An eleven month old child contracted serious Measles after visiting his family in the Philippines. The child was “too young” to be vaccinated before travel. This case should raise major alarm bells.
I have written a number of articles on Measles concerns for travellers and this case illustrates more than just the risk for intending travellers. It raises concerns on how we interpret the current recommendations on measles vaccination and whether more tolerance should be given for early immunisation of children who might be travelling to a high risk destination. It also raises the question on what precautions should be taken for “vulnerable” infants in a child care setting. This is very personal to me as I have a 6 month old grandchild attending child care currently.
It is important to note that Measles vaccine is recommended after 12 months old and vulnerable children are protected by the “herd” of protected members of any community. Australia has a high level of protection. This is not the same in many overseas destinations and when it breaks down we observe higher rates of early disease. This can have devastating consequences for the young and those unable to receive a live vaccine. It is often forgotten that the “vulnerable” in our community are not just those who are cannot receive live vaccines. Young children are at risk once they have lost protection from antibodies received via the umbilical cord at birth. These antibodies break down over a number of months after birth. During this time we observe a “honeymoon period” of good health for many diseases - perhaps for 6 months. It is also why we occasionally see an unwell mother with an unwell child where neither has protection.
Over the last few years I have had a very low threshold to give early measles immunisation for infants travelling to high risk locations eg Sudan, West Africa, India, Venezuela and the Philippines. I have also had increasing concerns for destinations in Western Europe and now North America. Many small children travel for urgent family reasons and any delay isn’t possible. My early vaccination has often prompted calls from well-meaning health professionals on why I have “ignored” the recommended schedule.
In 1985 I worked as the Islands Region Paediatrician for Papua New Guinea - based in Rabaul. I arrived just as a Measles epidemic spread throughout the region. This was a very difficult baptism for work in a less developed region. It was made worse by the fact my wife and I were accompanied by a child, just 5 months! We were comforted by the fact my wife had given him her protection at birth but as this was running out we became very concerned as the epidemic raged. Research indicated that a child would be protected for 8 to 9 months by the mother and early immunisation might be blunted by any maternal antibodies still present. Early immunisation would do no harm but might not provide any extra benefit. I chose to vaccinate early and over the next 9 months my son received 3 doses of MMR. He did not contract Measles. It is very important to note my wife had natural immunity to Measles, having contracted the disease during childhood. There was no immunisation against Measles at this time. She would have had high level protection from the disease and this perhaps would have provided a longer duration of protection. This is not the case for the current generation of mothers whose vaccine immunity might wane earlier. This fact needs to be considered in the current climate of increasing numbers of Measles cases worldwide and perhaps there needs to be a discussion on the timing of the first dose of MMR.
We also need to urgently review all policies in regard to child care. I believe all unvaccinated children should be excluded from a child care setting. I also believe that any child returning from overseas and unvaccinated for Measles should be excluded for at least the maximum incubation period. This could be up to 2 weeks. The infectious period can start from 4 days before the rash. This would rely on parental disclosure which has its limitations. Prevention is the key to any public health policy.
Let’s not wait until we see a death and have our politicians and courts say: “let us learn from this tragedy and make sure it never happens again”!