A new report by the World Health
Organization in the Weekly Epidemiologic Record has documented
more than 30,000 cases of measles in the European Region in 2010
and more than 26,000 thru October in 2011. These numbers of cases
come after three years of record low levels in 2007-2009.
Outbreaks
Measles outbreaks were reported
from 36 countries in the region in 2011 and about one quarter of
the reported cases (28%) in 2011 were hospitalized and 9 children
died.
Large outbreaks in Bulgaria in 2010
and in France in 2011 accounted for a large percentage of the new
cases. The outbreak in France was the largest in the region with
more than 14,000 cases accounting for 54% of all the cases in
2011. Six of the nine deaths were from that country. France’s
Health Director told the press “France can simply not afford to
have deaths, painful and costly hospitalizations, disruptions to
work and school from a completely vaccine-preventable disease.”
Vaccination
Approximately three quarters of the
European cases have been school age children 5 years of age or
older, and most have either been unvaccinated or have had an
unknown vaccination history. According to WHO, successful control
will required achieving and sustaining high vaccination coverage
with not just one but two doses of measles vaccine. Vaccine
coverage rates with one dose of vaccine are already estimated to
be over 90% in the European Region, however, two dose coverage
appears to be much lower.
Benchmark
While an extremely challenging
public health goal, measles elimination has been achieved and
sustained in the US and the entire WHO region of the Americas
since 2002, thereby creating an attainable benchmark which other
regions could also achieve.
Decline in Deaths
In an article entitled “A World
Without Measles” in a special supplement to the Journal of
Infectious Diseases published earlier this year, Peter Strebel
from WHO and colleagues [J Infect Dis.
(2011) 204
(suppl 1) ]reported that
measles deaths declined by “an impressive 78% from an estimated
733,000 deaths in 2000 to 164,000 in 2008.” This progress was
ahead of the 2010 target date for reducing measles mortality by
90% and encouraged global authorities to conclude that measles
could be eradicated by 2020 if progress continued through 2015.
Setbacks
According to the same article,
“this steady march toward a measles-free world is now facing a
setback. Starting in mid-2009, there has been a widespread
resurgence of measles with over 200,000 cases and 1,400 deaths
with the true number thought to be 10-20 fold higher at 2-4
million cases and 14-28,000 deaths.
Following publication of this
article, large outbreaks in 2011 have been seen not only in France
but in the Democratic Republic of the Congo (100,000 cases), and
Nigeria and Somalia (15,000 cases each) according to global
authorities. High numbers of deaths are also continuing to occur
in India.
Challenges
The serious challenge in 2011 to
measles elimination in the European region by 2015 is caused by
numerous factors according to WHO. These are 1) lack of knowledge
about the potential seriousness of the disease, 2) skepticism
about the benefits of vaccination, 3) increased fear of adverse
events after vaccination, 4) limited access to health care for
some populations, and 5) religious or philosophical objections to
vaccination in some areas.
According to Mark Muscat
from the Department of Epidemiology at the Statens Serum Institute
in Denmark writing in the same issue of the Journal of Infectious
Diseases, “…one of the main obstacles is the false perception of
parents that believe Measles, Mumps, Rubella (MMR) vaccination to
be more dangerous than the disease itself.”
Doctors As Problems
Doctors and health care providers
are key to providing reliable information for parents making
vaccination decisions and there is evidence that not all are
enthusiastic MMR vaccination proponents. In surveys in France,
Germany and elsewhere in Europe according to Muscat, substantial
percentages of health care providers are not strongly in favor of
vaccination.
At A Crossroads
On a worldwide basis, the setbacks
in measles elimination are being attributed to decreases in
financial support and political commitment to the elimination
goal. According to the Strebel article, WHO has calculated a worst
case scenario for lowered financial and political commitment which
could translate into more than 500,000 measles-related deaths
worldwide in 2013. They add, “Thus, the world is at a crossroads
regarding whether it has the will and the means to make the
sociopolitical and financial commitment to reverse the resurgence,
achieve the 2015 mortality reduction target, and reap the
tremendous long-term humanitarian and economic benefits of a world
without measles.”
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