Re: Ireland: Outbreak in West Cork- cases rising
Re: Ireland: Outbreak in West Cork- cases rising
HSE urges parents to make sure children are vaccinated against measles as holiday season approaches
The HSE today (Friday) urged parents to make sure that their children are vaccinated against measles as the holiday season approaches.
People around the country will be out and about and travelling around over the summer months increasing the risk of coming into contact with measles, says HSE Assistant National Director of Health Protection, Dr Kevin Kelleher.
“A measles outbreak in west Cork has now affected 51 children, including two who have been hospitalised, showing just how infectious measles is, how serious infection can be, and the importance of vaccination to prevent unnecessary illness and the associated complications.
“Most of the children infected in Cork are teenagers and 88% of cases have never received any dose of MMR vaccine. This large and rapidly spreading outbreak is a major concern not only to people in West Cork but for the whole of Ireland.
“Vaccination with MMR is the only way to protect against measles. Failure to vaccinate leaves children exposed to a serious and potentially fatal disease. But just as importantly, itexposes other children especially the most vulnerable babies under one year of age to this devastating disease. Children under one are those most likely to be liable to the severe complications and possibly death.
“MMR vaccine is routinely provided at 12 months of age and again at preschool age (4-5 years of age), so those aged less than 12 months will not have received the vaccine. Older children who did not get the MMR vaccine at these ages need to be vaccinated and their parents should contact their GP. Children younger than 13 years of age who missed out on MMR vaccine can still get it free of charge from their GP. Older children and teenagers can get the vaccine free but may have to pay an administration fee,” added Dr Kelleher.
ENDS
Last updated on: 01 / 06 / 2012
http://www.hse.ie/eng/services/News/measlesvaccinate.html
Epi Insight
volume 13 issue 6 June 2012
Measles outbreak West Cork May 2012
Measles outbreaks
Measles is still a common infection and large outbreaks of measles were reported in Europe in 2011, with more than 30 000 cases of measles being reported by the 29 EU and EEA/EFTA countries. Already in the EU region in 2012 more than 2,200 cases have been reported, the majority in Romania. In the Ukraine, a further 9,000 cases have been reported in 2012.¹
Outbreaks in Ireland continue to occur frequently. In 2011 a large measles outbreak occurred in the Dublin area, which commenced following a summer camp exposure to a measles case. Rapid spread of measles infection among the summer camp attendees then spread among the local community. As a result of that outbreak more than 200 cases were reported from the Dublin region.²
Meanwhile Ireland is now experiencing another measles outbreak in the southwest of the country. This report highlights the extent of the outbreak, reasons for the outbreak occurring and preventive action that can be taken to prevent measles. Measles is very infectious and over the summer many children travel around the country, so the risk of transmission is high unless children are vaccinated.
Background
Measles is an acute viral infectious disease. The disease is transmitted via airborne respiratory droplets, or by direct contact with nasal and throat secretions of infected individuals. The main features are fever, rash and respiratory illness. It is highly infectious but can be prevented with a measles vaccination. Before a vaccine was developed infection with measles virus was nearly universal in childhood and more than 90% of persons were immune by age 15 years.
Two doses of MMR vaccine are recommended for all children at the age of 12 months and again at 4-5 years of age.
Measles outbreak in West Cork 2012
In total in the HSE South 48 cases have now been reported (as of 28/05/2012); 47 cases are from the West Cork area and one case from Cork City area (with no known links to the outbreak). Most cases are in the 10-19 year age group. (figure 1)
Of the 48 cases, 42 were reported to be unvaccinated.Full vaccination (two doses) has been confirmed for only one case (who has not yet been laboratory confirmed). For the remaining four children who were reported to be partially vaccinated (one dose) it has not been possible to confirm vaccination status for three of them. Vaccination status of another child is unknown and no records are available on this child. (figure 1)
Figure 1. Measles cases in HSE South, by vaccination status 2012 (n=48 cases).
MMR vaccination coverage in Ireland and West Cork
National MMR vaccination rates at 24 months are currently 92% for the first dose of MMR (MMR1); 93% uptake was reported in HSE south overall, but for the West Cork area an uptake of only 86% was reported for the same time period (figure 2). For some years a significant number of parents in the West Cork area have declined vaccinations for their children. The resulting low coverage has resulted in a large population of children in the area who are susceptible to measles. This lower coverage in the area highlights the susceptibility of a large proportion of children in the area to measles.³
Figure 2. MMR1 immunisation uptake rates (%) by LHO, in those 24 months of age in Quarter 4-2011, in Ireland and Dublin region.
Local estimates of MMR coverage from the school programme (second dose of MMR) is about 75%.
As an MMR uptake of at least 95% for two doses is needed to prevent outbreaks it is clear that many more cases are likely to occur in the West Cork area in the forthcoming weeks unless children are vaccinated. Other areas of the country seen to be at high risk of measles include Galway, Dublin Southeast, Dublin Northwest and Meath (see figure 2). All of these areas have similarly low uptakes of MMR1 at 24 months as those seen in West Cork.
Control measures
Parents of children attending schools, creches and other child care facilities have been alerted to the outbreak and all children have been recommended MMR vaccination. Children who are ill with measles must be excluded from school to prevent transmission to other children who may be at risk due to underlying conditions. Unvaccinated siblings of measles cases have been recommended to stay out of school or child care to prevent spread of the infection.
As an additional control measure, children between 6-12 months of age in the outbreak area are recommended MMR vaccination during the outbreak period (only). A further dose will be required after 12 months of age in addition to the normal dose at 4-5 years of age.
GPs and hospital services in the area have also been informed and asked to notify public health and to isolate patients to prevent further transmission.
MMR vaccination is available to all children in the outbreak area and can be obtained, free of charge, from their GPs.
National recommendations
MMR vaccination is recommended for all children at 12 months and 4-5 years of age. Any child that has not received age appropriate vaccination should seek vaccination from their GP. MMR vaccination is free for all children up to the age of 12 years, and costs may apply after this age.
All children regardless of whether they are staying in Ireland over the summer or travelling should be vaccinated as appropriate for their age.
Students and children attending summer camps, colleges and other holiday activities should be up to date on MMR vaccination before they commence.
All students who will be attending third level colleges or universities after the summer are recommended to verify their MMR vaccination status and obtain MMR if they have not received two doses of MMR.
Organisers of summer schools and summer activity camps should remind parents to make sure their children are up to date with vaccination. This will protect children in their care and avoid unnecessary disruption to summer activities. Parents should be asked to provide vaccination information as part of the routine data collected from each child. In the event of a measles outbreak occurring, these children can then be excluded from the activities to protect themselves and others.
Dr. Suzanne Cotter (HPSC), Dr. Fiona Ryan, Mary MacSweeney, Dr. Helen Coughlan, Dr. Mary Kieran (HSE South)
1. European Monthly Measles Monitoring available here
2. Ward M, Ennis O, Fitzgerald M et al.Measles outbreak in eastern Ireland. Epi-Insight volume 12 issue. Available here.
3. Immunisation uptake Statistics for Ireland Q4 2011 available here
