Measles infections have rebounded. After reaching historical lows in Europe in 2016, last year cases quadrupled with more than 20,000 people affected and 35 deaths. The loss of respect for the disease has propagated unscientific theories that question the importance of vaccination. But the virus does not rest.
After several days of measles infection, the characteristic skin rash appears on the face, neck, hands and feet. / Fotolia
Measles is a serious disease caused by a virus, but it perfectly preventable with vaccines. However, at the end of last February the World Health Organization (WHO) made public its concern about the increase of cases in Europe.
After a historical minimum of 5,273 cases in 2016, cases have quadrupled in 2017 with more than 20,000 people affected and 35 deaths. Moreover, 15 European countries, including the United Kingdom, had large outbreaks; Romania, Italy and Ukraine were the territories with the highest incidence.
However, it is a health problem not only for Europe, but for the rest of the world. Countries from other continents (China, Ethiopia, India, Indonesia, Lao People's Democratic Republic, Mongolia, Philippines, Nigeria, Sri Lanka, Sudan, Thailand, and Vietnam, among others) also reported outbreaks of measles between 2016 and 2017.
In Spain, in recent years there have been between 100 and 300 cases as a major upturn - except in 2011, when the last major outbreak occurred with 3,518 cases (about 30,000 in Europe) -. Although it is not a negligible number, within the European scenario the country moves in a relatively low range of cases. In 2017 there were 160 cases reported.
"This is because in our country there are high rates of vaccination coverage with the triple viral (measles, rubella and mumps): 96.7% with the first dose (recommended between 12-15 months of life) and 94, 7% with the second dose (between 2-4 years of age), "explains Roi Piñeiro, coordinator of the consultation of advice on vaccines at the General Hospital of Villalba, to Sinc.
This pathology occurs with epidemic outbreaks with a rate of infection in unvaccinated people close to 100%. If we have close contact with a case and we are not vaccinated, it is almost impossible not to get infected. That is, the options are to be vaccinated or infected through the virus.
When an affected person appears, whether or not a significant outbreak occurs depends directly on the vaccination rate of the nearby population and the preventive measures taken. Air and contact isolation is necessary, since it is transmitted through direct contact with the respiratory secretions of infected people and through the air.
A step back in eradication
Measles is a disease candidate for elimination since its reservoir is exclusively human, there is an effective and cheap vaccine that provides lasting immunity, the virus barely survives in the environment and there are sufficient diagnostic techniques to detect the infection.
According to the WHO data, in 1980 - before the use of the vaccine became widespread - it caused about 2.6 million deaths per year. From 1990 to 2008 much progress was made in its eradication; however, since then outbreaks have been declared worldwide.
While at the beginning of the 21st century there were almost a million dead, in 2016 the number has fallen below 100,000. "In just over 15 years deaths have been reduced by 84%," declares José María Bayas, former president of the Spanish Vaccination Association (AEV) and current member of the medical department of GlaxoSmithKline Spain, to Sinc. "This has meant saving 20 million lives thanks to vaccines."
The expert reveals how this improvement can suppose, on the other hand, a loss of respect for the disease and the propagation of unscientific theories. "When the associated drama is lost, the idea is spread that it is better to suffer measles than to get vaccinated because this provides stronger immunity," he says.
"And it's true, but first you have to survive," says Bayas. "If you die, you no longer get this immunity. It is important to note that measles, in addition to killing, can have serious consequences, so the balance of immunity can also be negative. "
The first symptom of measles is usually high fever, which lasts between 4 and 7 days. In the initial phase, the patient may have nasal congestion, cough, watery and red eyes and small white spots on the inside of the cheeks. After several days a rash appears, usually on the face and upper neck, which lasts about 3 days and ends up affecting hands and feet.
The most important complications are blindness, encephalitis (infection accompanied by cerebral edema), severe diarrhea (which can cause dehydration), as well as severe ear and respiratory infections, such as pneumonia. They are more frequent in children under 5 and in those over 30.
