.  I am not just watching this through the glass of a television screen, I and my team at the Encephalitis Society are dealing with the aftermath of this preventable public health crisis.   It is not just us however.  Our health systems are already overburdened and at breaking point.  Outbreaks of preventable diseases like measles, only serve to increase that strain.

Social media, talk shows, and other news platforms must not provide airtime and credibility to the wrongful, misinformed discrediting of vaccines and vaccination, nor their proponents.

We must make vaccination as accessible as possible, and meet head-on the anti-vax propaganda by overwhelming and overpowering it with the truth: that vaccines save millions of lives around the world each year.

Conclusion

  • The current measles epidemic is a global public health crisis.
  • Vaccines are not toxic, unnatural, nor do they cause autism.
  • The anti-vax movement promotes misinformation and is responsible for deaths from vaccine preventable diseases.
  • We must protest loudly until the voice of the pro-vaccine communities are louder than the voices of those promoting dishonest and false anti-vax propaganda
  • Vaccines save lives.

 

Bibliography and to learn more

https://www.encephalitis.info/measles-infection-and-encephalitis

https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/

https://www.vox.com/science-and-health/2018/10/16/17964992/vaccine-autism-book-peter-hotez

https://www.who.int/immunization/diseases/measles/en/

https://www.nhs.uk/conditions/measles/

https://www.cdc.gov/measles/index.html

https://ecdc.europa.eu/en/measles

https://www.afro.who.int/health-topics/measles

https://www.gov.uk/government/news/measles-outbreaks-across-england

http://vk.ovg.ox.ac.uk/measles

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2930903-1

https://www.theguardian.com/society/2019/apr/25/nearly-170m-under-10s-unvaccinated-against-measles-worldwide

 

[1]https://www.encephalitis.info/Handlers/Download.ashx?IDMF=9ea058b7-fd6f-493e-8589-34d56e9ac164

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122668/pdf/cureus-0010-00000002919.pdf

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