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Measles: neither gone nor forgotten

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3976 (Published 25 September 2018) Cite this as: BMJ 2018;362:k3976

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Re: Measles: neither gone nor forgotten - Fuelling divisions and a lack of public debate are the main problems

It is 50 years since we, the trusting public, have been led to believe that a particular medical product introduced in 1968 would eradicate measles. Twenty years on, in 1988, a new bigger and better product came along. The, then, health minister Edwina Curry announced ‘one jab – lifelong protection’. However a few years later a booster dose was introduced? No mention of lifelong protection that time round.

According to the data on the PHE site, which starts from 1940, it is very clear that a large fall in measles mortality occurred in the first decade and a half, well BEFORE any medical attempt to eradicate measles was introduced. According to McKeown (1): ‘less than a quarter of all children had been protected by the end of 1972’, and yet still the measles cases and deaths continued to fall despite the low uptake. In a DoH book (2) it states that ‘from 1968 to 1980 the uptake remained between 50-60%’, and yet still the measles cases and deaths fell despite the fact that the uptake was nowhere near the, now claimed, required figure of 95% uptake of 2 doses of MMR.

At the end of the 1950s you will find the description of measles by medical doctors very different to the doctors of today. Why would that be? It was because measles had been declining over the centuries, alongside other zymotic diseases, mostly due to social improvements, and by the late fifties was generally viewed as a straightforward childhood illness in the majority of cases. For example, regarding a measles epidemic in early 1959 the BMJ published (3): ‘the writers (the reporting GPs) agree that measles is nowadays normally a mild infection….’ If in 1959 it was referred to as ‘normally a mild infection’ why are today’s public (including a good proportion of health professionals) being presented a very different image? We are constantly being told of the threat of serious complications and deaths if herd immunity (another questionable theory) is not achieved via high MMR uptake.

Has measles evolved into a more deadly disease?

Why are parents being made to fear a ‘normally mild infection’ of the 1950s? You would think that by now it should have evolved into an extremely mild infection or almost non-existent? Perhaps Elliman has an explanation? Does he consider measles more dangerous than back in the 1950s? And if so, why?

Quoting figures regarding immunisation status, I wonder if Elliman can be more detailed in his comment. In my experience it is very difficult to obtain the status, as it is not generally recorded. Stating that in the 90% of cases where the status was known is rather vague. For example, if there were only 10 cases with known status out of hundreds of measles cases with unknown status, then that would mean you are only talking about 90% of 10.

Good that the authors admit that ‘inaccurate data collection’ occurs regarding the variations in uptake. If it can occur in this area how accurate is the collection of data on other aspects of this subject?

Measles was predominantly a childhood illness and yet a worrying trend is appearing with the age of incidence now high in the 20-39 year olds? MMR uptake has generally been reasonably high since it’s introduction and it is very likely that many of those cases in the older age group received at least one MMR and/or the MR during the campaign targeting all 5-16 year olds back in Nov 1994. Has the MMR programme shifted the age of incidence to an age where there may be more complications? As one Public Health doctor pointed out to me recently: ‘The case–fatality ratio for measles is age-related and is high in children under one year of age, lower in children aged one to nine years and rises again in teenagers and adults’ (4)

Has the MMR suppressed the individual’s system - resulting in a delay in their ability to develop measles at the appropriate age? A medical paper (5) reporting on a measles outbreak in a tertiary level hospital in Portugal states that strikingly most cases were in the 18-39 year old fully vaccinated health care workers. They indicate this may be due to waning immunity.

Given that ‘immunity’ is not understood – what does the future hold regarding number of MMR doses? Shifting a ‘normally mild infection’ into an age bracket where there is an increased chance of serious problems is not a very productive achievement in my opinion.

Right-wing political parties? Russian trolls? Associating anyone who dare mention the ‘v’ word in any critical form with particular groups or individuals is sadly a growing trend. It is an attempt to alienate the general public towards those who are asking questions. People from all walks of life have many concerns and it is much more than just a sentiment.

We all share the same goal – good health for all. Those who speak out have nothing to gain and yet they are met with hostility or are demonized. As the scientist Wallace stated back in 1898 in his book Vaccination A Delusion (6):
“Why this effort at secrecy in such a matter if there is nothing to hide? Surely it is to the public interest that official statistics should be made as correct as possible; and private persons who go to much trouble and expense in order to correct errors should be welcomed as public benefactors and assisted in every way, not treated as impertinent intruders on official privacy, as it is too frequently the case.”

The health of the recent generations concerns me. We are long overdue for an independent critical overview before health is gone and forgotten.

References:
1. The Role of Medice, McKeown T. p.106
2. Immunisation Against Infectious Disease 1990; p52
3. Measles Epidemic; BMJ; 7 Feb 1959 p354
4. Plotkin and Orenstein, 2004, Chapter 19
5. Measles outbreak in a tertiary level hospital, Porto, Portugal, 2018: challenges in the post-elimination era. Machado et al; Eurosurveillance, Vol 23, Issue 20, May 2018
6. Vaccination A Delusion (1898); Wallace A R, p.27

Competing interests: No competing interests

03 November 2018
Magda Taylor
Director of The Informed Parent
Worthing, West Sussex