Friday, 27 April 2012

Europe's Embarrassing Problem

No, not the Euro, the other one - measles.

"While every country in the Americas, including its poorest, wiped measles off the map in 2002, Europe has been unable to do so. Cases have quadrupled since 2009, and the reemergence has become a threat to other countries. In 2011, the United States had 222 cases, the highest number since 1996, and most importations come from Europe."

So says Kai Kupferschmidt in the latest Science magazine.

Notice that the USA is concerned about a rise in cases to 222 in 2011, whereas Europe had 26,074 cases just from January to October 2011. Even worse, Kai points out that:

"Measles' stubborn persistence in Europe would also be a stumbling block in any plan to eradicate the disease globally."


Here in the UK we were well on our way to eradicating measles thanks to the MMR vaccine introduced in 1988 and the MR catch-up campaign in 1994, as this graph from the Department of Health shows:

"MR campaign" was the measles and rubella catch-up vaccination campaign run in 1994 to vaccinate 5-16 year olds who missed the MMR vaccine which didn't exist when they were babies. The yellow line (using the scale on the right) shows the percentage of population vaccinated against measles.

Three things jump out from this graph.

  1. MMR vaccine is amazing, it came close to stamping out measles in this country.
  2. MMR is better than single measles vaccine. There's no conspiracy theory here.
  3. Andrew Wakefield published his discredited lies about MMR and autism in 1998, watch the yellow line nosedive. Way to go Dr Andrew *slow hand clap*
You hear a lot of rose-tinted claptrap from adults about childhood diseases, "measles didn't do us any harm when we were kids", but the people who say that are the ones who didn't die from it. Survivor bias. 

In 1988, the year that MMR was introduced in the UK, 16 people died of measles. Between the start of the measles vaccination in the late 1960s and the MMR vaccine arriving in 1988 the UK typically saw between 10 and 20 measles deaths every year. If you're one of my old school friends born in 1977 or 1978, those years saw 23 and 20 measles deaths respectively. That was everyday life before MMR.

Before the single measles vaccine it was even worse: seeing 50-100 measles deaths in one year was quite normal, and a bad year such as 1961, 1963 or 1965 over 100 were killed by measles. Back in the 1950s it was worse still: the year my dad was born, 1950, there were 221 measles deaths followed by another 317 in 1951. The majority of all these measles deaths were children, of course.

It's little surprise that people hailed the measles vaccine in the 1960s and then the MMR vaccine in the 1980s as a wonder, and why there was a big push to get older children caught up with the MMR vaccine once people had seen just how effective it was. In the UK alone, thousands of deaths and millions of cases of measles have been avoided thanks to measles and MMR vaccination programmes.

More recently, there's been a huge worldwide effort to cut measles deaths through vaccination. Around half a million people died from measles in 2000, but ten years of effort to vaccinate brought that down to 140,000 in 2010. Most of these remaining deaths are in India and parts of Africa where vaccination levels remain low. It's hard to think of any health programme that's saved more lives and avoided more suffering than vaccination, apart from water sanitation.

Meanwhile, measles outbreaks continue to rage across Europe thanks to European parents who do not vaccinate their children, in contrast to the Americas where concerted vaccination effort has almost eliminated the disease even in poor nations. As the rest of the world strives to eradicate measles, Europe remains a major source of infection not because of poverty or lack of vaccine availability but through choice.

* Measles data from the UK's Health Protection Agency:

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