Vaccination Case Studies

This article reviews the epidemiology of the ongoing Rubeola Virus, a highly contagious and serious viral infection that is one of the leading causes of childhood morbidity and mortality, even though a cost-effective and safe vaccine is available (World Health Organization, 2017). There is an ongoing debate in Australia, of whether children should be vaccinated against this virus. Many parents fear the harm the vaccination will do to their children and some even doubt the professional integrity and authority the medical experts have. This paper seeks to focus on the “vaccination concerns of families with children/adolescents and proved a clear insight into vaccination debate” (Health article assessment, 2017). It is hoped that this study will inform many parents about the risks, epidemiology, and vaccination control of the Rubeola virus.

Keywords: Rubeola, epidemiology, vaccination, Measles, control, infection, Australia, debate

Introduction:
“Measles is a highly contagious, acute viral disease, spread by respiratory secretions” (The Australian Immunisation Handbook 10th edition, 2017).

Measles are more prevalent among young children as their immune systems are underdeveloped and caused “approximately 134200 deaths in 2015 especially those under the age of 5” (World Health Organization). Under the CDC vaccination guidelines, it is recommended children are to get two doses of the MMR (Measles, Mumps, Rubella) vaccines. The first does at 12 through 15 months of age and the second does at 4 through 6 years of age (Centres for Disease Control and Prevention, 2016). Following these guidelines resulted in a 79% drop in measles deaths in the past 15 years (Worlds Health Organisation, 2016). In 2005 and 2007 hospitalisation due to measles were recorded the lowest in Australia with only “3% parents not immunising their children due to religious of philosophical reasons” (N. Martin, R. Foxwell, 2009). The WHO are currently trying to eliminate measles worldwide mainly through

immunisation.

Key arguments/Points:
Historical statistics on measles notification and hospitalisations show that in 1993 and 1994 there were peaked cases at 265 and 351 per million population. This dramatically dropped in 2005 to 0.5 cases per million population, which was the lowest annual figure ever reported in the NNDSS (National Notifiable Diseases Surveillance System) (Anita E Heywood, et al, 2008). This was due to the widespread use of the measles vaccine around 2000 to 2009 (World health organisation, 2016). A high portion of the measles outbreak in Australia were imported cases, and are quickly contained. From 1998 and 2006 Victoria had 58 outbreaks mainly through imported transmission. The development of the MMR (Measles, mumps, rubella) vaccine has been proven to be 97% effective in the prevention of getting these viruses. Australia’s period of elimination for measles was 2005 and the criteria that covered the elimination were, “High two-dose vaccine coverage; >95% MCV1 coverage for those under 24 months and >90% MCV2 coverage by school entry. Containment of outbreaks, Serological evidence of population immunity >90%, Absence of endemic measles genotype.” (Anita E Heywood et al, 2009)

Though, the notifications and hospitalisations were dropped in 2005, from 2008 and onwards, the rates have been increasing (M. Chiew, A. Dey, N. Martin, H. Wang, S. Davis, P.B. Mclntyre, 2015). On the 20th of March 2014, the World Health Organisation announced that the elimination of measles has been achieved by Australia, “through well performing surveillance systems to rapidly detect and respond to measles cases, with over 230 million children being immunized against measles in the Western Pacific Region” (World Health Organisation, 2015).

National serosurveys study in 1999 and 2000 reported that the age group, most at risk of the measles infection in Australia were infants under the age of 12 months and 1 to 2 years old. This was mainly due to the delayed vaccine uptake, the ineligibility for vaccination, and the denial of vaccinating children. From 1999 to 2007, the measles notification and hospitalisation rates in Australia were consistently highest among those 0 to 4 years old (Appendix 1.1). In March 2006 there were 125 measles notifications where 66% of the outbreak was caused due to an Indian Spiritual Group touring Australia. 7% of the outbreak were fully immunised and the rest weren’t. Most measles notifications through all the states of Australia are very low, with less than 1.12 per 100,000 population for each state (C. Chiu, et al, 2010).

Most cases of outbreaks are due to a lack of immunization globally; During the 18th Commonwealth games in Melbourne, there were enhance surveillance measures implemented for the measles however, there were approximately 35 cases of Measles recorded by the NNDSS from overseas travellers (C. Chiu, et al, 2010). Although cases and outbreaks of measles in Australia may be low, there are many children whom aren’t vaccinated against Measles. Through parents’ misbeliefs on the vaccination, the broader community is put at harm.

Australia has one of the highest vaccination rates in the world with over 90% of children being fully immunised by 5 years old, however there are still a lack of vaccinated children. Recently there has been a rise in Vaccine objectors from 1999 being 0.23% to 1.79% in 2014 (Julie Leask WordPress, 2014). This rise was caused by ongoing research and articles such as “Courts Quietly Confirm MMR Vaccine Causes Autism”. It is hard to develop a healthy community if many refuse to accept vaccination. In a research article “When parents won’t vaccinate their children: a qualitative investigation of Australian primary care providers’ experiences” a GP said “Their answer is ‘no not doing that, see you later’ that’s it. That’s the most difficult, I mean what do you do with that?’” (N. J Berry, A. Henry, M. Danchin, L J. Trevena H W. Willaby, J. Leask). Many are “hesitant” to accept the process of vaccination and many are in against vaccination, but understanding the strategies and the reason for vaccination will help the protect the health of all Australians.

On the vaccination debate in Australia, there are negative media commentary stopping people from vaccinating their children. Australia’s one nation leader Pauline Hanson had said that “I have had so many people who have brought it to my attention, that’s why their kids are autistic”, she has also criticised the ‘no jab no pay’ laws which block welfare payments for parents who don’t vaccinate their children (Huffington Post, 2017).

However, many people comment on Pauline’s words that have no background information or evidence. They say, her comments are wrong and also dangerous for the community. There is evidence that vaccinations are safe and effective. On the positive side of media, Malcolm Turnbull commented that “If parents choose not to vaccinate their children, they are putting their children’s health at risk and every other person’s children’s health at risk too.” Other medical professionals come to comment that Pauline’s words were indeed dangerous and that vaccination is the most effective public health measure ever (B. Owler, 2017). This soon resulted in Pauline Hanson apologising and saying she was wrong. She now admits “Vaccinations have controlled a lot of diseases” and understands where the medical advisors are coming from, urging parents to “have their test first” to make sure their children do not react to the vaccination.

Conclusions

Measles was a big issue back in the 20th century causing millions of deaths without the invention of the MMR, more recently after the development of the vaccine and information about why people should vaccinate children, the morality rates have dropped dramatically. However, it is still an ongoing virus and still has outbreaks and with ongoing research, information and advice that medical professionals are reporting, there will be hope that almost 100% of children are vaccinated and prevented from getting measles, especially those that are most vulnerable and young.