Measles cases in Europe tripled from 2017 to 2018
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l634 (Published 07 February 2019) Cite this as: BMJ 2019;364:l634All rapid responses
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Several readers have been astonished by the report that 61% of measles cases in the current European outbreak were admitted to hospital. This is the figure from those notifying countries that reported hospitalisation and it is on the European WHO website:
http://www.euro.who.int/en/media-centre/sections/press-releases/2019/mea...
I am a retired paediatrician in my seventies and I am not be in the least astonished by this figure. When I was working (in the UK), advocating vaccination, I said to many a hesitating parent, “Never mind talk of subacute sclerosing panencephalitis, measles complications and mortality and all the rest of it. You have no idea how sick a child with simple, uncomplicated measles is. Never mind our folk memories (which I share) of how our mothers or grandmothers treated us with a few days in bed and lemon-barley water, almost no modern mother has ever seen a child this sick. Fever of 40C, continuous coughing, red eyes, clearly getting sicker by the hour; if we ever have an epidemic families will be running to the hospital demanding admission”.
I see this came to pass
Competing interests: No competing interests
In this article, Jacqui Thornton states 61% of "More than 80,000 people" who "contracted measles in 2018" were hospitalised, i.e. more than 48,800 people.*
This seems an extraordinarily high rate of hospitalisations for measles? Is this correct? Was there a similar rate of hospitalisation for measles before measles vaccination was introduced?
Also, re the 72 deaths mentioned in the article, is there more detailed information available on these deaths, e.g. age and health status of the individuals?
(*The paragraph mentioning this information didn't have a reference.)
Competing interests: No competing interests
Let us get a handle on this. I just looked up the population of Europe for 2018 on Google and discovered a figure of 738 million, so the chances of dying of measles last year in Europe was less than 1 in 10 million. While it seems unlikely that vaccination can ever eliminate measles - notably because the vaccine sheds - could this just possibly be a distortion of policy?
A couple of other observation regarding Jacqui Thornton's article [1]: (a) the number of cases is likely be an artefact of the drive to identify them; (b) 61% hospitalisation does not sound credible.
[1] Jacqui Thornton, 'Measles cases in Europe tripled from 2017 to 2018', BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l634 (Published 07 February 2019)
Competing interests: No competing interests
Re: Measles cases in Europe tripled from 2017 to 2018
Cooper’s advice to parents about the measles vaccination, in the early nineteen seventies, may have been appropriate for those times, in some settings. My memories of measles in a Welsh valley practice, in the same era, suggest that hospital admission was a rare exception.
Who wished, without excellent reason, to admit a hot, coughing, infectious child to the children's ward in our GP hospital?
Were our experiences unusual?
A retrospective survey of the 15 years from 1948 to 1962, revealed “157,300 notified cases of measles. A total of 4874 patients with measles were treated in hospital.” (1,2)
Does that 3% hospitalisation rate, compared with the current figure of 61%, reflect changes in symptom tolerance, good neighbourliness, the proximity of extended family, as well as the general health of children, then and now?
Are there other explanations?
Thornton’s BMJ article may reflect personal, public health, or corporate need, to engender fear about the lurking presence of the measles virus, ready to pounce on the unvaccinated, without making any attempt to educate your readers, so that we in turn may present that well rounded and comprehensive account of the advantages and possible side effects, that must legally be presented to UK parents, to allow fully informed consent, before any vaccination.
How often does such dialogue occur?
How often is the Patient Information Leaflet (PIL) given to patient or parent, opened, and read?
(The MMR vaccine PIL is headed, “Read all of this leaflet carefully before you or your child is vaccinated because it contains important information for you.”)
How often is a UK practice’s financial interest in its vaccination rate discussed?
Thornton’s article explains that community protection requires that “at least 95% of every population needs to be immune, through two doses of vaccination (sic) or prior exposure to the virus,” without adding the essential proviso that immunity following vaccination may be comparatively brief, while immunity from natural infection is lifelong.
Earlier responses of mine, relevant to this topic, attempted to explain that high vaccination rates do not prevent measles, (5) and how the “fundamental question” posed by Dr David Oliver (6), in earlier exchanges, deserves a simple reply. (7)
No one has demurred.
1 Tidstrom, B. (1968), Acta med.scand., 184, 411.
2 The Medical Annual 1970. Wright, Bristol. p 257
3 https://www.bmj.com/content/362/bmj.k3976/rr-4
4 https://www.bmj.com/content/362/bmj.k3596/rr-22
5 https://www.bmj.com/content/362/bmj.k3976/rr-4
6 https://www.bmj.com/content/362/bmj.k3596/rr-17
7 https://www.bmj.com/content/362/bmj.k3596/rr-22
Competing interests: No competing interests