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Measles: new efforts needed to stop an old disease

New diseases grab headlines. The latest influenza scare – H7N9 – has prompted much speculation about the direction the virus might take. And rightly so, as vaccines to fight new viruses can take some time…

Parents who choose not to vaccinate their children put the whole community at risk. Dave Haygarth

New diseases grab headlines. The latest influenza scare – H7N9 – has prompted much speculation about the direction the virus might take. And rightly so, as vaccines to fight new viruses can take some time to be produced. But there is an old virus that deserves our attention, too: measles, which causes a distinctive rash and fever.

Measles may not immediately strike fear into your heart, but in many countries it does. Children who contract the virus are at risk of serious complications such as pneumonia and encephalitis (brain inflammation), which can be fatal. The virus, one of the most infectious ever known, still kills more than 400 children every day – mostly in poorer countries with weaker immunisation systems.

These deaths are needless because we have an effective and inexpensive measles vaccine. In fact we have had it for almost half a century. Readers who are a bit older will remember the pre-vaccine measles outbreaks here in Australia, and the illness, deaths and long-term neurological disability they left in their wake.

Since we have had the vaccine, Australia has done fairly well against measles. In most parts of the country, our immunisation rates are high, giving most children protection against the virus.

However, as the latest immunisation coverage report from the National Health Performance Authority shows, there are several places in Australia – richer and poorer – where immunisation coverage is simply still too low, below the 93% to 95% coverage required to prevent measles outbreaks, putting children at unnecessary risk. It is in some of these places that we saw measles outbreaks in 2011 and again in 2012 with almost 400 cases.

The measles virus can move incredibly quickly around the world and when introduced into Australia by travellers – including unvaccinated Australians who have travelled to places where measles still persists – outbreaks can occur with rapid spread.

These outbreaks are costly. They cause illness, absenteeism at work and school, and the diversion of our health resources. Nurses and doctors spend time following up hundreds of people who may have been in contact with someone infected with measles, or caring for measles patients in hospital.

Australian children should be immunised against measles at 12 months of age with a vaccine that protects against measles, mumps and rubella. To provide life-long protection a second measles dose should be provided before the child goes to school and from June 2013 this will be recommended at 18 months of age.

International immunisation programs have reduced measles deaths globally by more than 70% since 2001. Julien Harneis

Unfortunately a small number of children cannot be vaccinated against measles because of pre-existing health conditions such as some cancers or because they are receiving chemotherapy. They are at particular risk and it is for their sake, and that of our own children, that we must ensure very high immunisation coverage everywhere in Australia.

Parents who do not have their children vaccinated due to ideological reasons, not only place their own children at risk, but also threaten the most vulnerable children in Australia.

Still, we have plenty of good news about measles control. The Western Pacific Region of the World Health Organization, to which Australia belongs, reduced measles cases by 93% between 2008 and 2012. The region includes countries like China, Japan, Cambodia and Papua New Guinea and is on track to eliminate measles. This would be an historic public health achievement.

So what is left to do to stop measles?

First, Australia should lead by example. The latest immunisation coverage figures must be used to target services in areas where immunisation coverage is low, and raise coverage to levels that will protect all Australian communities.

Second, Australia should continue to contribute to the Western Pacific regional goal to eliminate measles. The region can benefit from our financial and technical support and we can probably do even more to help poorer countries keep measles and other vaccine-preventable diseases at bay.

Third, Australia can contribute to the broader global effort to eliminate measles and rubella, which can be stopped with an inexpensive combined vaccine.

Partnerships including the Measles & Rubella Initiative (led by the American Red Cross) are raising funds and providing support to countries in sub-Saharan Africa and the Middle East to conduct measles campaigns and strengthen their regular immunisation services. These efforts can have a huge impact and have already reduced measles deaths globally by more than 70% since 2001.

The global goal is to reduce measles deaths by 95% by 2015, and to eliminate measles in most countries of the world by 2020.

Measles moves fast, and measles anywhere is a costly risk to unprotected communities everywhere. We can banish this old disease with a highly effective and safe “old” vaccine.

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  1. George Harley

    Retired Dogsbody

    The latest measles outbreak in Wales sees hundreds of parents queuing up to have their children vaccinated. Some of the children are in their teens. Any Australian parents that fell for the MMR vaccine medical hoax still have time to protect their own and other children.

