The measles outbreak in the Swansea area has highlighted just how quickly the disease can spread there have been just under 700 cases confirmed as I write, nearly a hundred of which have been diagnosed in the last week. And South Wales is unlikely to be the only part of the UK facing an epidemic this year given that at least a million children and young adults have missed one, or both of their measles, mumps and rubella (MMR) jabs.
Measles is often dismissed as an insignificant childhood illness but recent experiences suggest it is anything but. Fifty-one of those affected in Swansea so far have required hospitalisation, and a similar outbreak in Dublin in 2000 suggests there could be worse to come; during the Winter and Spring of that year there were nearly 1500 cases of measles in the city. A hundred children were hospitalised, 6 of whom ended up in intensive care, and three died.
Before routine immunisation against measles was introduced in the UK via the MMR in the late eighties, there were as many as 800,000 cases in a bad year. Complications were common – 1 in 20 cases developed pneumonia, 1 in 100 had convulsions and 1 in 1000 had encephalitis (potentially fatal inflammation of the brain).
The return of measles- there has been a six-fold increase in the UK over the last decade – is a legacy of the autism scare triggered by the now discredited Dr Andrew Wakefield. Worried parents turned their backs on the vaccine during the nineties and a huge cohort of children grew up with no immunity to the disease. And we are not the only country to be affected – popular holiday destinations like France, Italy and Spain are all facing a similar resurgence.
Ideally 95% of children should have both MMR jabs to ensure that measles is controlled to such a degree that outbreaks are unlikely, but the figure in the UK is currently only 88% – the highest for 13 years, but still short of ideal. And the national average hides pockets of much lower coverage.
Uptake is best in Scotland (93%) and Northern Ireland (91%) with Wales coming in third at 89%. But in London the uptake is just 80%, and if an epidemic can start in Swansea, then imagine what might happen in London with its low vaccination rate and much bigger population.
Fortunately it is not too late to act. Anyone who has not had the MMR, or received their second booster dose, should get vaccinated. The under-25’s are the main group at risk because people over this age will have either had the MMR in the pre-Wakefield days when uptakes were good, or if older, they are likely to have good natural immunity after catching the disease in the pre-MMR era.
And measles isn’t the only threat for those who have missed out on the MMR. Mumps is actually more common than measles and while generally mild in young children it can be much more serious in adults in whom complication rates are high. One in 5 men develop inflammation of the testicles (although the infamous infertility is a very rare complication), 1 in 7 cases develop meningitis, 1 in 1,000 will develop inflammation of the brain (encephalitis), and 1 in 15,000 will lose their hearing in at least one ear.
Rubella (german measles) is less of a problem but can have catastrophic consequences in pregnancy. I must declare a vested interest here as my younger sister, Caroline, was born profoundly deaf when my mother caught rubella during the third month of her pregnancy. If you have not had the MMR and are planning on starting a family, please get immunised.
To arrange catch-up vaccination contact your practice nurse at your local surgery, or student health services if you are at college/university. And for more information on all routine immunisations visit www.nhs.uk
- Measles is one of the most contagious viruses known to man. It’s spread via droplets produced by breathing, coughing and sneezing, and cases are infectious from the start of symptoms until the 5th day of the rash.
- Early symptoms – a temperature, sore red eyes and spots along the inside of the cheek – typically develop within 10 – 14 days of contact with someone with the disease, with the characteristic skin rash developing 3 – 4 days later.
- There is no specific treatment and therapy is aimed at symptom relief (paracetamol etc). Most cases settle within 7 – 10 days.