Australia ‘an island in a sea of measles’

Recent outbreaks in Pacific Island nations, combined with a global surge in cases, has seen Australia become ‘an island in a sea of measles’, according to the authors of a new Perspective article published in the Medical Journal of Australia.
 
However, while vaccination remains the key control mechanism for measles, no Australian state is currently reaching the 95% coverage rate required to eliminate ongoing measles transmission, according to data from the Australian Immunisation Register. Efforts to increase global vaccination rates have also stalled.
 
The RACGP has consistently advocated regarding the importance of high vaccine coverage in Australia, and the authors of the paper, led by the University of Newcastle’s Professor David Durrheim, believe this type of vigilance is needed to prevent a resurgence on local shores.
 
‘Measles virus is the ultimate opportunist and will capitalise on any gaps in immunity,’ Professor Durrheim and colleagues stated.
 
‘National programs are important, but measles control cannot be achieved without effective local prevention and control measures, including diligent vaccination and prompt diagnosis by alert clinicians.
 
‘With outbreaks occurring regionally, concerted effort is required to maintain Australia’s elimination of measles and continue progress towards the goal of global measles eradication.’
 
Yet despite advocacy and sustained efforts to stop the spread of misinformation, researchers noted a 900% increase in reports of anti-vaccination activity across Australia last month, according to The Age.
 
This ‘massive uptick’ has coincided with a drop in routine vaccination rates, which leading immunisation researcher Associate Professor Margie Danchin said could point to a dangerous increase in the campaign against vaccine science.
 
‘COVID-19 has really rallied – and provided almost the perfect storm for – anti-vaccination activity,’ she said.
 
‘They are using strong language and play on emotion and fear in the middle of a pandemic when people [are] concerned, frightened and know there are no cures.
 
‘We have [had] a drop in routine vaccination coverage. We don’t necessarily know if it’s related to anti-vaccination activity [but] we think it definitely looks like it has dropped.’
 
Professor Danchin said the decrease may be due to the fear of attending clinics or other pandemic disruption, but nonetheless described the widespread distribution of conspiracy theories and online misinformation campaigns as ‘pretty frightening’.
 
According to Professor Durrheim, as measles is the most highly communicable human virus known to medical science, ‘devastating and explosive’ outbreaks can occur where immunity gaps exist.
 
‘At the beginning of 2020, Samoa was in a state of emergency due to a measles outbreak,’ Professor Durrheim wrote.
 
‘It resulted in over 5700 cases and over 80 deaths, the majority being in children under five years of age. There were concurrent outbreaks regionally, in New Zealand, Tonga, American Samoa and Fiji.
 
‘Globally, there has been a massive resurgence of measles with over 360,000 cases reported to the World Health Organization between 1 January and 31 July 2019 – almost three times the number reported over the same period for 2018.
 
‘We have also seen the re-establishment of endemic measles in some countries, such as the United Kingdom, where it was previously eliminated.’
 
Australia had 285 confirmed measles cases in 2019, the highest number reported since 2014, the year it was verified by the Regional Verification Commission for Measles Elimination in the Western Pacific to have eliminated measles.
 
Professor Durrheim and his colleagues wrote that although the majority of measles cases occurred in under-immunised individuals, there has been a ‘small but increasing’ proportion of cases in adults reporting previous measles vaccination.
 
‘At the time of elimination verification in Australia, the estimated efficacy of measles vaccine was 96.7% for one dose and 99.7% for two doses,’ they wrote.
 
‘Thus, about one in 300 fully vaccinated people who are exposed to measles are vulnerable to “breakthrough” infection, resulting from either an inadequate response at the time of vaccination or waning of immunity over time.’
 
Earlier this year the RACGP produced a new fact sheet and checklist to support GPs and practice teams in response to the increasing number of measles cases.
 
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