Should the public health community be doing more to promote the benefits of vaccination? Yes, says Dr Melissa Stoneham from the Public Health Advocacy Institute WA.
In the latest edition of JournalWatch, she reviews recent research on the transmission of measles and measles vaccination rates in Australia. Are we heading for a measles outbreak, due to our falling vaccination rates? What can be done to prevent this?
As Zsuzsanna writes in a letter to The Lancet, measles elimination is a goal for 183 countries of the world. The Millennium Development Goals state that the global community has resolved to reduce measles deaths by 95% by 2015, and five of the six WHO regions, plan to eliminate measles within this decade.
Zsuzsanna who works with the WHO Regional Office for Europe in Copenhagen, discusses the current outbreak of measles in Swansea, UK saying it was inevitable due to large numbers of people who were unimmunised.
He states that the measles vaccine—one of the oldest and most effective in the vaccine arsenal, is responsible for dramatic reductions in child mortality and suggests three key strategies to protect the public’s health. These include paying close attention to the epidemiology of measles outbreaks and taking appropriate action, continuing to invest in new and old vaccines and engaging with the public to understand why some choose not to vaccinate, and finally capitalising on existing opportunities such as the Measles and Rubella Initiative.
In Australia, the Lateline program which aired on the 22 April 2013, highlighted recent outbreaks of measles and whopping cough in some parts of Australia with low vaccination rates and discussed how to balance public health with concerns about vaccinations among a minority of parents.
The following day, a commentary by Professor David Durrheim from the University of Newcastle indicated that the latest immunisation coverage report from the National Health Performance Authority shows there are several places in Australia – both rich and poor – where immunisation coverage is too low and is below the 93% to 95% coverage required to prevent measles outbreaks.
He suggests this puts children at unnecessary risk and that parents who do not have their children vaccinated due to ideological reasons, not only place their own children at risk, but also threaten the most vulnerable children in Australia.
Along similar lines, another article featured in this month’s edition of JournalWatch was a study by Hoad and colleagues which aimed to quantify the risk of transmission of measles associated with infectious people who travelled on aeroplane flights to or within Australia.
The study led by Hoad, who is a Public Health Registrar with the Public Health and Ambulatory Care, North Metropolitan Health Service in Perth, collected data on aircraft passengers who travelled to and within Australia while infected with measles, between January 2007 and June 2011 to determine the risk of measles transmission. For someone who is a regular air traveller, this article was of some personal interest!
During the study period, the researchers identified 45 infectious cases and found that 20 secondary cases, where people came down with the disease after the flight, emerged on seven of the 49 affected flights. Of these 49 flights, 36 were international and 13 were domestic flights.
Most of the primary cases were Australians who were infected overseas, in a range of countries – primarily developing countries in South-east Asia and Asia where measles transmission remains endemic, but also in some European countries, including the UK, which have had measles epidemic activity in recent years. Almost all the secondary cases were Australian. No cases were found on the domestic flights, reflecting the reasonably high levels of immunity against measles in Australia.
Around 45 per cent of the secondary infections were found in people sitting within two rows of the index case while 55 per cent were seated elsewhere and up to 21 rows distant. Although air is filtered regularly on an aircraft and circulates laterally, minimising the transmission of airborne infectious agents to passengers seated more closely to the initial patient, other risks such as people move around during or before a flight can impact on the transmission rates.
Thankfully, the researchers stopped short of recommending that each passenger be traced, but did recommend strategies including using general media alerts identifying flights on which passengers may have been exposed, and providing advice as to what passengers should do, or considering SMS messaging or email alerts to all passengers on an affected flight.
So whether you are flying on a plane, waiting in a queue or simply walking down the street, the only sure way of protecting yourself from diseases like measles, is to be fully immunised.
As health professionals we are well aware that vaccine-preventable diseases are dangerous and can have serious complications, and we know that thanks to vaccines, we have seen a dramatic decrease of new cases of infectious diseases and their devastating effects.
Yet, with outbreaks like that in Swansea, which has now reported its first death, and others throughout Australia, it seems it is once again time for us to better advocate for the benefits of vaccination.
Back to basics: the miracle and tragedy of measles vaccine. Zsuzsanna J & Salisbury D. The Lancet; Vol 381; Issue 9876; Pages 1433-1434
Risk of measles transmission on aeroplanes: Australian experience 2007–2011. Hoad V, Langley A & Dowse G Medical Journal Australia; Vol 198; Issue 6; Pages 320-323
The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.
The Journals reviewed include:
- Australian & New Zealand Journal of Public Health (ANZJPH)
- Journal of Public Health Policy (JPHP)
- Health Promotion Journal of Australia (HPJA)
- Medical Journal of Australia (MJA)
- The Lancet
- Journal for Water Sanitation and Hygiene Development
- Tobacco Control (TC)
- American Journal of Public Health (AMJPH)
- Health Promotion International (HPI)
- American Journal of Preventive Medicine (AJPM)
These reviews are then emailed to all JournalWatch subscribers and are placed on the PHAIWA website. To subscribe to Journal Watch go to http://www.phaiwa.org.au/index.php/other-projects-mainmenu-146/journalwatch
Previously at Journal Watch: