Measles - Prevention

Prevention

In developed countries, most children are immunized against measles by the age of 18 months, generally as part of a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than this because children younger than 18 months usually retain antimeasles immunoglobulins (antibodies) transmitted from the mother during pregnancy. A second dose is usually given to children between the ages of four and five, to increase rates of immunity. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune.

In developing countries where measles is highly endemic, WHO doctors recommend two doses of vaccine be given at six and nine months of age. The vaccine should be given whether the child is HIV-infected or not. The vaccine is less effective in HIV-infected infants, but the risk of adverse reactions is low. Measles vaccination programs are often used to deliver other child health interventions, as well, such as bed nets to protect against malaria, antiparasite medicine and vitamin A supplements, and so contribute to the reduction of child deaths from other causes.

Unvaccinated populations are at risk for the disease. Traditionally low vaccination rates in northern Nigeria dropped further in the early 2000s when radical preachers promoted a rumor that polio vaccines were a Western plot to sterilize Muslims and infect them with HIV. The number of cases of measles rose significantly, and hundreds of children died. This could also have had to do with the aforementioned other health-promoting measures often given with the vaccine.

Claims of a connection between the MMR vaccine and autism were raised in a 1998 paper in The Lancet, a respected British medical journal. Later investigation by Sunday Times journalist Brian Deer discovered the lead author of the article, Andrew Wakefield, had multiple undeclared conflicts of interest, and had broken other ethical codes. The Lancet paper was later retracted, and Wakefield was found guilty by the General Medical Council of serious professional misconduct in May 2010, and was struck off the Medical Register, meaning he could no longer practise as a doctor in the UK. The GMC's panel also considered two of Wakefield's colleagues: John Walker-Smith was also found guilty and struck off the Register; Simon Murch "was in error" but acted in good faith, and was cleared. Walker-Smith was later cleared and reinstated after winning an appeal; the appeal court's finding was based on the panel's conduct of the case, and gave no support to the MMR-autism hypothesis, which the official judgement described as lacking support from any respectable body of opinion. The research was declared fraudulent in 2011 by the BMJ. Scientific evidence provides no support for the hypothesis that MMR plays a role in causing autism.

The autism-related MMR study in Britain caused use of the vaccine to plunge, and measles cases came back: 2007 saw 971 cases in England and Wales, the biggest rise in occurrence in measles cases since records began in 1995. A 2005 measles outbreak in Indiana was attributed to children whose parents refused vaccination.