Parents urged to vaccinate children with MMR as cases of measles rise
Parents are strongly advised to ensure their children have 2 doses of MMR Vaccine, as cases of measles begin to rise in Ireland. Outbreaks have been reported in Dublin and cases linked to the Dublin outbreaks are being reported in other parts of the country. The MMR vaccine is the only protection from measles available. Measles can be a very serious and sometimes fatal illness.
There has been a rapid increase in numbers of measles cases recently, most of them centred in North Dublin City. Measles is a serious illness, and MMR vaccine is the only protection against it. In the year 2000, a serious outbreak in Dublin saw cases rise as high as 1600, and claimed the lives of 3 young children. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities.
Provisional data (08/09/2011) shows that the outbreak is spreading, with 191 cases of measles reported in Ireland since the start of 2011; over 86% of cases are in Dublin (mainly, but not exclusively, in the north Dublin area); 75% of cases have not been vaccinated with any MMR doses; 10% of cases have been hospitalised; no deaths have been reported.
The increase in cases among non-vaccinated children and young adults is a major cause for concern. Measles is a serious, but preventable, disease. Of the more than 26,000 cases across Europe, some have resulted in some severe outcomes, with six deaths, 14 neurological complications and 444 cases of severe pneumonia.
MMR Vaccine is the only protection against measles – parents are urged to make sure their children are fully protected by having the complete course of 2 MMR vaccinations. In Ireland, the first MMR dose is given routinely at 12 months of age, and the second dose at 4-5 years of age. At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
The HPSC urges all parents, country-wide, to seek MMR vaccination for their child if they have missed it.
What should parents do?
If you have a preschool or primary school child who never had an MMR shot – please go to your GP now for MMR vaccination.
If you have a primary school aged child who missed out on the MMR booster - please go to your GP now for MMR vaccination.
If you or an infant between 6 and 12 months is a contact of a measles case – please go to your GP for MMR vaccination.
If you’re not sure whether your child has had the full course of 2 doses – go to your GP for MMR vaccination
Symptoms of Measles:
High fever
Cough
Runny nose
Red eyes
Red rash that starts on the head and moves down the body
Measles can cause chest infections, fits, ear infections, swelling of the brain and brain damage.
If you think you or your child has measles, before you see your GP, call your doctor to arrange an appointment to minimise risk of transmission to others (either a house visit or a clinic visit at end of day).
Parents warned to vaccinate children with MMR as cases of measles rise
Parents are strongly advised to ensure their children have 2 doses of MMR Vaccine, as cases of measles begin to rise in Ireland. Outbreaks have been reported across Europe and in New Zealand. The MMR vaccine is the only protection available from measles, which can be a very serious and sometimes fatal illness.
There has been a rapid increase in numbers of measles cases recently, most of them centred in North Dublin City. Measles is a serious illness, and MMR vaccine is the only protection against it. In the year 2000, a serious outbreak in Dublin saw cases rise as high as 1600, and claimed the lives of 3 young children. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities.
There have been 135 cases of measles in Ireland since the start of 2011, with over 70% arising in North Dublin City. Of the more than 26,000 cases across Europe, some have resulted in some severe outcomes, with six deaths, 14 neurological complications and 444 cases of severe pneumonia.
MMR Vaccine is the only protection against measles – parents are urged to make sure their children are fully protected by having the complete course of 2 MMR vaccinations. In Ireland, the first MMR dose is given at 12 months of age, and the second dose at 4-5 years of age. At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
The HSE is contacting GPs in the North Inner City of Dublin area, informing them of the rising numbers of cases and giving specific advice on vaccination measures, and is also arranging for special MMR vaccination clinics to be delivered in primary schools in the North Dublin area, when schools return in September.
What should parents do?
If you have a preschool or primary school child who never had an MMR shot – please go to your GP now for MMR vaccination.
If you have a primary school aged child who missed out on the MMR booster - please go to your GP now for MMR vaccination.
If you or an infant between 6 and 12 months is a contact of a measles case – please go to your GP for MMR vaccination.
If you’re not sure whether your child has had the full course of 2 doses – go to your GP for MMR vaccination
Symptoms of Measles:
High fever
Cough
Runny nose
Red eyes
Red rash that starts on the head and moves down the body
Measles can cause chest infections, fits, ear infections, swelling of the brain and brain damage.
The MMR vaccine is free.
More information on measles is available here and from the HSE National Immunisation Office at www.immunisation.ie.
Parents urged to ensure children are vaccinated before travel as Europe sees increase in measles cases
The HSE National Immunisation Office today (Wednesday) urged parents to make sure that their children are fully vaccinated against measles following a large pan national outbreak of the disease in Europe.
Since the start of 2011 there have been more than 21,000 cases of measles in Europe. More than half of the reported cases occurred in France where six deaths, 14 neurological complications and 444 cases with severe pneumonia have been reported, according to the head of the HSE National Immunisation Office, Dr Brenda Corcoran.
"One death occurred in Germany and large outbreaks are also being reported from Romania, Switzerland, Spain, Belgium, Denmark, UK and Italy.
"Many cases are due to travel of infected people between countries. As there is more travel between Europe and Ireland over the summer, there is an increased risk to Irish children and teenagers who are not fully vaccinated against measles.
"There have been significant outbreaks in France, Spain and Belgium, which are popular holiday destinations for Irish families and with college students on holiday, working, visiting relatives and friends or attending summer camps or other summer activities. Additionally, the World Youth Day in Madrid will bring a large gathering of youth from all over the Europe together.
"Vaccination with MMR vaccine is the only way to protect against measles. In Ireland, the first MMR dose is given at 12 months of age, and the second dose at 4-5 years of age. Parents must make sure that their children and teenagers are protected against measles by ensuring they have been immunised with MMR before they visit Europe. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities.
