On Wednesday, Ireland’s first confirmed case of measles this year, an adult, died in the Dublin Midlands Health Area.
This follows a cabinet meeting on Tuesday, where Health Minister Stephen Donnelly warned colleagues that a measles outbreak is likely in the coming months.
The World Health Organization (WHO) also warned of an “alarming” rise in cases in Europe. Approximately 42,200 cases were reported in 2023, compared to 941 in 2022.
Several public health experts and doctors who spoke to Prime Time agreed with Minister Donnelly’s assessment and expressed concern about the potential impact of a measles outbreak in Ireland.
“No doubt we will see incidents.” [in Ireland]…The real question will be what those chains of transmission will be and how large the outbreak will be,” said Pediatric Infectious Diseases Consultant at Child Health Ireland. said Cillian Ó Mardamnay.
Measles is a highly contagious disease that can result in hospitalization, disability, and even death in children.
The MMR vaccine (which covers measles, mumps and rubella) has been available in Ireland since 1985.
“In terms of the level of effectiveness, the two-dose measles vaccine is probably 99% effective. It not only blocks the disease in individuals, but it also appears to significantly reduce transmission.”Trinity Vaccine Immunization said the professor. Ed Lovell of University College Dublin said:
Doctors say vaccination rates have declined in recent years and are now below what is needed to prevent community-acquired outbreaks.
The WHO and other health organizations say 95% of the population needs to be vaccinated with the MMR vaccine to achieve and maintain herd immunity. Furthermore, when the infection rate falls below that threshold, the risk of an outbreak increases and the likelihood of a large outbreak increases.
The MMR vaccine is given in two doses. The first dose is usually given at 12 months of age and the second dose in the first year of primary school, when he is 4 years old or she is 5 years old.
The latest data from the Health Protection Surveillance Center (HPSC) shows that the first vaccination rate for the MMR vaccine in Ireland has fallen to 89.2%. The announcement means the figure has been below 90% for six consecutive quarters, the first time since 2008.
Vaccination rates also vary by region, with vaccination rates in Louth and Meath below 80%, while in south-west Dublin the rate is 94.4%.
Rates of second-dose vaccinations, which are usually given in schools, are also declining nationwide. The latest HPSC data for 2021-2022 shows vaccination coverage in schools is 87.5% and in areas where GPs administer second doses, it is 86.3%.
Uptake rates had been declining before the pandemic, but fell “significantly” from 2019/2020 to 2020/2021, according to the HPSC report. During this period, rates fell from 91.1% to 88.0% in schools and from 90.3% to 88.1% in GP practices.
Professor Lovell said the trend was “very worrying”.
“Twenty years ago, people were talking about global eradication of measles… and now we’re really trying to stem the tide of increasing measles incidence.”
“It’s done, it’s effective, it’s been deployed, and now we’re going backwards,” he added.
Experts who spoke to Prime Time cited a variety of reasons why fewer people are vaccinating their children, but most of the related concerns are “complacency” or “misinformation.” It may be classified under this heading.
Self-satisfaction
According to Niall Conroy, consultant in public health medicine and health protection and adjunct professor of public health at University College Cork, complacency with the disease itself is one of the main reasons.
“Measles has not been a feature of life in Ireland for many years,” Dr Conroy said, leading people to believe it was “a relatively benign disease”.
“Unfortunately, as someone who has treated hundreds of measles cases in my career and been at the center of quite a few measles outbreaks, I can tell you that this is far from reality.”
Dr. Conroy worked in public health in Somalia in 2015. At that time, measles cases were rapidly increasing, and we realized that low vaccination rates among children were playing a role.
“At best, measles can make children really, really miserable and give them a high fever for a few days,” Dr. Conroy said.
“I have seen many children die from measles and many children become very sick from measles. This is a disease that we should never be complacent about,” he said. I did.
Measles can also cause very painful ear infections, measles pneumonia, and in rare cases, encephalitis, a very serious swelling of the brain.
Dr O Maoldomhnaigh, who works opposite CHI Crumlin and Temple Street, says there is an element of “collective forgetfulness” when it comes to measles and vaccinations.
