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The Fight Against Measles. The Present Situation The Strategies The Vaccination The Controversy . Recent Outbreaks. About 20 million cases each year around the globe. 2011 UK- 804 cases Ireland – 173 cases Europe - more than 26,000 cases 8 deaths

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the fight against measles
The Fight Against Measles

The Present Situation

The Strategies

The Vaccination

The Controversy

recent outbreaks
Recent Outbreaks
  • About 20 million cases each year around the globe.
  • 2011

UK- 804 cases

Ireland – 173 cases

Europe - more than 26,000 cases

8 deaths

24 cases measles encephalitis

  • Africa and Asia , remains one of leading causes of death in children. – WHO - 164,000 people died from measles in 2008, most younger than 5 years old.
recent outbreaks 2
Recent Outbreaks (2)
  • Increase in measles cases and deaths in recent months
  • Prevalent in famine and drought areas
  • Unvaccinated children forced to live in cramped refugee camps
  • Somalia – 24%of 1yr olds immunized in country
eradication
Eradication
  • Increase in US cases
    • over 92% population vaccinated
    • Dropped due to importation of disease from WHO European Regions and South East Asian regions.
    • 33 countries in WHO European Region have increased measles cases
mmr vaccine
MMR Vaccine
  • Developed in 1960s by Maurice Hilleman
  • 3 live attenuated viruses
  • First dose ~1 year, second ~5 years.
  • Before vaccination, measles “as inevitable as death and taxes”.
  • Now contracted by <1% of individuals under 30 in countries with routine childhood vaccination
  • Prevents illness, disability, death.
who strategy 1994 2004
WHO Strategy 1994 - 2004
  • Aim: Vaccinate >90% in all districts
  • All children to get second dose
  • 71% of targeted children in 1999 -> 76% in 2004
  • Sub-Saharan Africa – 49% -> 65%
  • South Asia – 54% -> 61%
  • 2004 – 168 counties (88%) offered second round
mmr in ireland
MMR in Ireland
  • First dose at 12 months
  • Second dose (not booster) at 4-5 years
  • Through school/HSE or GP
  • Recent outbreaks of measles and mumps due to missed second dose
vaccination strategy ireland
Vaccination Strategy- Ireland
  • 1985 - Monocomponent measles vaccine introduced- 10,000 cases in that year reduced to 201 in 1987
  • 1988- combined MMR introduced -12-15months
  • 1992- Second dose recommended- 10-15 years
  • 1999- Age of second dose reduced to 4-5 years
  • Childhood vaccination Schedule for children born after 1st July 2008- Free From the Department of Health, HSE
      • 12months from GP
      • 4-5 yrs from GP or in School
        • Primary School Immunisation Programme
slide10

Outbreak in 1993- affected 4,000 people

  • 2000- 1,600 cases resulted in 3 deaths
  • From 2001 to 2006 – 1,562 cases
    • Rapid spread during these outbreaks due to:
      • Incomplete vaccination coverage
      • Susceptible pool of older unvaccinated children
  • Today- 221cases reported in 2011, so far (411 in 2010)
      • 85% occurred in North Dublin City
  • 90% of children have received 1st dose by 24months
w h o measles eradication
W.H.O-Measles Eradication
  • Global mortality reduced by 78% , from estimated 733 000 deaths in 2000 to an estimated 164 000 deaths in 2008-78%
  • The WHO region of America has
  • sustained elimination since 2002
  • The WHO has set a target of

elimation of measles in

remaining 4 out of 5

WHO regions by 2020.

