Measles

September 2014

MEASLES INCIDENCE BEGAN TO DECLINE BEFORE MASS UPTAKE OF VACCINATION

1940

1943

1946

1949

1952

1955

1958

1961

1964

1967

1970

1973

1976

1979

1982

1985

1988

1991

1994

1997

2000

2003

2006

2009

2012

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Measles notifications in England & Wales

Noti

fica

tions

Source: https://www.gov.uk/government/publications/measles-deaths-by-age-group-from-1980-to-2013-ons-data/measles-notifications-and-deaths-in-england-and-wales-1940-to-2013; 5 Immunisation Uptake Rates – completed primary course: two year rate England and Wales 1966-77, England only 1978-195/6. Department of Health Statistics Division, Communicable Diseases surveillance Centre, UK

Vaccine uptake rate exceeds 55% for first time in 1980.

Measles vaccine introduced in 1968. 33% uptake in that year.

AROUND 90% OF MEASLES DEATH RATE DECLINE WAS BEFORE VACCINATION

1940

1943

1946

1949

1952

1955

1958

1961

1964

1967

1970

1973

1976

1979

1982

1985

1988

1991

1994

1997

2000

2003

2006

2009

2012

0

200

400

600

800

1000

1200

1400

Total Deaths from Measles

Total Deaths

Noti

fica

tions

Source: https://www.gov.uk/government/publications/measles-deaths-by-age-group-from-1980-to-2013-ons-data/measles-notifications-and-deaths-in-england-and-wales-1940-to-2013

99% of the reduction in measles deaths happened BEFORE vaccination was introduced in1968

At least 20% of mortality in the 2000s has been in immune

compromised patients.

PERCEPTION OF MEASLES AS A SERIOUS CONDITION IS RELATIVELY RECENT

1964:“In this country at least, measles is now usually regarded as a minor childhood illness through which we all must pass rather than as a public health problem.”

2014:“Complications can develop from measles, some of which can be extremely serious. It's estimated that around one in every 5,000 people with measles will die as a result of a serious complication.”

Source: Miller DL Frequency of complications of measles, 1963. Report on a National Inquiry by the public health laboratory service in collaboration with the society of medical officers of health. Br Med J. 1964 Jul 11;2(5401):75-8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1815949/pdf/brmedj02558-0019.pdf; http://www.nhs.uk/Conditions/Measles/Pages/Complications.aspx

MEASLES COMPLICATIONS CORRELATE WITH NUTRITION/HEALTH, NOT VACCINATION

• “Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases…. As high as 10% of measles cases result in death among populations with high levels of malnutrition and lack of adequate health care”

• “Severe complications from measles can be avoided though supportive care that ensures good nutrition (beforehand?), adequate fluid intake and treatment of dehydration (through diarrhoea or vomiting) with WHO-recommended oral rehydration solution.”

• “Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.“

Source: World Health Organisations, http://www.who.int/mediacentre/factsheets/fs286/en/

US PATIENTS SELF-REPORTED >320 SERIOUS ADVERSE REACTIONS TO MEASLES VACCINE IN 2013

• Data comes from Vaccine Adverse Events Reporting System (VAERS).

• The Vaccine Adverse Event Reporting System (VAERS) is a USA vaccine safety surveillance program co-sponsored by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).

• Data shows reports for whole of USA, 2013 for:– Measles + Rubella

(live)– Measles + Mumps

(live)– Measles + Mumps +

Rubella (live)– Measles + Mumps +

Rubella + Varicella (live)

• Europe has no equivalent system to VAERS.

Hospita

lized

, Pro

long

ed

Death

Perm

anen

t Disa

bility

Life

Thre

ating

Hospita

lized

0

50

100

150

200

250

6 932 47

229

Patient reported adverse measles vaccination events, USA, 2013

Source: http://www.medalerts.org/;; http://vaers.hhs.gov/index

58.2% of reported events occurred in children under 3 years old.

SOME STUDIES SUGGEST MEASLES MAY HAVE BENIGN LONG-TERM HEALTH EFFECTS

• A study conducted by the Danish epidemiologist Tove Rønne and published in the Lancet in 1985, found that having measles with a typical rash was associated with a lower incidence of developing immunoreactive diseases, sebaceous skin diseases, diseases of bone, cartilage and certain tumours in adult life.

• Early exposure to measles may be associated with a lower risk of adult onset doctor diagnosed asthma.

• A statistically significant inverse association between measles vaccination and atopic (allergic) sensitization was found in relation to allergen-specific serum IgE level of 3.5 kU/L.23 (meaning those with measles had less allergy).

Source: www.thelancet.com/journals/lancet/article/PIIS0140-6736(85)90961-4/abstract; www.ncbi.nlm.nih.gov/pmc/articles/PMC1745751/pdf/v055p00383.pdf; Rosenlund H et al,.Allergic disease and atopic sensitization in children in relation to measles vaccination and measles infection. Pediatrics. 2009 Mar;123(3):771-8. http://pediatrics.aappublications.org/content/123/3/771.full.pdf+html