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Measles

Measles immunisation was introduced in Ireland in 1985, and continued as MMR (measles, mumps and rubella) immunisation from 1988 onwards. Since that time, efforts have been made to encourage parents to have their children immunised against these potentially serious childhood diseases.

In 1993/1994, there was a large increase in the number of cases of measles identified in Ireland, which was due to not enough children being immunised to prevent spread of the disease.

In 2000, 1603 cases occurred in Ireland. Unfortunately there were three deaths in children - two children died of pneumonia complicating measles and one child later died from a post measles encephalitis.

 

measles child
A child infected with measles in the 2000 outbreak who has subsequently recovered fully

Measles is an acute infection caused by the measles virus. Measles is usually a childhood infection and is most common in the non-immunised 1-4 year old age group. However, one can catch measles at any age. Measles is caught through direct contact with an infected person or through the air when the infected person coughs or sneezes. It is highly infectious. Measles is most infectious before the rash appears and only trivial contact may be sufficient for the virus to spread.

Symptoms develop 9-11 days after becoming infected and last up to 14 days from the first signs to the end of the rash. The first stage of measles includes irritability, a runny nose, conjunctivitis (red eyes), a hacking cough and an increasing fever that comes and goes. These symptoms may last up to 8 days. The rash starts from day 4. It usually starts on the forehead and spreads downwards over the face, neck and body. The rash consists of flat red or brown blotches, which can flow into each other. It lasts 4-7 days. There can also be diarrhoea, vomiting and abdominal pain.

Complications are quite common. They include a severe cough and breathing difficulties (croup), ear infections (1 in 20), viral and bacterial lung infections (pneumonia) (1 in 25), and eye infections (conjunctivitis). Most of the complications are caused by secondary bacterial infections, which can be treated with antibiotics. More serious problems involve the nervous system and are rarer. Inflammation of the brain (acute encephalitis) occurs 2-6 days after the rash has appeared. Less than 1 in 1,000 measles cases is affected in this way, but 25% of those affected are left with brain damage. SSPE (subacute sclerosing pan-encephalomyelitis) is the most severe complication of measles. It usually occurs years after the initial illness and is a slowly progressive brain infection. SSPE starts with intellectual impairment and deteriorates to seizures and eventually death. It is, however, very rare occurring in less than 1 in 100,000 cases of measles. Measles infection during pregnancy can result in the loss or early birth of the baby.

Severe disease and complications are most likely in infants under 12 months, those with weakened immune systems, and the malnourished.

A highly effective vaccine, MMR, can prevent measles in over 90% of immunised children, following a single dose of the vaccine. With the second dose of MMR vaccine, over 99% of immunised children are protected from measles infection. This vaccine is given free by the GP at 12 to 15 months and a second dose is now given at entry to school (age 4-5 years). MMR vaccination is also recommended for children, age 11-12 years. This can be omitted, however, if two previous doses of MMR have been given.

The administration of MMR vaccine is contraindicated in the following persons:

  • Those with untreated malignant disease and immunodeficiency states other than HIV infection.
  • Those on immunosuppressive therapy, high-dose x-ray therapy and current high-dose systemic corticosteroids
  • Those with a history of anaphylaxis to a previous dose of MMR vaccine or one of its constituents (eg. neomycin, gelatin)
  • Women known to be pregnant. Furthermore, pregnancy should be avoided for one month after MMR immunisation.

In the past there have been some media reports and public concern about claims that MMR vaccine is associated with Crohns disease and autism. This may have led parents to hold off getting MMR vaccine for their children, and may have contributed to the current rise in cases seen in Ireland today. All the scientific evidence points to there being no link between MMR vaccine and Crohns disease and autism.

The current reported uptake of MMR vaccine at 2 years is well below that required to prevent outbreaks of measles and spread throughout the community. In countries in Europe where there has been a low uptake of MMR vaccine, large outbreaks of measles have occurred. In the Netherlands, more than 2300 cases occurred in 1999/2000 among a community that are philosophically opposed to vaccination. Three of these children died, 53 were hospitalised, four of whom developed encephalitis (inflammation of the brain). In addition more than 500 children were treated at home for complications of measles, mainly respiratory tract infections. These epidemics in Ireland and the Netherlands show that measles infection has serious consequences, and the need to ensure that all children are protected against this serious disease.

HPSC is encouraging parents to bring their children to the GP for MMR immunisation if they have not already done so. The vaccine is safe, and is effective in protecting against measles.

A measles information leaflet for the Traveller Community is available here.

Last updated: 19 January 2010



Health Protection Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1, Ireland. t: +353 1 8765300 f: +353 1 8561299 e:hpsc@hse.ie
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