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UK: Low MMR uptake blamed for surge in measles cases across Europe

21 Aug, 2018
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More than 41,000 cases of measles reported in the EU in six months to June – almost double the number over the whole of 2017

People queue for the MMR vaccination at the Princess of Wales Hospital in Bridgend.
 People queue for the MMR vaccination at the Princess of Wales Hospital in Bridgend. Photograph: Rex/Shutterstock

A huge surge in measles cases across Europe has been reported by the World Health Organisation, which says low MMR vaccination rates are to blame.

More than 41,000 cases of measles have been reported in the European region between January and June. Last year there were nearly 24,000 for the whole 12 months, which was the highest count in any year of the last decade.

“We are seeing a dramatic increase in infections and extended outbreaks,” said Dr Zsuzsanna Jakab, WHO regional director for Europe. “We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease.”

In seven countries (France, Georgia, Greece, Italy, the Russian Federation, Serbia and Ukraine) more than 1,000 children and adults have been infected in the first half of 2018 and at least 37 people have died. The biggest toll was in the Ukraine, which had 23,000 cases – half the European total. There were measles-related deaths in all seven countries. Serbia, with 14, had the most.

Two countries that had eliminated measles had outbreaks that continued for 12 months. The measles status of Germany and Russia has been reclassified by the WHO to endemic as a result. The outbreak in Germany began in Duisburg in early 2017 and spread to other cities.

The WHO goal to eliminate measles from Europe by 2020 faces major problems because of regions or cities with particularly low vaccination rates and the easy transmission across borders of the measles virus, which is one of the most infectious agents known. Some of the deaths in Greece in 2016 were in the Roma community, who had not had access to immunisation clinics. Outbreaks in Romania, Italy or Austria quickly spread as people travel for migration, work or pleasure.

But the virus can do no harm in communities that have been fully immunised – WHO says 95% need to have been vaccinated to prevent transmission. Confidence in the MMR (measles, mumps and rubella) jab slumped after the gastroenterologist Andrew Wakefield at the Royal Free hospital in London published a paper in the Lancet in 1998 wrongly alleging a link between the vaccine and autism. The paper was retracted and Wakefield, who had not declared he was taking money from solicitors hoping to pursue vaccine damage cases, was struck off the medical register for dishonesty and irresponsibility.

Take-up of the MMR by parents for their children recovered across Europe, but there have been pockets of hesitancy and denial in every country, creating areas in which the general immunisation rate is too low to protect unvaccinated children.

The cause of the vaccine doubters has been embraced by some political movements, who advocate “parent choice”. The Five Star movement in Italy opposes a law that would have fined parents who do not immunise their children, while in France, Marine le Pen of the newly-renamed National Rally party is against mandatory vaccination.

The record number of cases “is a reflection of so many children and adolescents who are still susceptible to the disease because they are not vaccinated,” said Mark Muscat, medical officer for vaccine-preventable diseases at WHO Europe.

“This is a disease that could be totally prevented by two doses of MMR vaccine, but we are seeing measles cases across all age groups.”

In 2016, there was a record low number of cases – just 5,273 across the WHO’s Europe region. “But it doesn’t mean there were no susceptible individuals. It was simmering in the background. When you get importation of the measles virus, it spreads like wildfire and will infect everybody who is still susceptible to the disease,” he said.

Some parents do not take their child for vaccination while others delay. “I think there is hesitancy for very many reasons,” he said. “There are a lot of rumours and misinformation about safety. There are also problems where some parents have limited access to health systems and some have become complacent. They do not realise the importance of vaccinating their children because the diseases is not around.

“That is totally wrong. Unfortunately we have some measles-related deaths. Last year it was 38. This year it is already 37 in the first six months.”

In England there have been 828 confirmed measles cases so far this year, across the country. London had the biggest number, at 291, the south-east had 169, the south-west had 138, the West Midlands 85 and Yorkshire and Humberside had 80.

“We have seen a number of measles outbreaks in England which are linked to ongoing large outbreaks in Europe,” said Dr Mary Ramsay, head of immunisation at Public Health England. “The majority of cases we are seeing are in teenagers and young adults who missed out on their MMR vaccine when they were children.”

Dr Pauline Paterson, co-director of The Vaccine Confidence Project team at the London School of Hygiene & Tropical Medicine, called the high number of measles cases so far this year “astounding”.

“While most people vaccinate, some individuals do not. The reasons for non-vaccination can vary from issues of vaccine access, a lack of perceived need to vaccinate, and concerns around the safety of vaccination – in 2016 the Vaccine Confidence Project found that the European region was the most sceptical in the world on vaccine safety,” she said.

“Vaccines work. If measles is to be eliminated, we must continue to further our understanding of the underlying reasons for non-vaccination and to address them with effective evidence-based interventions.”

Ramsay urged people who might not have been immunised to see their doctor. “Anyone who missed out on their MMR vaccine in the past or are unsure if they had two doses should contact their GP practice to catch-up. We would encourage people to ensure they are up to date with their MMR vaccine before travelling to countries with ongoing measles outbreaks, heading to large gatherings such as festivals, or before starting university,” she said.

This entry was posted on Tuesday, August 21st, 2018 at 8:11 am and is filed under Latest News.

Literature Literature archive

Baalen, S. van. 2018 Research Ethics 14(4), 1–17. https://doi.org/10.1177/1747016117750312
Lutz CS, Carr W, Cohn A, Rodriguez L. 2018 Vaccine Volume 36: 7445–7455

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