Measles - another illness which should have vanished.

[Doc Alan]

Measles is a highly contagious disease caused by measles virus. Anyone can get it – but only once ( immunity is lifelong ) ; there is fever, rash, and cold-like symptoms. Most recover, but a few get severe complications like pneumonia and brain inflammation.


• It caused millions of deaths worldwide before measles vaccines. There were still up to 158,000 deaths in 2011 ( World Health Organisation ). High levels ( 95% ) of vaccine coverage are desirable. Recent outbreaks in sub-Saharan Africa, Europe, and the USA show how measles viruses can re-enter communities.


• Now the latest epidemic centred on Swansea in south Wales has affected over 800 people. Outbreaks elsewhere are occurring and expected, with possibly a million UK children in secondary school at risk.


• Two doses of the MMR ( measles, mumps, and rubella ) vaccine give near complete protection. They should be given around 12-13 months, and then around 4 – 5 or 6 years old. This applies to UK and Philippines.


• MMR may also be given to older children or adults, including women planning pregnancy ( rubella, not measles, may cause congenital abnormalities ).



• MMR is safe ! Side-effects at most may include mild forms of measles / mumps. But as we now know, measles outbreaks ( at least in the UK ) are the result of a health scare. A Dr Wakefield suggested a link between bowel disease, autism, and MMR. His work was published in the Lancet ( which later discredited it ). He was finally removed from the General Medical Council register in 2010. There is NO good evidence linking the vaccine to autism or bowel disease.


• As a result, the proportion of children vaccinated fell as low as 80 %. Rates have risen again but not ( yet ) to 95 %. There is an urgent need for those who have not been vaccinated – especially children – to do so as soon as possible.


• Deaths from measles are fortunately now rare in the UK and other western countries ( possibly 1 in 1000-3000 infections ). But it’s a more severe infection in the tropics – World Health Organisation reporting 28 deaths in the Philippines in 2011.


• The Philippines is aiming to eliminate measles through “ Ligtas Tigdas “ ( “ Safe from measles “ ) vaccination campaign, started a decade ago. Before then, thousands died from measles complications – mostly children from poor households with least access to public health. Vaccination rates are claimed to be good, but not yet at the 95% level needed.


• Measles really is an infection which should be consigned to the history books . The outbreak in Wales was unnecessary, and the UK may not even have seen this epidemic reach its peak. Two lessons have been learned – medicine must be evidence-based, and MMR is safe and effective .


http://www.nhs.uk/Conditions/vaccina...r-vaccine.aspx

http://www.nhs.uk/conditions/Measles...roduction.aspx

http://www.bbc.co.uk/news/health-22203121

[Jamesey]

I was just watching a debate about this on Question Time. The panellist from the Daily Mail made me so angry when she tried to defend that paper's sensationalist and scare-mongering stories about the MMR so-called "scandal".

I would be in favour of compulsory vaccination of all children.

[Jamesey]

medicine must be evidence-based

[Steve.r]

Thanks for that Alan, I will make sure that Vincent has had his Ligtas Tigdas injection, and if not, he will get it soon.

[Trefor]

One thing I can't understand is that with all the negative press around the combined MMR vaccine (whether true or false), why people didn't just pay for individual vaccines for their children if they didn't want 'risk' MMR.

[Doc Alan]

No vaccination is compulsory in the UK ( or the Philippines ) but of course if enough ( over 5% ) parents choose not to vaccinate their children, they put them at risk and encourage spread of infections.

Single vaccines would need six separate injections which would delay complete protection. Results ? Measles outbreaks, babies born with congenital defects from rubella in the mother, and complications of mumps like deafness.

Even if parents didn’t know this and were mislead by the unfounded scare stories about MMR, uptake has been poorer with single vaccines. Before the health scare, there were more MMR vaccinations than previously with the single measles vaccine.

MMR is the vaccine of choice in many countries worldwide, including UK and Philippines. No country recommends single vaccines – MMR has been more thoroughly tested than the single vaccines it has replaced.

[Doc Alan]

I’m not sure what more I can do to publicise this illness – which is serious in the UK ( about a tenth have required hospital treatment in Swansea ; up to a fifth in the north east of England ) - and even more so in the Philippines .

All I can hope is that members who might have reason to consider MMR will do so promptly. Children and young adults are most at risk as they are least likely to have acquired natural immunity.


