Measles is one of the world's most infectious illnesses, but until recently cases had declining. So what's leading to recent outbreaks?
In Rockland County, New York State, declared a state of emergency last week after a severe re-emergence of the preventable virus.
It's far from an isolated case, with the US already in the course of this year to see most of the measles cases since 2000, when the disease was officially eliminated.
Other countries, such as Mexico, France and Madagascar, have seen similar outbreaks in communities with gaps in immunity.
In most cases, measles is relatively minor, but it can also lead to potentially life-threatening complications such as pneumonia , meningitis and brain inflammation
Although the disease has been on the rise for several years, although still far below historical levels. Reported cases rose by 31
According to Unicef, 98 countries reported an increase in measles cases in 2018, with almost three quarters of these occurring in 10 countries.
What's happening to vaccinations?
Successful vaccination programs have ensured that measles has become rare in many places.
When a measles vaccine became widely used in the 1980s, the cases fell significantly, eventually leading to some countries declaring it had been eliminated.
Before then, large epidemics of measles occurred every few years.
For example, in 1967, the year before the measles vaccine was introduced in England and Wales, there were almost half a million reported cases and 99 deaths. By 1998, this had fallen to an all-time low of 56 cases and no deaths.
A vaccination target of 95% creates "herd immunity" in a community, to prevent this highly infectious disease from spreading.
All the measles outbreaks have taken hold in areas where there is not enough immunity but the reasons behind this vary from place to place.
The high-profile anti-vaccination movement has become influential in parts of the US and Europe.
Despite the overwhelming scientific evidence supporting vaccination, "anti-vaxxers" can believe the vaccines are unnecessary or harmful.
They sometimes embrace conspiracy theories around "big pharma" and are distrustful of government.
In the UK, a scare over the safety of the measles, mumps and rubella (MMR) vaccine, now discredited, has had a major impact for a time.
In 2004, the first-dose MMR coverage fell to 80% in England and 78% in Wales
In two decades, uptake has recovered, with over 90% of UK two-year-olds receiving the vaccine in 2017- 18
But many adolescents and young adults who are not given MMR as infants are now catching measles.
We may also see future outbreaks of rubella – German measles – in this age group, and especially concern they reach the childbearing age.
Usually a mild disease, the rubella can be catastrophic if caught in the early stages of pregnancy, causing serious vision, hearing, and learning problems in the unborn baby.
- Measles cases in Europe tripled in 2018
In Ukraine, for example, the public trust in vaccination was severely shaken.
In Ukraine, for example, public confidence in vaccination was severely shaken In 2008, after the death of a teenager after a measles vaccination, which, though unconnected, led the government to halt the vaccination campaign.
By 2016, Ukraine had one of the smallest uptake of measles vaccine in the world by 2016, with only one in three of six-year-old children protected by two doses of vaccine.
Although over 90% of the six-year-olds are now protected, the reservoir of young people left unprotected has allowed the measles to take hold.
The country has become a hotspot for measles, with 54,000 cases in 2018, compared with about 5,000 in the previous year.
Immunity levels have also fallen in countries where the health system has collapsed, such as Yemen, which is in the middle of a civil war, and Venezuela, which tackles a serious economic crisis.
Measles are a highly infectious virus spread in the droppings from the kleps, which can be found in other countries too, such as in Brazil, which has experienced mass migration from Venezuela
What is measles?
- sneezes or direct contact
- It may hang in the air or stay on surfaces for hours
- At its mildest, The disease is more severe in the very young, in adults and in people with immune problems
- Measles is still a major cause of child death in many low-income countries, although the measles vaccine, in my opinion, has prevented more than 20 million deaths in 2000-17
How are countries responding to these outbreak s?
Some countries are tightened up on existing requirements.
Italy and France have extended existing requirements with fines and restricted school attendance. And Germany is currently discussing making measles vaccine mandatory.
In New York's Rockland County, unvaccinated children have been banned from public places for 30 days. But it is difficult to see how this can be effectively enforced and there is little evidence that mandatory vaccination is always the best approach.
Those who are determined to not vaccinate will find a way around the system, for example, by home-schooling or paying a fine.
Meanwhile, parents about the vaccination may become more resistant if they feel they are not given a choice. A better solution may be the opportunity to have a conversation with a health professional to respond to their concerns.
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Meanwhile, checking the status of vaccination when entering a nursery and then into school would act as a useful reminder to parents and strengthen their importance.
As most of the under-immunization results from difficulties accessing services, tailored immunization services would also be helpful.
For example, an innovative response to a measles outbreak in the London borough of Hackney was the "spotty bus" – a mobile immunization unit that toured the neighborhood, parking in school playgrounds and supermarket car parks, vaccinating nearly 1,000 children whose parents Simply needed easier access to immunization services
It is not enough for health services to expect parents to come to them.
Proactive approach and offering these kinds of easily accessible vaccine programs would help prevent future outbreaks.
Since the global decline in vaccination rates mainly results from practical or logistical issues, it is often more important to have everything in place for a successful vaccination program.
This means having enough vaccines to go around, through services that are well organized, easy to access and supported by government efforts to increase public confidence in vaccination.
About this piece
Helen Bedford is a professor of children's health at University College London.
You can Follow her on Twitter here .
Edited by Eleanor Lawrie