“When you don’t see the immediate danger of something like this, you’re less motivated to do it, and that’s natural,” he added.
Dr Scott Walkin, a general practitioner in Sligo and Mayo, agrees.
“It is human nature that when a vaccine is highly effective and significantly reduces the incidence of disease, what is ‘out of sight’ is ‘out of mind’. And… You can become complacent,” he said. Prime time.
Professor Lovell said the problem is that measles is not only serious, but also more contagious than the virus that causes influenza and Covid-19.
“On average, one infected person can infect 12 other people,” he said.
“When we find ourselves in the following situation on a global scale, [vaccination] Levels are dropping, but if people travel and come back… an outbreak could occur. ”
Dr O Maoldomhnaigh added that during lockdown, “people weren’t leaving their homes, they weren’t going to their GPs, so they weren’t getting their children vaccinated.”
“It was also a situation where the virus wasn’t circulating in the community, so people had less reason to go to their GPs, so perhaps people were less interested,” he added.
Vaccine misinformation
Misinformation is also a major problem when it comes to vaccines in general, Dr. Conroy said.
The MMR vaccine in particular has been the subject of misinformation and harmful false claims, resulting in severe measles outbreaks and deaths.
Most notably, in 1998, British gastroenterologist Andrew Wakefield published a study in the Lancet medical journal that attempted to link the MMR vaccine to autism.
The study received extensive media attention around the world in the years following its publication, and a small number of Irish doctors publicly supported this conclusion. However, this finding was later disproved.
In 2010, the study was retracted from The Lancet and Wakefield was removed from the UK medical register.
“I think some people probably don’t know that Andrew Wakefield has concerns about MMR, and that those concerns have been shown to be completely unfounded,” Dr. Walkin says.
“It may be very difficult to put the genie back in the bottle… [still] It’s an element of residual effects,” he added.
In 2000, an outbreak of measles in Ireland, which Dr. O. Moldhomnay said was linked to the attention of the Wakefield paper, resulted in hundreds of children being hospitalized and three children dying.
“There is certainly still a group of vulnerable young people, vulnerable people, who are part of the Wakefield generation,” Dr O Maoldomhnaigh says.
A 2023 study by the HPSC’s National Serosurveillance Program, which estimates and monitors immunity in Ireland, estimated that 10.7% of adults aged 18 to 34 have no immunity to measles.
For men aged 18-19 born in 2003-2004, this number jumps to 17.9%. This change is not seen in women, according to the report.
The report said “unreliable studies” linking the MMR vaccine to autism “may have contributed to widespread vaccine hesitancy and impacted vaccination uptake.”
“Parental behavior regarding children’s MMR vaccination differed for males and females. This may have been influenced by public perception that males have a higher overall risk of autism. There is a sex.”
Wakefield, now based in the United States, is a prominent figure in the anti-vaccination movement and has risen to prominence again during the pandemic.
Dr. Conroy said misinformation from the original study, which was retracted, still affects the population of parents of young children.
“Sometimes things like this can get in people’s minds and cause them to take a moment to think about getting vaccinated, or choose to avoid vaccination as what they think is the least risky option.”
During the COVID-19 pandemic, general anti-vaccine sentiment and misinformation gained significant attention, especially online.
“Misinformation about vaccines often piggybacked on popular conspiracy theory messages,” Dr. Conroy added.
“There has been no doubt that confidence in childhood immunization programs around the world has declined during COVID-19.” [but] there was nothing new [scientific] Problems with routine vaccination during the pandemic are likely due in large part to a gradual increase in common anti-public health misinformation. ”
“For those unfamiliar with the vast amount of safety and efficacy data on vaccines like MMR, it can be easy to be fooled by people with impressive-sounding credentials and convincing graphics. Yes,” Dr. Conroy added.
He said that behind most misinformation are “well-intentioned people falsifying data that they haven’t properly analyzed, or more malicious people using misinformation to drive clicks on social media platforms.” It is said that there is a person.
“In both cases, the children end up suffering.”