Measles has been eliminated in the UK, global health leaders say, in what doctors have linked to a decline in fears over discredited research linking autism with the MMR vaccine nearly 20 years ago reports The Independent. The disease has ceased to freely circulate in Britain for three years, which is the length of time a country must sustain “interruption of endemic transmission” before an elimination can be verified, according to the World Health Organisation (WHO). The UK is also on the verge of confirming the elimination of rubella, the organisation said.
According to the report, medical experts in Britain said the WHO’s announcement marked a “sign of recovery” after a discredited research paper by former doctor Andrew Wakefield in 1998 had slowed the process of eradicating the disease. Wakefield’s research, which claimed that children’s behaviour changed “drastically” shortly after they received the MMR jab, caused vaccination rates to plummet.
The report says the proportion of toddlers getting the jab in the UK fell from well over 90% during the mid-1990s, to below 70% in some places five years after the paper was published – causing measles rates to climb. However, the alleged link between the MMR and autism became widely discredited and no respected research has ever supported the findings, prompting the Lancet to say it should never have published the study.
Dr Mary Ramsay, head of immunisation at Public Health England, said in the report that there was a correlation between the elimination of the disease and the reversal of attitudes towards the MMR vaccine as word spread that Wakefield’s research was false. “The Wakefield stuff significantly impacted on uptake, so we moved further away from it. Because of the number of people who weren’t vaccinated due to Andrew Wakefield’s claim, we’re seeing more cases now in people aged 18-25. It’s a sign of recovery following that rumour having such an impact on uptake rates, so it’s good news.”
Ramsay said Wakefield’s claimed caused a dip in MMR vaccination rates due to the panic caused by the research, as well as “spikes” of measles outbreaks in the UK over the past 20 years. “There were spikes in cases from 2005 and even into this decade, because it’s a certain age of people who didn’t get their jab,” she added. “When people travelling from abroad mingle with groups of people who haven’t been vaccinated – for example this happened last year at festivals – then you do tend to see outbreaks.”
The report says the news comes just a week after it was announced England had achieved the WHO target of giving 95% of children their first dose of the measles, mumps and rubella vaccine by their fifth birthday.
Ramsay said Public Health England was “delighted” about the measles elimination, and the attainment of national vaccine coverage by hitting the 95% target. She added: “This is a huge achievement and a testament to all the hard work by our health professionals in the NHS, to ensure that all children and adults are fully protected with two doses of the MMR vaccine. We need to ensure that this is sustained going forward by maintaining and improving coverage of the MMR vaccine in children, and by catching up older children and young adults who missed out.”
The WHO reports that in the WHO European Region, 42 of 53 countries have interrupted endemic transmission of measles, and 37 countries have interrupted endemic transmission of rubella as of the end of 2016. This was determined by the European Regional Verification Commission for Measles and Rubella Elimination (RVC) at its 6th meeting in June 2017.
“I congratulate each country for fulfilling the commitment to protect its people from measles and rubella and collectively moving the European Region closer to its elimination goal,” said Dr Zsuzsanna Jakab, WHO regional director for Europe. “However, we cannot become complacent now. Outbreaks continue to cause unnecessary suffering and loss of life, and routine immunisation coverage is decreasing. It is unacceptable that 1 in every 15 children still does not receive the first vaccination dose against measles and rubella on time. We will eliminate these diseases from our region, but need to be ready to walk the hardest last mile.”
The number of countries in the region that have demonstrated interruption of endemic measles and/or rubella transmission continues to increase. Based on 2016 reporting, the RVC concluded that: Austria, Germany, Kyrgyzstan, Poland, the Russian Federation, Switzerland and Turkey have interrupted endemic measles transmission for at least 12 months, bringing the total of countries to 42 for the region; and Bulgaria and Kyrgyzstan have interrupted endemic rubella transmission for at least 12 months, bringing the total of countries to 37 for the region.
Elimination of measles or rubella can be verified once a country has sustained interruption of endemic transmission for at least 36 months. The RVC verified that the following countries achieved elimination status as of 2016 for one or both diseases:
Denmark, Spain and the UK eliminated measles; the Republic of Moldova, Sweden and the former Yugoslav Republic of Macedonia eliminated rubella; and Croatia, Greece, Iceland, Lithuania, Montenegro and Uzbekistan eliminated both measles and rubella.
This brings to 33 the total of countries that have eliminated measles and also to 33 the total of countries that have eliminated rubella. The region can be verified as having eliminated measles and/or rubella when all 53 Member States have achieved elimination for both diseases.
The measles virus can spread wherever immunity gaps exist. Despite progress towards elimination in many countries and a record low in measles cases for the region in 2016 (5,200), over 11 000 measles cases have been reported so far this year. The largest outbreaks have taken place in the remaining endemic countries, but cases have also been reported following importation of the virus into countries that no longer have endemic transmission.
Regional coverage with the first dose of measles-containing vaccine is estimated to have gradually decreased over the last 5 years from 95% in 2012 to 93% in 2016. At least 95% vaccination coverage is considered necessary to protect an entire population from this highly contagious disease. In 2016, 25 Member States reported national coverage below this threshold.
The barriers to achieving and sustaining high immunisation coverage include vaccine shortages, inequitable or inconvenient access to immunisation services, vaccine hesitancy among parents and/or insufficiently informed health workers. Overcoming these barriers requires an all-government effort. By protecting everyone in the Region from vaccine-preventable diseases, countries contribute directly to their populations’ health and well-being, but also to a range of other global targets enshrined in the Sustainable Development Goals.
“This region has eradicated polio, eliminated malaria and drastically reduced the transmission of measles and rubella. With continued commitment and hard work we will be the generation that also eliminates measles and rubella from the remaining endemic corners of this region,” says Dr Nedret Emiroglu, director for health emergencies and communicable diseases of WHO/Europe. “This is not only our contribution but also our obligation to the generations that follow us.”