It seems that only 4 out of 5 of the general public think MMR is safe ; just over half support compulsory vaccination ; about half blame newspapers and/or “ Dr “ Wakefield for the low uptake ( “ YouGov “ quoted in yesterday’s Sunday Times ). Private clinics selling single measles vaccines have put childrens’s health at risk by quoting discredited research on the risks of autism. It’s hard if not impossible to obtain single mumps vaccines in the UK. A course of available single vaccines could cost hundreds of pounds. MMR is safe and free !

[Doc Alan]

I judge this topic to be important in BOTH our countries. If it’s reminded just one moderator to have his son vaccinated, that’s reward enough .


Over two thousand cases of measles in the UK ( mostly England and Wales ) last year, and three times that number in the Philippines ( 2011 ) is sufficient cause for concern, in my opinion - especially as the numbers have increased recently .


Cambodia has just celebrated over a year without a single reported case of measles, thanks to an effective vaccination programme, and other countries are well on their way to eliminating the virus.


You can easily Catch measles, but you Can’t Catch up with it ! It’s likely there will be outbreaks on a larger scale than Swansea. Rates of MMR uptake in areas of London - for example - are far lower in 10-12 year olds than elsewhere in the UK. Scotland and Northern Ireland suffered less from the low vaccine uptake following the “ Wakefield “ health scare.


Failure to vaccinate is the main cause for measles outbreaks :-


• Complacency ( it’s often not that serious … but in the world over 400 children died every day from measles in 2011 ; mumps and rubella may also be serious )


• Confidence ( lacking, post “ Wakefield “ and misleading press / internet )


• Communities … Crowding … Convenience ( remote, lack of health personnel, bureaucracy ); Cost too high; Conflict in certain regions.


• Compulsory vaccination – NOT essential for high vaccine uptake, proved in many countries. Better to invest in improved access.


• Conscientious objections exist; also Certain individuals ( with illnesses preventing good immunity ) Cannot be safely vaccinated. They are susceptible to the very illnesses which MMR would prevent in the community !


• Check with your doctor if you’re not sure whether you or your children have been vaccinated. A second MMR vaccine won’t harm ( if in doubt ).




Good health and happiness to ALL members and their loved ones .

[Steve.r]

Thanks Alan, Vincent is covered

[Rosie1958]

My son had the MMR vaccination when he was around 14/ 15 months old and promptly caught a mild form of measles. I am sure that he would have had a much stronger bout later on had he not had the vaccination

Understanding some of the awful affects that measles can have (meningitis and encephalitis to name two of the serious ones that could be fatal) I believe that those parents that don't have their children innoculated are putting them and others at risk. The MMR vaccination is there for a reason, we are so lucky to have it available and it's a no-brainer not to want to protect your children

I am just getting over a second bout of shingles which is related to the chicken pox virus and it's a pity that there isn't a vaccination for chicken pox which I suffered from quite badly with numerous complications when I first started school.

[Steve.r]

I am just getting over a second bout of shingles .

My Father also had a bout of this last year Rosie, I know how it made him feel and it took several months to fully recover. He is fine now, but it's not nice.

[Doc Alan]

It’s serious – if understandable - that lack of resources have so far prevented “ Ligtas Tigdas “ from eliminating measles in the Philippines. But there’s now a spectre of measles outbreaks in the UK – not just through lack of resources, but for additional reasons. There are too many susceptible individuals, especially children. About 1/10 have had no MMR ( and another 1/10 only 1 dose ). It’s hard to predict where the next outbreak will be.

As for chickenpox, it’s caused by the same virus ( herpes varicella zoster ) that causes shingles, usually in later life.

The chickenpox vaccine is not part of the routine ( free ) UK childhood vaccination schedule, nor is it ( to my knowledge ) routinely recommended in the Philippines.

There is a case for more chickenpox vaccination - although it doesn’t give complete protection, with concerns that it might increase the chance of shingles later in life. Note that if someone has not had chickenpox ( naturally / vaccinated ) they can catch it from someone with shingles, but shingles is not spread person-person.

There are changes planned for the UK later this year – including rotavirus vaccine ( the virus is a cause of diarrhoea and vomiting ) for babies, and a flu vaccine for 2 year olds.

Also planned - not a moment too soon – is a shingles vaccine for people in their 70s across the UK. This type of vaccine is not ( to my knowledge ) yet readily available in the Philippines.

(http://www.nhs.uk/Conditions/vaccina...x-vaccine.aspx http://www.bbc.co.uk/news/health-22335511 )

[andy222]

Great post doc very informative.

[Steve.r]

Is Shingles something that once you have had it you are then self immunised?

[Doc Alan]

It is possible to have shingles more than once, but this is uncommon. It tends to recur where the person’s immune system is weaker because of ageing or other illness. For the same reason the proposed vaccine is not expected to be effective in all cases ( perhaps as few as half ).

