The unwanted rise of measles

In the midst of dramatic increases in measles cases in this country, the frustration of some public health advocates is palpable. They know this is an illness which could be wiped out through vaccination, in the same way smallpox was.

Smallpox was last seen in Somalia in 1977 and declared eradicated in 1980, following the world-wide immunisation campaign led by the World Health Organisation (WHO).

Before the measles vaccine was introduced in 1963, there were major epidemics internationally killing an estimated 2.6million people a year. About 60% of measles deaths are due to pneumonia and another 15% the result of swelling of the brain. New Zealand was doing well with measles, in 2017 one of few countries awarded WHO eradication status for the disease. This status did not mean there would not be any cases of measles in the country, but it recognised there was no homegrown disease, and that each outbreak (triggered from cases coming from overseas) was eradicated within a 12-month period.

An increase in cases internationally has seen four countries lose their eradication status and ours is looking a little shaky. Cases in the current Auckland outbreak are rising daily and those who are unvaccinated or without immunity to the disease are advised to avoid that city. This year there have been at least 849 cases, most in Auckland, but there are some pockets of the highly contagious disease in other places, including three cases in Queenstown last month.

In its update on the New Zealand situation a week ago, the Institute of Environmental Science and Research (ESR) showed the largest number of cases this year have been in those aged 20 to 29, followed by 10-19 year-olds, those aged under 15 months and then those aged 30-49 years. (Children do not usually receive their first vaccination until 15 months.) Nearly two-thirds of the youngest children who contracted the disease this year were hospitalised, and overall , hospitalisation rates of those with measles are about 36%.

Efforts are being ramped up to reach families in Auckland who may have been finding it hard to get to their family doctor for vaccinations, with plans for nurse vaccinators to run clinics in a variety of places including schools, churches and malls and at varied times such as weekends and evenings.

Is more needed across the country to help plug the gaps in vaccination coverage?

Pharmacists are keen to get involved. There are 864 accredited pharmacists who already provide a variety of vaccinations, but only the few who also have prescribing rights can administer the Measles Mumps Rubella (MMR) vaccine because it is a prescription medicine. The rules need to change on this.

Popping in to a pharmacy would be convenient for many and would also mean those getting vaccinated would not be exposed to the coughing and spluttering of sick patients in family doctors' waiting rooms.

One of the known gaps in coverage is in those born between 1969 and 1990 when it was standard practice to give one vaccination instead of the current two. It is also possible some in this group might not have been vaccinated as a result of the spurious claims made about the vaccine back in the 1990s.

Is there a need for a specific education campaign for young adults living away from home and beyond studenthood? Many in this group may find it hard to relate to an illness which has been uncommon in their lifetime.

Some over-50s, considered likely to be immune from their childhood exposure, may be subtly downplaying the need for vaccination too, not fully comprehending the damage the disease caused in their youth.

That "I survived measles, so I can't see what the fuss is about" attitude is one which may also need to be addressed in any future campaign to boost vaccination.


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