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  2. Suzy Gneist
    Suzy Gneist is a Friend of The Conversation.

    Multi-tasker at Graphic Design & Montville Coffee

    I was vaccinated as a child, I have the records, yet could someone explain to me why if I was vaccinated against measles, mumps, smallpox and rubella, I was also infected with measles, chickenpox, mumps, rubella during my schooling time?
    I've often heard arguments asserting that I probably got milder infections than I would have otherwise, but this seems to be unproven since I got some of these lightly and others not so and so did my sibling.
    I would like to see a comparison study between vaccinated…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Suzy Gneist

      Suzy - I have no idea how old you are, but, if you want to check what vaccines you actually got against the time of introduction (assuming you grew up in Australia), here is a reference:
      http://www.health.gov.au/internet/immunise/publishing.nsf/Content/past-immu-prog

      There is no way that our own personal experience can tell us whether mass public health measures work. To know whether phenomena are related rather than coincidental, we need structured data analysis involving whole populations of…

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    2. Maureen Chuck

      logged in via Facebook

      In reply to Trevor Kerr

      Trevor, remember when you had to be immunised against smallpox to travel overseas? At least Suzy didn't get that!

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    3. Tyson Adams

      Scientist and author

      In reply to Suzy Gneist

      Vaccination isn't 100% effective (hint, nothing ever is). You also need regular booster shots.

      So you could be one of the people who didn't develop the antibodies when vaccinated, or your body could have stopped producing the antibodies in sufficient quantities by the time you were exposed to the diseases.

      Vaccination isn't a once off, nor is it just about you. It is about making sure enough of society has been vaccinated so that any one person who is exposed to the disease is less likely to catch it or be able to pass it on. You may have heard the reports saying that vaccination rates need to be quite high (>90% from memory) to make sure outbreaks don't occur. This is because not everyone's antibodies are being produced, not everyone produces the antibodies, some people are immune compromised and some people are just too old or young to vaccinate and will catch the diseases.

      Keep vaccinating, but make sure everyone else is too!

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    4. David Arthur

      resistance gnome

      In reply to Suzy Gneist

      Hey Suzy, let's test the idea that non-vaccination is a good idea:

      in large cities, eg Sydney, there is sufficient density of school-children to designate one school in 6, say, to children that do not have full vaccination. This, way, 5 schools in 6 will have children with full vaccination certificates, and the other children can go to the sixth school.

      You want it, you get it: what more could you ask?

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    5. Judith Olney

      Ms

      In reply to Suzy Gneist

      Hi Suzy, I was also vaccinated as a child, even had the smallpox vaccine as well, as I lived overseas. As an adult I had to have chemotherapy and radiation treatment, both of which destroy any immunity that childhood vaccines would have given me. When I was well enough, 12 months after my last treatment, I had to have all my vaccinations again, and several booster shots in the following years.

      I ended up contracting pertussis (whooping cough), before I could recieve my vaccination, and was hospitalised…

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    6. Suzy Gneist
      Suzy Gneist is a Friend of The Conversation.

      Multi-tasker at Graphic Design & Montville Coffee

      In reply to Sue Ieraci

      Hi Sue, I suppose I do know your position on this, but I'm still questioning the assertions I read :)
      I grew up in Germany and vaccination rates were very high, most parents assumed mandatory - I'm not sure it was, but germans tend to do as they're told by authorities ;). still, childhood diseases were not uncommon, at school or in other vaccinated children which, reading what I do more recently here, does not make sense in proving that it actually protects everyone better.
      Chickenpox: I have…

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    7. Suzy Gneist
      Suzy Gneist is a Friend of The Conversation.

      Multi-tasker at Graphic Design & Montville Coffee

      In reply to Tyson Adams

      Well, I'm assuming its my now natural immunity (after getting some of those infections as a child) since I didn't ever get infected from direct contact with kids or other people since, maybe I don't need any booster because its more effective ;)

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    8. Sue Ieraci

      Public hospital clinician

      In reply to Suzy Gneist

      HI, Suzy

      Regarding your comment "Another issue that concerns me is that by suppressing 'simple' infections we provide fertile ground for more aggressive ones to develop which may be even worse in their effects than measles once were."

      Immunisation doesn;t do anything to the infectious organisms - it primes the natural immune system'to be ready for the next exposure, so that it can be fought off more effectively.

