Measles back in UK three years after elimination

The United Kingdom was declared to be free of measles infection three years back in 2016 by the World Health Organization (WHO). In a recent development, due to the increasing number of cases of measles among unvaccinated children, the WHO has declared that UK can no longer be called measles-free. The health organization says that the main reason behind this come back of the vaccine preventable viral infection is due to the decrease in the vaccination coverage of measles, mumps, and rubella vaccine or the MMR vaccine across Europe over the last ten years. Two doses of the MMR vaccine are offered to children from the NHS for better immunization.

Measles viruses. 3D illustration showing structure of measles virus with surface glycoprotein spikes heamagglutinin-neuraminidase and fusion protein - Illustration Credit: Kateryna Kon / Shutterstock
Measles viruses. 3D illustration showing structure of measles virus with surface glycoprotein spikes heamagglutinin-neuraminidase and fusion protein - Illustration Credit: Kateryna Kon / Shutterstock

The WHO experts say that declaring a country measles-free does not mean complete eradication of the illness. High vaccine coverage that allows for minimal number of cases could be the basis for declaring a nation measles-free says WHO. According to the WHO, there have been 231 cases of measles reported in the first three months of 2019 alone in the UK. In 2017 and 2018 respectively there were 284 and 991 confirmed cases of measles in England and Wales. Most of the cases of measles have been reported among individuals who had not been vaccinated as a child. Young adults in their twenties are most commonly affected. Since 2017 there has been a steady rise in measles cases mainly due to inadequate vaccination and that is the reason behind withdrawal of the “measles-free” status of UK. Most of the outbreaks of measles in Europe have been from Serbia, Ukraine, Georgia, Greece, Romania, Italy and France especially among unvaccinated travellers.

Measles is a viral infection that can spread easily via the infected sputum and secretions released when coughing or sneezing. Common manifestations include runny nose, rash and high fever. In most cases there is complete recovery from the infection within a few days. In some however there may be complications which may range from minor to life threatening. The measles vaccine, included in the MMR injection, is one of the safest and most effective way to prevent the spread of this infection. According to the WHO, all individuals in a community should be vaccinated for complete protection. In reality, this is not possible because people with suppressed immunity, infants below 6 months and elderly should not be vaccinated with MMR. In order to provide “herd immunity” to the whole community, 95 percent of the community should be vaccinated against the infection. This would also protect the remaining 5 percent from getting the infection, says WHO. In the UK, there was 95 percent coverage with the vaccine in 2016 when the WHO had declared it measles-free.

In Costa Rica for example, there is a high vaccine uptake and over the last few years the cases of measles recorded were among European tourists who came into the country unvaccinated. Due to the non-endemicity of these cases, the nation was declared measles free. The United Nations International Children’s Emergency Fund (UNICEF) reported that between 2010 and 2017 there have been over 170 million children across the world that were not vaccinated for measles and of these around 527,000 were from the UK. Only around 87 percent of the children below the age of five years have received the second booster dose of measles, says the organization. The two doses of the vaccine have a 99 percent efficacy in protecting an individual from getting the infection.

One of the major reasons for parents choosing not to vaccinate their children despite public health is the spread of false information regarding safety of vaccinations. In the late 90’s a controversial paper by Andrew Wakefield was published that connected the MMR jab with autism. Since then the researcher has been discredited and the paper withdrawn after it was proven to be baseless. However the fear remains and so are the anti-vaccination campaigners on social media and the internet who propagate conspiracy theories and discourage parents from vaccinating their children. The WHO in 2019 has declared anti-vaccination stand as one of the top ten health threats.

In response to this declaration by the WHO, the UK Prime Minister Boris Johnson has started a campaign against the spread of false information by people who are against vaccination or the anti-vaxxers. Johnson’s statement reads, “After a period of progress where we were once able to declare Britain measles-free, we’ve now seen hundreds of cases of measles in the UK this year. One case of this horrible disease is too many, and I am determined to step up our efforts to tackle its spread. From reassuring parents about the safety of vaccines to making sure people are attending follow-up appointments, we can and must do more to halt the spread of infectious, treatable diseases in modern-day Britain.” Health Secretary Matt Hancock also added that all the resources and social media tools are being tapped to improve the vaccination levels. Johnson has called upon the social media companies in a summit to find ways to use these tools for spreading public awareness. UK however would not be imposing vaccinations as mandatory for school admission as has been seen in some of the other nations.

The picture in United States of America

The United States has also fared badly in terms of measles outbreaks due to the rise in spread of misinformation by anti-vaxxers. Numbers reveal that there were 350 cases of measles in 2018 in the US and this year up untyil last week there have been over 1,200 reported cases of measles in the US. The WHO had declared measles to be eradicated from US in 2000 and since then 2019 looks like it would be one of the years with highest number of cases of confirmed measles. There have been no deaths yet but more than 100 have been hospitalized for complications associated with measles infection including pneumonia and encephalopathy etc. The CDC (Centre for Disease Prevention and Control) has warned that at present there are six outbreaks of measles that are ongoing across four states in the US including New York, California, Washington, and Texas.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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