The Present Situation The Strategies The Vaccination The Controversy.
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Transcript of The Present Situation The Strategies The Vaccination The Controversy.
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The Present Situation
The Strategies
The Vaccination
The Controversy
The Fight Against Measles
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• About 20 million cases each year around the globe.
2011
UK- 804 cases
Ireland – 173 cases
Europe - more than 26,000 cases
8 deaths
24 cases measles encephalitis
• Africa and Asia , remains one of leading causes of death in children. – WHO - 164,000 people died from measles in 2008, most younger than 5 years old.
Recent Outbreaks
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•Increase in measles cases and deaths in recent months
•Prevalent in famine and drought areas
•Unvaccinated children forced to live in cramped refugee camps
•Somalia – 24%of 1yr olds immunized in country
Recent Outbreaks (2)
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Increase in US cases
•over 92% population vaccinated•Dropped due to importation of disease from WHO European Regions and South East Asian regions.•33 countries in WHO European Region have increased measles cases
Eradication
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MMR Vaccine
Developed in 1960s by Maurice Hilleman
3 live attenuated viruses
First dose ~1 year, second ~5 years.
Before vaccination, measles “as inevitable as death and taxes”.
Now contracted by <1% of individuals under 30 in countries with routine childhood vaccination
Prevents illness, disability, death.
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WHO Strategy 1994 - 2004
Aim: Vaccinate >90% in all districts
All children to get second dose
71% of targeted children in 1999 -> 76% in 2004
Sub-Saharan Africa – 49% -> 65%
South Asia – 54% -> 61%
2004 – 168 counties (88%) offered second round
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MMR in Ireland
First dose at 12 months
Second dose (not booster) at 4-5 years
Through school/HSE or GP
Recent outbreaks of measles and mumps due to missed second dose
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1985 - Monocomponent measles vaccine introduced- 10,000 cases in that year reduced to 201 in 1987
1988- combined MMR introduced -12-15months
1992- Second dose recommended- 10-15 years
1999- Age of second dose reduced to 4-5 years
Childhood vaccination Schedule for children born after 1st July 2008- Free From the Department of Health, HSE• 12months from GP
• 4-5 yrs from GP or in School
• Primary School Immunisation Programme
Vaccination Strategy- Ireland
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Outbreak in 1993- affected 4,000 people
2000- 1,600 cases resulted in 3 deaths
From 2001 to 2006 – 1,562 cases • Rapid spread during these outbreaks due to:• Incomplete vaccination coverage
• Susceptible pool of older unvaccinated children
Today- 221cases reported in 2011, so far (411 in 2010)• 85% occurred in North Dublin City
90% of children have received 1st dose by 24months
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Global mortality reduced by 78% , from estimated 733 000 deaths in 2000 to an estimated 164 000 deaths in 2008-78%
The WHO region of America has
sustained elimination since 2002
The WHO has set a target of
elimation of measles in
remaining 4 out of 5
WHO regions by 2020.• This can only be achieved by
Increasing routine immunization coverage• improving surveillance systems• political and financial commitment
W.H.O-Measles Eradication
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• There are two treatments to protect against measles:
• MMR: measles, mumps and rubella vaccine.
• MMRV: measles, mumps, rubella, and varicella vaccine.
Vaccination
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• From nucleotide tests all vaccines were shown to be similar.
• At present the MMR vaccine has a 95% efficiency.
• First virus was obtained from David Edmonston in 1954.
• The virus strain was grown in chick embryos.
• Made the virus more suited to chicks than humans
• Similar attenuated vaccines around this time were developed.
Development
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• Control: reduce incidence of disease. Due to 95% efficiency a two dose strategy is need to prevent an accumulation of susceptible individuals.
• In 2010, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.
WHO: Eradiation PolicyControl
Outbreak Prevention
Eradication
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Children should be vaccinated with the MMR vaccine 12 to 15 months after birth and should receive a second dose at 4-5 year usually before the child enters school.
Before the vaccination programme was implemented in USA, between 3 to 4 million people were infected each year, with 400 to 500 dying
Measles is a highly contagious virus and was estimated there was 242,000 Measles deaths which equals 27 deaths every hour.
Measles Vaccine
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• The vaccine like many vaccines can cause allergic reactions, most people however do not have any problems with it.
• Mild problems: fever (1 in 6 doses), mild rash ( 1 in 20) or rare swelling of glands.
• Moderate problems: seizure (1 in 3,000 doses), temporary pain in joints ( 1 in 4 teenage and adult women) and temporary low platelet counts which can lead to a bleeding disorder ( 1 in 30,000 doses).
• Sever problems: 1 in 1 million: deafness, long-term seizures or comas and permanent brain damage.
MMR Vaccine Risks
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• Has a fever
• Is taking steroids
• Has had another live attenuated vaccine in the last three days
• Is receiving chemotherapy/radiotherapy
• Has a compromised immune system
Less safe if recipient...
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Developing Countries Immunodeficiency
Individuals with low immune responses can’t handle certain vaccines due to the presence of attenuated or live virus.
• Presence of maternal antibodies during first 9 months of life reduces efficiency of immunization.
• Measles virus infects children by the respiratory tracts and little of the maternal antibodies will be transduced onto mucosal surfaces
Problems with Vaccine
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Aerosol delivery and high titre vaccinations to overcome problems in vaccinating young infants.
1. Recombinant virus
2. Immune-stimulating complexes
3. DNA vaccination
Advancements
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Controversy:Wakefield et al. 1998
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• 12 Children with Gastrointestinal symptoms, lost acquired skills including communication
• In 8 children, parents and/or physicians linked onset of behavioural problems with MMR
• Main cause of public concern
Wakefield et al. 1998
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• Wakefield: “I cannot support the continued use of these vaccines in combination…”
• Public uproar & slump in MMR vaccinations
• Brian Deer Sunday Times investigation 2003-2011
• Prof. John O’ Leary slander
Media Coverage
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• Hornig et al. 2008 replications
• Wakefield foul play
Evidence against autism link & aftermath of investigation
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Referenceshttp://www.immunisation.ie/en/Downloads/NIACGuidelines/PDFFile_15482_en.pdf
http://www.irishhealth.com/article.html?id=780
http://www.immunisation.ie/en/Downloads/PDFFile_15371_en.pdf
http://www.who.int/immunization_monitoring/diseases/measlesreportedcasesbycountry.pdf
http://www.immunisation.ie/en/ChildhoodImmunisation/PrimaryImmunisationSchedule/
http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_18-en.pdf
http://www.who.int/immunization/newsroom/news_wha_2010_measles_eradication/en/index.html
www.braindeer.com
http://www.who.int/mediacentre/factsheets/fs286/en/
http://www.cdc.gov/vaccines/vpd-vac/measles/default.htm
http://www.immunisation.ie/en/ChildhoodImmunisation/VaccinePreventableDiseases/MMR/
J. Wakefield, S. H. Murch, A. Anthony, J. Linnell, D. M. Casson, M. Malik, M. Berelowitz, A. P. Dhillon, M. A. Thomson (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.
T. F. Wild (1999) Measles vaccines, new developments and immunization strategies. Vaccine 17; 1726-1729.