The recent outbreak of measles in Swansea has caused serious concerns for the health of the city’s inhabitants. Under current investigation by a coroner, is the fatality of a 25-year old man who is suspected to have died of measles which if this case is confirmed, it will be the first death from measles since 2008. So far, the cases of measles in the area have totaled over 800. Parents have been advised as a matter of urgency to schedule an MMR vaccine for their children. In relation to the fatality, Maria Lyon – director of health protection for Public Health Wales has said:
“My sympathies are with the family at such a tragic time. Whatever the cause of death in this case, we should not be surprised if, as the outbreak grows, we start to see deaths in Wales. Measles is a potentially fatal disease and around one in every 1,000 people who contracts measles in developed countries will die…We know that there are unprotected people in all age groups but we have particular concerns about the 10-to-18 age group. The MMR vaccine is recommended by the World Health Organisation, UK Department of Health and Public Health Wales as the most effective and safe way to protect children against measles.”
Those who have not completed the full course of the vaccine are now at a severe risk of contracting the disease as it is highly contagious. Measles is an airborne virus and is spread through water droplets that are passed by coughing and sneezing. The disease initially presents as a bad cold or fever but soon develops into the well-known, all-over body rash. As it’s a viral infection, anti-biotics do not work and there are currently no drugs to treat measles. Once contracted, the virus should be fought off by the patient’s immune system within 7-10 days, though rarely, complications can occur such as meningitis, pneumonia, or hepatitis – especially in patients whose immune system is compromised.
In 1998, Andrew Wakefield wrote a paper in the Lancet, which claimed to have identified a new syndrome which they called autistic enterocolitis, raising the possibility of a link between a novel form of bowel disease, autism, and the MMR vaccine. The paper itself did not assert that there was in fact a causal connection but in press interviews, Wakefield strongly advocated for the MMR vaccine to be withdrawn until the link could be proven. The report was later widely discredited and his paper was formally retracted by the Lancet. In 2010, Wakefield was struck off the medical register by the General Medical Council (GMC), the most serious sanction the GMC could impose, for unethical conduct, improper evidence collection and serious professional misconduct:
“He had abused his position of trust and brought the medical profession into disrepute in studies he carried out on children.”
Sarah Ditum writing for the Guardian, has identified another contributor to the scare surrounding the MMR vaccine specific to South Wales that has perhaps contributed to the city’s recent outbreak. A series of articles were written in 1997 by the South Wales Evening Post investigating the possibility of negative effects from the vaccine. The campaign, a year before Wakefield’s article was released, decreased the uptake of the injection by almost 14% in the area. At the time, the coverage of the issue was applauded. The campaign even won a prize from the BT Wales Press Awards for its investigative reporting. The Post has defended its record by stating:
“Our campaign reflected the concerns of parents, it told their stories, it called for answers, it wanted clarity. What it did not do was tell people to avoid immunising their children.”
Although re-examining the articles, Ditum has suggested that the newspaper went beyond reporting the simple concerns of parents:
“The Post also seemed to downplay the risk of measles, reporting on 6 July 1998 that “not a single child has been hit by the illness‚ despite a 13% drop in take-up levels”. It’s not parents who should feel embarrassed by the Swansea measles outbreak: some may have acted from overt dread at the prospect of harming their child, and some simply from omission, but all were encouraged by a press that focused on non-existent risks and downplayed the genuine horror of the diseases MMR prevents. The shame belongs to journalists.”
Whatever the cause, the recent outbreak in Swansea has raised general concerns for the potential vulnerability of the generation of people who have not had the full vaccine course for MMR. A form of immunity, known as herd immunity, usually steps in to provide a measure of protection for those who are not immunized from an illness as the chains of infection for contagious disease are likely to be disrupted when large numbers of the population are immune. The World Health Organisation (WHO) estimates the herd immunity threashold for measles is 83-94%. This threshold is now in jeopardy thanks to the scare surrounding the Wakefield paper, potentially causing a resurgence of a disease that would ordinarily be firmly under control.
For further information about this, please see:
http://www.guardian.co.uk/society/2013/apr/19/measles-outbreak-man-died-swansea
http://jech.bmj.com/content/54/6/473.full
If you are interested in issues like immunisations or medical ethics then you might be interested in our Medicine Summer School (Part Three) on 17th-18th August.