    • This can only be achieved by

Increasing routine immunization coverage

      • improving surveillance systems
      • political and financial commitment
vaccination
Vaccination
  • There are two treatments to protect against measles:
  • MMR: measles, mumps and rubella vaccine.
  • MMRV: measles, mumps, rubella, and varicella vaccine.
development
Development
  • First virus was obtained from David Edmonston in 1954.
  • The virus strain was grown in chick embryos.
  • Made the virus more suited to chicks than humans
  • Similar attenuated vaccines around this time were developed.
  • From nucleotide tests all vaccines were shown to be similar.
  • At present the MMR vaccine has a 95% efficiency.
who eradiation policy
WHO: Eradiation Policy
  • Control: reduce incidence of disease. Due to 95% efficiency a two dose strategy is need to prevent an accumulation of susceptible individuals.
  • In 2010, about 85% of the world\'s children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.
measles vaccine
Measles Vaccine
  • Children should be vaccinated with the MMR vaccine 12 to 15 months after birth and should receive a second dose at 4-5 year usually before the child enters school.
  • Before the vaccination programme was implemented in USA, between 3 to 4 million people were infected each year, with 400 to 500 dying
  • Measles is a highly contagious virus and was estimated there was 242,000 Measles deaths which equals 27 deaths every hour.
mmr vaccine risks
MMR Vaccine Risks
  • The vaccine like many vaccines can cause allergic reactions, most people however do not have any problems with it.
  • Mild problems: fever (1 in 6 doses), mild rash ( 1 in 20) or rare swelling of glands.
  • Moderate problems: seizure (1 in 3,000 doses), temporary pain in joints ( 1 in 4 teenage and adult women) and temporary low platelet counts which can lead to a bleeding disorder ( 1 in 30,000 doses).
  • Sever problems: 1 in 1 million: deafness, long-term seizures or comas and permanent brain damage.
less safe if recipient
Less safe if recipient...
  • Has a fever
  • Is taking steroids
  • Has had another live attenuated vaccine in the last three days
  • Is receiving chemotherapy/radiotherapy
  • Has a compromised immune system
problems with vaccine
Problems with Vaccine

Developing Countries

Immunodeficiency

  • Individuals with low immune responses can’t handle certain vaccines due to the presence of attenuated or live virus.
  • Presence of maternal antibodies during first 9 months of life reduces efficiency of immunization.
  • Measles virus infects children by the respiratory tracts and little of the maternal antibodies will be transduced onto mucosal surfaces
advancements
Advancements
  • Aerosol delivery and high titre vaccinations to overcome problems in vaccinating young infants.
  • Recombinant virus
  • Immune-stimulating complexes
  • DNA vaccination
wakefield et al 1998
Wakefield et al. 1998
  • 12 Children with Gastrointestinal symptoms, lost acquired skills including communication
  • In 8 children, parents and/or physicians linked onset of behavioural problems with MMR
  • Main cause of public concern
media coverage
Media Coverage
  • Wakefield: “I cannot support the continued use of these vaccines in combination…”
  • Public uproar & slump in MMR vaccinations
  • Brian Deer Sunday Times investigation 2003-2011
  • Prof.John O’ Leary slander
evidence against autism link aftermath of investigation
Evidence against autism link & aftermath of investigation
  • Horniget al. 2008 replications
  • Wakefield foul play
references
References
  • http://www.immunisation.ie/en/Downloads/NIACGuidelines/PDFFile_15482_en.pdf
  • http://www.irishhealth.com/article.html?id=780
  • http://www.immunisation.ie/en/Downloads/PDFFile_15371_en.pdf
  • http://www.who.int/immunization_monitoring/diseases/measlesreportedcasesbycountry.pdf
  • http://www.immunisation.ie/en/ChildhoodImmunisation/PrimaryImmunisationSchedule/
  • http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_18-en.pdf
  • http://www.who.int/immunization/newsroom/news_wha_2010_measles_eradication/en/index.html
  • www.braindeer.com
  • http://www.who.int/mediacentre/factsheets/fs286/en/
  • http://www.cdc.gov/vaccines/vpd-vac/measles/default.htm
  • http://www.immunisation.ie/en/ChildhoodImmunisation/VaccinePreventableDiseases/MMR/
  • J. Wakefield, S. H. Murch, A. Anthony, J. Linnell, D. M. Casson, M. Malik, M. Berelowitz, A. P. Dhillon, M. A. Thomson (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.
  • T. F. Wild (1999) Measles vaccines, new developments and immunization strategies. Vaccine 17; 1726-1729.
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