      Immunity gained from exposure to the antigens in vaccines is just as natural…

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    9. Suzy Gneist
      Suzy Gneist is a Friend of The Conversation.

      Multi-tasker at Graphic Design & Montville Coffee

      In reply to David Arthur

      Or you could just compare, say, Australian Steiner schools (I'm assuming they have lower rates, I may be wrong) and some in highly vaccinated schools for frequency of outbreaks, severity of infections, etc.
      it can't be that difficult to get a sample of each group and do a proper scientific comparison, can it? I prefer this to your method ;)

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    10. Sue Ieraci

      Public hospital clinician

      In reply to Suzy Gneist

      Suzy - you can read about the current or recent outbreaks of infectious diseases. For measles or whooping cough outbreaks, when you consider the rate of vaccinated vs unvaccinated, the infections are much more common (as a proportion of) the unvaxed kids.

      Here are a couple of references:

      "Increased protections during a measles outbreak of children previously vaccinated with a second dose of measles-mumps-rubella vaccine" Vitek C et al The Paediatric Infectious Disease Journal 1999

      "Measles Outbreak, the Netherlands, 2008" Hahne' et al Emerging Infectious Diseases 2010

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    11. Suzy Gneist
      Suzy Gneist is a Friend of The Conversation.

      Multi-tasker at Graphic Design & Montville Coffee

      In reply to Sue Ieraci

      So when the organism mutates, it still can't get through the vaccine protection? Or can it overpower the antibody protection by changing enough?
      Since many vaccines are based on simian-derived infections (?) is there any chance species barriers can be compromised and introduce new strains?
      I have read of instances were this has already been suspected and vaccines had to be withdrawn. Maybe I better read those articles you mentioned first...

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    12. Suzy Gneist
      Suzy Gneist is a Friend of The Conversation.

      Multi-tasker at Graphic Design & Montville Coffee

      In reply to Judith Olney

      Hi Judith, thanks for sharing your story and I hope you'll retain your health in future :)
      We had quite a few kids with whooping cough over the last few years at the local school - often not being kept home until they had opportunity to infect others. Fortunately no one here ended up in hospital as far as I know.
      Many families send their kids to school sick when they shouldn't because they aren't always able to stay home with them - I suppose my mum and I were/are both lucky to be able to fit…

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    13. Judith Olney

      Ms

      In reply to Suzy Gneist

      Whooping cough is one of those diseases that is most dangerous to the very young, and those with compromised immune systems, and this is one of the reasons it is important to vaccinate everyone, herd immunity protects those most vulnerable. I understand that there are parents that send their kids to school or daycare when they are sick, but with whooping cough a child may be a carrier of the disease and have little or no symptoms themselves, another reason why vaccination is so important.

      Same…

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    14. David Arthur

      resistance gnome

      In reply to Suzy Gneist

      No Suzy, comparing Steiner schools with other schools is insufficient - they'd be having to do all sorts of complicated stats to sort it out.

      No, let's keep it simple; 100% vaccinated shoccls in these schools, all other kids in the other schools. Advantage: it's all sorted out, completely and utterly, once and for all. The benefit for you is, if your arguments have merit, then they are demonstrated.

      As a reality-based advocate, surely you'd want that?

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    15. James Walker

      logged in via Facebook

      In reply to David Arthur

      Suzy wanting an explanation of why her immunization didn't take is quite reasonable.

      And one of the answers is that nothing in life is 100%. Everyone is slightly different, and with millions of vaccinations, even a 1% fail rate means tens of thousands of people not protected.
      And that is a minor downside in your plan David: if immunization doesn't take you are dependent on everyone around you being immunized. The students in the unvaccinated schools you propose would still visit shops, movies, neighbours, friends from other schools - endangering people whose immunization didn't take.
      The *major* downside, of course, is that the children in the unvaccinated schools would just be innocent victims of their parents' inaction.

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    16. David Arthur

      resistance gnome

      In reply to Suzy Gneist

      Ms Gneist, beyond rearranging public schools to provide specific schools for un-vaccinated children, I'm proposing no further separation.

      Just contemplating your suggestion, that vaccinated children become carriers for whooping cough virus home from their at-risk classmates, potentially exposing neonates who are to young to be vaccinated AND WHO WOULD BE VACCINATED SHOULD THEY SURVIVE TO VACCINATIBLE AGE, but whose little lives are destroyed through advocacy of groups such as the Australian Vaccination Network, suggests a certain brutality on their part.

