Measles continues to be a problem in Europe and it is now unlikely that the World Health Organization target of eradication of the disease in Europe by 2015 will be met
Christine Clark PhD FRPharmS FCPP(Hon)
The second half of the 20th century saw major advances in the control of infectious diseases through vaccination programmes and yet we are now seeing the resurgence of measles – a disease that the World Health Organization (WHO) had planned to eliminate from its European region by 2015. In contrast, measles is now rare in North and South America, where vaccination rates are high.
At the time of writing, an outbreak of measles in South Wales continues to spread, with just over 1000 cases reported so far. The majority of cases are among 10–14-year-old children who have not been vaccinated. Fifteen years ago, a publication in The Lancet suggested that the measles mumps and rubella (MMR) vaccine was associated with the development of autism in children. Although the study has been thoroughly discredited and its author struck off the medical register, the seeds of doubt were sown in many parents’ minds and they did not allow their children to be vaccinated.
This is not only a problem for the UK. The European Centre for Disease Prevention and Control reported that there were 8032 cases in Europe between January 2012 and February 2013; France, Italy, Romania, Spain and the UK accounted for 94% of the cases, mainly in unvaccinated individuals. Many were under one year of age and therefore would not have been vaccinated. However, a significant proportion is over one year of age. Measles is a highly contagious disease and its elimination relies on a high level of ‘herd immunity’. A sustained vaccination rate of 95% is required for this effect to operate, but vaccination rates have fallen well below this figure in many places.
In consequence, those under one year of age and older unvaccinated (or partially vaccinated) individuals are now at risk of catching measles. Add to this the fact that people are infectious for several days before the characteristic rash erupts and the relative ease of international travel, and it is easy to see how the disease can spread.
There are a number of reasons why parents do not allow their children to be vaccinated. One reason is complacency. Measles used to be a common childhood disease that everyone recognised. Now it is relatively uncommon and many people are unaware of its potential severity or complications, perceiving it as a mild disease. Measles encephalitis, which can lead to long-term complications, occurs at a rate of 1 per 1000; some patients require hospitalisation for other reasons and a small number die. Paediatricians are asked, “Is the vaccination really necessary now that people don’t get measles?” But of course, the reason for the low rate of infection for many years was systematic vaccination of the majority. Last year the WHO published a leaflet for parents explaining the risk and responsibilities of choosing not to vaccinate children.
Others do not allow their children to be vaccinated because of lingering fears that the risks associated with the vaccine outweigh the risks of the disease, or deeply held beliefs that vaccines are unnecessary.
What has this to do with hospital pharmacists? All healthcare professionals have a responsibility to be credible, well-informed sources of information about the management of vaccine-preventable diseases and the safety of vaccines. People need reliable and accurate information about measles and its prevention and hospital pharmacists have a part to play in reinforcing the healthcare community’s efforts to eradicate this disease.