More than a 100 measles-related deaths have been reported in the Papua region of Indonesia over the last few weeks. The death toll is likely to go much higher. A low level of vaccine coverage is likely responsible.
This is an important reminder for overseas travellers to also consider their “routine vaccines” as well as those which might be recommended for the destination.
Two doses of MMR vaccine provide lifetime immunity. Individuals born between 1966 and 1980 may have had only one dose. Ten percent of the one dose group may be unprotected.
I have always had a special interest in measles as my first challenge in working as a paediatrician in Rabaul, Papua New Guinea was to manage a major measles outbreak in the islands region. Many previously healthy children died during this outbreak and the helplessness experienced at a clinical level has stayed with me ever since. It was also very confronting personally as I had travelled to PNG with a 5 month old child. At this age a child relies on maternal immunity as vaccination would only provide limited protection. I vaccinated him nevertheless and gave him a further booster at the normal time. He did not contract measles.
Doctors in Australia would rarely if ever see a case of Measles. We have over 94% cover in most regions of Australia and this degree of cover provides “herd immunity”. We are very fortunate. Measles is a killer! It can also cause serious neurological damage if contracted as an adult. I often have to convey this message to unvaccinated adolescents and children about to leave the “herd”!
According to CDC in the US, “in the decade before the live measles vaccine was licensed in 1963, an average of 549,000 measles cases and 495 deaths were reported annually”. It is likely more than a 1,000 people developed chronic neurological disability. These figures are likely to be an underestimate as underreporting was common.
There are more than 130,000 deaths annually world-wide. This is unacceptable when we have a very effective safe vaccine.
Outbreaks continually occur in overseas destinations where vaccine coverage is less than optimum. Unvaccinated returning travellers are mostly responsible for mini outbreaks in Australia. Major outbreaks are not limited to the developing world and have been reported in frequently visited countries including and not limited to England, France, Germany, and the Philippines. Many cases to the USA have come from Japan.