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Have we forgotten that measles can be a killer?

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Until the late 20th century measles was considered an almost inevitable disease of childhood – although adults are also susceptible.

In most cases the disease is an unpleasant but acute illness from which patients make a full recovery. However, it can cause serious long-term health problems and has a mortality rate of just over 0.1% – in populations with high levels of malnutrition and poor healthcare it can be far higher.

A vaccine made available in the UK in 1970 offered the possibility of eradicating measles if herd immunity could be achieved – this requires 95% of the population to be vaccinated.

However, uptake was disappointingly low until the introduction of the MMR vaccine in the late 1980s; this offered protection against measles, mumps and rubella in just two injections. Coverage levels of over 90% were achieved and incidence of measles fell dramatically, saving thousands of lives and sparing even more from lifetimes of disability.

It is therefore distressing to see that by mid-August there had been 828 confirmed cases in England alone this year; in 2017 the total for England and Wales was 277.

“A significant amount of blame can be laid at the door of Andrew Wakefield”

The majority of cases are linked to ongoing outbreaks in Europe and have been in teenagers and young people who missed out on their MMR vaccine as children.

So why are we seeing such numbers? A significant amount of blame can be laid at the door of Andrew Wakefield, the disgraced former doctor whose now discredited research, published in 1998, linked MMR with the development of autism. Despite undisclosed financial interests, a sample size of only 12, an uncontrolled study design and speculative conclusions, the study gained huge and sensational publicity, and vaccination rates dropped dramatically.

”Public Health England is encouraging unprotected students to get themselves vaccinated as soon as possible”

Huge amounts of research were undertaken globally to test Wakefield’s claims, and no link between MMR and autism could be established, but the damage was done and an ardent community of ‘antivaxers’ was born. Wakefield moved to the US and has become an anti-vaccine crusader with enough influence to be invited to Donald Trump’s inauguration ball.

Twenty years after Wakefield’s study, unvaccinated young people are old enough to travel independently. They are probably more likely to mix with local populations, staying in budget accommodation in more adventurous locations than their parents might have taken them and are bringing home an unwanted souvenir – other cases have been linked to music festivals and other large public events.

With the university term around the corner, Public Health England is encouraging unprotected students to get themselves vaccinated as soon as possible. The same goes for other unprotected adults, while parents are encouraged to accept the offer of vaccination for their children within the childhood immunisation schedule, or contact their GP for catch-up vaccinations.

We have published a summary to help nurses understand their role in preventing, identifying and managing measles outbreaks – a crucial aspect is encouraging parents to accept vaccination for their children and unprotected adults to have catch-up vaccinations. The article is open access, so free to access for registered users of nursingtimes.net.

Measles killed just under 90,000 people worldwide in 2016, but in the UK, the availability of vaccines has allowed us to forget just how serious an illness it can be – and how common it can be in an unvaccinated population. In 1961, which had the highest number of notifications, there were almost 800,000 cases in England and Wales, and 152 deaths. Who knows how many people were left with long-term health problems?

Of course, measles is unlikely to return to such prevalence, but by encouraging those without protection to accept vaccination you could save lives or preserve quality of life.

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