"Parents should speak with their GP and get the vaccine for their child if needed. The vaccine is free.
"At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
"So far, 110 cases of measles have been reported in Ireland since January 2011. Seventy nine percent, or 87 cases of measles, have occurred in residents in the HSE East and 14 cases were under 12 months of age and were too young to have been vaccinated. Nearly 50% of cases occurred in individuals who were eligible for vaccination but had not received any dose of MMR vaccine while 22 cases received one dose of MMR. Two doses of MMR will protect 99% of those receiving the vaccine. Twelve individuals with measles have been hospitalised for between 2 and 14 days.
"At least eight of our measles cases were infected while travelling overseas in Europe, transmission from these cases then occurred in Ireland," added Dr Corcoran.
Measles outbreaks in Europe continue to escalate - July 2011
As measles continues to spread in Europe and in Ireland parents are urged to ensure children and teenagers are fully immunised against measles with the MMR vaccine.
Since the start of 2011 more than 21 000 cases were reported in EU and EEA/EFTA countries. Most cases are either un- or incompletely immunised individuals.
In France there is a huge ongoing outbreak which accounts for more than half of the reported cases in 2011. Six deaths, 14 neurological complications and 444 cases with severe pneumonia have been reported. Large outbreaks are also being reported from Romania, Switzerland, Spain, Belgium, Denmark, UK and Italy.
Mass gathering events such as the upcoming World Youth Day in Madrid in August 2011 poses a risk to susceptible participants who may be exposed to measles while there and bring it home with them, spreading the disease to others.
Two doses of MMR vaccine are routinely recommended for children;
The first dose at 12 months of age and the second at 4-5 years.
Unvaccinated older children, teenagers and young adults should get it to protect against measles.
Measles outbreaks in Europe highlight importance of vaccination before travel and attending mass gathering events
The Health Protection Surveillance Centre (HPSC) is urging parents to make sure that their children are fully vaccinated against measles following a large pan national outbreak of the disease in Europe. Today ECDC stressed the importance of getting vaccinated before attending mass gathering events.
Since the start of 2011 there have been more than 10,000 cases of measles and four related deaths in 18 European countries. Many cases are due to travel of infected people between countries. As there is more travel between Europe and Ireland over the summer, there is an increased risk to Irish children and teenagers who are not fully vaccinated against measles.
There have been significant outbreaks in France, Spain and Belgium, which are popular holiday destinations for Irish families and with college students on holiday, working, visiting relatives and friends or attending summer camps or other summer activities.
Vaccination with MMR vaccine is the only way to protect against measles. In Ireland, the first MMR dose is given at 12 months of age, and the second dose at 4-5 years of age. Parents must make sure that their children and teenagers are protected against measles by ensuring they have been immunised with MMR before they visit Europe. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities. Parents should speak with their GP and get the vaccine for their child if needed. The vaccine is free.
At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
So far, 42 cases of measles have been reported in Ireland since January 2011. Eight of these cases were in children under 12 months of age who were too young to have been vaccinated but almost half of the rest had not received any doses of MMR vaccine. One in five cases in Ireland were either related to recent European travel or to contact with infected individuals from European countries where measles outbreaks occurred.
MMR vaccine is routinely recommended for all children at 12 months and at 4-5 years of age. The vaccine is given free of charge.
Many parents and GPs have inquired about administering MMR vaccine to children less than 12 months of age who are travelling to areas where measles outbreaks are occurring in Europe.
MMR vaccine can be given be given to children as young as 6 months of age during outbreak situations (although vaccine effectiveness is usually less at this age than when given after 12 months of age).
MMR vaccine may take up to 4 weeks to be effective.
Parents who wish to lessen the risk of measles in their children between 6-12 months of age who may be exposed to measles may wish to avail of MMR vaccine. If they do so the vaccine is provided free via the HSE National Cold Chain Service but parents should pay for the vaccine administration.
This dose would not be counted as a valid dose from the point of the vaccination programme and should be repeated at 12 months of age, at least one month after the first vaccine with a further dose at 4 - 5 years of age.
Parents who wish to lessen the risk of measles in their children between 1-5 years of age who may be exposed to measles may wish to avail of a second dose of MMR vaccine. If they do so the vaccine is provided free via the HSE National Cold Chain Service but parents should pay for the vaccine administration.
This dose would usually be counted as a valid dose from the point of the vaccination programme and no further MMR vaccine is required.
Note: If a child under 18 months of age receives a second MMR vaccine within three months of the first MMR a third MMR vaccine should be given at 4-5 years of age.
For more information:
See press release issued by HSE Communications - 30/5/11
Parents urged to ensure children are fully vaccinated against measles
The Health Protection Surveillance Centre (HPSC) is urging parents to make sure that their children are fully vaccinated against measles following a large pan national outbreak of the disease in Europe.
Since the start of 2011 there have been more than 10,000 cases of measles and four related deaths in 18 European countries. Many cases are due to travel of infected people between countries. As there is more travel between Europe and Ireland over the summer, there is an increased risk to Irish children and teenagers who are not fully vaccinated against measles.
There have been significant outbreaks in France, Spain and Belgium, which are popular holiday destinations for Irish families and with college students on holiday, working, visiting relatives and friends or attending summer camps or other summer activities.
Vaccination with MMR vaccine is the only way to protect against measles. In Ireland, the first MMR dose is given at 12 months of age, and the second dose at 4-5 years of age. Parents must make sure that their children and teenagers are protected against measles by ensuring they have been immunised with MMR before they visit Europe. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities. Parents should speak with their GP and get the vaccine for their child if needed. The vaccine is free.
At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
So far, 42 cases of measles have been reported in Ireland since January 2011. Eight of these cases were in children under 12 months of age who were too young to have been vaccinated but almost half of the rest had not received any doses of MMR vaccine. One in five cases in Ireland were either related to recent European travel or to contact with infected individuals from European countries where measles outbreaks occurred.
