Cases of childhood measles are surging to shocking levels around the globe, led by 10 countries that account for three-quarters of the rise. Amid warnings of “disastrous consequences” for children if the disease continues to spread unchecked, a worldwide survey by the UN children’s agency, UNICEF, said 98 countries around the globe reported a rise in measles cases in 2018 compared with 2017. That total includes a number of countries that had previously eradicated the disease. The increases were noted not only in countries affected by serious conflict, where access to vaccination has been disrupted, but also in states that have experienced an increase in “vaccine hesitancy” because of misinformation spread by anti-vaccination advocates.
Highly contagious, measles spreads more easily than Ebola, tuberculosis or influenza, infecting the respiratory tract. It is potentially fatal to malnourished children and babies too young to be vaccinated. In addition, once infected, there is no specific treatment for measles, making vaccination a life-saving tool. Among the 10 countries worst affected, Ukraine, the Philippines and Brazil experienced the greatest increases in measles cases. Last year, Ukraine recorded 35,120 cases of measles; the disease has claimed 30 lives in the country since 2017. Western Ukraine, where attitudes to vaccination have led to low rates of immunisation and vaccines are in short supply, was worst hit. According to the government, a further 24,042 people have been infected in the first two months of 2019 alone. In the Philippines, 12,736 measles cases and 203 deaths have been recorded so far this year, compared with 15,599 cases in the whole of 2018. “This is a wake-up call,” said Henrietta H Fore, UNICEF’s executive director. “We have a safe, effective and inexpensive vaccine against a highly contagious disease – a vaccine that has saved almost a million lives every year over the past two decades. These cases haven’t happened overnight. Just as the serious outbreaks we are seeing today took hold in 2018, lack of action today will have disastrous consequences for children tomorrow.”
The report blames the global surge on a perfect storm of inferior health infrastructure, conflict, poor health education, complacency and vaccine hesitancy. The combined impact of these various factors has contributed to serious outbreaks in both developed and developing countries. For example, in the US the number of measles cases increased six-fold between 2017 and 2018, reaching 791 cases. More recently, the US has had outbreaks in New York and Washington state. Some of the worst affected countries are embroiled in serious conflict or political crisis, like Yemen and Venezuela. However, the presence of France on the 10-strong list appears to be linked to anti-vaccination sentiment in a country with an MMR vaccination rate among the worst in Europe. France has one of the lowest rates of vaccine confidence in the world. “Almost all of these cases are preventable, and yet children are getting infected even in places where there is simply no excuse,” Fore added. “Measles may be the disease, but, all too often, the real infection is misinformation, mistrust and complacency. We must do more to accurately inform every parent, to help us safely vaccinate every child.”
Credit: Peter Beaumont for The Guardian, 1 March 2019.