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Potential Measles Outbreak In Ireland

Measles is a serious disease – Vaccination is the only effective protection.

The HSE has confirmed to us that there has been eight cases of measles reported.  If it reaches ten, then it will be considered an outbreak.  It has been notified of two cases in north Dublin city, but the health authority says there are now at least eight cases in Dublin, Kildare, Wicklow and Meath, with most cases in Dublin.

Dr John Cuddihy is the Acting Assistant National Director for Health Protection and he said that measles can be a serious illness and is highly contagious.

A HSE spokesperson said

“The Measles Outbreak Control Team continues to investigate and advise on measures to control the further spread of this potentially serious illness, Alerts regarding measles have been sent to all emergency departments and General Practitioners (GPs) in the affected areas.  Work is ongoing in identifying close contacts of cases who are being notified and advised by public health officers.”

The HSE continued: “Anybody who has symptoms suggestive of measles should stay at home, not go to school or work and phone your GP and explain that you may have measles.  The best protection is to be fully vaccinated with two doses of MMR vaccine”.

Measles (sometimes known as rubeola) is a highly infectious viral illness. It causes a range of symptoms including fever, coughing and distinctive red-brown spots on the skin.

The measles virus is contained in the millions of tiny droplets that come out of the nose and mouth when an infected person coughs or sneezes. You can catch measles by breathing in these droplets or, if the droplets have settled on a surface, by touching the surface and then placing your hands near your nose or mouth. The most effective way of preventing measles is the measles, mumps and rubella (MMR) vaccine. 

Measles outbreaks still occur in Europe

Measles has become rare in Europe compared to some other regions in the world, thanks to vaccination. Many people, including healthcare workers, may never have even seen a person with measles. This can give rise to a belief that the disease has been eliminated. But measles outbreaks continue to occur in many parts of Europe. An estimate of one out of four people with measles will need hospitalisation and every year several people die in Europe as a consequence of measles infection.

 

Measles FAQ 

What is measles?
Measles is an acute and serious infection caused by the measles virus. It causes a rash illness, with cough, runny nose, conjunctivitis and high fever. The disease is very infectious. Before vaccination was available the infection most commonly affected young children. However, anyone can catch measles at any age if they are not protected against the infection, either from vaccination or as a result of previous infection.

Measles is a serious disease - Infographic (ECDC)

What does measles rash look like?
Images of measles skin rash can be viewed at http://www.cdc.gov/measles/about/photos.html and http://www.immunize.org/photos/measles-photos.asp

How is measles transmitted?
Measles is transmitted through direct contact with an infected person or through the air when the infected person coughs or sneezes. It is so infectious that it can be transmitted to people who may breathe in the air-borne virus upon entering a room where an individual with measles was coughing up to two hours before.

When is measles most infectious?
The most infectious period of the measles illness is during the four days before and four days after rash onset. During the four days before rash onset the person with measles will usually not know that this is the illness they have. During this time they can easily transmit the virus. Once the rash develops people may know what they have and will normally be at home recovering from the illness. During this time they are less likely to transmit the virus (although still infectious) because they are at home. However, people in the house if not protected against measles are at risk during this time. During the infectious period, even trivial contact may be sufficient for the virus to spread.

How soon after contact with measles virus does disease develop?
The incubation period (the time from exposure to the virus until the first symptoms develop is typically 10-12 days. From exposure to rash onset averages 14 days (7-18 days).

What are the symptoms of measles?
The first stage of measles includes irritability, a runny nose, conjunctivitis (red eyes), a hacking cough and an increasing fever that comes and goes. These symptoms usually last 2-4 days (occasionally up to 7 days). The rash starts from day 4. It usually starts on the forehead and spreads downwards over the face, neck and body. The rash consists of flat red or brown blotches, which can flow into each other. It lasts about 4-7 days. There can also be diarrhoea, vomiting and abdominal pain.