MMR vaccine is routinely recommended for all children at 12 months and at 4-5 years of age. The vaccine is given free of charge.
Many parents and GPs have inquired about administering MMR vaccine to children less than 12 months of age who are travelling to areas where measles outbreaks are occurring in Europe.
MMR vaccine can be given be given to children as young as 6 months of age during outbreak situations (although vaccine effectiveness is usually less at this age than when given after 12 months of age).
MMR vaccine may take up to 4 weeks to be effective.
Parents who wish to lessen the risk of measles in their children between 6-12 months of age who may be exposed to measles may wish to avail of MMR vaccine. If they do so the vaccine is provided free via the HSE National Cold Chain Service but parents should pay for the vaccine administration.
This dose would not be counted as a valid dose from the point of the vaccination programme and should be repeated at 12 months of age, at least one month after the first vaccine with a further dose at 4 - 5 years of age.
Parents who wish to lessen the risk of measles in their children between 1-5 years of age who may be exposed to measles may wish to avail of a second dose of MMR vaccine. If they do so the vaccine is provided free via the HSE National Cold Chain Service but parents should pay for the vaccine administration.
This dose would usually be counted as a valid dose from the point of the vaccination programme and no further MMR vaccine is required.
Note: If a child under 18 months of age receives a second MMR vaccine within three months of the first MMR a third MMR vaccine should be given at 4-5 years of age.
For more information:
See press release issued by HSE Communications - 30/5/11
Measles outbreaks in Ireland, Europe, Africa - Measles vaccination recommended in addition to other travel vaccines
The large measles outbreak reported in Ireland earlier this year is decreasing but is not gone.
Since the beginning of 2010, 389 measles cases have been reported to the HPSC; most (52%) cases are less than 5 years of age and from the Dublin area (30%); with 22% less than 1 year of age, too young to have the vaccine usually. Most cases were preventable; of the 230 cases 12 months of age or older, for whom information on vaccination was known, 97% were either unvaccinated or had only one dose of MMR (73% unvaccinated, 24% one dose).
Measles can only be prevented with the MMR vaccine. It is very infectious, and is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. Symptoms usually appear 8–12 days after infection and include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards.
Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia.
Reminder about need for MMR vaccination for those travelling and resident in Ireland • Measles outbreaks whether in Ireland or overseas pose a risk to non-vaccinated Irish children and adults • All children need two doses of MMR vaccine; at 12-15 months and at age 4-5 years • Older children and young adults who have not received at least two doses of MMR should contact their GP for this vaccine. • Further details on measles can be found on the HPSC website at http://www.hpsc.ie/hpsc/A-Z/VaccinePreventable/Measles/
Measles outbreak - children must get vaccinated
The Health Protection Surveillance Centre is urging all parents to make sure that their children are vaccinated against measles following a national outbreak of the disease which has caused a number of children to need hospitalisation.
The outbreak which started in August, is continuing, and there are real concerns about spread among non-vaccinated individuals. A majority of cases this year have occurred among children from the Traveler community.
Measles is highly infectious and can cause severe illness and occasionally cause death. An outbreak in 2000 resulted in more than 1600 cases and three deaths.
As vaccination with the MMR is the only way to prevent measles infection, all parents must make sure their children have received the recommended two doses of the vaccine. While the first dose is usually given at 12 months of age by GPs and the second in school at 4-5 years of age, the vaccine can be received at any time. Anyone who is not sure about their vaccination status should get another dose, which will not do them any harm, and will protect against measles, mumps and rubella.
Further information on the measles outbreak is available in a recent HPSC press release and measles articles in January's issue of Epi-Insight and the March issue of Eurosurveillance.
HSE offers MMR Vaccine to post Junior Cert students as Mumps cases continue to increase
The Health Service Executive (HSE) today announced that it will offer MMR vaccination to Transition, 5th and 6th Year students in secondary schools nationwide before the summer break. This measure is being taken in response to continued increases in cases of mumps in older teenagers and young adults across the country.
Dr Brenda Corcoran from the HSE’s National Immunisation Office today said ‘Outbreaks of mumps have become increasingly frequent in those aged 15 to 24 over recent years, and from January 2009 to date. There has been a huge increase in notifications reported to the Health Protection Surveillance Centre – 1957 compared to 128 for the same period in 2008.’
Mumps is an acute viral illness that causes fever, headache and painful, swollen salivary glands. It requires isolation or quarantine, and can cause people to miss up to two weeks from school, work, studying, taking exams or socialising. Generally complications are mild but mumps can cause meningitis, deafness or inflammation of the pancreas or testicles. MMR vaccine provides protection from mumps, as well as measles and rubella.
Dr Corcoran explained ‘This outbreak is happening because there are lots of older teenagers who have not had two doses of MMR vaccine and so are at risk of getting mumps. Outbreaks of mumps have been reported in secondary schools, colleges, universities, and sports clubs – that’s why we’ve decided to offer this group a dose of MMR. It will protect them now, and when they leave school.’
Teams from HSE Public Health Departments and Local Health Offices will contact second level schools across the country this week to schedule immunisation clinics in schools in the coming weeks. MMR vaccine will be provided to all those in Transition, 5th and 6th years, free of charge, protecting those who get the vaccine from contracting mumps.
The National Immunisation Advisory Committee, a committee of independent immunisation experts supports the HSE campaign to control this outbreak and to prevent future ones.
Recent studies estimate that one dose of MMR is approximately 80% effective and estimates for two doses of MMR range from 88-95% effective in preventing mumps illness. If a young person’s MMR history is not known, an extra dose of MMR will do no harm, and could offer valuable protection against mumps.
The HSE will be attending as many schools as possible in the weeks before the summer break, and any schools that are not targeted will be followed up in September. In addition, the HSE continues to advise those in 3rd level institutions to attend Student Health services for MMR vaccine.
