RECENT MEASLES OUTBREAK IN MALAYSIA: MOST COMMONLY ASKED QUESTIONS REGARDING THE RECENT CHANGE IN THE VACCINATION SCHEDULE
Ministry of Health (MoH) recently reported an increase in the number of measles cases in Malaysia. The number of confirmed measles cases had risen to 602 cases (26.3 per million population) compared with 235 cases (7.8 per million population) in 2014 and 195 cases (6.6 per million population) in 2013. The number of outbreaks had also increased more than threefold, that is 37 episodes of the epidemic, compared to only 11 in 2014.
In view of these alarming figures, MoH has recently announced that effective this year, they would change the measles vaccination schedule, in which the first dose will be given at 9 months and the second dose at 12 months. Currently, children are only getting vaccinated at 12 months and 7 years.
Q1. So, how effective would this be in combating measles.
To answer this question, one needs to understand how the human immune system functions and what are the current incidences or epidemiology of a disease. From the moment we are born into this world, we have been exposed to all sorts of pathogens or, in layman’s terms, germs. Naturally, our body will learn to combat the infections by building up immunity towards the pathogens.
How our body does that is quite amazing. As newborns, humans are highly dependent on their mothers to provide initial immunity, transferred to the babies throughout the pregnancy via the placenta (umbilical cord). However, researchers have shown that this passive immunity can only last in babies for up to nine months before it starts to fade away. This is particularly true in cases of maternal antibodies that combat several infections, particularly the measles infection. Maternal antibodies not only work to protect newborns from certain infections, but may also work against vaccines. Therefore, vaccines are not going to be effective if administered before the age of 12 months.
So, based on this knowledge, the initial WHO guidelines in the 1960’s recommended measles vaccination to be administered when the baby is 12 months old. This active form of immunity (from vaccine administration) had to be introduced in order to assist our bodies in developing resistance towards this disease.
However, the MMR vaccination is only recommended for six- to nine-month-old babies if they are at high risk of becoming infected under certain circumstances like a measles outbreak.
Even so, these children may not have sufficient future protection from this early dose, so they will still need the standard MMR doses at 12-13 months and 40 months of age.
Theoretically and based on previous experience with this vaccine, it is hoped that by administering the measles vaccine at a much earlier age, our community will be able to achieve measles free country status in the next five to ten years. In comparison, measles free country status was achieved by the United States in the year 2000 with measles elimination status (defined as interruption of year-round endemic measles transmission).
Q2. Are babies at risk of getting measles? How might babies catch measles?
Answer: Babies are naturally at risk due to the nature of the low immunity towards all infections. Compared to adults, their immune system is immature as their B-cells and T-cells work differently. These cells served as “our natural soldiers” to combat against any form of infections.
Measles is a highly contagious viral disease. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine.
Measles is transmitted via droplets from the nose, mouth or throat of infected persons. Initial symptoms, which usually appear 10–12 days after infection, include high fever, a runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards.
Q3. How important is it for children to be vaccinated?
Answer: Routine measles vaccination for children, combined with mass immunization campaigns in countries with low routine coverage, are key public health strategies for reducing global measles related deaths.
As mentioned earlier, vaccination is a form of active immunity with which a person can develop immunity or resistance towards any particular infection. It is crucial that all children be vaccinated for 3 reasons:
i. Their bodies can fight against infection in the event of exposure to the measles virus.
ii. The vaccine also works to prevent the development of severe forms of the disease.
iii. Development of herd immunity in the community.
The measles vaccine has been in use for 50 years. It is safe, effective, and inexpensive. WHO recommends immunization for all susceptible children and adults for whom measles vaccination is not contraindicated. Reaching all children with 2 doses of measles vaccine, either alone, or in measles-rubella (MR) or measles-mumps-rubella (MMR) combination, should be the standard for all national immunization programmes.
Q4. What happens if they fail to get the vaccine? How critical can the situation get?
Answer: Measles is one infectious disease known to mankind as an important cause of death and disability among children worldwide. Those unvaccinated against the disease are at risk of suffering from severe health complications such as pneumonia, encephalitis (a dangerous infection of the brain causing inflammation), and blindness. These diseases can also be fatal.
We have learned from history that measles outbreaks have caused high number of deaths in the 1950’s in UK and Europe. Later, similar scenarios occurred in several Asia countries due to lack of efficacy for the immunisation campaign.
Q5. Why some parents hesitate to vaccinate their children (E.g.: Concern on the halal status of the vaccines)? What can be done to change their mindset?
Answer: There are unfortunately several misconceptions and myths surrounding the issue of vaccination. In recent years, many muslim parents have decided to reject the vaccines out of fear that the vaccines may contain pig (porcine) DNA.
Based on data gathered from government clinics, the Ministry of Health has discovered that the number of parents rejecting vaccinations for their children had increased from 470 cases in 2013 to more than 12,000 cases in 2014. The rumours could have started due to some vaccines on the global market being cultivated using trypsin enzyme from pigs.
But even in these cases, muslim scholars argue that the porcine elements are so negligible that Islam allows for it if it means saving a life.
In addition, other misconceptions used as justification for rejecting immunization among these parents are that natural immunity is better than immunity from vaccination. It is also alleged that vaccines contain dangerous toxic chemicals such as mercury. Finally, the most infamous allegation is that measles, mumps, and rubella (MMR) vaccine causes autism in children. These myths are based only on hearsay and have been rejected by scientific research.
To change the community’s mindset, all parties in the community must work together to reinforce government policies and campaigns. Collaboration among the various religious bodies with full support from NGOs is needed to help promote this issue. I-Medik, for example, has taken a proactive approach by running a strong campaign on educating the public on vaccination, publishing online articles on our websites and fan pages on issues pertaining to vaccination, and organising forums and conferences to promote a healthy lifestyle. This includes the widespread practise of vaccination in the community.
We believe that such objectives will not be achieved overnight, and that the effects resulting from vaccination refusal will only be eliminated after five to ten years of promoting awareness on the importance of vaccination.
Q6. How can MoH, parents, schools, respective medical associations play a role in creating awareness on the importance of vaccination?
Answer: All bodies must sit at one table and put forward well-planned strategies to ensure that all policies and campaigns are complimentary to each other. We value high impact policies such as the ‘No Jab No Pay’ campaign that was proposed by the Australian Government where child care payment will only eligible for all children less than seven years that meet the required vaccine schedule.
Article written by:
Dr Nor Azyati Yusoff
A Medical Officer
Vice Secretary, I-Medik