Posted by: Margaret McCartney2 May 2013
Over the past month, Swansea has been the scene of public health in action par excellence. Clinics have had queues of parents and children waiting for the MMR vaccine. Over a thousand have been vaccinated in days. Nearly 900 cases of measles have been reported, and sadly, horrifically, at the time of writing one fatality has now been linked to (but not proven to be caused by) the outbreak.
In Dublin, in 2000, three children died in an outbreak; at that time they had an MMR coverage in children of 79%.1 London’s coverage is just a percentage point away from that. If avian flu taught us anything, it is that disease can travel fast, globally. Measles kills 430 children a day, says the World Health Organi- sation. How awful would a measles outbreak be in a densely populated place like London?
Here are the numbers. The most recent data shows that in 2012 80.8% of children aged five received two MMRs in London; on the south-east coast, 86%; the figure for England as a whole is 88%. In Scotland we are at 93%, in Wales and Northern Ireland, 90%.2
Measles killed over a thousand people in 1941; almost half a million were notified as having it in 1967. Vaccination works; the two deaths due to measles in the UK between 1992 and 2012 were of children who were immunocompromised.
But pockets of poor MMR uptake remain – and they bring real risk. In the Netherlands, in 2000, the background immunisation rate was an impressive 96%. But at an ‘orthodox, reformed’ school, whose parents mainly refused MMR on religious grounds, just 7% of school children were vaccinated. The inevitable outbreak resulted in 213 cases in 255 pupils, and 327 household contact measles cases.3
Dealing quickly with a lack of herd immunity requires cooperation across teams and communities, and hard work.
In 1995, in Minnesota, an outbreak of Neisseria meningitidis led to nine cases and one death – and the immunisation of 30,000 of 55,000 residents. In one school, a thousand students were vaccinated in 35 minutes.4
Catch-up campaigns have now been announced for England and Scotland targeting those who are either unvaccinated or only partially vaccinated. This is an enormous task, but it is also crucial. It is to be run through GPs and/or school programmes.
Yet we are at the start of the contract year, when we are asked to do all sorts of tickboxing that means little and matters less. And in the wake of the NHS reforms, primary care is becoming fractured, with services tendered for by the lowest bidder.
For once, GPs have an evidence-based public-health intervention to administer; we should be allowed to focus on it at the expense of our contract. Let’s hope that, if needed, our colleagues in public health will be able to make the case for contract suspension to allow concentration of efforts on catch-up vaccination.
We hear all the time from pressure groups about what GPs are ‘ideally placed’ to do. This is one time when it actually makes sense.
Dr Margaret McCartney is a GP in Glasgow
1 Pubmed. ‘Measles outbreak in Dublin, 2000’. bit.ly/14y92s4
2 HPA. ‘Quarterly vaccination coverage statistics for children aged up to five years in the UK: October to December 2012’. bit.ly/11onu2i
3 NCBI. ‘Measles outbreak in a community with very low vaccine coverage, the Netherlands’. 1.usa.gov/ZJFxwK
4 Public Health Report. ‘How to Vaccinate 30,000 People in Three Days: realities of outbreak management’. 1.usa.gov/13Tpzap
(All pages accessed on 22 April 2013)