More information is available from www.mumps.ie or the HSE infoline 1850 24 1850.
Continued increase in mumps cases in 2009
The number of individuals affected by the mumps outbreak is increasing, with 843 cases notified to the Health Protection Surveillance Centre since the beginning of the year (as of 4/3/09); 453 cases were notified in February alone, the greatest number reported in any one month period since the outbreak began in 2004. (Figure 1)
Those most affected by mumps are between the ages of 15-24 years (66.5%). (Figure 2) Slightly more males (54.8%) than females have been reported. Information on hospitalization status was available on 330 cases, of whom 14 cases have been hospitalized (for orchitis and/or pancreatitis and unspecified reasons), all were male. Vaccination status was reported for 41% of all cases (n=336); of whom 25% were unvaccinated, 29% were incompletely vaccinated and 46% reported two doses of vaccine (complete vaccination).
Since the beginning of 2009, 16 new outbreaks have been reported, colleges/universities, and other educational facilities (school, crèche). These are in addition to already recognized community wide outbreaks reported in 2008 when 18 outbreaks were reported in university or third level colleges, seven school outbreaks were reported and one outbreak in a crèche. Workplace outbreaks were also reported in 2008.
The mumps outbreak in Ireland demonstrates similar characteristics to outbreaks reported in other developed countries; England, the United States, and Canada. All these countries have reported large mumps outbreaks in recent years, most notable in colleges and third level academic institutions. Outbreaks have been particularly common in those countries or areas with low MMR coverage, and are affecting students in age groups many of whom are incompletely vaccinated. Some outbreaks have been reported in highly vaccinated populations (United States) but the numbers are substantially less than that reported in countries with low immunization rates. In areas where outbreaks have occurred, and where targeted action has successfully improved MMR uptake, the outbreaks have been controlled. A combination of primary vaccine failure (failure to develop immunity after the vaccine) and waning immunity may both have a part to play in these outbreaks now being seen in developed countries.
Figure 1. Mumps notifications by month and year (01/2001-02/2009*)
CIDR: data downloaded 04/03/2009 at 16:45 hours. Provisional data for 2008/2009
Figure 2. Mumps notifications by age group (2009*)
Protecting against mumps Mumps vaccination, available in the MMR vaccine is the best preventive method to prevent mumps and its associated complications. Recent studies published in international literature estimate that one dose of MMR is approximately 80% effective and estimates for two doses of MMR range from 88-95% effective in preventing mumps illness.
All individuals less than 25 years of age are recommended to ensure that they have had two doses of MMR. If they do not have vaccination records documenting two doses they are advised to seek MMR vaccination from their GP or other health provider (e.g. student health service for students). The MMR vaccine is free to this age group. Payment for the GP visit may be required for non medical card holders. Student health services are free.
Individuals older than 24 years are usually immune from mumps as a result of natural infection. However, if individuals in older age groups wish to receive MMR vaccine this can be obtained from the GP. There is no upper age limit to the MMR vaccine.
References
Dayan GH, Quinlisk PM, Parker AA, Barskey AE, et al. Resurgence of Mumps in the United States. NEJM 2008 358(15); 1580-1589
Rubin SA, Qi L, Audet SA, Sullivan B, Carbone KM, Bellini WJ, Rota PA, Sirota L, Beeler J. Antibody Induced by Immunization with the Jeryl Lynn Mumps Vaccine Strain Effectively Neutralizes a Heterologous Wild-Type Mumps Virus Associated with a Large Outbreak. The Journal of Infectious Diseases 2008; 198:508 –15
Cohen C, White JM, Savage EJ, Glynn JR, Choi Y, Andrews N, et al. Vaccine effectiveness estimates, 2004–2005 mumps outbreak, England. Emerg Infect Dis [serial on the Internet]. 2007 Jan [date cited]. Available from http://www.cdc.gov/ncidod/EID/13/1/12.htm
Mossong J, Bonert C, Weicherding P, Opp M, Reichert P, Even J, Schneider F. Mumps outbreak among the military in Luxembourg in 2008: epidemiology and evaluation of control measures. Euro Surveill. 2009;14(7):pii=19121. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19121
Mumps cases exceed 1000 in 2008
Teenagers and young adults have been warned by the Health Protection Surveillance Centre to make sure that they have had two doses of MMR vaccine following over 1000 cases of the disease in 2008.
1166 cases have been reported so far compared with 132 for the same period last year. Dr Suzanne Cotter, Specialist in Public Health Medicine, HPSC advised that MMR vaccination is the only way to tackle this increase.
The huge rise in cases – nearly 60% of whom are between 15 and 24 years old - highlights once again the importance of getting vaccinated with two doses of MMR, which are needed to minimize the risk of infection. This is especially important for all teenagers and young adults, particularly students in schools and colleges following at least seven outbreaks in third level colleges this year.
Anyone who has not had two doses of MMR needs to talk to their GP or student health service about getting protected. People who are not sure about their vaccination status should get another dose to be on the safe side. The vaccine is free although an administration fee may apply for non-medical card holders.
Mumps is a contagious acute viral illness that causes fever, headache and painful swollen glands. Complications are usually mild but it can cause meningitis, deafness and inflammation of the testicles, ovaries or pancreas. Students need to be aware that the best way to avoid it is to get vaccinated. Anyone who has mumps should stay off for five days after the onset of swollen glands.
Since the beginning of 2008 there has been an increase in mumps cases notified to the HPSC, with nearly a thousand cases reported by mid-November. Most cases are teenagers and young adults (15-24 year age group) with smaller numbers occurring among younger and older individuals.
Many outbreaks are reported in colleges, universities as well as in the general community.
