File photo of a measles rash. Source: Shutterstock/phichet chaiyabin

THERE WERE 80 reported measles cases in Ireland in 2019, up from 77 in 2018, according to provisional statistics compiled by the Health Protection Surveillance Centre (HPSC).

Despite there only being a slight increase in cases last year, there are still concerns that Ireland could lose its measles-free status as the number of cases here tripled from 2017 to 2018.

Two further cases were reported in the first week of this month.

Of the 80 reported cases last year, 42 were confirmed to be measles, seven were probable and 31 were possible.

More than half of all reported cases last year were in the east of the country.

Source: HPSC

The majority of cases involved children but there were 26 reported cases among people aged 20-44 years.

Source: HPSC

There were 45 cases among females and 37 among males in 2019 and the first week of 2020.

Source: HPSC

Four European countries – the UK, Greece, the Czech Republic and Albania – lost their measles-free status in August as the number of cases skyrocketed globally.

More than 140,000 people died from measles worldwide in 2018, the majority of whom were children under the age of five, according to the World Health Organization (WHO) and US authorities.

Five countries – the Democratic Republic of Congo, Liberia, Madagascar, Somalia and Ukraine – accounted for half of measles cases in 2018. More than 6,000 people have died from measles in DR Congo in recent months in what the WHO has described as the world’s largest and fastest moving measles outbreak ever.

A spokesperson for the HSE said the relative stabilisation in the number of cases reported in Ireland is due to the fact outbreaks here last year were “relatively small” and all “likely to linked to imported cases”.

“The outbreaks have all been contained quickly after identification,” the spokesperson noted.

‘A real threat’

However, given the increase in cases in recent years, the HSE remains concerned that Ireland could lose its measles-free status.

As long as measles continues anywhere in the world there is a risk of measles being reintroduced into Ireland, with the potential for subsequent spread. The possibility or losing measles elimination is a real threat, hence the efforts to raise awareness among the population and travellers that they should be vaccinated.

The spokesperson said that, to date, Ireland has been able to maintain its measles-free status because of “the rapid response, investigation and control measures that are put in place whenever a suspect case is notified”.

They added that this process of rapid notification, testing, isolation and control of any suspect cases is done in collaboration with GPs, hospitals, laboratory services and public health doctors and nurses.

Vaccination rate

The uptake rate of the MMR vaccine, which protects against measles, mumps, and rubella, for children at 24 months in Ireland is 91% (in the second quarter of 2019, the most recently available statistics).

The uptake rate in 2018 was 92%. There has been a steady increase in the uptake of the MMR vaccine in recent years after dipping to 73% in 2001 and 2002, and much lower in certain parts of the country.

However, it remains below the HSE’s goal of 95%, the level needed for herd immunity. A minority of people can’t be vaccinated for valid medical reasons, such as children who are receiving chemotherapy, and rely on others to be vaccinated so they and the wider population are protected.

All children in Ireland entitled to, and advised to, get the MMR vaccine at the age of 12 months. They are supposed to get a second dose when four or five (in junior infants).

The HSE provides vaccinations to children as part of the national childhood immunisation programme. This programme is free for all children and is delivered through the GP system.

The HSE spokesperson told TheJournal.ie vaccination is the “only way to control and prevent measles”, adding that the MMR vaccine is 99% effective once two doses have been delivered.

“All countries are at risk of measles outbreaks if vaccination rates decline below the minimum of 95% for two doses of the measles containing vaccine. The best way to prevent spread is to ensure that we have achieve 95% uptake of two doses of the MMR vaccine among all individuals born since 1978.”

The spokesperson added that many adults who are not vaccinated “may not realise that they are unprotected”. Anyone who is unsure about whether or not they are vaccinated should discuss the issue with their GP.

Misinformation about vaccines

The so-called ‘anti-vax movement’ — driven by completely disproven claims linking the MMR vaccine to a risk of autism in children — has gained traction in Ireland and abroad in recent years.

Health Minister Simon Harris last week announced that funding of €500,000 has been made available to support the work of the Vaccine Alliance, a network of healthcare professionals, policy makers, patient advocates, students, and representatives from groups most affected by vaccine hesitancy.

The funding will be used to boost the uptake of childhood vaccines and improving confidence in vaccines.

Speaking on Friday, Harris noted that nine out of 10 parents in Ireland choose to vaccinate their child against measles and other conditions.

However, he added: “We have also seen alarming instances of how misinformation about vaccines can lead to unnecessary illness and harm, and we know that many of those that currently choose to vaccinate are uncertain about aspects of vaccination.”

The minister has been engaging with companies such as Twitter, Facebook and Google in recent months in a bid to tackle the spread of misinformation about vaccines online.

Harris said a detailed research programme will be conducted with parents, in the first instance, to find out their views and attitudes, to vaccines “to better understand and address these concerns”.

“The learning gained from this listening exercise will be used to develop targeted and effective communications aimed at improving confidence in vaccines. This vital work will be carried out during 2020,” Harris stated.

TheJournal.ie explored the rise in measles cases in Ireland and globally in a previous episode of The Explainer podcast:

Source: The Explainer/SoundCloud

MEASLES: WHAT YOU NEED TO KNOW

What are the symptoms of measles?

High fever

Cough

Runny nose

Red eyes

Red rash that starts on the head and spreads down the body – this normally starts a few days after onset of illness; the rash consists of flat red or brown blotches, which can flow into each other; it lasts about four to seven days

Vomiting, diarrhoea and tummy pain may also happen

Measles can cause chest infections, fits (seizures), ear infections, swelling of the brain and/or damage to the brain.

The Department of Health gives the following advice in relation to the MMR vaccine:

All children should get the MMR vaccine when they are aged 12 months; if any child aged over 12 months has missed this vaccine they should get it now from their GP

All children should get a second dose of MMR vaccine when they are four to five years old or in junior infants at school; if any child in senior infants or older has missed this vaccine they should get it now from their GP

Adults under 40 years who have not had measles or have not received two doses of MMR vaccine should contact their GP to get the MMR vaccine

Adults over 40 years of age may sometimes be at risk and if such adults never had measles nor a measles-containing vaccine they should consider getting the MMR vaccine from their GP

What advice does the HSE give to people who think they might have measles?