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HPSC urges parents to get their children vaccinated against measles as ongoing outbreak leaves child severely ill in hospital

The HSE Health Protection Surveillance Centre today (Monday) urged parents to make sure that their children are vaccinated against measles following a national outbreak of the disease which has left a child severely ill in hospital with pneumonia as a result of measles infection.

The current outbreak which started in August, is continuing, and there are real concerns about spread among non-vaccinated individuals, according to HPSC specialist in public health medicine, Dr Suzanne Cotter.

Eleven cases have been reported to date in November, bringing the total to 75 so far this year. This compares to 50 for the same period in 2008. Eighteen people have been hospitalized with measles this year and no deaths have been reported. One case has required intensive care treatment and ventilation for severe pneumonia.

Most cases (80%) are less than 10 years of age; with 30% aged 1-2 years of age. 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, said Dr Cotter.

HPSC urges parents to get their children vaccinated following measles outbreak

The HSE Health Protection Surveillance Centre today (Thursday) urged parents to make sure that their children are protected against measles following an outbreak of the disease in three HSE regions.

Measles can be a serious and potentially fatal illness and children who have not been vaccinated are particularly at risk of measles during this time, says HPSC specialist in public health medicine, Dr Suzanne Cotter.

"The outbreak in the HSE South, HSE Southeast and the HSE West, is predominantly affecting young children and teenagers from the Traveller Community. Since January, 63 cases of measles have been notified nationally, 12 of whom were hospitalised. This compares with a total of 55 for all of 2008.

"The majority of notified cases have been in the 1-4 year age group, but cases have also been reported in children less than one year of age and teenagers. The oldest case reported was 33 years of age. No deaths have occurred and none of the confirmed cases were vaccinated.

"This is the second outbreak affecting travellers in 2009, following a family outbreak earlier this year, which was linked to the ongoing measles outbreak in the UK.

"Measles is a highly infectious disease, 1 in 20 will get pneumonia, 1 in a 1000 will get encephalitis, 1-2 in a 1000 will die. To be protected you either need to have received the MMR vaccine or to have had the disease. There is no other way to prevent measles infection.

"Two doses of MMR are recommended, the first at 12 months of age, which is given by a GP, and the second at 4-5 years of age, which is usually given in schools. It is particularly worrying in this outbreak is that many of the parents of the children affected were not aware that their children were not vaccinated and therefore not protected.

"Parents need to check their child's immunisation records and see if their child received two doses of MMR. If no records are available then the child should be brought to the GP for vaccination. GPs are encouraged to provide all parents with hand held immunisation records so that parents can keep track of vaccines received. MMR given to a child within 72 hours of exposure to measles may prevent measles," she said.

ENDS

Note for editors:

One dose of MMR is considered to be approximately 95% effective in preventing measles, while two doses are considered to be 99% effective.

The current MMR uptake in children at 24 months is 90%, with regional rates varying from 76%-98%.

Any area or community with low MMR coverage is at particular risk of measles outbreaks in the community.

Although there are no MMR uptake figures for the traveller community, anecdotal reports suggest that children in some families may have lower uptake than children in the settled community. This may be related to increased mobility, uncertainly about vaccines received and lack of readily accessible immunisation records (including hand held records).

The last large measles outbreak occurred in 2000 when over 1600 cases were reported and there were three measles associated deaths.

Football fans warned about measles vaccination following major disease outbreaks in Euro 2008 host countries

The Health Protection Surveillance Centre has today (Wednesday) 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, says HPSC specialist in public health medicine, Dr Suzanne Cotter.

"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,” she said.

System needed to identify at risk children in event of measles outbreak in schools and creches. 'Legislation needed to record immunisation status of children'

The Director of the National Disease Surveillance Centre, Dr Darina O'Flanagan today (Wednesday) said that a system must be put in place to ensure that children who have not had MMR jabs can be identified and treated rapidly, in the event of a measles outbreak in a school or creche.

"Low immunisation uptake is putting lives at risk and legislation is needed to record the immunisation status of children.