Are complications common with measles?
Yes, complications are quite common. They include a severe cough and breathing difficulties (croup), ear infections (1 in 20), viral and bacterial lung infections (pneumonia) (1 in 25), and eye infections (conjunctivitis). Most of the complications are caused by secondary bacterial infections, which can be treated with antibiotics. More serious problems involve the nervous system and are rarer. Inflammation of the brain (acute encephalitis) occurs 2-6 days after the rash has appeared. Less than 1 in 1,000 measles cases is affected in this way, but 25% of those affected are left with brain damage. SSPE (subacute sclerosing pan-encephalomyelitis) is the most severe complication of measles. It usually occurs years after the initial illness and is a slowly progressive brain infection. SSPE starts with intellectual impairment and deteriorates to seizures and eventually death. It is, however, very rare occurring in less than 1 in 100,000 cases of measles. Measles infection during pregnancy can result in the loss or early birth of the baby.

Severe disease and complications are most likely in infants under 12 months, those with weakened immune systems, and the malnourished.

Can measles be prevented?
In Ireland a vaccine that contains measles-mumps-rubella vaccines as a combined vaccine (called MMR) is used to prevent measles (as well as mumps and rubella). The vaccine produces an inapparent or mild infection that does not cause disease or harm to the child. The MMR vaccine stimulates antibodies in the child to protect against the wild measles virus if the child is exposed to the virus.

When was measles vaccine first introduced in Ireland?
Measles immunisation was introduced in Ireland in 1985, and from 1988 the MMR vaccine was used to replace the single measles vaccine. Since that time the uptake of MMR vaccine has reached most children and the risk of measles infection in Ireland has decreased over time.

Have any large measles outbreaks occurred since the MMR vaccine was introduced?
In 1993/1994, there was a large increase in the number of cases of measles identified in Ireland, which was due to not enough children being immunised to prevent spread of the disease.

Another large measles outbreak occurred in Ireland in 2000, with more than 1600 cases reported and three deaths in young children were associated with this outbreak. Since 2000 other smaller outbreaks have been reported in different parts of the country. These outbreaks occur among children or young adults who are either unvaccinated or under-vaccinated (one dose of MMR only). The outbreaks have been prevented from further spread by offering vaccine to those individuals who need additional doses of MMR vaccine.

How effective is MMR in preventing measles?
MMR vaccine can prevent measles in over 95% of children given MMR at or after 12 months of age. For those that fail to respond to the first dose (about 2-5%) a second dose provides protection to more than 99% of those immunised.

When is MMR vaccine given in Ireland?
The first dose is given at 12 months and the second dose at 4-5 years of age. MMR vaccine can also given to those who need it (not immune) at any age if they need it for travel, for work or to protect vulnerable children or adults.

Is MMR contraindicated for anyone?
The administration of MMR vaccine is contraindicated if an individual has any of the following

Anaphylaxis (severe, potentially life-threatening allergic reaction) to any of the vaccine constituents

Significantly immunocompromised persons, such as those with untreated malignant disease and immunodeficiency states other than HIV infection, and those who are receiving immunosuppressive therapy, high-dose x-ray therapy and current high-dose systemic corticosteroids

Pregnancy. Furthermore pregnancy should be avoided for one month after MMR.

What is the uptake of MMR in Ireland?
The uptake of MMR at 24 months and among school children has improved in recent years, thereby decreasing the risk of measles in Ireland. Uptake data by HSE region and Local Health Office area is available on the HPSC website. Some children/people are still unvaccinated and are at risk of measles.

What should I do if I think my child has measles?
Keep your child at home if you think that he/she might have measles. Call your GP so that he/she can see your child at a time/place when no one else is there (to avoid infecting others). Your GP will also organise a test to confirm the diagnosis – this is usually done by using a small swab that takes a sample of the oral fluid from the child. If any complications develop the GP will prescribe antibiotics if needed for bacterial infections that can develop after the measles infection.

Are all cases of measles reported to Public Health?
Yes, measles is a notifiable disease (under Infectious Disease legislation) and all cases are reported to Departments of Public Health for investigation and risk assessment. The doctor/nurse from the HSE contacts all cases (or parents) to identify the source of the measles infection and risk of spread to others. They provide advice on how to prevent transmission to others.

For more information on MMR vaccine see the HSE immunisation website http://www.hse.ie/eng/health/immunisation/

 

 

2017 - Measles Is A Serious Disease

 

Downloads

DCDC VACC loolkit leaflet on measles

Measles information leaflet for the travelling community

Recognize, prevent spread, and notify.

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