Are we losing the global fight against measles?
On 29 August 2019, the World Health Organisation (WHO) reported that, following several years of steady progress toward elimination of measles in the WHO European Region, the number of countries having achieved or sustained elimination of the disease has declined. Closer to home, a measles outbreak in New Zealand is also causing serious concern, with 1,131 cases confirmed between 1 January 2019 and 9 September 2019. We spoke with Doctor Vikram Vaska, Consultant Microbiologist at Mater Pathology, to discuss how this may have happened and what it could mean for the future.
“The WHO certifies a country's measles status based on data collected and reviewed by experts. The term ‘eradication’ indicates that measles is not circulating in a country and also that any spread of the disease into the community from imported cases can be controlled. Measles remains one of the leading causes of illness and death among young children globally, despite the availability of a safe and effective vaccine. Therefore, re-establishment of measles transmission is a serious concern.
“Measles is an acute viral infection that typically causes fever, cough and other respiratory symptoms followed by a widespread rash. It is spread by respiratory secretions - including by airborne spread of infectious particles. It is highly infectious and non-immune persons who have close contact with an infectious case will almost always become infected. Even previously healthy persons can become severely unwell and require hospital treatment. Complications in some of those infected with measles include pneumonia and encephalitis. Deaths are noted to occur around the world in groups such as malnourished children but also occasionally in those who are otherwise well,” said Doctor Vaska.
According to the WHO, the countries of Albania, Czechia, Greece and the United Kingdom have all lost their measles eradication status. This, along with the current measles outbreak in New Zealand highlights the importance of maintaining high measles immunisation rates.
“Measles had been eradicated in Australia and New Zealand within the last few years. However, cases can occur in travellers arriving in or returning to Australia or New Zealand from overseas, with the possibility of spread of the disease to others in the community. Where there are areas with numbers of non-immune people, measles can become re-established from cases contracted elsewhere. An increase of cases in a community leads to the possibility of serious complications, including death. It is essential that those travelling overseas check that they have been vaccinated against measles regardless of their destination. In New Zealand, the Ministry of Health is advising that unvaccinated individuals in New Zealand avoid travel to Auckland.
“Preventing transmission of measles requires high vaccination coverage (>95%) to be maintained. Measles is highly infectious, and if re-established in a community, those with limited immunity are most at risk, including infants and young children too young to have received the full vaccination course. Countries with measles outbreaks in recent years have experienced a range of challenges, including a decline or stagnation in overall routine immunisation, low coverage among some groups, and immunity gaps in older people. Most cases of measles are unfortunately occurring in unvaccinated or under-vaccinated individuals,” said Dr Vaska.
In Australia, many people have had the recommended two doses of measles vaccine, and most people born in 1965 or earlier have immunity from having had the disease. To maintain Australia’s elimination status, it is critical that the high levels of vaccination with two doses of measles vaccine are continued.
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This article appeared in the September 2019 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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