Measles flare-up feared as parents shun
MMR jab
BY SAM LISTER, HEALTH CORRESPONDENT
BRITAIN faces a measles epidemic this winter on a scale not seen for
more than 30 years as a direct consequence of the drop in uptake of
the combined measles, mumps and rubella vaccine.
Experts from the Health Protection Agency (HPA), the Government´s
public health watchdog, said that London is at imminent risk of a
severe measles outbreak.
Analysis suggests that a national epidemic will follow within the next
two years as rates of infection reach critical levels. As many as 12 per
cent of children and 20 per cent of adults could be taken to hospital
because of lower natural immunity.
Latest MMR figures, released last month by the Department of
Health, showed uptake of the combination vaccine among two-yearolds
fell by 2 per cent in the 12 months to April, to a low of 80 per
cent. The HPA has analysed data on MMR coverage, measles
epidemiology and population levels of immunity amid growing
concerns that the jab is being shunned.
As a result, the agency predicted that an epidemic of the infection
could occur at any time and affect thousands of children. The latest
figures on MMR uptake are a drop of 12 per cent on the peak of 92
per cent coverage seen in 1995-96, before research claimed that the
MMR jab was linked to autism. The research by Dr Andrew
Wakefield, published in The Lancet in 1998, has since been
discredited, although many parents remain concerned.
The latest large-scale study, published last month in the same
medical journal, concluded that there was no evidence to support a
link between the combined vaccine and autism in children. But
confidence in the jab remains low — well below the 95 per cent
recommended by the World Health Organisation — despite the efforts
of health officials to reassure the public.
London has one of the lowest uptakes of MMR at 70 per cent, falling
to 62 per cent in southeast London and 69 per cent in northwest
London.
Using their data, the HPA calculated that the “reproduction number”
— the number of infections resulting from each case — had already
reached the critical watermark of 1.0 in London. They said it would do
so in the rest from the UK from 2005-06.
Mary Ramsay, consultant epidemiologist at the HPA, said: “We´re
predicting an epidemic from this, and many places in London are
already at a point where an epidemic can occur.”
Reporting the HPA´s concerns, Pulse, the medical publication, said
that poor immunity meant an average of 15 per cent of children and
adults would be admitted to hospital if infected by measles. As well as
having a rash, people with measles can suffer serious complications
such as meningitis and pneumonia. It is more common for eyes and
ears to develop a secondary infection needing antibiotics.
Infectious disease experts believe that London alone has 350,000
susceptible youngsters under 16 and could face an epidemic of many
thousands of cases. The HPA is working with public health officials in
London to formulate an emergency plan to stop measles spreading.
Some parts of London have already seen outbreaks of the infection.
Before vaccination started in the late 1960s, Britain had about
800,000 cases and 100 deaths a year from measles.
Vaccination rates rose from about 50 per cent in 1968 to 76 per cent
in 1988. These had led to a steady decline in measles cases. The
introduction of MMR in 1988 caused a further increase in the
vaccination rate. This wiped out measles as an endemic disease. But
people continued to bring the virus into Britain from abroad, causing
small outbreaks.
There were 71 measles cases in 2001 and 308 in 2002. The largest
outbreak affected about 100 people. Phil Johnson, editor of Pulse,
said: “GPs have been warning for years that the continued fall in
MMR uptake would have dire consequences for patients. It looks like
those predictions will be proven correct. A measles epidemic was as
predictable as its consequences for patients and health professionals
will be serious.”
Graham Fraser, HPA regional epidemiologist for London, said: “We
are aware that for several years the number of children in London
susceptible to measles have been steadily increasing, and we are
concerned about the increased risk of an epidemic. We are working
closely with the directors of public health in London and the
Department of Health to plan a response to tackle this situation.”
A Department of Health spokeswoman said: “There is no measles
epidemic in the UK — so far this year the cases of measles are less
than they were last year. Coverage of the MMR vaccine has risen in
three out of the last four; however, we recognise that overall coverage
is lower than ideal and this leaves a concerning vulnerability. We
encourage parents to vaccinate their children with MMR as the safest
form of protection from the disease.”
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