Re: Measles in the UK: a test of public health competency in a crisis
We commend the swift response of NHS England and its key players, the newly established Public Health England and Local Authority Public Health teams, to the current upsurge in number of measles cases. We also endorse the views of Greaves and Donaldson that we must not be complacent about the seriousness of measles and must ensure that there is a well-coordinated response by parties in the new health system. We must learn lessons to maximise the effectiveness of NHS vaccination programmes.
The Chief Medical Officer has written to GPs and others to urge them to proactively seek and immunise their non-vaccinated population, particularly targeting 10-16yr olds. This age group were most affected by the drop off in vaccine uptake following the (now retracted) 1998 Lancet publication of the paper by Dr Andrew Wakefield which erroneously suggested a link between the combined MMR vaccine, autism and bowel disorder.
The public concern initiated by the Wakefield publication, and subsequent media reporting, left a cohort of unimmunised individuals. It was really only a matter of time before they were exposed to the highly infectious measles virus. We have had many years of grace whilst the measles virus was not in circulation in the UK but the impacts of low MMR uptake are now being seen. Once vaccinations rates dropped below 93-95% the benefit of heard immunity, as demonstrated by Brisson and Edmunds , would not apply and thus we have had many years with a large cohort of now young adults at risk of infection.
We have had more than ten years in which to plan and address the issue of vaccinating the now young adults who had not been immunised. Whilst a catch up campaign in 2008 went some way to address the dip in vaccination uptake there has remained around 300,000 unvaccinated young people who remain susceptible to a measles infection. Thus perhaps the efforts to improve vaccination rates in this cohort should have been sustained until higher vaccine coverage was achieved, potentially preventing the current increase in measles cases.
Our failure to ensure vaccination coverage for a very infectious disease achieved the herd immunity threshold perhaps highlights that we, as a profession, still have lessons to learn about how to effectively communicate risk and ensure greater uptake of vaccination. Perhaps we could have presented and communicated the science more effectively and made sustained efforts to improve the vaccine uptake rate in the population at risk. Perhaps there are examples of good practice we can draw upon from Wales, Scotland and Northern Ireland where we understand there has been greater integration and closer working between their Primary Care and equivalent Public Health Departments.
Whilst we are currently focused on measles with the current increase in cases we must not forget there remains a population of young women of child bearing age who are susceptible to rubella. A rubella infection acquired in pregnancy can have catastrophic consequences for the unborn child.
Finally we note that primary prevention of illness via vaccination is an enormously cost effective public health measure and thus this measure ought to be followed with greater resolve. We should not forget how lucky we are to have vaccines that enable us to protect ourselves, our families and our communities from the suffering caused by a number of serious infectious diseases.
Yours sincerely,
Emily van de Venter (Public Health Speciality Registrar)
Bharat Pankhania (Consultant in Communicable Disease Control)
Rapid Response:
Re: Measles in the UK: a test of public health competency in a crisis
We commend the swift response of NHS England and its key players, the newly established Public Health England and Local Authority Public Health teams, to the current upsurge in number of measles cases. We also endorse the views of Greaves and Donaldson that we must not be complacent about the seriousness of measles and must ensure that there is a well-coordinated response by parties in the new health system. We must learn lessons to maximise the effectiveness of NHS vaccination programmes.
The Chief Medical Officer has written to GPs and others to urge them to proactively seek and immunise their non-vaccinated population, particularly targeting 10-16yr olds. This age group were most affected by the drop off in vaccine uptake following the (now retracted) 1998 Lancet publication of the paper by Dr Andrew Wakefield which erroneously suggested a link between the combined MMR vaccine, autism and bowel disorder.
The public concern initiated by the Wakefield publication, and subsequent media reporting, left a cohort of unimmunised individuals. It was really only a matter of time before they were exposed to the highly infectious measles virus. We have had many years of grace whilst the measles virus was not in circulation in the UK but the impacts of low MMR uptake are now being seen. Once vaccinations rates dropped below 93-95% the benefit of heard immunity, as demonstrated by Brisson and Edmunds , would not apply and thus we have had many years with a large cohort of now young adults at risk of infection.
We have had more than ten years in which to plan and address the issue of vaccinating the now young adults who had not been immunised. Whilst a catch up campaign in 2008 went some way to address the dip in vaccination uptake there has remained around 300,000 unvaccinated young people who remain susceptible to a measles infection. Thus perhaps the efforts to improve vaccination rates in this cohort should have been sustained until higher vaccine coverage was achieved, potentially preventing the current increase in measles cases.
Our failure to ensure vaccination coverage for a very infectious disease achieved the herd immunity threshold perhaps highlights that we, as a profession, still have lessons to learn about how to effectively communicate risk and ensure greater uptake of vaccination. Perhaps we could have presented and communicated the science more effectively and made sustained efforts to improve the vaccine uptake rate in the population at risk. Perhaps there are examples of good practice we can draw upon from Wales, Scotland and Northern Ireland where we understand there has been greater integration and closer working between their Primary Care and equivalent Public Health Departments.
Whilst we are currently focused on measles with the current increase in cases we must not forget there remains a population of young women of child bearing age who are susceptible to rubella. A rubella infection acquired in pregnancy can have catastrophic consequences for the unborn child.
Finally we note that primary prevention of illness via vaccination is an enormously cost effective public health measure and thus this measure ought to be followed with greater resolve. We should not forget how lucky we are to have vaccines that enable us to protect ourselves, our families and our communities from the suffering caused by a number of serious infectious diseases.
Yours sincerely,
Emily van de Venter (Public Health Speciality Registrar)
Bharat Pankhania (Consultant in Communicable Disease Control)
Competing interests: No competing interests