Monday Malady: Measles

As a healthcare writer and a mum, my knowledge of many things medical has on occasion been called upon by friends and relatives. I never proclaim to be an expert on diagnosis, but now and again a friend will ask for advice. Usually about vaccines.

I’ve been asked about the whopping cough vaccine, the flu vaccine, but most of all the MMR vaccine. Were we allowing our children to be vaccinated? Was I happy that the claims linking MMR to autism really were false? Surely, there’s no smoke without fire? In 2006, 8 years after Andrew Wakefield published his now-discredited paper, my friends were still more fearful of the MMR vaccine than of measles, mumps or rubella.

Many of us could remember having measles or mumps as a child. It didn’t seem that bad. No worse than chickenpox surely. So why were we being asked to subject our precious babies to the (albeit transient) trauma of vaccination? Were these childhood diseases not just part of childhood and a good way to strengthen the immune system?

No. They’re not just a part of childhood. Or at least they don’t have to be thanks to the MMR vaccine. Those of us that can remember having measles or mumps as a child were lucky. We probably weren’t malnourished or immune deficient, otherwise we would have been at risk of developing pretty serious complications. Up until the introduction of the MMR vaccine in 1988, measles was a major cause of morbidity and mortality in the UK. Between 1970 and 1983, more than half the acute measles deaths that occurred were in previously healthy children who had not been immunised (Miller CL (1985) Deaths from measles in England and Wales, 1970–83. BMJ (Clin Res Ed) 290(6466): 443–4.)

Otitis media (7 – 9% of cases), pneumonia (1 – 6%), diarrhoea (8%) and convulsions (one in 200) were common complications of measles and in 1993/94, a measles epidemic, affecting the west of Scotland, led to 138 teenagers being admitted to one hospital.

Following the introduction of the MMR vaccine in 1988 and uptake levels in excess of 90%, measles transmission was substantially reduced and confirmed cases of measles fell steadily to very low levels. Until 2006, the last confirmed death due to acute measles in the UK had been in 1992. Measles was becoming a thing of the past. It’s no wonder that many parents became complacent about vaccination and decided that the perceived mild risks of a childhood disease like measles was a better bet than a frightening vaccine with many a tabloid headline to its name.

Sadly, measles is now beginning to rear its ugly head again. In 2012 there were 2,030 confirmed cases of measles in England and Wales. In 1998, there were 56.

The current outbreak in Swansea has affected over 600 children.*

The success of the MMR vaccine at almost eradicating the measles virus was cruelly its undoing. People forgot about the risks of not vaccinating. They forgot that vulnerable children, including babies too young to be vaccinated could die from measles. Herd immunity protects these vulnerable children by ensuring that the virus is no longer circulating in the community. Vaccination is about more than protecting the individual.

In a world of instant global communication and instant gratification, it’s easy to think that measles is a virus we left behind with formica and angel delight. But we’d be wrong. It was just waiting for the opportunity for a revival.

*An update on the BBC website today (16th April) reported that the number of cases had now risen to 765.