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The Fight Against Measles

The Fight Against Measles. The Present Situation The Strategies The Vaccination The Controversy . Recent Outbreaks. About 20 million cases each year around the globe. 2011 UK- 804 cases Ireland – 173 cases Europe - more than 26,000 cases 8 deaths

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The Fight Against Measles

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  1. The Fight Against Measles The Present Situation The Strategies The Vaccination The Controversy

  2. Recent Outbreaks • About 20 million cases each year around the globe. • 2011 UK- 804 cases Ireland – 173 cases Europe - more than 26,000 cases 8 deaths 24 cases measles encephalitis • Africa and Asia , remains one of leading causes of death in children. – WHO - 164,000 people died from measles in 2008, most younger than 5 years old.

  3. Recent Outbreaks (2) • Increase in measles cases and deaths in recent months • Prevalent in famine and drought areas • Unvaccinated children forced to live in cramped refugee camps • Somalia – 24%of 1yr olds immunized in country

  4. Eradication • Increase in US cases • over 92% population vaccinated • Dropped due to importation of disease from WHO European Regions and South East Asian regions. • 33 countries in WHO European Region have increased measles cases

  5. MMR Vaccine • Developed in 1960s by Maurice Hilleman • 3 live attenuated viruses • First dose ~1 year, second ~5 years. • Before vaccination, measles “as inevitable as death and taxes”. • Now contracted by <1% of individuals under 30 in countries with routine childhood vaccination • Prevents illness, disability, death.

  6. WHO Strategy 1994 - 2004 • Aim: Vaccinate >90% in all districts • All children to get second dose • 71% of targeted children in 1999 -> 76% in 2004 • Sub-Saharan Africa – 49% -> 65% • South Asia – 54% -> 61% • 2004 – 168 counties (88%) offered second round

  7. MMR in Ireland • First dose at 12 months • Second dose (not booster) at 4-5 years • Through school/HSE or GP • Recent outbreaks of measles and mumps due to missed second dose

  8. Vaccination Strategy- Ireland • 1985 - Monocomponent measles vaccine introduced- 10,000 cases in that year reduced to 201 in 1987 • 1988- combined MMR introduced -12-15months • 1992- Second dose recommended- 10-15 years • 1999- Age of second dose reduced to 4-5 years • Childhood vaccination Schedule for children born after 1st July 2008- Free From the Department of Health, HSE • 12months from GP • 4-5 yrs from GP or in School • Primary School Immunisation Programme

  9. Outbreak in 1993- affected 4,000 people • 2000- 1,600 cases resulted in 3 deaths • From 2001 to 2006 – 1,562 cases • Rapid spread during these outbreaks due to: • Incomplete vaccination coverage • Susceptible pool of older unvaccinated children • Today- 221cases reported in 2011, so far (411 in 2010) • 85% occurred in North Dublin City • 90% of children have received 1st dose by 24months

  10. W.H.O-Measles Eradication • Global mortality reduced by 78% , from estimated 733 000 deaths in 2000 to an estimated 164 000 deaths in 2008-78% • The WHO region of America has • sustained elimination since 2002 • The WHO has set a target of elimation of measles in remaining 4 out of 5 WHO regions by 2020. • This can only be achieved by Increasing routine immunization coverage • improving surveillance systems • political and financial commitment

  11. Vaccination • There are two treatments to protect against measles: • MMR: measles, mumps and rubella vaccine. • MMRV: measles, mumps, rubella, and varicella vaccine.

  12. Development • First virus was obtained from David Edmonston in 1954. • The virus strain was grown in chick embryos. • Made the virus more suited to chicks than humans • Similar attenuated vaccines around this time were developed. • From nucleotide tests all vaccines were shown to be similar. • At present the MMR vaccine has a 95% efficiency.

  13. WHO: Eradiation Policy • Control: reduce incidence of disease. Due to 95% efficiency a two dose strategy is need to prevent an accumulation of susceptible individuals. • In 2010, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.

  14. Measles Vaccine • Children should be vaccinated with the MMR vaccine 12 to 15 months after birth and should receive a second dose at 4-5 year usually before the child enters school. • Before the vaccination programme was implemented in USA, between 3 to 4 million people were infected each year, with 400 to 500 dying • Measles is a highly contagious virus and was estimated there was 242,000 Measles deaths which equals 27 deaths every hour.

  15. MMR Vaccine Risks • The vaccine like many vaccines can cause allergic reactions, most people however do not have any problems with it. • Mild problems: fever (1 in 6 doses), mild rash ( 1 in 20) or rare swelling of glands. • Moderate problems: seizure (1 in 3,000 doses), temporary pain in joints ( 1 in 4 teenage and adult women) and temporary low platelet counts which can lead to a bleeding disorder ( 1 in 30,000 doses). • Sever problems: 1 in 1 million: deafness, long-term seizures or comas and permanent brain damage.

  16. Less safe if recipient... • Has a fever • Is taking steroids • Has had another live attenuated vaccine in the last three days • Is receiving chemotherapy/radiotherapy • Has a compromised immune system

  17. Problems with Vaccine Developing Countries Immunodeficiency • Individuals with low immune responses can’t handle certain vaccines due to the presence of attenuated or live virus. • Presence of maternal antibodies during first 9 months of life reduces efficiency of immunization. • Measles virus infects children by the respiratory tracts and little of the maternal antibodies will be transduced onto mucosal surfaces

  18. Advancements • Aerosol delivery and high titre vaccinations to overcome problems in vaccinating young infants. • Recombinant virus • Immune-stimulating complexes • DNA vaccination

  19. Controversy:Wakefield et al. 1998

  20. Wakefield et al. 1998 • 12 Children with Gastrointestinal symptoms, lost acquired skills including communication • In 8 children, parents and/or physicians linked onset of behavioural problems with MMR • Main cause of public concern

  21. Media Coverage • Wakefield: “I cannot support the continued use of these vaccines in combination…” • Public uproar & slump in MMR vaccinations • Brian Deer Sunday Times investigation 2003-2011 • Prof.John O’ Leary slander

  22. Evidence against autism link & aftermath of investigation • Horniget al. 2008 replications • Wakefield foul play

  23. References • http://www.immunisation.ie/en/Downloads/NIACGuidelines/PDFFile_15482_en.pdf • http://www.irishhealth.com/article.html?id=780 • http://www.immunisation.ie/en/Downloads/PDFFile_15371_en.pdf • http://www.who.int/immunization_monitoring/diseases/measlesreportedcasesbycountry.pdf • http://www.immunisation.ie/en/ChildhoodImmunisation/PrimaryImmunisationSchedule/ • http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_18-en.pdf • http://www.who.int/immunization/newsroom/news_wha_2010_measles_eradication/en/index.html • www.braindeer.com • http://www.who.int/mediacentre/factsheets/fs286/en/ • http://www.cdc.gov/vaccines/vpd-vac/measles/default.htm • http://www.immunisation.ie/en/ChildhoodImmunisation/VaccinePreventableDiseases/MMR/ • J. Wakefield, S. H. Murch, A. Anthony, J. Linnell, D. M. Casson, M. Malik, M. Berelowitz, A. P. Dhillon, M. A. Thomson (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. • T. F. Wild (1999) Measles vaccines, new developments and immunization strategies. Vaccine 17; 1726-1729.

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