The fight against measles
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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

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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


The fight against measles

  • 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


    Controversy wakefield et al 1998

    Controversy:Wakefield et al. 1998


    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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