FOUR EUROPEAN COUNTRIES have lost their measles-free status as the number of cases skyrockets across the continent.

Measles is no longer considered eliminated in the UK, Greece, the Czech Republic and Albania, based on 2018 data.

The latest development resulted in the World Health Organization (WHO) today warning that countries need to step up vaccination efforts.

An expert last week told TheJournal.ie that Ireland is also at risk of losing its measles-free status following an increase in cases here and a drop in the number of people being vaccinated.

Gunter Pfaff, the head of the WHO’s European Regional Verification Commission for Measles and Rubella Elimination, said the recent spike in measles cases across Europe is “concerning”.

“If high immunisation coverage is not achieved and sustained in every community, both children and adults will suffer unnecessarily and some will tragically die,” he said today.

There were 89,994 cases of measles in 48 countries in the WHO European region in the first six months of 2019, more than double the number in the same period in 2018 when there were 44,175 cases. That’s more than the 84,462 cases reported for all of 2018, according to WHO figures.

Measles is considered eliminated when there is no endemic disease transmission for 12 months or more in a specific geographic area. Three years after eliminating the disease, the UK was stripped of its measles-free status earlier this month.

While the disease is highly contagious, it can be prevented through a two-dose vaccine, but the WHO has in recent months sounded the alarm over vaccination rates.

The UK reported 953 measles cases in 2018 and 489 for the first six months of 2019. In the same time periods, Greece reported 2,193 and 28 cases, Albania 1,466 and 475, and the Czech Republic 217 and 569.

“Each of these countries are examples that have extremely high national vaccination coverage. So these are not examples of countries that have particularly weak systems,” Kate O’Brien, director of the WHO’s Immunization Department, said.

This is the alarm bell that is ringing around the world: being able to achieve high national coverage is not enough, it has to be achieved in every community, and every family for every child.

There have been 56 reported cases in Ireland to date in 2019 – 33 of which have been confirmed. The number of cases here tripled from 25 in 2017 to 77 in 2018.

Most cases in Ireland to date this year were among children, however there were 17 cases among people aged 20-44. Thirty-one cases involved males and 25 cases related to females.

Potentially fatal

Measles is a highly infectious airborne illness that spreads very easily, often via coughing or sneezing. Symptoms include a high fever, cough, runny nose and rash.

Thirty-seven deaths were reported across 48 of the 53 countries in the WHO European region in the first six months of 2019. There were at least 74 measles death in Europe last year.

Other severe complications can include blindness and, for pregnant women, miscarriage.

Some 60% of patients in Europe in the first half of 2019 were under the age of 19. Four countries were home to 78% of cases in the first six months of the year: Ukraine, Kazakhstan, Georgia and Russia — 60% of cases were reported in Ukraine alone.

Meanwhile, Austria and Switzerland were confirmed to have elimination status in 2018, the WHO said.

Measles has been declared eliminated in 35 of the 53 countries in the WHO’s European region for 2018, down from 37 in 2017.

It is considered endemic in 12 countries, including France and Germany. In the latter, vaccination against the disease will become mandatory in March 2020.

According to the WHO, more than 20 million deaths have been prevented around the globe between 2000 and 2016 thanks to measles vaccination.

Worldwide, the number of cases reported from 1 January to 31 July this year tripled to 364,808, compared with 129,239 during the same seven months last year.

The highest numbers of cases were reported in the Democratic Republic of Congo, Madagascar and Ukraine. The United States meanwhile registered its highest number of cases in 25 years.

The numbers are especially worrying as nine in 10 cases are believed to go unrecorded worldwide, according to the WHO.

O’Brien said that in reality, around 6.7 million deaths each year were linked to measles.

Anti-vaccine movement

The disease had been officially eliminated in many countries with advanced healthcare systems, with numbers steadily decreasing until 2016 when a resurgence began.

According to the WHO, the reasons for people not being vaccinated vary significantly between communities and countries, with a lack of access to quality healthcare or vaccination services hindering some from getting the jabs, while others may be misinformed about vaccines and the need to vaccinate.

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

Uneven vaccination coverage and gaps and disparities between communities, geographic areas and among age groups has allowed measles to flourish even in countries with high national vaccination rates.

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). Adults who are not sure if they received the vaccine as a child are advised to contact their GP to check and discuss getting a booster if needed.

The uptake rate for the MMR vaccine here is 90.1% – below the HSE’s goal of 95%, the level needed for herd immunity.

Dr Kevin Kelleher, Assistant National Director of the HSE’s Health Protection section, last week told TheJournal.ie a minority of people haven’t had the vaccine for “valid medical reasons”, such as children who are receiving chemotherapy, and rely on others to be vaccinated so they and the wider population is protected.

Ireland reached an uptake rate of 92% last year but the upward trend we had been experiencing is now being eroded. The 90.1% figure relates to children who were two years old in the first quarter of 2019. Kelleher said the “slight and slow decline” in MMR uptake rates is “absolutely a concern”.

TheJournal.ie explored the issue in a previous episode of The Explainer podcast:

Source: The Explainer/SoundCloud

Contains reporting from © AFP 2019