The European authorities had warned of the risk posed by low vaccination coverage against measles and the worst omens have come true. The disease, easily preventable with two doses and which practically disappeared from the continent during confinements, has re-emerged in recent months, and has done so strongly in some areas.
Three people – two of them babies – have died in Romania, a country that has declared…
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The European authorities had warned of the risk posed by low vaccination coverage against measles and the worst omens have come true. The disease, easily preventable with two doses and which practically disappeared from the continent during confinements, has re-emerged in recent months, and has done so strongly in some areas.
Three people – two of them babies – have died in Romania, a country that declared the infection a “national epidemic” this December. In England, “dozens of children” have been hospitalized in Birmingham (center of the country) since November, according to local media, and the authorities are forcing unvaccinated minors in the city to isolate at home without going to school if they have been in contact with someone who is sick. Austria has been fighting since the beginning of 2023 with several outbreaks that have already caused nearly 200 cases, while in a school in Guilherand-Granges (in the French department of Ardèche) dozens of unvaccinated children have been infected in an episode that already has more than 60 patients and several hospitalized.
Spain, for now, has been spared the increase. The country barely registered a dozen cases last year, all of them imported or related to them, without any chain of infections or relevant outbreak developing. Part of this is due to vaccination coverage that, although below international recommendations in some variables, is still high (97.2% in the first dose and 93.9% in the second, according to data from the Ministry of Health).
According to the statistics of European Center for Disease Prevention and Control (ECDC) corresponding to 2022, The average coverage in the European Union is notably lower and remains at 92.4% for the first dose and 89.7% for the second. The organization, however, warns that these percentages have been decreasing in countries like Romania in the last decade, reaching 78% and 62%, respectively.
“The number of measles cases in the European Union and the European Economic Area [que incluye a Suiza, Noruega e Islandia] “It is constantly increasing since June 2023. Taking into account vaccination coverage, which is suboptimal for the second dose in most countries, an increase in incidence is expected in the coming months and during the spring,” warns the latest alert bulletin ECDC.
Quique Bassat, pediatrician and epidemiologist of Barcelona Institute for Global Health (ISGlobal), highlights the complexity of the fight against the measles virus. “It is one of the most contagious that exists, which forces you to systematically maintain vaccination coverage above 95% to prevent its circulation. Each point that falls from that represents a significant risk, since the usual thing is that the unimmunized tend to be grouped in certain areas or groups, and form pockets of susceptible population. Sooner or later, the virus will reach them and cause an outbreak,” he says.
In recent years, new problems have been added to these difficulties, such as anti-vaccine movements and the difficulty of getting prevention and public health messages to some groups due to their socioeconomic or cultural situation.
The measles vaccine is administered in two doses, the first at the first birthday and the second at three or four years, depending on the autonomous community. The same puncture that protects against this infection also protects against rubella and mumps, which is where the name “MMR” comes from.
“It is a disease that we must have a lot of respect for because it can cause very serious illnesses and even the death of one in every 1,000 infected children. And if the death of a child is always a tragedy, it is much more so when it is due to a disease so easy to prevent thanks to vaccines,” explains Antoni Trilla, head of the Preventive Medicine service at the Hospital Clínic (Barcelona).
The disease is transmitted by contact with the already infected person or through aerosols (microscopic droplets of saliva that float in the air). After an incubation that usually lasts 7 to 14 days, the first symptoms are high fever, cough and runny nose. Between three and five days later, the characteristic rash will appear on the skin. The most dangerous complications that the virus develops are pneumonia, neurological conditions and eye conditions (blindness).
The goal of 95% vaccine coverage—set by the World Health Organization (WHO) to one day eradicate the disease—is to achieve so-called herd protection, in which the benefit of vaccines is no longer just individual, but it acquires a social dimension by also protecting those for whom immunization is not possible (due to age, for example…). What happened in Romania is a good example: two of the three deaths were seven-month-old babies who had not yet been able to receive the vaccine. For safety reasons, this should not be administered until the first year of age, although in epidemic crisis situations such as the one the country is now experiencing, its use can also be extended to babies who are between 9 and 11 months old.
Coverage in Spain
In 2022, 97.2% of children born in Spain received the first dose on their first birthday, although in five communities this percentage fell below 95%: Castilla y León (94.8%), the Canary Islands (94. 7%), Catalonia (94.4%), La Rioja (91.1%) and Castilla-La Mancha (90.4%).
The problem in Spain—a country declared free of “endemic transmission” of the virus by the WHO in 2017—is with the second dose, admits the head of the Vaccination Programs area of the Ministry of Health, Aurora Limia. “Spain in general has high coverage and it has remained quite stable over the years. The percentages dropped a little with the pandemic, but the communities have later managed to raise them again. The second dose, however, falls almost every year somewhat below the 95% target,” she explains. In 2022, the percentage for all of Spain remained at 93.7%, with five communities with notably lower levels: Canary Islands and Extremadura (both 90.3%), Castilla-La Mancha (88.8%), La Rioja (88.1%) and Basque Country (88%).
Limia shares the ECDC’s position on the foreseeable increase in measles cases and outbreaks in the coming months in Europe, also taking into account that the circulation of the virus is usually more frequent in spring. “The low coverage in other neighboring countries is worrying and Spain also has room for improvement. If cases rise in Europe, they will also do so in Spain, although we can trust that the outbreaks will not have a great impact here, because we continue to have high coverage,” he concludes.
2024-01-18 04:30:00
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