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Major Measles Outbreak Erupts In England As Vaccine Hesitancy Increases
Child with measles.
gettyIn England, the Birmingham Children's Hospital is currently grappling with a major outbreak of measles. More than 50 children have been hospitalized in the past month. Vaccine-preventable diseases such as measles and polio remain a public health threat. And with childhood vaccine hesitancy—or simply outright refusal—on the rise in the U.K., U.S. And Europe, the problem is likely to worsen.
The measles outbreaks in the U.S., including most recently in Philadelphia, are worrisome. But the situation appears to be more severe in England. There, cases have been surging. According to new figures released by the U.K. Health Security Agency there were 1,603 suspected cases of measles in 2023, which represents an increase from 735 in 2022 and 360 in 2021.
The spike in cases is fueled by vaccine hesitancy towards the measles, mumps and rubella shot. According to National Health Service England, in December 2022 the MMR vaccination rate in the Birmingham region was around 83%. To optimally protect the population, a rate of at least 95% is critical.
The UKHSA has confirmed that the West Midlands, which encompasses Birmingham and the area surrounding it, is the epicenter of the largest current outbreak of the infection in the country. In just the past month the agency's figures show there have been at least 167 laboratory confirmed cases with a further 88 likely cases and more than 50 children hospitalized. Remarkably, around 80% of the most recent cases in Europe have been in the West Midlands.
Looking a bit further back in time, at the period from January to October of last year, there were 30,000 recorded cases of measles across Europe. This constituted more than a 30-fold increase compared to 2022.
The disease causes an initial flu-like illness with symptoms that include a high fever of over 103 Fahrenheit (39.4 Celsius), copious congestion, red eyes and a rash that spreads around the entire body. Patients with measles can develop ear infections, severe gastrointestinal upset, pneumonia and brain swelling. It's the latter that killed author Roald Dahl's seven-year old daughter, Olivia, in 1962. This was before the advent of vaccines.
In 1986, Dahl penned an essay about her death as an appeal to parents everywhere to vaccinate their children. Dahl wrote:
"Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of colored pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn't do anything.
"Are you feeling all right?" I asked her.
"I feel all sleepy," she said.
In an hour, she was unconscious. In twelve hours she was dead."
In the 1960s, measles was the single leading killer of young children globally. Vaccination campaigns significantly reduced mortality. Based on estimates published in the journal The Lancet, the global number of measles deaths in 2020 was 60,700, a 94% decrease from 1,072,800 deaths in 2000, and a 98% drop from 2,600,000 deaths in 1980.
However, from 2020 to 2022, measles fatalities worldwide have more than doubled, reaching 136,000.
And after having achieved measles elimination in 2017 the U.K. Relinquished that status due to re-established endemic transmission of measles.
Measles isn't the only vaccine-preventable disease that poses a public health threat in Britain and elsewhere. Others include polio. In 2022 there was sustained detection in London, according to an article published in The Lancet. Specifically, 118 type 2 poliovirus isolates were identified in sewage samples collected in the city between February and July 2022. After an intensive public health campaign to boost polio vaccinations, transmission levels, as suggested by wastewater monitoring, diminished by March 2023.
Reluctance on the part of vaccine skeptics to have their children receive the two-dose MMR series and other jabs targeting polio, diphtheria, tetanus, whooping cough and hepatitis B, is due to lingering fears around debunked claims linking the shots to autism and other disorders. The launch of Covid-19 vaccines seems to have prompted more unwarranted concerns about vaccination.
But the more people forego childhood immunizations, the greater the chances infectious diseases such as measles stage a comeback as we're witnessing today. The now persistent problem of the return of vaccine-preventable diseases is a direct result of the steady increase in vaccine hesitancy lately.
In the wake of the upsurge in measles in England, British doctors and government officials are posting urgent pleas to parents to have their children vaccinated.
Going forward, elimination of measles and other communicable diseases such as polio can only be sustained by improving and then maintaining population-wide coverage of the vaccines children are supposed to take.
Oral Polio Vaccine Now Linked To Outbreak
Oral polio vaccine used for prevention of the disease has been linked to the recent outbreaks of the virus that is re-emerging in some countries, Kenya included.
It is emerging that the use of this oral vaccine, which contains some mild strains of the virus, will put a healthy person who is immunnised at risk when they come into contact with the vaccine-derived viruses.
The reason behind this risk, as disclosed by World Health Organisation (WHO), is that once the vaccine has done its job in stimulating one's immune system to create a defense against polio, it is excreted, but comes out already mutated.
It is this mutated version of the vaccine that ends up causing polio infections.
However, WHO Director of Polio Eradication Programme Michel Zaffran told the CNN that though the oral vaccine has been linked to the outbreaks, it is not yet time to withdraw it from the market.