Why is this increase occurring? From the data available to HPSC it appears that the majority of mumps cases are either unvaccinated or only partially vaccinated (only received one dose of MMR). Full vaccination requires two doses of MMR.
Why are we not seeing as many cases in the very young and older individuals? The lower incidence of disease in younger children is most likely related to better immunity among this group because these children are more likely to have received two doses of MMR in recent years. Older individuals are more likely to have immunity as a result of infection when they were children.
How effective is the vaccine? Outbreak based studies have demonstrated that the two doses of the MMR vaccine will protect between 80%-95% of individuals against mumps. During outbreak periods some cases are expected among vaccinated individuals because not all individuals will have protective immunity. Without vaccination more cases would occur.
What can be done to prevent mumps? The best way to prevent mumps for individuals who are not immune is by getting the MMR vaccine.
In the childhood immunization schedule MMR is already routinely given to children after 12 months of age and at 4-5 years of age.
Children who are older than 5 years of age and have not already been vaccinated through the school programme or by their GP and young adults (particularly those < 25 years of age) who have not received 2 doses of MMR should be vaccinated by contacting their GP.
Individuals who don’t know how many doses of MMR they have received Many individuals do not know what vaccines they had in childhood - in which case it is recommended that young adults and teenagers who have missed out on the school programme should receive at least one dose of the MMR vaccine to protect against the disease.
Where can people get the MMR vaccine? GPs are provided with the MMR vaccine from the National Immunisation Office. Payments for vaccine administration (but not the vaccine) may apply for some individuals.
The Health Protection Surveillance Centre (HPSC) has noted an increase in the number of mumps cases reported in 2008 compared to the previous year. To date in 2008, 459 mumps cases have been reported to HPSC, 22 of whom were admitted to hospital. Almost 60% of reported cases are in the 10 to 24 year age group. This follows 142 cases in 2007, 427 in 2006 and 1079 cases in 2005 which was due to a nationwide outbreak that year. Several mumps outbreaks have been notified in third level colleges and in schools, both primary and second-level this year.
Since 2004, teenagers and young adults have been most affected by mumps. Most individuals affected by mumps either never received or received just one dose of MMR (measles, mumps and rubella) vaccine. MMR protects against measles, mumps and rubella and two doses are needed to provide protection against infection. The vaccine is free although an administration fee may apply for non-medical card holders. The vaccine is available from GPs or student health services in third level colleges.
Mumps is a contagious acute viral illness which causes fever, headache and painful swollen glands. Complications are usually mild but it can cause meningitis, deafness and inflammation of the testicles, ovaries or pancreas. It is important to be aware that the best way to avoid it is to get vaccinated. It is also advised that anyone who has mumps should stay off work/college/school/crèche etc for nine days after the onset of swollen glands.
Football fans warned about measles vaccination following major disease outbreaks in Euro 2008 host countries
The Health Protection Surveillance Centre has warned football fans planning to travel to this summer’s Euro 2008 tournament to make sure that they have been vaccinated against measles, following major outbreaks of the disease in Austria and Switzerland, who are jointly hosting the competition.
While Ireland did not qualify for the tournament some fans may still travel and should be aware that measles is an extremely contagious and potentially fatal disease. These European outbreaks are a reminder of the importance of vaccination, especially for children, as it is the only safe and effective way to prevent measles from spreading. High levels of MMR vaccination are needed to protect against infection and to protect very young children - under 12 months of age - who are too young to be vaccinated.
While measles usually occur in children under four years old, people of any age if not already protected through natural infection or vaccination, can catch the disease. Severe disease and complications are most likely in young children under five years and adults over 20 years. It is important to realise that almost half of the deaths associated with measles occur in previously healthy children and young adults. The European outbreaks are a timely reminder to get vaccinated. MMR uptake for Irish children at 24 months of age in Ireland currently stands at 88% - which although the highest level ever recorded here - is still short of the 95% needed to prevent the virus from circulating and causing outbreaks. MMR is usually given in childhood – the first dose at 12 -15 months and the second at 4 - 5 years of age. Both the MMR vaccine and the administration fee is free for all children. Most adults, particularly those born before 1978, are likely to have already had measles infection. However, any individual in this age group who has never had measles infection or the measles vaccine should speak with their GP about getting it prior to travel. For adults administration fees may apply.
ECDC warns of upsurge of measles in Europe: unvaccinated people are at risk
In 2007, several European countries experienced high numbers of measles cases, notably Switzerland, and to a lesser extent the United Kingdom (UK) and Romania (more than one case per 100,000 population per year). Full data for measles cases in Europe for 2007 can be found on the website of EUVAC.Net, a European Union (EU) -funded Surveillance Community Network for Vaccine Preventable Infectious Diseases [1].
So far in 2008, over 1,300 measles cases have been reported in Europe. These cases have been in Switzerland, the UK, France, Denmark, Germany, Austria, Spain and Norway (unpublished EU data). The European Union alert system for communicable diseases guarantees that information on these outbreaks is shared between the Member States, the European Commission, the ECDC and the World Health Organization. On April 2, the Centers for Disease Control and Prevention in the United States (US) issued a health advisory regarding cases in several US states, some of which were linked to ongoing outbreaks in Europe and Israel [2]. Since then, more US states and Canada have reported additional cases [3,4,5,6,].
In Europe, very few countries have reached the target of 95% measles vaccination coverage which is necessary to prevent outbreaks and eliminate the disease. Different factors contribute to low vaccination coverage, e.g. some people refuse to be vaccinated, and other groups may be hard to reach such as nomadic populations or specific religious communities [7]. This results in a significant proportion of the European population remaining at risk for acquiring measles. Exposure to the virus may come from travellers who have visited outbreak-affected or endemic areas, as has been reported in the US.
ECDC would like to raise awareness of the ongoing measles outbreaks in several European countries and wants to use this as an opportunity to reiterate the importance of measles vaccination, which is the best available measure for preventing infection. Full protection is obtained by two consecutive doses of measles-containing vaccine. Further details on vaccination schedules can be obtained from national authorities.