"There has been 100 cases of measles nationwide in the last 7 weeks alone, where around 30 cases is the norm for this period. Most of these cases have occurred in three areas - south west Dublin, the Midlands and the Western Health Board region - and are directly related to the low uptake of the MMR vaccine.

"To be fully protected children need two doses of the MMR vaccine, one at around fifteen months and a second at 5 to 6 years of age.

"With the continued poor level of uptake of the MMR vaccine, it is time to seriously examine incentives used in other countries to improve uptake. In Australia for example, a certain proportion of child benefit payment is linked to immunisation uptake - with an opt out clause for conscientious objectors."

1597 Reported Cases of Measles So Far This Year - 1248 of These Cases in Eastern Regional Health Authority. Measles epidemics occur because Irish Children are not being vaccinated. Protect Your Children Against This Virulent Life-Threatening Infection

The NDSC again strongly urges all parents and carers to have their children vaccinated against measles. The MMR vaccine, which is free, can prevent measles in over 90% of cases. This vaccine is given by your GP/ Family Doctor to all children aged 15 months (with the exception of children in Dublin who are given the vaccine at 12 months in the whole of the ERHA region because of the increased number of cases there) and a second dose is now given at primary school at age 5-6 years. With the second dose, over 99% of immunized children are protected from measles infection.

"So far (up to 23rd December 2000) the National Disease Surveillance Centre has received notification of 1597 cases of measles in comparison to only 148 cases in total in 1999. 1248 of these cases have been in the Eastern Regional Health Authority (formerly known as the Eastern Health Board). Present vaccination uptake levels against measles are as low as 73% to 75% in some parts of the country when they should be at least 95%. This is leaving Irish children vulnerable to epidemics" commented Dr Darina O'Flanagan, Director of the NDSC.

Measles is an acute infection which usually occurs in children age 1-4 years of age who have not yet been vaccinated against it but it can also occur at any age. Measles is caught through direct contact with an infected person or through the air by coughing and sneezing. It is highly infectious before the rash appears.

Complications associated with measles include severe cough and breathing difficulties (croup), ear infections, viral and bacterial lung infection (pneumonia) and eye infections. Other more serious problems involve the nervous system and inflammation of the brain. Severe disease and complications are most likely in young children under 5 years and adults over 20 years. While complications are more common in those who are malnourished or those whose immune system is not working properly, it is important to realise that almost half of the deaths associated with measles occur in previously healthy children and young adults.

The Royal College of Physicians has recently changed the age of the second dose of MMR to 5-6 years. Previously children received the second dose at 11-12 years. The change in the timing of the second dose is intended to provide protection for the 5-10% of children who do not respond to the first dose.

1,221 Reported Cases of Measles So Far This Year - 997 of These Cases in Eastern Regional Health Authority

"So far (up to 30th June 2000) the National Disease Surveillance Centre has received notification of 1,221 cases of measles in comparison to only 148 cases in total in 1999. 997 of these cases have been in the Eastern Regional Health Authority (formerly known as the Eastern Health Board). Present vaccination uptake levels against measles are as low as 70% to 75% in some parts of the country when they should be at least 95%. This is leaving Irish Children vulnerable to epidemics" commented Dr Darina O'Flanagan, Director of the NDSC.

930 Reported Cases of Measles So Far This Year

NDSC Warns of Measles Epidemic: Protect Irish Children Against This Virulent Life-Threatening Infection

In welcoming the launch of the Department of Health and Children Public Education Vaccination Campaign, which will initially concentrate on measles, the NDSC again strongly urges all parents and carers to have their children vaccinated against measles. The MMR vaccine, which is free, can prevent measles in over 90% of cases. This vaccine is given by the GP to children aged 15 months and a second dose is now given at primary school at age 5-6 years. With the second dose over 99% of immunized children are protected from measles infection.