"In terms of these outbreaks caused by the vaccine-derived viruses, this can only be stopped when we stop altogether using the vaccine, and we will not stop using the vaccine until we have eradicated the wild virus. So it's a chicken and egg situation," said Mr Zaffran.
After being polio free since 2013, Kenya is now alert of a possible outbreak after traces of polio Type Two virus were found in a sewage in Kamkunji, Nairobi.
This type of virus has been linked to oral vaccines by WHO, and has affected other countries such as Syria, Democratic Republic of Congo and Papua Guinea.
"But we first need to eradicate the wild virus. After that, we will actually withdraw globally the use of the oral polio vaccine," said Zaffran.
Papua Guinea was certified as polio free in 2000, while Kenya was set to be certified this year if no case arose.
After the alert, the Ministry of Health moved with speed to immunise children below the age of five years in Nairobi. Up to 817,000 children were targeted.
On Sunday, the Ministry concluded a four-day campaign to vaccinate 2.4 million children under the age of five in 12 high-risk counties.
The Director of Medical Services Jackson Kioko has also issued a directive to all counties to examine and report all findings on paralysis of the limbs in any child below 15 years, to determine if the floppiness was caused by polio.
Stunted growth
Other symptoms of polio include stunted growth, fever and pain in joints.
There are two types of polio outbreaks - one caused by the wild polio virus like that of the early 1900s and that caused by the vaccine itself, usually referred to as the vaccine derived polioviruses.
The injectable version of the vaccine, known as the Inactivated Polio Vaccine (IPV), is derived directly from the polio wild virus and resembles the original 1952 version, but is not as effective since it is not 'live' and only offers protection to the victim, but does not stop them from being infected.
This means one vaccinated by IPV, though they may not get to show signs of polio infections, they will still infect others, just like any other polio- stricken patient.
"IPV induces very low levels of immunity in the intestine. As a result, when a person immunised with IPV is infected with wild poliovirus, the virus can still multiply inside the intestines and be shed in the feces, risking continued circulation," states the Global Polio Eradication Initiative.
But it is not just this IPVs disadvantage that makes it not suitable, it is also the price: "IPV is over five times more expensive than Oral Polio Vaccine. Administering the vaccine requires trained health workers as well as sterile injection equipment and procedures," adds GPEI.
Related TopicsPapua New Guinea Polio Outbreak Declared
Polio remains endemic in Pakistan, Nigeria and Afghanistan, say global health officialsAn outbreak of polio has been confirmed in Papua New Guinea, 18 years after the country was declared free of the disease.
The World Health Organization (WHO) says the virus was detected in a six-year-old boy in April.
The same strain of the virus has now been detected in other healthy children in the same community, making it officially an outbreak.
Polio has no cure and can lead to irreversible paralysis.
It mainly affects children under the age of five, and can only be prevented by giving a child multiple vaccine doses.
"We are deeply concerned about this polio case in Papua New Guinea, and the fact that the virus is circulating," said Pascoe Kase, Papua New Guinea's heath secretary.
"Our immediate priority is to respond and prevent more children from being infected."
The US Centers for Disease Control and Prevention said at the end of last week that the same virus that was found in the six-year-old boy was also found in samples taken from two healthy children in the same community, the WHO said.
This means the virus is circulating in the community, representing an outbreak, it added.
Immediate steps to stop the spread of the highly contagious disease include large-scale immunisation campaigns and strengthening surveillance systems that help detect it early.
Papua New Guinea has not had a case of wild poliovirus since 1996, and the country was certified as polio-free in 2000 along with the rest of the WHO Western Pacific Region.
What is polio?Source: World Health Organization
Only 61% of children in the area affected - Morobe province on the northern coast of the country - currently receive the recommended three doses of polio vaccine, the WHO says.
Inadequate sanitation and hygiene were also issues, it added.
Because of the region's isolation and the planned immunisation, the risk of the virus spreading to other countries is low, the WHO said.
There were some 20 cases of polio globally in 2017, with these cases occurring in just two countries: Afghanistan and Pakistan.
Will the world ever become polio-free?Smitha Mundasad, global health correspondent
As recently as four decades ago, polio left 1,000 children paralysed every single day. The world has come a long way since then. Now, there are just a few countries where it is endemic and there have been just 15 cases so far this year. Zero seems tantalisingly close.
The good news is that polio is one of the few diseases that we actually have the ability to get down to zero. That is partly because it only infects humans - this means animals can't act as hidden reservoirs. And there are relatively inexpensive and effective vaccines that can offer protection for many years. Add in good sanitation and we are well equipped to battle the disease.
But global health experts say until it is completely eradicated, there remains a risk of polio spreading globally.
And areas like Morobe province in Papua New Guinea are particularly vulnerable as low vaccination rates and weak public health systems provide the ideal breeding grounds for cases to re-emerge.
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