Measles is an almost perfect shield for the Spaniards against the European threat

There is only one way to get rid of measles: a vaccine. “There is no other way to stop transmission,” says Maria del Mar Tomas Carmona, a spokeswoman for the Spanish Society of Infectious Diseases and Clinical Microbiology (Seimc). While the paramyxovirus family of viruses that cause infection do their work around the world, Spain has almost perfect shielding thanks to high vaccination coverage, averaging 95%.

The new measles warning is linked to two large outbreaks. One in the United Kingdom, where between 23 October 2023 and 15 January there were 198 confirmed cases and 104 probable cases in the central West Midlands. 80% of them were located in Birmingham.

This prompted a massive call for vaccination against the virus across the country. UK Health Security Agency (UKHSA) director Jenny Harris said “national action” was needed to ensure that children and some adults born between 1998 and 2004 receive the vaccine.

Another occurred in Romania, where three minors died, leading to the declaration of an epidemic situation. According to data published in Eurosupervision, After two years of no reported cases, more than 500 cases were reported from March to August. At the end of the year, according to his Ministry of Health, More than two thousand have already accumulated.

Measles – an old KNOWN THREAT

Here risk is perceived rather as a fable about Peter and the wolf. International organizations and experts continue to warn and insist again and again that vaccination is the only thing that stops transmission of the virus. “We’ve been warning about this since 2018,” says Thomas.

“Vaccination coverage below 95% leaves room for the pathogen to spread,” he emphasizes. At the end of 2023, WHO and ECDC were already alerted to the situation and focused on restoring vaccination rates, which had declined for one reason or another.

In the first two decades of the new millennium, estimated global coverage rose from 72% to 86%, but Covid has slowed this growth, falling to 83% in 2020 and 81% in 2021. increased in all regions except the American and European continents.

Thomas emphasizes that “the anti-vaccination movements, their resurgence during the pandemic and their persistence after it, have created holes in the system.” But they are not the only ones to blame. “Problems of access to the vaccine too.” And he clarifies that “there are structural barriers, such as wars and climate-related disasters, that prevent this infectious disease from being eradicated.”

The latest WHO report estimates that between 2000 and 2022, vaccination saved 57 million lives compared with no vaccination. Among the 144 countries reporting excluded cases in 2022, half met the measles surveillance sensitivity target of two or more excluded infections per 100 000 inhabitants.

This is an increase compared to the third country that did so in 2021, 2020 and 2019. Global Measles and Rubella Laboratory Network laboratories received 273,080 specimens for paramyxovirus testing in 2022, compared to 139,319 in 2021 and 121,257 in 2020.

Risks of measles: highly contagious

“We’re talking about a highly contagious disease,” Thomas emphasizes. Transmission is not only through skin secretions, “there are also studies showing it is airborne.”

This possibility was already pointed out 40 years ago. It was a magazine JAMA who reported an experience in a Michigan pediatrician’s office in which three children became infected in the waiting room despite entering the room about an hour after a minor with measles had passed through. After other studies in Lancet They would delve deeper into this issue.

The first signs of a viral infection are confused with other processes. “It starts with respiratory symptoms, cough, mucus, conjunctivitis… And then it can be clinically distinguished from chickenpox because the rash starts on the face and neck and spreads to the arms and hands of the feet,” Thomas elaborates. During this entire time, up to two weeks, there is a risk of infection.

CREATE A SAFE SHIELD against the virus

The Diet spokesman notes that Spain has already done its homework. “If there is an outbreak it will be limited, we have done a good job of getting minors vaccinated.” The Spanish Association of Pediatrics (AEP) says average coverage is above 95%, but there is room for improvement.

“It must be taken into account that full immunization consists of two doses and that in both cases the 95% threshold must be exceeded,” explains Thomas. With the first dose, administered after 12 months, it reaches 97.2% in Spain as a whole.

There are 12 regions that have exceeded the 95% bar (in addition, three more regions are close to this indicator); while four other communities are below or do not provide data (only Melilla is below 90% and Castile-La Mancha is only slightly above this figure).

However, the performance must be improved in the second dose, which corresponds to three to four years, as it only reaches 93.9%, which is below the target. It is surpassed by Andalusia, Aragon, Asturias, Cantabria, Valencia, Murcia and Navarre.

And they are below 90%, which means they are in a high-risk area – Castile-La Mancha, Basque Country, La Rioja, Ceuta and Melilla; while the Canary Islands and Extremadura only exceed this figure by a few tenths. No data is provided for the Balearic Islands in AEP.

Threats of imported cases

“We are a globalized society and subject to migration movements. “This forces us to be on guard before any outbreak,” Thomas emphasizes. So far, according to the latest Spanish Weekly Surveillance Report from Renave, one case has been reported in Catalonia in 2024. In 2023 they exceeded ten.

The WHO this week returned its focus to European outbreaks. “If we take a quick look at what’s happening in the region, we see that between January and November 2023 there were about 42,000 cases of measles, which is almost 45 times more than what we saw in 2022,” – Siddhartha Sankar Datta warned. WHO Regional Adviser on Vaccine-Preventable Diseases and Immunization.

Which is a very worrying situation. “We must also be cognizant of the fact that between 2019 and 2022, measles coverage has decreased by 3% (due to the pandemic years),” concluded Sankar.