Low vaccination rates at root of European measles epidemic

France is among the hardest-hit countries in the worst measles epidemic in Europe in a decade, and experts say that anyone who is unvaccinated or has not had the disease is at risk of infection.

Sergei Supinsky, AFP | A nurse injects a measles vaccine into a girl in a pediatric polyclinic in Kiev on January 15, 2018.

In France, three people died of measles between January and June of this year. They are among the 41,000 people in Europe who suffered from the disease during that time – more than any 12-month period this decade – and the 37 who were killed by it, according to the World Health Organisation(WHO).

By contrast, in 2017, 23,927 people in Europe suffered from measles, and that was a dramatic spike from the 5,273 cases reported the year before. Half of this year’s cases have been in Ukraine, the WHO said, with France, Italy, Greece, Serbia and Russia all having more than 1,000.

French public health authorities say more than 2,700 people have come down with measles in the country since last November. Between January and May of this year, four people died from the disease in Italy, including a 10-month-old baby, according to data released in July by Italy’s National Health Institute.

“The issue is immunisation,” said Dr. Dragan Jankovic, Technical Officer, Vaccine-preventable Diseases and Immunisation for the WHO’s regional office for Europe, who explained that a person needs to receive two doses of the vaccine to be protected. “The coverage is not sufficient.”

Part of the problem is that distrust of vaccines remains strong in many parts of Europe, especially France, which has one of the highest rates of vaccine skepticism in the world. The MMR vaccine – which protects against measles, mumps and rubella – is particularly problematic because of a paper published in 1998 that alleged an association between the vaccine, bowel disease and autism.

The mainstream medical community has conducted many studies since then and continues to hold that no such link is evident and that the vaccine is safe. Many parents remain unconvinced, however, and have declined to immunise their children.

Adults can be at risk, too. The vaccines only became standard in Europe in 1967, Jankovic said, and not everyone received the required two doses.

“There absolutely will be a cohort of adults who had one or no vaccine and never got [measles] because it died out,” said Dr. Louise Kenny, Executive Pro-Vice-Chancellor for the Faculty of Health and Life Sciences at the University of Liverpool.

Anyone who is nearing their 60s or older and doesn’t have a confirmed history of measles – which provides immunity against further episodes – should get vaccinated. “There is no such thing as too many doses,” Jankovic said.

Experts say that to prevent an outbreak, 95 percent of the population must be immunised. Of the European measles patients whose vaccination status was known, 87 percent had not been inoculated against the disease, according to the European Centre for Disease Prevention and Control.

Unvaccinated populations pose a danger not just to those living in the region but also to tourists who are not protected against the virus. Public Health England (PHE) said people travelling to countries where there have been outbreaks should make sure their vaccines are up to date. The US has issued measles-related travel warnings for the UK, France, Greece, Italy, Romania, Serbia and Ukraine.

“Traveling throughout Europe in areas that have had measles outbreaks is not without risk,” Kenny said.

It’s virtually impossible to protect against contracting the disease if one doesn’t have immunity. “Measles is one of the easiest diseases to transmit,” Jankovic said. “One person can infect between 18 and 25 [others], depending on the environment.”

The virus can be spread through coughing or sneezing and is one of the leading causes of death among young children.

Italy responded to the outbreak there by introducing a law requiring parents to vaccinate their children against measles and nine other diseases. Romania passed a similar bill that included penalties of significant fines for non-compliance. In France, 11 vaccines are now obligatory, including the jab for measles.

In its earliest stages, the measles can look like a cold, cause eye soreness and light sensitivity, and small light spots on the inside of the cheeks. After a few days a blotchy rash appears, usually starting on the head or neck.

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