Analysis

Measles outbreak: misinformation and poverty fuel quadrupling of worldwide cases

False claims on social media mean nurses need to reassure parents about vaccinations

False claims on social media mean nurses need to reassure parents about vaccinations

clinic door poster
Warning poster on a clinic door, New York. Picture: Getty

Cases of measles worldwide have quadrupled this year and poverty combined with misinformation spread on social media are two of the influencing factors.

The World Health Organization (WHO) says the number of reported cases is four times higher in the first three months of this year compared to last, with Africa seeing the biggest rise, but other countries including India, Ukraine, Brazil, Pakistan and Yemen highlighted.

2%

Percentage of parents reported refusing vaccination in the childhood immunisation programme

(Source: Public Health England 2018)

But there have been outbreaks in the US and European countries such as Italy and the UK – where there is concern about falling vaccination rates – nurses are being urged to reassure parents that getting their child vaccinated is the best preventive approach.

Public health emergency

In New York City mayor Bill de Blasio recently declared a public health emergency in some parts of Brooklyn, ordering all residents to be vaccinated to fight a measles outbreak concentrated in the Orthodox Jewish community.

Every adult and child who lives, works or resides in Williamsburg, an area of Brooklyn, who has not received the measles, mumps and rubella (MMR) vaccine should be vaccinated, according to the city’s health commissioner Oxiris Barbot.

If the city’s health department identifies a person with measles or an unvaccinated child exposed to measles in Williamsburg, that individual or their parent or guardian could be fined $1,000.

Dr Barbot said that the outbreak was being ‘fuelled by a small group of anti-vaxxers in these neighbourhoods’ who have been spreading ‘dangerous misinformation based on fake science’.

A spokesperson for the New York State Nurses Association says it supports the mayor and calls for adults and children to receive the MMR vaccine.

Although measles was declared as having been eliminated from the United States in 2000, Centers for Disease Control and Prevention (CDC) statistics show that between January 1 to April 4 2019, 465 individual cases of measles were confirmed across 19 states.

The CDC claims this is the second highest number of cases reported in the US since 2000.

82,596

people contracted measles in Europe in 2018 – three times more than in 2017 and the most this decade

(Source: World Health Organization 2019)

Patchy vaccination uptake

In Europe the WHO says that more children are being vaccinated against measles than ever before, but progress has been patchy between and within countries, leaving ‘increasing clusters of susceptible individuals unprotected’ and resulting in a record number of people affected by the virus in 2018.

WHO statistics show 82,596 people in 47 of 53 European countries contracted measles in 2018, the highest this decade and three times the total of 23,927 cases reported in 2017.

Estimated coverage with the second dose of measles vaccine was below the 95% threshold to achieve ‘herd immunity’ and protect the circulation of measles in 34 European countries in 2017.

The European Vaccine Action Plan 2015-2020 sets out a strategy endorsed to eliminate measles and rubella, with at least 95% of every population needing to be immune, through two doses of vaccination or prior exposure to the virus to ensure ‘community protection for everyone’, the WHO says.

NHS Digital is due to publish 2018-19 childhood vaccination coverage statistics for England towards the end of this year, however, those published in September 2018, showed that coverage for the MMR vaccine decreased in 2017-18 for the fourth year in a row.

In England it is now at 91.2%, the lowest it has been since 2011-12. Uptake of the second dose of MMR vaccine in five-year-old children is currently 88%.

Social media

Helen Donovan
Helen Donovan.
Picture Barney Newman

RCN professional lead for public health Helen Donovan explains that stories from the US show that social media can have an effect on people’s beliefs about vaccination, but she questions whether the impact has been the same in the UK.

‘In the UK vaccinations are given specifically by nurses, which is not the case in many other countries. All immunisers should know how to talk to parents who may be reading a plethora of information from different sources.

‘To make sure we up vaccine levels, nurses need to be up to date with the correct information so they can reassure parents. Parents asking questions is normal and it’s not wrong for them to want to know vaccines are safe.

‘What nurses need to do is ensure confidence.

4 times

number of reported cases of measles in first three months of the year compared to 2018

(Source: World Health Organization 2019)

‘The number of people who don’t want vaccines is actually quite low, something else might have happened stopping them from turning up for their vaccine. From a nursing and clinical perspective, it is important to recall these patients and be uncritical.

‘Nurses need to be aware of the anti-vaccination movement, but it’s fundamentally about giving the right information and keeping the door open for patients to be vaccinated.’

She also warned that for young people going to university, it is essential that they and their parents make sure they are up to date with the MMR and MenACWY vaccines to protect them from MMR and meningococcal disease.

Last month, more than 220 suspected cases of mumps were reported at Nottingham Trent University and the University of Nottingham.

Herd immunity

Jenny Aston
Jenny Aston

Jenny Aston, advanced nurse practitioner and Granta Medical Practices nurse lead, Cambridge and Peterborough training hub, says that most parents are responsible about vaccinating their children, but adds: ‘Unfortunately, many less understand the importance of herd immunity to keep everyone safe from infectious diseases.

‘Few parents are aware of the seriousness and permanent side effects which may result from diseases like measles.

‘Years ago, people all knew of someone who had experienced a common disease but today because serious childhood diseases are so rare, the risk is not recognised.’

Ms Aston believes information from sources like Public Health England (PHE) is good, but has the view that parents are more likely to be influenced by the press, social media or friends. 

‘We should make every effort to make appointments easy and encourage parents to vaccinate their children, but I do feel that it would really help to insist that children are vaccinated before being admitted to school, unless they have a medical reason not to,’ she says.

Online Harms

In April a white paper called Online Harms was introduced with a 12-week consultation.

It sets out plans for an independent regulator to enforce stringent online safety laws and fines for social media firms if they fail to abide by mandatory ‘duty of care’ to protect users.

In March, health and social care secretary Matt Hancock told the BBC’s Today programme that he wanted new legislation to force social media companies to remove content promoting false information about vaccines.

Measles and rubella remain endemic

MMR
Picture: Getty

The World Health Organization (WHO) has confirmed that the UK eliminated rubella in 2015 and measles in 2016.

However, Public Health England (PHE) says both diseases remain endemic in many countries and, with recent large measles outbreaks across Europe, imported infections pose ‘a real threat to the UK’s achievements’.

In January, PHE developed a new measles and rubella elimination strategy including achieving and sustaining 95% coverage with two doses of MMR vaccine in the childhood immunisation programme.

Since the strategy’s launch, PHE has established a multi-agency group to implement it, and is encouraging local teams to develop their own plans.

PHE has also issued guidance for health visiting services’ commissioners to ensure MMR is offered to unvaccinated new mothers and that children get vaccinated, and it has been auditing measles testing against WHO standards for measles and rubella surveillance.

It says a new payment to GP practices will be introduced as part of the 2019-20 GP contract to check vaccination status and offer catch-up MMR vaccinations to children aged 10-11 years.


Resources

GOV.UK (2019) Online Harms White Paper

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