In the light of the World Health Organization’s goal to eliminate measles in the European Region by the year 2010, the current outbreaks are worrying. Improving measles vaccination coverage is essential to containing and preventing further such outbreaks, and for reaching the goal of elimination [7].
2. Measles outbreaks in the United States: Public health preparedness, control and response in healthcare settings and the community. Centers for Disease Prevention and Control, Atlanta, United States. 2 April 2008. Health advisory. Available from: http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00273
3. Health Department advises New York city residents to make sure they have had measles shots before traveling abroad. New York City Department of Health and Mental Hygiene, New York, United States. 8 April 2008. Press release. Available from: http://www.nyc.gov/html/doh/html/pr2008/pr024-08.shtml
4. Possible measles exposure in SeaTac Airport on March 26, 2008. Public Health, Seattle & King County, Seattle, United States. 9 April 2008. News article. Available from: http://www.metrokc.gov/health/news/08040802.htm
5. Girl With Measles At Home; Health Officials On Watch. American Broadcasting Corporation (WISN). 8 April 2008. News article. Available from: http://www.wisn.com/health/15827358/detail.html
7. World Health Organization. (2003) Strategic plan for measles and congenital rubella infection in the European Region of WHO. Available from: http://www.euro.who.int/document/e81567.pdf
Measles outbreaks in Europe and United States - information for travellers
HPSC has been informed about a number of reported measles outbreaks occurring in Europe and the United States. These reports are summarised in the following sections. To date, HPSC is unaware of any Irish cases linked to these outbreaks. However, measles cases continue to be reported in Ireland. During the first 10 weeks of 2008, 14 measles cases were reported nationally, but only one was laboratory confirmed.
These outbreaks may place unimmunised Irish travellers to these destinations at risk of this highly infectious and potentially very serious disease. Two doses of MMR vaccine are recommended for all children and young adults to prevent infection with measles.
France Between January 21st and March 17th 2008, 16 measles cases were reported in the city of Reims, the Marne district (department), Champagne region, North-eastern France.
The first case occurred in a non-vaccinated young woman on January 21st 2008. She was hospitalised for pneumonia. Subsequently, her two young children and two other young adult household contacts were also diagnosed with measles, three of whom were also hospitalised. During her admission to hospital transmission of the measles virus occurred in the hospital to three hospital staff, a medical student and three hospitalised children (aged 11 months to 7 years). An additional four measles cases have been reported in Reims, and appear to be related to another strain.
Switzerland This nationwide outbreak has been ongoing since November 2006. Measles outbreaks are reported particularly in the cantons of Lucerne, Basel-Land, Zurich, Bern, Aargau and Geneva. In recent years, Switzerland has had a particularly high incidence of measles compared to other European countries. The current outbreak has mainly affected unvaccinated children of school age, but also unvaccinated young adults. Transmission occurred primarily in families and schools. As many Irish people may be travelling to Switzerland for the European football championship (EURO 2008) in June, MMR vaccination is recommended for all children and young adults who have not already received two doses.
Germany In February, German Health Authorities published a preliminary report in Eurosurveillance on 16 measles cases occurring in the region of Baden-Württemberg, south-west Germany. Some cases in this outbreak relate to German citizens with residence in Switzerland or to Swiss citizens who commute to Germany.
Denmark Danish Authorities have published data in the February edition of Eurosurveillance on an outbreak of five measles cases in Copenhagen. The index case was a 23-year-old unvaccinated man who developed a rash on 12 January 2008, nine days after his return to Denmark after travelling to Nepal and India. The following four cases were a 24-year-old woman, a 10-month-old girl, a 26-year-old woman and a 39-year-old man with onset of rash on 1 February. The second case was the girlfriend of the index case. Two cases are believed to have been infected from the index case while at the waiting room of two different general practitioners' practices and another one in the hospital to which the index case was admitted.
USA Twelve measles cases have been reported in San Diego, California linked to a measles case in a seven year old unvaccinated boy who returned from Switzerland with his family in mid-January 2008. Subsequent spread occurred among his two non-immunised siblings, school contacts, friends and children attending the same paediatrician's office. For further information on the USA outbreak please see the CDC report published in the MMWR on 29th February 2008.
Reminder about need for MMR vaccination for travellers and Irish residents:
Travel between Ireland and the aforementioned European countries, as well as more distant countries where measles is endemic, is common.
MMR vaccination is routinely recommended for all children at 12-15 months of age and a second dose is administered at 4-5 years of age. Older children and young adults who have not received at least two doses of MMR are advised to contact their GP for this vaccine. The vaccine is free.
All individuals travelling abroad should review their immunisation records and obtain MMR vaccination if required. Vaccination is particularly important for children and young adults who may be travelling as part of school groups, for business or on pleasure.
To prevent transmission in health care settings all health care workers and health care students should also be appropriately vaccinated.
MMR vaccination for 3rd level students (academic year 2007-2008)
If you are a student starting college and are under 25 years of age you could be at risk of getting mumps during the next academic year. Many Irish universities and colleges had major mumps outbreaks in 2004 and 2005. Despite a marked decline in recent years cases continue to occur, particularly among non-vaccinated individuals.
Since 2004 teenagers and young adults have been most affected by mumps. Most individuals affected by mumps either never received, or received just one dose of MMR (Measles, Mumps and Rubella) vaccine. Two doses are needed to provide maximum protection.
MMR vaccination is now routinely recommended for all third level students aged 17-24 years of age who have not received two doses of MMR. Both the vaccine and the visit to the GP is free to students who need it. The cost of the programme is being supported by the HSE. Speak with your GP or the Student Health services at your college or university.