"So far (up to 10th June 2000) the Department of Health and Children has received notification of 930 cases of measles in comparison to only 148 cases in total in 1999 - 769 cases have been in the Eastern Health Board. Present vaccination uptake level against measles are as low as 70% to 75% in some parts of the country when they should be at least 95%. This is leaving Irish Children vulnerable to epidemics such as that which is occurring in the Eastern Health Board" commented Dr Darina O'Flanagan, Director of the NDSC.

Editors Notes:
The Royal College of Physicians has recently changed the age of the second dose of MMR to 5-6 years. Previously children received the second dose at 11-12 years. The change in the timing of the second dose is intended to provide protection for the 5-10% of children who do not respond to the first dose.

National Disease Surveillance Centre Warns of Outbreak of Measles in the Eastern Health Board and Strongly Advises Parents To Get Their Children Vaccinated

The National Disease Surveillance Centre (NDSC) has been advised of an outbreak of measles in Dublin. Since January 2000 over 40 cases of measles have been notified to the Eastern Health Board. Over 17 children have been hospitalised, with 3 children needing intensive care.

Measles is an acute infection which usually occurs in children aged 1-4 years of age who have not yet been vaccinated against it but it can also occur at any age. Measles is caught through direct contact with an infected person or through the air by coughing and sneezing. It is highly infectious before the rash appears.

Complications associated with measles include severe cough and breathing difficulties (croup), ear infections, viral and bacterials lung infections (pneumonia) and eye infections. Other more serious problems involve the nervous system and inflammation of the brain. Severe disease and complications are most likely in infants under twelve months, those who have weakened immune systems and those who are malnourished.

The National Disease Surveillance strongly urges all parents and carers to have their children vaccinated against measles. The MMR vaccine which is free, can prevent measles in over 90% of cases. This vaccine is given by the GP to children at 12-15 months of age and a second dose is given in primary school at age 11-12 years.

The current reported uptake of the MMR vaccine in Ireland is well below that required to prevent outbreaks of measles and spread throughout the community.

All children need to be protected against measles. Without protection, there is a very real chance that more children may become infected and suffer serious consequences.

Symptoms Associated with Measles

MMR Uptake by Health Board at 2 years of age

*Health Board*	*MMR % Uptake*
Eastern	76%
Midland	68%
Mid-Western	73%
North Eastern	77%
North Western	80%
South Eastern	86%
Southern	75%
Western	78%

Notification of Measles by Health Board ~ 2000
	*Jan*	*Feb*	*Mar*	*Apr*	*May*	*June*	*To Date*
EHB (Now ERHA)	18	74	198	308	251	148	997
MHB	0	0	0	8	13	6	27
MWHB	2	1	1	1	3	5	13
NEHB	0	2	10	9	3	9	33
NWHB	0	0	3	2	2	3	10
SEHB	0	0	2	5	18	42	67
SHB	0	0	22	24	7	6	59
WHB	1	2	3	3	3	3	15

ROI	21	79	239	360	300	222	1,221

Notification of Measles in Republic of Ireland (1982 - 2000)

*Year*	*Number*
82	1897
83	6180
84	5725
85	9903
86	451
87	201
88	936
89	1248
90	556
91	135
92	179
93	4328
94	1233
95	235
96	228
97	185
98	204
99	148
2000*	1,221
* 1/1/2000- 30/06/2000

MMR Uptake by Health Board
*Health Board*	*MMR % Uptake*
Eastern	76%
Midland	68%
Mid-Western	73%
North Eastern	77%
North Western	80%
South Eastern	86%
Southern	75%
Western	78%

Notification of Measles by Health Board ~ 2000
	Jan	Feb	Mar	Apr	May	June	To Date
EHB	18	74	198	308	163	8	769
MHB	0	0	0	8	13	3	24
MWHB	2	1	1	1	3	1	9
NEHB	0	2	10	6	1	0	19
NWHB	0	0	3	2	2	1	8
SEHB	0	0	2	5	18	13	38
SHB	0	0	22	24	3	0	49
WHB	1	2	3	3	3	2	14

ROI	21	79	239	357	206	28	930