Before the use of the vaccine became widespread, measles caused about 2.6 million deaths per year. / Fotolia
The risk of suffering measles in the 21st century
Early diagnosis is essential to initiate the isolation of the patient and thus prevent transmission. However, younger doctors hardly know the disease because today it is not normal to see it in the consulting rooms.
"On the one hand, pediatricians stopped recognizing measles, because it should be in an eradication phase," says Piñeiro, who is secretary of the Spanish Society of Pediatric Infectious Diseases. "But on the other hand, a small part of the population loses fear of the disease and, given the low prevalence, considers it a good option not to vaccinate their children."
"Parents who decide not to vaccinate their children obviously love their children, but they handle the wrong information," says José María Bayas. "They have been duped by unscrupulous people. Not vaccinating a child of measles while this disease exists is a hoax; sooner or later you will end up finding the virus."
Within the group of parents who do not vaccinate their children there are those who even organize the so-called 'measles party'. When one of the children acquires the disease, they invite the rest of the unvaccinated from the community to a kind of birthday celebration, so that they all go through the viral process together.
To avoid a resurgence of this disease, immunization systems must be strengthened, but also anti-vaccines movements must be fought. "The Internet is a wonderful tool, but it can also do a lot of damage. Many people are not capable of discriminating between serious and rigorous information and that which is not, "says Bayas.
Thus, although the unfounded rumor published 20 years ago about a possible link between the MMR vaccine (measles, rubella and mumps) and autism has been widely discredited, the fear it created damaged the trust of certain groups. "It is tremendous that characters like Trump support these ideas discarded as they involve new outbreaks," qualifies the expert.
Why it is so important to vaccinate children
For those who argue that the vaccine itself can also cause encephalitis, Piñeiro states that the prevalence is less than one per million children vaccinated. "And not always proven, because most are diagnosed with encephalitis of unknown cause, which are finally attributed to the vaccine by a casual relation (temporary), but not necessarily causal."
It's easy to make numbers. For every child allegedly affected by encephalitis due to the vaccine, at least 333 children will have been saved and at least 1,000 cases of encephalitis avoided, not mentioning controlling the disease and preventing an outbreak that affects all a population. And that in the first world. In developing countries, the measles mortality rate reaches up to 10% of cases.
In Spain, at the moment the coverage is good, so nobody considers the obligatory nature of the vaccination calendar as France or Italy have started. But what makes us think that we are vaccinated against anti-vaccines?
"Strategies must be implemented before the outbreaks arrive, and to improve communication with parents from empathy, respect and affection. The easy thing is to attack a family that is reluctant to vaccinate," says Piñeiro. "The challenge is to overcome their phobias and immunize their children. That must be the goal, and we're not going to get it by forcing them to vaccinate."
Another option would be to admonish economically, as in Australia. This country accepts non-vaccination in exchange for withdrawing tax benefits to parents. Interestingly, there vaccination coverage is greater than 99%.
The measles virus does not rest. He is always looking for his next victim. The best thing is to be vaccinated and not check it in our own body. "The medicine is not an exact science, but the mathematics do not fail and they are asking us to shout that we vaccinate ourselves, all", concludes Roi Piñeiro.
Vaccines have proven to be the most cost-effective measure used in public health. In Spain the vaccination program began in 1963, the year in which the mass vaccination with the oral polio vaccine (in Spanish, VPO) was carried out.
In 1965 vaccines against diphtheria, tetanus and whooping cough (in Spanish, DTP) were incorporated; in 1978 the measles vaccine was incorporated and in 1981 the use of the triple virus against measles, rubella and mumps (in Spanish, SRP) was generalized.
In the nineties vaccines against hepatitis B and Haemophilusinfluenzae type b have been incorporated. In 2000, the conjugate vaccine against meningococcal type C was incorporated.
In 2005, the varicella vaccine was introduced in susceptible adolescents between 10-14 years of age and in 2008 vaccination campaigns against the human papillomavirus (in Spanish, HPV) began in a single cohort of girls between 11 and 14 years old, to be decided in each autonomous community.