Doctors urge people to get vaccine as Ireland 'at high risk' of measles outbreak

The MMR vaccine is given in two shots, one at 12 months old and one in junior infants. File photo

Fears are growing around the potential for a large-scale measles outbreak in Ireland for the first time in decades with doctors identifying multiple reasons for this, including a vaccine scare over 20 years ago.

This week, the HSE confirmed a 48-year-old man has died from measles, with nine other suspected cases now under investigation. This is amid a huge jump in cases across Europe with the World Health Organisation identifying 42,200 cases last year compared to just 941 during 2022.

Doctors are now raising the alarm around low vaccination rates, particularly among young children and people in their early 20s. The MMR vaccine is given in two shots, one at 12 months old and one in junior infants.

Among junior infants, the vaccine uptake is at 87% overall when 95% is required to prevent the spread of measles, the latest HSE/HPSC data shows.

By region, the lowest rate is in Dublin North Central at 74% with three other Dublin areas at 80% or less. Rates are also low in Limerick (83%), Clare (85.9%) and Waterford (87%) and at 90% in Tipperary. The rate in the southwest ranges from 91.2% in West Cork and across Kerry up to 94.2% in North Cork.

Dr Peter Barrett, consultant in public health medicine with the HSE South West covering Cork and Kerry, warned: “We are at high risk of an outbreak. There are a lot of children who missed out on their routine MMR, particularly over the last few years, so we are below that 95% threshold that we need to prevent outbreaks.” 

He added: “Most parents do tend to vaccinate their children, but we saw over the pandemic some parents didn’t want to attend any healthcare setting because of covid-19.” 

He urged parents to check their vaccine handbooks and contact their GP to arrange a catch-up if necessary. “It is absolutely still effective,” he said, even if they are older now.

Also of concern are people aged 18 to 24, he said. “Studies in Ireland are showing that age group is at high risk because up to one-in-five of them are not fully up to date with MMR vaccines,” he said.

“The MMR coverage is lower in men than women at that age.” Vaccination can also still be arranged at this age, he said.

Vaccine scare

So what happened in the late 1990s and early 2000s to cause parents to shy away from the MMR vaccine? Dr Barrett said a vaccine scare “certainly contributed” to the reluctance.

He said:

Those theories have been completely disproven, there is no scientific basis to them.

“It is important to highlight that individual has been struck off the medical register and the medical journals have all withdrawn previous publications on that. We are very satisfied the MMR vaccine is safe.” 

In 1998, Andrew Wakefield, then a gastroenterologist in England, published research in this area. He suggested during a press conference the possibility of a link between the MMR vaccine and autism, saying single vaccines might be preferable.

He did not say he was involved with a patent on a new measles vaccine. This information only emerged later, following articles in The Sunday Times and an investigation by the UK General Medical Council.

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The council ruled he “acted dishonestly and irresponsibly”, and had “abused” his position as a doctor. They said he put children involved in his research through “invasive” and unnecessary surgical procedures. This included lumbar punctures; inserting a needle into the spine to collect fluid. 

The council said he agreed in 1996 to be an expert in MMR for legal litigation. He received £50,000 through the Legal Aid Board for research, which was arranged by a solicitor for families taking claims.

They said: “He also failed to disclose to the editor of the Lancet his involvement as the inventor of a patent relating to a new vaccine for the elimination of the measles virus (Transfer Factor)".  

The disgraced doctor is since reported to have met with Donald Trump and others with doubts about vaccines. In Ireland, and around the world, his claims understandably frightened parents.

Dr Scott Walkin, Irish College of General Practitioners clinical lead on infection control, echoed Dr Barrett’s concerns.

“In 18 and 19-year-old boys, the proportion of people who are not immune to measles is around 20%,” he said. “That is very worrying. That is a population who tend to mix a lot, they are quite social so there is a real worry there.” 

He said it is “very likely” this is connected to that 1998 paper. “The work that Andrew Wakefield did has been absolutely discredited and withdrawn by The Lancet, the journal,” he said. “But unfortunately there is a residual effect.” 

Andrew Wakefield has been struck off the medical register since he suggested the possibility of a link between the MMR vaccine and autism. File photo: Steve Parsons/PA

There was an outbreak of about 1,600 cases in Ireland in 2000, he said, with three deaths. “That’s a death rate of a little less than one in 500, it is really high,” he said. 

“Somewhere in the region of 30% of measles will result in complications.”  This can be pneumonia, encephalitis, deafness, and other serious health conditions, he said.

However, he said many parents have never seen a measles infection, saying: "Vaccines can become a victim of their own success leading to people thinking it is not a dangerous condition."

He urged: “It is a serious illness, and it is very much preventable by vaccination.” 

One reason for the fears, he explained, is how extremely contagious measles are, even compared to covid-19 or the flu. "In unvaccinated populations, the R0 (reproductive number) for measles is 12 to 18, so it is really contagious," he warned. 

Catch-up vaccines

The HSE’s National Immunisation Office head, Dr Lucy Jessop, said catch-up vaccination programmes are now being considered. “There is a lot of complacency around the illnesses we vaccinate against, unfortunately,” she said.

“There are diseases people think have gone away but unfortunately it's only because we’ve had such good rates of vaccination that they have gone away. But when the rates drop they can come back.” 

In UCC, Dr Michael Byrne, head of student Health, confirmed they will facilitate any vaccination catch-up clinics being considered. They have already advised students to check their vaccination status.

"The high attendance rates of UCC students at the HSE-delivered HPV catch-up clinics on campus recently prove that this approach can work,” he said.