Increase in Measles cases in the UK - Summer 2007
In a recent press release (30th August 2007), the Health Protection Agency UK has reported an increase in measles cases in England and Wales in 2007. Nearly 500 confirmed cases of measles were reported in the UK so far this year compared to 756 cases for the whole of 2006 (provisional data). Between June to August 2007 more than 300 confirmed cases of measles were reported. Such a large increase over a short period of time is of deep concern.
The UK health authorities have urged parents to make sure that their children are up to date with MMR immunisation to prevent further spread of the disease.
Current situation in Ireland Although the HPSC has not seen an increase in measles cases in Ireland compared to previous years, there is concern that measles cases from the UK could be imported into Ireland, particularly as there is so much travel between the two countries.
Ireland experienced a large outbreak in 2000, with over 1600 measles cases reported. Three children died as a result of infection acquired during that outbreak. Low levels of MMR vaccination among children meant that large numbers of children were susceptible to infection, and the virus spread rapidly throughout the country.
MMR vaccination uptake in Ireland (Q1 2007) Most recent figures indicate that 86% of Irish children at 24 months of age have received one dose of MMR (Immunisation report Q1 2007). In recent years there has been a gradual increase in MMR uptake. But to prevent measles outbreaks occurring a sustained MMR uptake rate of at least 95% is needed.
Measles is a highly infectious disease that can cause serious complications, particularly among children less than 5 years of age and adults. The infection is characterized by a general body rash, a fever, and one or more of the following; cough, conjunctivitis, and runny nose. Measles is a notifiable disease.
MMR to protect against measles MMR vaccine protects against measles. The vaccine is safe and effective. It is routinely given when children are 12-15 months of age, and a booster is given at 4-5 years of age.
All parents are urged to ensure that their children are vaccinated with MMR at the appropriate age to protect against measles infection. MMR vaccine is available from the GP.
All children who are entering school for the first time (junior infants) should have at least one MMR already. Older children (> 5 years of age) should already have received two doses of MMR. If they have not, please bring your child to your GP who can administer the vaccine free of charge.
Summary Whole-cell pertussis (wP) and measles vaccines are effective in preventing whooping cough and measles respectively. However, in the past there have been concerns expressed about a suspected increase in the risk of encephalopathy or encephalitis following vaccination with these vaccines. In many countries this led to a decline in these vaccination rates and subsequent outbreaks of the pertussis or measles were reported. Many developed countries switched to using an acellular pertussis vaccine (aP) which is less reactogenic and was perceived to be safer. DTP is still widely used in developing areas.
Previous studies have sought to assess whether there was an association between these vaccines and the development of encephalopathies. Many studies produced indeterminate results or failed to prove an association. Some experts who evaluated the data felt that because these neurologic outcomes are rare, the studies lacked sufficient statistical power to identify associated risk. This new study has addressed this issue by looking at a paediatric population of more than 2 million children, giving it sufficient statistical power. The results of this research conclude that there was no increased risk of encephalopathy among recipients of whole-cell pertussis or measles vaccines.
How the study was done The researchers carried out a retrospective case-control study among children registered with four medical insurance companies in the western part of the United States. The researchers looked at hospital records of children aged 0-6 years for a 15-year period (from January 1, 1981, through December 31, 1995). They identified all children between 0-6 years of age who had been hospitalised with encephalopathy or related conditions during this time. The cause of the encephalopathy was categorised as known, unknown or suspected but unconfirmed. Up to 3 controls were matched to each case. Conditional logistic regression (specialised statistical analysis method) was used to analyse the relative risk of encephalopathy after vaccination with DTP or MMR vaccines in the 90 days before disease onset as defined by chart review compared with an equivalent period among controls.
Results Among a population of more than 2 million children, the researchers identified 452 cases of encephalopathy. Cases were no more likely than controls to have received either vaccine < 90 days before disease onset. No distinct pattern of symptoms was seen in the children who developed encephalitis/encephalopathy < 14 days after DTP vaccination, or < 30 days after MMR vaccination.
Conclusions In this study of more than 2 million children, DTP and MMR vaccines were not associated with an increased risk of encephalopathy after vaccination. This study provides strong evidence for the safety of MMR and DTP vaccines.
New studies show no link between MMR and autism
The first study was carried out by Makela and colleagues in Finland and published in the journal Pediatrics. The authors examined the records of over 500,000 Finnish children who had received MMR and looked at whether or not these children were admitted to hospital for aseptic (i.e. viral) meningitis, encephalitis or autism. MMR is known to protect against encephalitis due to measles, mumps and rubella. The authors found that aseptic meningitis rates decreased by 35% and encephalitis rates by 25% after the introduction of MMR.
The authors did not find any association between hospitalisation for autism and time since vaccination with MMR. None of the 309 children identified in the study with autism were admitted to hospital at any time because of inflammatory bowel disease.
While these results add to the already large body of evidence showing no association between MMR and autism this study has some limitations, as identified by the authors. The main one is that they only looked at hospital admissions. Thus they might have missed children with autism who were not admitted to hospital. However they do point out the hospital admission is a common part of the initial management of autism in Finland.
The second study, published in the New England Journal of Medicine, is even more comprehensive. Madsen and colleagues studied all children born in Denmark between 1991 and 1998. The vaccination records of over 500,000 children were examined. They also looked at the admission records of psychiatric hospitals, psychiatric departments and outpatient departments to identify cases of autism and autism spectrum disorder (ASD). There are a number of factors specific to Denmark relevant to this study: autism can only be diagnosed by child psychiatrists, children with suspected autism are routinely referred to such specialists and there is a virtually complete reporting of childhood vaccination. These factors, combined with the fact that the authors were able to examine results for all children born in Denmark, make this a very robust study.
Madsen and colleagues found that the risk of autism was the same in vaccinated and unvaccinated children. They also found that there was no association between the age that MMR was given, time since vaccination or the date of vaccination and the development of autism. There was no evidence to suggest that there could be a subgroup of children who are particularly at risk of developing autism after MMR.
