Measles: The continued threat of a preventable disease
Itzhak Matthai asks why measles continues to kill hundreds of thousands of people despite the availability of a simple and cheap solution and despite a marked global improvement over the last few years.
Everyone knows about measles, but do we perhaps take it for granted, thinking it an unproblematic and easily avoidable issue? A disease most prevalent amongst young children between the ages of one to four, it is highly contagious - particularly in the four days before any sign of physical symptoms - and has been responsible for millions of deaths worldwide, mostly through the various complications it is liable to cause including hepatitis, conjunctivitis, encephalitis and severe respiratory infection (1).
Thank goodness, then, for the measles vaccine, which costs around GBP 0.17 including safe injection equipment and has been around for 40 years (2). Furthermore, the vaccine has been proven to be both safe and effective - so why does the disease continue to take lives even today across the whole world?
Figures released by the Measles Initiative, founded by WHO, UNICEF, the American Red Cross, US Centers for Disease Control and Prevention (CDC), and the United Nations Foundation, show that in 2006, 242 000 people worldwide died as a result of measles (3). In one respect, this is quite an impressive result, considering that only five years earlier the death toll reached 757 000 (3), and enormous credit must go to those behind the Measles Initiative who, since its foundation in 2001 have contributed hugely to this massive drop. On the other hand, however, one cannot get away from the fact that even in light of this considerable effort nearly a quarter of a million people died two years ago as a result of measles - that’s on average 27 deaths every hour.
It is well known that the disease is more easily contractible in developing countries, or those areas ravaged by war. Poorer infrastructure and greater population density are indeed allies to a potentially fatal and highly contagious disease. The Measles Initiative, naturally aware of this, has turned its attention in particular to these regions. The Initiative was in fact able to help reduce measles deaths in Africa by 91% from 2001-2006 and will move to target India in a greater way in the future (3). However it is important to recognise that the disease remains a threat even in developed countries, despite such cheap and readily available treatment. Prior to this year’s European Football Championships, warnings were issued to travelling fans of recent outbreaks of measles in the host nations of Austria and Switzerland. Last year, along with Switzerland and Romania, the UK and Ireland were the countries with the highest number of confirmed measles cases per 100 000 population (4). In England and Wales alone, 971 instances were reported in 2007 (5). GPs have recorded 22 cases of measles in the resort of Blackpool in the last three weeks alone (6). For the first time in eight years, two children at a preschool in Canterbury, New Zealand have been diagnosed with measles in the past two weeks (7). Doctors found six cases of measles in the village of Mkhunyoni in the Eastern Cape of South Africa last week (8). And only a few days ago, figures released by the United States of America have shown that the rate of measles cases being confirmed so far this year has more than doubled that of last year (9) - this from a country whose CDC claimed as of 2000 to have officially eliminated the disease (10). Obviously, it is important to note at this point that those contracting measles in richer countries are far less likely to die as a result of the disease when compared with those in the poorer areas of the world, but the fact remains that developed countries, who have a means to eradicate measles completely ought to have next to no cases at all. However, this has clearly not been the case, as the figures above show.
What is the reason for this dramatic increase in the number of measles cases in countries such as the USA and the UK? Perhaps the main cause is the research done over a decade ago into the MMR (measles, mumps and rubella) vaccine and its possible links to autism or Crohn’s disease, a condition that causes inflammation of the gastrointestinal tract (gut) which leads to stomach pains, diarrhoea and weight loss. This research, though it has since been discredited as being unfounded and inaccurate, seems to have nevertheless had an effect on the public. The Times Online reports that uppermiddle-class parents in America have decided to ‘opt out’ of the MMR vaccine and that US Health Authorities are now fearing an unprecedented and potentially disastrous comeback of the deadly disease (9). The figures above clearly show that parents across the globe are worried about the health of their children, but are perhaps not well-informed enough about just how dangerous and common measles is, and about the fact that any links to autism or Crohn’s disease are tenuous at best. Even if the risk of death is lower in developed countries, there nevertheless remains a high chance of a measles sufferer contracting a serious, debilitating, and potentially permanent problem if a vaccine is avoided.
Whilst the need for extra funding towards finding effective methods of prevention of rare diseases is becoming more and more important, as covered in past week’s Lancet, it is surely just as, if not more, important that methods of prevention which have been discovered and which have been in circulation for many years against the most common and most dangerous diseases are effectively implemented, especially when such methods are as cheap and as simple as the measles vaccination process. This is not to say that global coverage is a easy feat, but undeniably a lot can be achieved as long as those in developed countries take responsibility for the welfare of their own children, and as long as the Measles Initiative continue their good work across the poorer states, and hopefully succeed in achieving their projected targets for 2010.
Itzhak Matthai
zacmonder@gmail.co.uk
1. BBC Health - Measles. http://www.bbc.co.uk/health/conditions/measles2.shtml (accessed 16 June, 2008)
2. WHO. Measles. http://www.who.int/mediacentre/factsheets/fs286/en/ (accessed 16 June, 2008)
3. Measles Initiative. http://www.measlesinitiative.org/index3.asp (accessed 16 June, 2008)
4. BBC Health. Euro 2008 fans at risk of measles. http://news.bbc.co.uk/1/hi/health/7352490.stm (accessed 16 June, 2008)
5. BBC Health. Measles cases jump to record high. http://news.bbc.co.uk/1/hi/health/7259338.stm (accessed 16 June, 2008)
6. Blackpool Gazette. Measles outbreak in Blackpool prompts vaccine call. http://www.blackpoolgazette.co.uk/blackpoolnews/Measles-outbreak-in-Blackpool-prompts.4176819.jp (accessed 13 June, 2008)
7. Radio New Zealand. Call for measles immunisation rate to be raised. http://www.radionz.co.nz/news/latest/200806132009/3ebcba7a (accessed 13 June, 2008)
8. SABC News, South Africa. E Cape health authorities monitor measles outbreak. http://www.sabcnews.com/south_africa/health/0,2172,171426,00.html (accessed 13 June 2008)
9. The TimesOnline. Measles cases rise as parents snub MMR jab because of autism fears. http://www.timesonline.co.uk/tol/news/world/us_and_americas/article4100287.ece (accessed 16 June, 2008)
10. Orenstein WA, Papania MJ, Wharton ME. Measles elimination in the United States. J Infect Dis 2004;189(Suppl 1):S1–3.