WHO gives warning on missed measles vaccinations

The World Health Organization (WHO) has warned that global progress in the fight against measles is being undermined by the pandemic.
 
In a press release this month, the WHO cited evidence in a new report it carried out with the US Centers for Disease Control and Prevention (CDC). Their analysis found that more than 22 million infants missed their first dose of the measles vaccine in 2020, a rise of three million children on the numbers recorded for 2019.
 
The WHO said it marked the ‘largest increase in two decades’, and that the situation is ‘creating dangerous conditions for outbreaks to occur’.
 
The global number of reported measles cases has decreased since the onset of the COVID-19 pandemic, with an 80% decline in 2020 compared to the previous year.
 
In Australia, there have been no cases recorded this year, while the level of immunisation appears to have been maintained at pre-pandemic levels. Current tables recording the immunisation rates among two-year-olds in Australia show that coverage of the MMR vaccine is well over 90% in every state and territory.
 
On a global level, however, the WHO’s Dr Kate O’Brien warned the decrease in cases is ‘the calm before the storm’.
 
The organisation reports that measles surveillance deteriorated last year, with the number of specimens sent for laboratory testing the lowest in over a decade. It suggests that weak monitoring and testing will affect the capacity of some countries to prevent outbreaks of the highly infectious disease.
 
Professor Kim Mulholland, a paediatrician at the Murdoch Children’s Research Institute (MCRI), describes the situation as ‘very worrying’.
 
‘I would say that it’s an accident waiting to happen, if it’s not happening already,’ he told newsGP.
 
Professor Mulholland, who is also a member of the WHO’s Strategic Advisory Group of Experts on Immunisation, says one of the main challenges is obtaining accurate data on the international presence of measles.
 
‘My feeling is of frustration because the measles world, like the COVID-19 world, has been dominated by mathematical models in part because it’s very hard to see what’s really going on there in the world,’ he said.
 
‘But perhaps more than with COVID, the situation with measles is that most deaths happen out of sight, out of mind.’
 
In Australia, the impact of the pandemic does not appear to have reduced immunisation rates. A report published by the National Centre for Immunisation Research and Surveillance (NCIRS) last November suggested rates had been maintained, at least in the initial months of the pandemic up to July 2020.
 
Using data from the Australian Immunisation Register (AIR), it monitored vaccination uptake in Australian children for the National Immunisation Program. The report assessed the impact of physical distancing and movement restrictions across Australia, and ultimately reached some reassuring conclusions.
 
The authors reportedly found ‘no evidence of any substantial impact’ on vaccination uptake in children at either a national or individual state or territory level.
 
‘This is a welcome finding, which likely reflects consistent messaging from health authorities that it is important to maintain immunisation through the pandemic and efforts to provide COVID-19 safe vaccination services,’ they wrote.
 
A subsequent study in the Medical Journal of Australia also found that early childhood immunisation rates were ‘resilient’ during the 2020 lockdown in Victoria.
 
Dr Frank Beard, a public health physician and Associate Director at the NCIRS, was one of the authors of that study. He is ‘pretty confident’ the high rates of measles, mumps and rubella (MMR) vaccination have been maintained.
 
‘However, that’s not the only story,’ he told newsGP. ‘We know that there are some gaps in immunity in older populations, particularly adults [in their] 20s up to their mid-50s, knowing that when they were children the vaccine coverage rates were lower.’
 
He said those age groups include a high proportion of people who are likely to travel.
 
‘That would be a message for GPs to make sure anyone that comes in for a travel consultation that [measles immunisation] is something that’s considered.
 
‘Often people don’t have good records for vaccinations that long ago. If it’s unclear whether people have had two doses of vaccine, then it’s quite safe to give them an additional one or two doses.’
 
He said that as more international travellers return to the country, general practices will need to be vigilant for measles cases so that contact tracing and a public health response can be put into place when the disease inevitably re-appears.
 
‘A lot of GPs these days likely never have seen measles, and so certainly they need to be on the alert, particularly among people who’ve returned from overseas, but also in general because obviously, people can still catch it from other people who’ve returned from overseas,’ he said.
 
Major outbreaks occurred in 26 countries in 2020, which the WHO says accounted for 84% of all reported cases last year.
 
Prior to the pandemic, the disease accounted for an estimated 207,500 deaths globally in 2019.
 
Professor Mulholland believes the pandemic is masking what is really happening with the highly infectious disease.
 
‘There are real measles outbreaks going on now and we should be collecting real data from those places, finding out what’s happening, [like] in DR Congo where lots of children have been getting measles and dying, and trying to understand more about it.
 
‘We haven’t been doing that. I feel like the world has taken [its] eyes off measles to be honest.’
 
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immunisation infectious diseases measles MMR vaccination WHO World Health Organization