All of the studies published to date that have investigated possible links between MMR and autism have found no association. The study by Madsen and colleagues was very well-designed and extremely comprehensive and probably represents the best evidence yet that there is no association between MMR and autism.
MMR versus Separate Single Vaccines for Measles, Mumps and Rubella
Some people have suggested that children should be vaccinated against measles, mumps and rubella using separate single vaccines, rather than the combined MMR vaccine. This is based on the supposed link between MMR vaccine and autism spectrum disorders (ASD). The theory is that because MMR contains three different components it somehow "overloads" or weakens the child's immune system, making them more susceptible to developing ASD.
Parents are understandably concerned when links are suggested between a vaccine and a devastating disease such as ASD. Even if the link were only theoretical, giving the three vaccine components separately would seem to be a sensible precaution. The evidence, however, suggests otherwise:
There is no evidence of any association between MMR and ASD The original supposed link between MMR and ASD was based on a study by the Inflammatory Bowel Disease Study Group (IBDSG), at the Royal Free Hospital in London.1 They described 12 children with ASD where the onset of ASD apparently coincided with receiving the MMR vaccine. The original study stated: "We did not prove an association between measles, mumps and rubella vaccine and the syndrome described". Further studies, including ones carried out by the IBDSG, have not shown any link between MMR and ASD.2
One study, by Kaye et al, found that there was a significant increase in reported cases of ASD in the UK between 1988 and 1999. However, the rate of MMR vaccination remained the same throughout this period. Thus the increase in ASD cases could not be explained by exposure to MMR.3 Another study, by Dales et al, compared the number of cases of ASD with rates of MMR vaccination in California from 1980 to 1994. Again they found a large increase in the incidence of ASD, but only a small increase in MMR vaccination rates. The small increase in MMR rates could not explain the increase in ASD. Furthermore they found that the large increase in ASD incidence occurred before the small increase in MMR vaccination rates.4
Seven international expert groups have reviewed the evidence relating to MMR and ASD. They were all unanimous in their conclusions that the current evidence does not support a link between MMR and ASD.5
Combination vaccines do not overload or weaken the immune system The MMR vaccine contains 24 different antigens (the chemicals that stimulate the immune system to produce immunity to viruses and other foreign substances). This number of antigens is minute compared to the total number that the immune system is capable of responding to (up to 100,000,000,000).6 Indeed there are fewer antigens in all of the current childhood vaccinations combined then there were in either the single smallpox or older pertussis (whooping cough) vaccines. Likewise we are all exposed to hundreds of times as many antigens every day, in the food we eat, the water we drink and the air we breathe.
Vaccines are designed to strengthen the immune system, not weaken it. In one study from Germany it was found that vaccinated children were not only protected against the diseases for which they had received the vaccines, but also had fewer infections with other bacteria and viruses compared to non-vaccinated children. This was thought to be due to an overall boosting of the immune system by vaccines.7
On the other hand infections with bacteria and viruses often make children more prone to infection with other bacteria or viruses. Measles infection often leads to other infections, such as pneumonia and middle ear infections.
Using three separate vaccines is untested, untried and raises too many unanswered questions The use of three separate vaccines for measles, mumps and rubella has never been used in any country in the world. There have been no studies done to determine whether or not this approach is safe or effective. Likewise there is no experience with using this approach. This raises a number of unanswered questions: Is this approach safe? Will it protect children against these diseases? What order should the vaccines be given? How much time should be taken between vaccine doses?
In contrast the MMR vaccine has been in use for over 30 years and underwent rigorous studies to ensure that it was safe and effective before it was released for general use. The combined research evidence and decades of experience with MMR has confirmed that it is safe and effective. Indeed, the World Health Organisation recently concluded that MMR is one of the safest vaccines ever produced.
Using three separate vaccines may be less effective and cause more side effects than MMR The three separate vaccines do not have as long or as rigorous a safety record as MMR. Some varieties of the individual mumps vaccine, in particular, give cause for concern. Some mumps vaccines may contain the Rubini strain of the virus, which was found to be ineffective. Others may contain Urabe strain, which is associated with an increased risk of viral meningitis.2
Separating the vaccines leaves a child exposed to the risk of infection Leaving a gap between the individual measles, mumps and rubella vaccines means that children are at risk of acquiring one of the other infections before they receive the next vaccine.
Separating the vaccines requires six injections Two doses of measles, mumps and rubella vaccine are required to ensure maximum protection against these diseases. This means that giving them separately will require six trips to the doctor and six separate injections. Apart from the difficulty of organising six separate visits to the doctor this means that children will have to have an extra four injections unnecessarily. Combining the three vaccines together in the MMR vaccine means fewer traumas for children and fewer visits to the doctor.
MMR is a safe vaccine and protects children against potentially devastating infections. It also prevents the weakening of the immune system that occurs with natural infections. Giving the three vaccines separately is less effective and may be less safe. Given that we have a proven safe, effective vaccine, backed up by more than 30 years experience, it would be unwise to recommend three separate vaccines.
References:
Wakefield AJ et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351: 637-41.
Elliman DAC and Bedford HE. MMR vaccine: worries are not justified. Arch Dis Childhood 2001; 85: 271-4
Kaye JA et al. Mumps, measles and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend survey. BMJ 2001; 322: 460-3
Dales L et al. Time trends in autism and in MMR immunization coverage in California. JAMA 2001; 285: 1183-5
Medical Research Council. Review of autism research: epidemiology and causes. Department of Health (UK), 2001
Offit PA et al. Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune system? Pediatrics 2002; 109: 124-9
Otto S et al. General non-specific morbidity is reduced after vaccination within the third month of life: the Greifswald study. J Infect 2000; 41: 172-5
