Measles: alarming worldwide surge seriously threatens children, says UN
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l981 (Published 01 March 2019) Cite this as: BMJ 2019;364:l981
The number of measles cases around the world jumped by 48.4% last year and is still climbing quickly, the UN children’s agency Unicef has warned, blaming the rise on inadequate vaccine coverage caused partly by misinformation.
“This is a wake-up call,” said Henrietta 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.”
Some 98 countries saw a rise in measles cases in 2017-18, said Unicef, with 10 countries accounting for 74% of the increase. Ukraine, the Philippines, and Brazil saw the biggest jumps in cases, followed by Yemen, Venezuela, Serbia, Madagascar, Sudan, Thailand, and France.
Madagascar announced on 14 February that a measles outbreak that began last September has caused 928 deaths, mostly of children. An emergency vaccination campaign is currently under way. It reached 1.4 million children in February and should immunise a further 3.9 million children this month.
Brazil surged to 10 262 measles cases in 2018 after reporting zero cases in 2017. In Ukraine figures from the first two months of 2019 show that a very large outbreak centred around Lviv continues to accelerate. The region’s schools were closed to unvaccinated children at the beginning of February.
Ukraine—like Madagascar, Yemen, and Venezuela—has seen vaccine supplies interrupted by conflict, poverty, or instability. But measles has also been rising in countries where the main impediment to full coverage is parental reluctance.
The Philippines saw immunisation rates plunge last year. Confidence in all vaccines was rocked when the government halted a dengue fever vaccination campaign, citing safety concerns that were disputed by the vaccine’s maker, Sanofi.1 Measles rates are now soaring, and 203 deaths were reported in January and February, up from only 25 over the same period in 2018.
Japan is experiencing its worst measles outbreak in 10 years, concentrated around the religious group Kyusei Shinkyo, which rejects not only vaccines but medicine in general.
France, known for very low public confidence in vaccines, has the highest measles rates in western Europe, along with Italy, whose vaccine sceptic populist government relaxed measles vaccination requirements last year, only to reinstate them as cases surged.
Misinformation
A study published on 25 February in the European Journal of Public Health found a “highly significant positive association” between the percentage of people in a country who voted for populist parties and those who believe that vaccines are unimportant (R=0.7923; P=0.007) or ineffective (R=0.7222; P=0.0035).2
An unvaccinated French family last week reintroduced measles to Costa Rica, said the health ministry of the Central American country, which had previously gone five years without a case.
“Children are getting infected even in places where there is simply no excuse,” said Unicef’s Fore. “Measles may be the disease, but, all too often, the real infection is misinformation, mistrust, and complacency.”
In the United States measles cases rose sixfold in 2018 to reach 791, frustrating health officials in a country that had declared the disease eliminated in 2000. Congressional hearings this week discussed ways to overcome vaccine disinformation.
Facebook announced earlier this month that it will take steps “to reduce the distribution of health related misinformation,” probably by deprioritising anti-vaccine pages in its search results.
Several US doctors told the UK’s Guardian newspaper that closed Facebook groups hosting thousands of like minded vaccine opponents have launched organised online attacks on the websites of clinics and doctors who have spoken in favour of vaccination.3 In addition to hostile comments the attacks leave thousands of fake negative reviews on websites such as Yelp, potentially hurting the business of any healthcare professional who dares to post pro-vaccine content on Facebook.
“This is the digital equivalent of 39 000 people storming into our waiting room and screaming at us and our patients,” said one doctor whose clinic was targeted after posting a video about the HPV vaccine.