National ‘call to action’ required following measles outbreak in Cardiff

Dr Dylan Jones, Lecturer in Biomedical Sciences (Haematology & Human Physiology) North Wales Medical School

The recent warning by the Chief Executive of the UK Health Security Agency, Professor Dame Jenny Harries, highlights a worrying trend in measles cases among children, particularly in the West Midlands.

As of January 18, 2024, there have been 216 confirmed cases and 103 probable cases since October 1, 2023, with the majority being children under 10 years old.

This spike in cases is something we have also seen here in Wales. There have been sporadic occurrences of measles, including a major outbreak back in 2013. Indeed, the end of a recent outbreak in Cardiff has only just been announced.

National incident

Given the rise in cases, the UK Health Security Agency has declared a national incident to address this growing public health risk and focus efforts on preventing further spread​​​​.

But what is measles and why should we be concerned? Measles is a highly infectious virus that can spread easily among unvaccinated individuals, especially in settings like nurseries and schools.

While it can be perceived as a childhood illness, it can lead to serious complications, hospitalizations, and, in rare cases, death. Symptoms include a nasty rash, high fever, and ear infections, and about one in 1,000 people with measles develop inflammation of the brain.

This infection is more severe in adults and has no specific treatment apart from managing symptoms​​​​.

Measles is a classic example of a vaccine preventable disease and we have long had an effective and safe inoculation.

Highly effective

The Measles, Mumps, and Rubella (MMR) vaccine is a highly effective immunization tool designed to protect against three significant viral diseases: measles, mumps, and rubella.

It’s a combined vaccine, meaning it contains weakened versions of the viruses causing these diseases. Administering this vaccine triggers the immune system to produce antibodies against these viruses without causing the actual diseases.

The standard schedule includes two doses, typically given in childhood – the first dose at around 12 to 15 months and the second dose between 3 and 5 years of age.

This vaccine schedule ensures long-lasting immunity against these viruses. The MMR vaccine is celebrated for its role in drastically reducing, and in some places, virtually eliminating these once common and potentially severe illnesses.

Its safety and effectiveness have been extensively validated, making it a cornerstone of public health initiatives worldwide.

Unfortunately, the efficacy of the MMR has been eroded by a growing hesitation amongst parents and carers about ensuring that children receive a full dose of the vaccine.

Several factors have contributed to the low uptake of the MMR vaccine with the overall vaccination rates dropping to about 85% of children arriving at school with two MMR doses, significantly below the 95% coverage target set by the World Health Organization​​​​.

False link with autism

Perhaps the most well-known story with regards to the vaccine are the discredited concerns from a 1998 report by Andrew Wakefield. This study falsely linked the MMR vaccine to autism, sparking widespread fear and concern.

Despite the fact that Wakefield’s research was later discredited, retracted, and Wakefield himself was struck off the UK medical register, the damage was done.

The myth of a link between the MMR vaccine and autism persists in public consciousness, fuelled by the echo chambers of social media and celebrity endorsements.

Another factor is the general perception of risk. When the immediate threat of a disease seems to have diminished, public urgency for vaccination can decrease.

Complacency

This complacency is dangerous, as evidenced by the current rise in measles cases. In 2019 the World Health Organization conducted a survey which identified that young adults who were born between 1998 to 2004 are amongst the most unvaccinated populations in recent history.

Many of these individuals are now in frontline roles not only exposing them to the risk of falling ill and the long-term consequences, but also putting them in prime position to help spread the virus. Catching up on vaccines as an adult is therefore crucial​​ to help close this immunity gap.

The situation demands a national ‘call to action’ to prevent the spread of measles. This involves not only increasing vaccine uptake but also improving public understanding of the disease and the vaccine.

Innovative delivery approaches and community engagement are key to turning around the falling MMR uptake rates and ensuring that this measles outbreak will be the beginning of the end for measles in Wales and the wider United Kingdom.