Unlike mumps and rubella, measles is a major cause of childhood deaths worldwide and is the subjct of a global vaccination campaign strongly backed by the WHO.
According to the WHO:
“Measles remains a leading cause of death among young children… More than half a million people, the majority of them children, died from measles in 2003 (the last year for which figures are available)… Measles is one of the most contagious diseases known. Almost all non-immune children contract measles if exposed to the virus.”
However, although measles can be a killer in any country, it is worth exploring the real risks for a healthy, well-nourished child living in a developed country like the United Kingdom.
Measles is unpleasant but does not normally cause serious or permanent complications. Severe cases are most likely in malnourished children, especially those who are Vitamin A deficient, or children whose immune systems are already compromised, such as by HIV. Where death occurs, it is usually caused by complications such as pneumonia, serious diarrhoea, ear infections and the like – all conditions that are easily treatable in a modern healthcare system. As the WHO reports: “Severe complications from measles can be avoided through proper clinical management.”
The WHO reports that: “The case fatality rate in developing countries is generally in the range of 1 to 5%, but may be as high as 25% in populations with high levels of malnutrition and poor access to health care.”
No figures are given for well-nourished, healthy children in developed countries with good access to healthcare, but it is safe to assume that the case fatality rate is significantly less than the 1 to 5% reported in developing countries. I do not know when the last measles death occurred in the United Kingdom, but certainly such deaths are very rare today.
According to the NHS MMR website death occurs in about 1 in 2,500-5,000 cases, although it is not stated whether this is UK-specific or not. Complications requiring hospitalisation are said to occur in about 1% of cases.
It is also worth noting that measles is in fact a very uncommon illness in the UK. This is largely because of high vaccine coverage. The incidence of measles may have been falling before introduction of the vaccines, but vaccination does appear to have made a dramatic difference nonetheless.
It could be argued that, given the low incidence and low risk of the disease in the UK, it is not worth immunising against it. Moreover, given that the risk from the disease itself appears to be very low, the risk of vaccination side effects might even be higher.
Against that, the NHS makes two counter-arguments.
Firstly, measles is highly contagious. As a result, if vaccination levels were to drop it is possible and perhaps even likely that the incidence of measles would rocket. As the WHO reported (see above), almost all non-immune children exposed to the virus would catch the disease. It is therefore said to be wise to maintain high levels of immunisation even in the UK.
Secondly, the NHS points out that although measles is rare in the UK it is very common in other parts of the world. As such non-immune people would still be at risk of catching measles either while travelling abroad or while mixing with other people who have come from or been to a country where measles is common.
So, measles is not a particularly serious illness in the UK, although in a few cases it can cause complications. However there is, arguably at least, good reason to consider immunisation even in this country. The decision must rest on a careful consideration of the risks of measles against the risks of vaccination. In developing countries, it is clear that the balance of risk must favour vaccination. The decision is in my view less clear in a developed country, where good nutrition and good healthcare facilities mean that the measles is unlikely to cause any serious complications.
