Health authorities warn outbreak could grow

January 26, 2024
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LONDON — A serious outbreak of measles in England could grow to tens of thousands of cases, health experts there have warned, as Europe grapples with a spike in the highly contagious disease.

The U.K. Health Security Agency said Friday that since October, there have been 216 confirmed cases and 103 probable cases in the West Midlands region, an urban part of England centered on the city of Birmingham, where around 80% of the cases were recorded. That’s higher than last year’s total of 209 measles cases and the 2022 tally of 53.

Last year, the government warned that a measles outbreak in London could lead to between 40,000 and 160,000 cases there if the vaccination rate did not improve. The rate in England has been falling for years due to misinformation and declining community health budgets. 

Around 89% of children in England have received their first measles, mumps and rubella (MMR) vaccine dose by age 2, according to the state-run National Health Service — down from 93% a decade ago. The World Health Organization considers 95% the necessary threshold to maintain herd immunity. 

A British information campaign is now urging people to ensure their children get the vaccination.

British lawmaker Maria Caulfield, who was previously the minister of state for health, laid bare the scale of the challenge when she told the House of Commons on Monday that more than 3.4 million children under 16 are not vaccinated against measles. 

In Europe overall, Hans Kluge, the World Health Organization’s director for the region, warned Wednesday that there had been 42,200 measles cases across 41 countries in 2023 — a nearly 45-fold increase from the 941 recorded the previous year. He said last month that nearly 21,000 people had been hospitalized.

A crisis is also building in central Asia, where more than 13,600 cases were recorded in 2023, the majority among unvaccinated children under 14, the WHO said.

Three U.S. states have also recorded measles cases in the last month. Philadelphia has confirmed at least eight locally acquired cases, in addition to one “imported” case that prompted a health alert in December. Camden County, New Jersey, confirmed a case on Jan. 13, then Georgia health officials confirmed the state’s first case in four years soon after: an unvaccinated resident in Atlanta. 

Measles is most common in children. The disease is characterized by a red, blotchy rash that usually follows a high fever, cough, runny nose and red, watery eyes. Around 1 in 5 unvaccinated people with measles are hospitalized, and up to 3 out of 1,000 children with measles die from complications such as pneumonia or swelling of the brain, according to the U.S. Centers for Disease Control and Prevention

The MMR vaccine is offered to children in Britain starting at 12 months, with a second dose shortly after they turn 3. Children in the U.S. get their second dose between 4 and 6 years old. Two shots are 97% effective, according to the CDC. 

“Even if you reach them, it’s really difficult to keep such high levels of vaccination sustained over a long period,” said Helen Bedford, a professor at University College London’s Great Ormond Street Institute of Child Health. “You get there, the disease goes away, people think, ‘Oh, well, the disease has gone away; I don’t need to vaccinate.’” 

Several other factors have fueled England’s vaccination challenges, experts said. One is that uptake remains especially low among low-income and more ethnically diverse groups, according to a 2021 NHS study in southeast England.

“It’s poor people, people who are highly mobile and don’t stay in one place,” said Azeem Majeed, professor of primary care and public health at Imperial College London. “In regards to messaging, the NHS needs to be more proactive on this.”

On Thursday, in an effort to reach non-English speakers, the local council in the borough of Brent released a video about measles in Romanian.

A second factor is a now-discredited study published in 1998 that falsely claimed the MMR vaccine was linked to autism. The paper was partially retracted in 2004, but by then vaccine uptake had dipped to 81%. The study was fully retracted in 2010 and its author, Andrew Wakefield, was removed from the U.K. medical register. 

Thousands of children born in the late ’90s and the early 2000s are now unvaccinated adults.

“It’s this combination of low uptake about 20 years ago, so you’ve got lots of young adults that are susceptible, and then over the years an accumulation of susceptible people, particularly in some parts of London,” Bedford said.

However, Bedford doesn’t consider vaccine hesitancy and the spread of conspiracy theories to be the main problem. British parents’ confidence in vaccines is as high as 90%, according to a 2022 study.

“The anti-vaccine movement is very, very small, but it has a very loud voice,” she said. “So I think it’s important not to get too hooked on that because there are lots of things we can do. And if we just focus on anti-vaccine, it’s much more difficult to know what to do.”

Instead, Bedford pointed a finger at two other factors: a reduction in community nurses and reforms made to the NHS — namely the 2013 decision to spread the responsibility for vaccines across several agencies rather than one.

What’s more, she said, there is a lingering opinion among some Britons that measles is a trivial childhood illness, which is a dangerous view.

“In a best-case scenario, measles is a nasty disease that makes children feel very ill. But of course there is a recognized significant complication rate, with ear infections, pneumonia, inflammation of the brain and, yes, it can kill you,” Bedford said. 

This week, doctors’ clinics in the West Midlands area urged patients not to turn up unannounced if they suspect they have measles: “Call ahead, that way if you do have measles — you won’t pass it on to others — it can be a fatal disease if someone has a weak immune system,” a public information flyer said.

Patrick Smith reported from London and Aria Bendix from New York.





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