Usually shingles – pain and rash because of viral infection of a nerve, often many years AFTER chickenpox – occurs for no obvious reason. In most cases there are no complications, and antiviral drugs are not routinely needed.

It used to be thought that you could only get chickenpox once , but we now believe a small proportion do get it more than once – because they haven’t developed adequate immune ( antibody ) response, and not just because it was misdiagnosed in the first place.

I don’t intend to scaremonger over the topic of measles and other vaccinations. But whether or not to vaccinate – while it remains an individual decision - does have effects beyond those making it; on their dependents and other contacts.

( http://www.bbc.co.uk/news/health-22335512
http://www.patient.co.uk/health/shingles-herpes-zoster )

[Rosie1958]

Thanks for the information and link to the details on Shingles, Doc Alan.

I am aware that 1 in 50 people will suffer from shingles more than once and this is confirmed in the article. I guess I was unlucky to have chicken pox aged 5, my first bout of shingles at 41 and the latest episode now at 54 - (and I previously thought that I was healthy!). It was quite a coincidence at the time of my first bout of shingles to later discover that whilst I was visiting a local primary school as a governor, I had unknowingly been in contact with a number of school children who were suffering from an outbreak of chicken pox and the selfish parents had sent them to school!

This time around, I was prescribed an antiviral drug which I am still taking and my spots are now fading fast so I am no longer infectious. I was interested to read in the article you provided that the USA has been routinely innoculating against chicken pox since 1996 but there is a concern that this may cause shingles in later life.

Anyway, back on topic, as a responsible parent, I fully support the innoculation of the MMR vaccination together with the booster

[sars_notd_virus]

I have a question Doc Alan...
My daughter has been given all this vaccination in the Philippines by her pedia , she had the first and 2nd dose of MMR ,...but recently we received a letter from our local surgery here in the UK about the measles outbreak in Wales and is asking a permission from husband and I about it,...shall we go on with it ? or do i just have to let them see my daughters vaccination book.
my only worry is that i believe viruses have got different strains here in the UK , will this MMR vaccine they are using be the same vaccine they have in the Philippines?

[Doc Alan]

The MMR vaccine contains weakened versions of live measles, mumps and rubella viruses, proven to be safe, which causes the immune system to produce antibodies to these viruses.

To my knowledge the vaccine is the same worldwide because these viruses ( measles, mumps and rubella ) are “ stable “ - they don’t mutate / change like ‘flu viruses, for example. The vaccine likely to have been used in the Philippines ( “ Priorix “ ) produced by Glaxo-Smith-Kline, is one of the two available in the UK ( the other is “ MMRvaxPro “ produced by Sanofi-Pasteur ).


Mari, your daughter should be immune. Of course, as I know you’re responsible parents, it would do no harm to show the vaccination record at your surgery. It’s so important for everyone coming to the UK from the Philippines ( or elsewhere ) to keep as comprehensive a medical record as possible – not just a “ TB certificate “.


Measles, mumps and rubella are highly infectious, common conditions that may have serious complications – and are preventable by a safe vaccine. Parents should be encouraged to have their children immunised, without – in my opinion – any attempt to make vaccination compulsory.

The measles vaccine was introduced in the 1960’s in the USA and UK. Without the vaccine, millions of children would have died worldwide. It has virtually been eliminated in the USA ; the Western Pacific Region is on its way to elimination ; but Europe is lagging behind other, poorer areas of the world.

The World Health Organisation aims to reduce worldwide measles deaths by 95% ( if not to completely eliminate it ) in the next two years. It would be a failure of UK – or Philippines - public health if easily preventable diseases like measles could not be controlled.

[sars_notd_virus]

Thank you doc Alan. You are the best..
I have booked an appointment with her GP ...to show them her vaccination booklet again...i have provided copies of my daughters medical history on our "first" visit with her GP here in the Uk...I Wonder why it is not in their database and have to waste paper to remind us over and over again.

[Doc Alan]

The “ Ligtas Tigdas “ ( “ Safe from measles “ ) national campaign launched a decade ago by the Philippines Department of Health (DOH) has - so far - not been a complete success. There has been a recent upsurge of cases in certain areas , especially Metro Manila. DOH recorded over 1,700 cases, and 21 deaths ( due to complications like pneumonia ) in the country last year.


The ONLY way of preventing measles is through vaccination – preferably “ two jabs “ each for at least 95% of children – and this has not been achieved in the Philippines recently . Such vaccinations should be available for free. Reasons suggested for children missing vaccinations include family mobility ( changed residences, moving to other towns / cities ), and parents who don’t get their children vaccinated for religious or other beliefs ( rather like the UK health scare by - then - doctor Wakefield in the early 2000s ).