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    17. David Arthur

      resistance gnome

      In reply to James Walker

      James, you're neglecting the bigger downside of allowing unvaccinated children to mingle at school with vaccinated children.

      If a child is vaccinated, but that vaccine doesn't take, then it would be prudent to minimise their exposure to the virus.

      Separating out unvaccinated children into their own schools has the benefit of maximising "herd immunity" into adult life because unvaccinated are near-certain to acquire immunity by exposure to the diseases in their unvaccinated school.

      IF the results are as beneficial as the Australian Vaccination Network argues, then more parents will opt to not vaccinate their children, and more public schools can be allocated to non-vaccinated children.

      It's a win-win.

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    18. Chris Saunders

      retired

      In reply to Suzy Gneist

      Can I suggest next time you take your unvaccinated child to your GP with suspected measles or possibly rubella that you alert your GP to the fact so that she can ensure there aren't any pregnant women in the waiting room?

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    19. Suzy Gneist
      Suzy Gneist is a Friend of The Conversation.

      Multi-tasker at Graphic Design & Montville Coffee

      In reply to Chris Saunders

      I did ring them first, as I did the school, just in case, and I rang again to let them know there was no danger. He hadn't been to school for several days prior due to not feeling 100% and he is vaccinated with MMR. Can I suggest you make fewer assumptions and don't consider others less responsible as yourself? Thanks, Chris.

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    20. David Arthur

      resistance gnome

      In reply to Suzy Gneist

      Gday Ms Gneist,

      1) please note that I do not assume you are associated with AVN.

      2) if my presumption that the views you express are consistent with those of AVN is wrong, I apologise.

      3) if my presumption that you prioritise the merits of non-vaccination ahead of risks of exposure of neonates to infectious diseases. then I apologise for that also.

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  3. Maureen Chuck

    logged in via Facebook

    Suzy you must be the unluckiest person alive to have been vaccinated against all those diseases and to still contract them. Even someone who is not vaccinated would have to be very unlucky to contract all of those diseases because of community (herd) immunity.
    The main reason I can think of that you would have been so unlucky is that you lived in an area of very low vaccination rate.
    The chickenpox vaccine was not introduced onto the vaccination schedule until 2005, so anyone who was born before that date was susceptible to infection.
    I was unfortunate to have been born before there was a measles vaccine available. I contracted measles at the age of 4 and spent a week in hospital in an oxygen tent with bilateral pneumonia. That was a traumatic enough experience that I still remember it more than 50 years later.
    The comparison studies that you call for are not necessary because we have the evidence from the dramatic reduction in infections since the introduction of the vaccines.

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    1. Suzy Gneist
      Suzy Gneist is a Friend of The Conversation.

      Multi-tasker at Graphic Design & Montville Coffee

      In reply to Maureen Chuck

      Actually, Maureen, from memory, none of those diseases were that terrible for me - maybe itchy, but not that bad... I think i even got mumps twice, less severe the second time. I do know that some people, like you, can have complications and terrible results, but that is the case for many infections, even those not vaccinated against.
      Mostly I remember having a fever, and being checked a few times a day and treated with cold wraps and cherry juice (my mum always told me it helps bring the temperature…

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    2. Chris Saunders

      retired

      In reply to Suzy Gneist

      Purely anecdotal evidence to put maybe another light (or not) on Suzy’s strange results. My eldest was born in West Germany in 1968, he had his first vaccinations there and then when brought to Australia at 9 months his shots were begun from scratch. I protested that surely this was hardly necessary as German medicine had always been held in high regard and I had the official vaccination record. The answer was that we cannot really trust the vaccines from other countries are the same. I did not…

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    3. Suzy Gneist
      Suzy Gneist is a Friend of The Conversation.

      Multi-tasker at Graphic Design & Montville Coffee

      In reply to Chris Saunders

      If personal observation is 'anecdotal' then your own statement falls under the same label and has no more strength than you consider mine to have. Neither you or I are researchers, so our observations are as valid as each others, as are our opinions, even if they are based on different ideologies.
      I never had to repeat any vaccinations after coming to Australia, except for tetanus boosts, but at an earlier time immigrants from India or Germany weren't treated any differently and the same rules often applied to the medicals prior to receiving residency. My medical during the 80s was obviously at a sufficient standard for Australia and I didn't have to repeat anything.

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