An Outbreak of the Vexatious Pediatric Illness: Threat to the Elimination Program

Measles caused by RNA virus that belongs to the Paramyxoviridae family is an extremely contagious illness.[1] According to the Centres for Disease Control and Prevention (CDC), hospitalization is necessary for around one in every five unvaccinated individuals who contact measles. Furthermore, subacute sclerosing panencephalitis (SSPE) and pneumonia are among the complications that can result in devastating consequences. The condition is characterized by the presence of fever, congestion, runny nose, and watery eyes, which are typically accompanied by a maculopapular rash. A source of infection is the only possible source of infection. It is readily transmitted through respiratory routes, predominantly via droplets and, to a lesser extent, aerosols.[2]

Measles, despite its global prevalence, becomes increasingly epidemic during the late winter and early spring seasons, as indicated by the nearly annual surge in cases in England. Despite the fact that the disease burden has diminished since the introduction of the MMR vaccine, it continues to kill a significant number of children in Europe. The nation has thus far documented 216 cases this season, with numerous others being suspected.[3]

A developed nation may be confronted with such a surge for a variety of reasons, vaccine hesitancy, the dissemination of antivaccine conspiracy theories, and parental scepticism regarding vaccines, particularly among ethnically diverse and low-income populations. There are fund cuts for community health and a decline in the number of community health workers and inaccurate information regarding the MMR vaccine and autism.

Elevated levels of vaccination are sustained for an extended duration. As determined by the World Health Organization, a minimum threshold of 95% is required to sustain herd immunity. Parental involvement in ensuring that their children receive the vaccination is crucial for increasing vaccination rates. As of the turn of the millennium, thousands of children born in the late 1990s and early 2000s remain unvaccinated.[4] It is a combination of low absorption approximately 20 years ago, which rendered a large number of young adults susceptible, and an accumulation of susceptible individuals over time. Patients with compromised immune systems should be strongly advised to isolate themselves if there are suspicions of measles, given the potentially fatal nature of the disease. PPE and isolation of the patient in a negative pressure room are necessary when handling such cases.

In central Asia, there were over 13,600 cases documented in 2023, the majority of which were unvaccinated children under the age of 14. A comparable crisis is developing there as well. In addition, Philadelphia, New Jersey, and Georgia in the United States have documented cases of measles.[5] Measles cases reported in England from January 2023 to February 2024 till date are shown in Figure 1.[6]

Figure 1.

Monthwise laboratory-confirmed measles cases reported between January 1, 2023 to February 19, 2024. Adapted from Measles epidemiology 2023 and 2024 UK Government website.[6] https://www.gov.uk/government/publications/measles-epidemiology-2023/confirmed-cases-of-measles-in-england-by-month-age-and-region-2023

So we conclude that one side, we are talking about the elimination of measles from the world, but recent outbreaks are pointing out to other pictures of the world. Whatever progress we achieved in the measles elimination, these outbreak incidences either open the actual status or uncover the hidden area which still need to focus. To get complete elimination of measles from the world, we still need more time and we should have to ensure 100% vaccination status before moving to elimination.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.