Dr. Görkem Astarcıoğlu
The sentence we so often heard at school – “Our country serves as a bridge between Asia and Europe” – is highly significant when it comes to infectious diseases.
As was the case with smallpox, if a disease is not seen in a country for 10 years, it is considered eradicated – that is, completely eliminated. At that point, vaccination against that disease is no longer necessary.
Since 2002, Turkey has adopted the World Health Organization’s measles elimination goal and has carried out successful vaccination and careful monitoring of the spread of the disease. Under the legal regulations introduced for this purpose, measles is a notifiable disease. As a result of these efforts, the number of measles cases, which used to be 7,000–10,000 a year, fell to zero in 2008, and no new cases were seen until 2012.
In European countries, however, outbreaks continue. “Anti-vaccine propaganda” spreading around the world is causing growing numbers of vaccine refusals, and this affects every country in the world when it comes to infectious diseases.
Measles Cases in 2018 by Country
Ukraine 43,036 / Serbia 5,069 / France 2,856 / Italy 2,435 / Israel 2,207 / Greece 2,192 / Russian Federation 2,114 / Georgia 1,721 / Albania 1,439 / Romania 1,017 / United Kingdom 1,007
Measles cases in European countries by year: 2009: 7,499 / 2010: 30,625 / 2017: 23,927 / 2018: 85,596
Measles
Although it is more common in children, measles can occur at any age.
It is spread through the airways and causes fever and a rash, which may be accompanied by cough, a runny nose and red eyes. The disease leads to a complication in 30% of cases, and this risk is higher in babies under 1 year and in adults. Of the early complications, one in five is pneumonia, one in five is diarrhoea, one in four is an ear infection, and one in ten is blindness, encephalitis or death. A late complication is a form of brain damage called SSPE, seen in 1 in 100,000 cases. There is no specific antiviral treatment for measles; vitamin A is given as support, and complications are treated as they arise.
A person who has caught the virus is contagious before any symptoms appear. This is why the disease so easily turns into outbreaks.
Protection
The only way to protect against measles is vaccination.
After exposure, everyone known to have been in contact with a patient should be vaccinated: people living in the same household, attending the same school, sleeping in the same dormitory, waiting in the same waiting room, working at the same workplace, sitting within 2 rows on the same plane, visiting a hospital within 2 hours of a measles patient, or involved in their treatment. Babies under 6 months (because antibodies from the mother prevent the vaccine from working), pregnant women (because the foetus may be infected) and people for whom vaccination is not advisable (see the section on vaccine ingredients) should receive immunoglobulin.
Turkey’s Vaccination Policy
Because of the virus spreading from Europe and the ongoing war in the Middle East – with large numbers of migrants arriving from countries with inadequate vaccination programmes, such as Syria and Afghanistan – cases began to appear again in Turkey in 2012. The MMR vaccine, given at 12 months, was moved forward to 9 months, and cases were brought back under control by the end of 2016. As a result, from March 2017 the MMR vaccine could be moved back to 1 year of age, when the response is better. To protect against primary vaccine failure, a second dose is given in the first year of primary school.
The MMR Vaccine and Its Ingredients
It is a live vaccine, so it is not given to people with a weakened immune system.
The virus used for the vaccine is grown in chicken embryo fibroblasts. (This is important for those who say “it contains animal embryos”: the vaccine does not contain embryos; the virus needed for the vaccine is grown in them.) For this reason, people with an egg allergy should be vaccinated with care. The vaccine is only withheld in the case of anaphylaxis, a life-threatening allergy; allergies with a mild rash or redness are not a reason to avoid vaccination.
As with any product that is not used the moment it is made (food, medicines, vaccines and so on), preservatives must be added so that the contents reach the end user intact and no other microorganisms can grow in them. These preservatives are used in amounts permitted by international standards that will not cause illness or long-term harm. Vaccines go through very strict checks before they are licensed, and the amounts of these substances are measured.
The measles vaccine also contains trace amounts of an antibiotic called neomycin. It is not given to people with an anaphylactic allergy to this antibiotic.
It contains gelatine, which may be of animal or plant origin. Turkey uses vaccines with gelatine of bovine origin. (This is for those who say it contains pork products.)
It contains thiomersal, which is ethylmercury. It is eliminated from the body in 7–10 days. The toxic form is not ethylmercury but methylmercury, which is also found in seafood. Methylmercury takes about 50 days to leave the body, so repeated exposure can lead to accumulation and illness. Ethylmercury does not accumulate in the body and does not cause chronic disease.
In 1998, a study by Dr. Andrew Wakefield was published in The Lancet, a highly respected medical journal, claiming that thiomersal in the MMR vaccine could cause autism.
When this study, which caused a worldwide sensation, was investigated, it was found that its results had been distorted and altered to reach a particular conclusion. The journal retracted the original publication and issued a correction, and after the investigations the author’s medical licence was revoked. However, on the back of the anti-vaccine wave, studies were launched to test the claim, and in 2002 the WHO Global Advisory Committee on Vaccine Safety, in 2004 the European Medicines Agency, and in 2005 an independent US committee all stated that there is no link between the vaccine and autism.
Reviews carried out after many years of vaccination have found no vaccine-related increase in neurological events of unknown cause in the population.
Public Health
According to a news report published on 27/03/2019 on www.hurriyet.com.tr:
Authorities in the US state of New York took action because of rising measles cases.
Measles was declared eliminated in the USA in 2000, but according to data from the Centers for Disease Control and Prevention, it has reappeared across the country since last year and has been detected in 314 people.
In Rockland County, an emergency measure banning unvaccinated children from public places comes into force at midnight. The measure will remain in place for 30 days and may be extended if necessary; in Rockland, home to 300,000 people, unvaccinated children will not be allowed into public places such as schools, libraries, shops and places of worship.
Measles Alarm in Germany
Pointing out that 1,600 children die in Germany every year as a result of neglecting measles vaccination, Prof. Dr. Karl Lauterbach, a health policy expert of the Social Democratic Party (SPD), stated that Federal Health Minister Jens Spahn also supports making measles vaccination mandatory in Germany, as it is in many other countries such as Italy and France.
Lauterbach, who said that parents who fail to have their children vaccinated are committing abuse and that this should have legal consequences, added that families should be better informed – above all in nurseries, but also in schools, social service facilities and cultural institutions. His proposal was supported by many groups.
It is very clear that anti-vaccine propaganda threatens public health. That is why raising awareness, explaining vaccines and diseases, and spreading accurate information are so important.
As a paediatrician, aware of how important it is to prevent diseases before they occur, I felt the need to write this article.
Dr. Görkem ASTARCIOĞLU