Health workers are now being mobilized for an enhanced measles vaccination drive, especially in Metro Manila, to slow – or stop – the virus from spreading.


Numbers of measles cases in the Welsh outbreak, which was declared over last July, after 8 months, were over 1,200.


The Philippines and UK are not alone .


World Health Organization ( WHO ) reckons about 160,000 people died from measles in 2011. Shocking, but still FAR fewer than in 2000 - over half a million deaths. Worldwide measles control efforts do seem, for various reasons including cost, to have stagnated.


At least half of the 20 million children worldwide who were NOT vaccinated live in five countries ( Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan ). Large outbreaks were reported in these countries in 2011, but there were also significant outbreaks in the Philippines, Europe ( especially France and Italy ), and other countries.



The WHO Region of the Americas has actually maintained measles elimination since 2002. Although WHO Western Pacific Region ( which includes the Philippines ) is hopeful also of achieving elimination, outbreaks such as still occur in the Philippines are slowing progress. It is also likely that Western Europe will miss its target. Resistance to vaccination has prevented coverage from reaching the " 95% benchmark ".

Among possible reasons for this : –

• Europeans have forgotten how nasty the disease can be ;


• mistrust of vaccination ( unjustified ) ;


• people are trusting “ herd immunity “ ( if they think everyone else is vaccinated, why should they bother ? ).


Good luck to the Philippines' renewed drive for vaccination . Measles is vaccine – preventable, and truly another illness which SHOULD by now have vanished.



http://www.thelancet.com/journals/la...133-6/fulltext

[grahamw48]

My sister contracted Measles when she was 6 years old...and it almost killed her !

I made sure my son had all the required vaccinations. I still have all the records, including everything from his ultrasound scan picture when he was still in the womb, birth details, and beyond.

[Doc Alan]

• Last year’s Philippines " final measles tally " of 58,010 cases ( quoted in another thread ) is the total suspected cases, far more than those actually confirmed by laboratory, clinical and epidemiological tests; it’s unclear whether the 110 deaths claimed were based on clinical diagnoses during life and / or post mortem examinations. Pneumonia is the least uncommon cause of death. Regardless of their accuracy, it is clear that the Philippines has a continuing problem with a serious, but vaccine-preventable, infection .



• Measles may usually be diagnosed clinically – from symptoms, signs, and a history of exposure to other(s) with measles. Lab tests are to confirm a clinical suspicion; to test for immunity following infection or vaccination ; and for public health purposes.



• The UK NHS ( like the USA CDC ) recommends travellers to areas known to have had outbreaks to be vaccinated. It’s generally safe to have the MMR ( measles, mumps, and rubella ) vaccine, which is free on the NHS. Although no vaccinations are compulsory in the UK ( unlike the USA ) MMR should be routinely given to children as part of the childhood immunisation programme.


• If you’re unsure whether you have had the MMR jab, check with your GP / practice nurse – a repeat course ( two jabs ) may safely be given. MMR is preferable to single vaccines ( a course of 2 jabs is more likely to be completed than 6 " single " jabs ).


• The MMR vaccine doesn’t cause autism or bowel disease – any side effects which may occur are usually mild. There is, however, still a minority who are reluctant to have MMR, or for some parents to allow their children to have it. Unless there are good clinical reasons ( such as immune deficiency ), it should be encouraged, not only for the individuals but also to protect others ( " herd immunity " ).


• The vaccine is recommended, and available for free, in Philippines health centres. It seems, however, that a " donation " is required in such clinics, which adds to the difficulties in ensuring mass vaccination ; such as poverty ; lack of access ( including moving residences ) ; ignorance and prejudice. " Ligtas sa Tigdas ang Pinas " started over a decade ago, but clearly needs to be intensified .



• For members who wish to know more, these are a few useful links :-

1. Philippines measles " profile " :-

http://www.wpro.who.int/immunization...4_phl.pdf?ua=1

2. Measles information :-

http://www.nhs.uk/conditions/Measles...roduction.aspx


3. MMR vaccine :-

http://www.nhs.uk/conditions/vaccina...r-vaccine.aspx


4. Lab tests for measles :-

http://labtestsonline.org.uk/underst...sles/tab/test/

[Michael Parnham]

Great thread Alan as usual, checked with Maritess and her family about what injections they have had in their lifetime and no one seems 100% sure!

[Michael Parnham]

Thanks Alan