Friday 18 January 2019

'No one should have to die from measles' - Irish doctor says parents who don't vaccinate are misinformed

Amid an outbreak of the disease, GP Brian Higgins why vaccination is vital

GP Brian Higgins
GP Brian Higgins
Photo posed

In 1980s Ireland, hair was big, Rick Astley was a sensation and measles were a fact of life. Each year, approximately 10,000 children in Ireland contracted measles - 500 of whom would have developed ear infections, 400 would have developed pneumonia and at least seven would have died.

By 1987, not only did Guns'n'Roses give us Sweet Child O' Mine but there were only 201 cases of measles in all of Ireland - and no deaths. Medics projected that measles, a disease that had caused brain damage and killed countless children around the world, would be eradicated from Europe by 2010.

However, so far in 2018, I have had two of my own patients contract measles. In all of Ireland there have been 67 reported cases, in Europe 41,000. Oh, and 37 people have died. Needlessly.

Measles is now the leading cause of vaccine-preventable death around the world. It is also the most highly-infectious viral illness of which we know. It is spread by the fine mist of droplets that enter the air when sneezing or coughing. If a non-immune person comes into contact with this mist there is a 90pc chance of them contracting the illness.

After 10 days, this person will become unwell with a fever, sore eyes, diarrhoea and a lovely cough spreading this infectious mist to those near and dear. Three days after this, a brownish-red rash will appear, spreading from behind the ears across the body.

While most will recovery from the illness after a few days of misery, one in 10 will require admission to hospital for IV-rehydration, temperature control and pain management. One in 20 will develop a pneumonia, and this is what kills most children who die from measles. About one in 1000 will develop a brain inflammation called encephalitis that can lead to seizures, brain damage or death.

Probably the most horrifying complication of measles is a very rare but very real condition called subacute sclerosing panencephalitis. This is the consequence of the measles virus persisting in the brain tissue.

Symptoms develop about five to 10 years after an apparent recovery from the original measles infection. Symptoms appear slowly, with a progressive loss of cognitive ability and motor function. Deterioration is slow but relentless. It takes about three years to die. There is no cure.

So what happened? How could we have been so wrong about vanquishing measles from our shores? Why do children still die from this infection? Well, we weren't wrong in predicting that measles could be beaten. But what we couldn't have predicted was that a mistaken linking of the measles vaccine with health consequences - particularly autism - would have serious consequences that are still being felt 20 years on.

The original decline in infection rates was directly due to the introduction of a vaccine against measles. Vaccines are what doctors should be most proud of. There is satisfaction in healing someone who is sick but having created something that safely prevents someone from becoming unwell in the first place is the greatest achievement of modern medicine.

Right now, measles should be in the same category as polio and shoulder pads, a thing of the past. However, in 1998. British medic Andrew Wakefield published research that apparently linked the vaccine to a number of health consequences. In the years since, this article has been proven bogus time and time again, and Wakefield has been struck off the medical register in the UK, but the misinformation has persisted. It went viral, so to speak: fake news but a very real problem.

That is not to say vaccines are not without risks. About one in 20 kids will get a small rash with swollen glands as the body's immune system reacts to the MMR - this is harmless and will pass - and one in 10,000,000 can have a severe reaction. However, these risks are far, far less than the consequences of actually contracting measles.

People became scared. Understandably so. They trusted what this article said and unscrupulous, or ignorant (make up your own minds) people fanned their fears. Ill-informed but well-meaning parents were afraid to harm their children with the MMR and chose not to vaccinate.

Ironically, sadly, these good intentions harmed children. These good intentions killed 37 people across Europe this year so far. Vaccine rates remained high enough that we didn't often see children being admitted to hospital with the complications of measles; the risk of measles didn't feel immediate. The scaremongering, the vaccine bogeyman, kept people awake and more and more people chose not to vaccinate.

My father told me when I started this job, "If you get upset by every sorrowful thing you see you won't last as a doctor, but if you get upset by nothing you should not last as a doctor." He was right, we deal with sadness, tragedy, loss and unfairness every day. Few things upset me - but parents who choose not to vaccinate certainly do.

Speaking to these parents used to really get under my skin. I would be sad for the child but irritated that someone would just not listen to sense. Imagine someone not strapping an infant into a car seat - this is how doctors view choosing not to vaccinate.

These parents, invariably, have done what is always referred to as "my own research". This usually equates to reading abstracts from the same few websites and books that are quite popular. I found that the more time I spent explaining my knowledge of vaccines and listening to their beliefs, the more I realised that people actually derived satisfaction from these conversations.

Afterwards, I would be upset that they were needlessly putting their child at risk, but they would have enjoyed what they saw as an "intelligent conversation" about what they consider a controversial health issue. I'm very sorry, but questioning the safety of the MMR is not controversial. It's more like claiming the earth is flat; it's just wrong.

These days, I explain my position to my patients who choose not to vaccinate. I talk about how readily available and well-presented misinformation on the topic is and how I genuinely do understand the confusion and anxiety that it can cause. I will spend considerable time educating concerned parents on the facts of vaccines, if they agree to discuss them.

However, I explain my belief that a child's right to health is more important than a parent's right to make the wrong decision. I passionately believe that if any parent thinks I would actively and intentionally do something that would harm their child, that they should not choose for me to be their doctor.

All parents do what they think is right. Decisions are made from a good place but the sad fact is those people who chose not to vaccinate are doing something very wrong in the belief they are doing the right thing. Most people do not realise that they are not just putting their own child at risk, they risk the spread of illness by choosing not to vaccinate.

The child with measles could sit beside someone with a poor immune system in my waiting room, or on a train, or in school, cough on them and kill them. Or, the child with rubella sits beside a pregnant woman and causes a congenital abnormality of an unborn baby. There is an outbreak of measles at the moment and there is a safe an validated method of preventing the spread. If you are someone who has chosen not to vaccinate your children, contact your local doctor. They will always be delighted to protect your child by providing a catch-up vaccine.

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