Measles: why they keep coming back

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

More posts by Christiane Fux All content is checked by medical journalists.

The goal was ambitious, but not utopian: the World Health Organization (WHO) wanted to eradicate measles worldwide by 2020. Like smallpox in the 1970s. But that can no longer be achieved - not enough people are vaccinated against measles. Why is that?

To eradicate an infectious disease, more than 95 percent of the population would have to be vaccinated. Only then is the so-called herd protection complete. The virus simply no longer finds enough human hosts in the population in which to multiply.

In addition to individual protection against infection, herd protection is the most important benefit of vaccinations. Because it also protects those who cannot be vaccinated themselves for special medical reasons. For example, babies who are too young to be vaccinated, or children and adults with weak immune systems. Anyone who decides against vaccination and thus jeopardizes herd protection is not only endangering himself but also others. If in doubt, even your own child.

Teething troubles are not child's play

The measles virus can kill: one in a thousand infected people dies. Almost 60,000 measles cases and at least 64 deaths were recorded in the WHO Europe region last year. Around 150,000 measles deaths occur worldwide every year.

They die from complications like lung failure or inflammation of the brain that gradually destroys the organ. A path of suffering that can last six to eight years.

Far from herd protection

In Germany, too, there is still a long way to go from providing complete herd protection against measles. Paradoxically, a major reason is the success of the vaccinations: "Many people no longer really perceive the dangers of the disease, only the much lower risks of a vaccination," said the Ärztezeitung, quoting the infectiologist Prof. Horst von Bernuth from the Berlin Charité at one Discussion of the Friedrich Naumann Foundation.

In Germany, for example, 98 percent of children born in 2013 received the first measles vaccination. The second immunization, which was supposed to take place at the age of 24 months, was only given to 86.5 percent of the children, even one year late. "This means that every year around 180,000 two-year-olds do not have reliable measles protection - or the children are not even vaccinated. That is an untenable situation," says Lothar Wieler, President of the Robert Koch Institute (RKI).

Pediatricians keep reporting to many parents that it is not at all clear that the second vaccination is important at all. However, for up to five percent of children, vaccination protection is only complete after the revaccination.

Vaccine skepticism in the "bourgeois milieu"

The numbers given by the RKI are also only average values ​​- they can vary greatly from state to state and even within districts and large cities. That was at least confirmed by a study by the Central Institute for Statutory Health Insurance from 2013. “Our study shows in which regions of Germany vaccination against measles is either not taken seriously enough. Or where insecure parents decide against immunization or postpone it, ”explains study author Maike Schulz.

The reasons are missing or incorrect information about the benefits and risks of vaccination. Above all in the "bourgeois milieu", vaccination skepticism is widespread, said the scientist in the Tagesschau.

How dangerous experts consider vaccination skepticism to be, shows a current assessment by the WHO: It has identified vaccination refusals as one of the ten greatest health risks worldwide.

Vaccination picking for those born after 1970

The largest vaccination gap, however, is not among children, but among adults born after 1970. At that time, children were increasingly vaccinated against measles for the first time - but by no means all: According to the Robert Koch Institute (RKI), more than 40 percent of children received only one measles vaccination or no vaccination at all.

The effect: While almost every child had a measles infection before 1970 and thus acquired lifelong immune protection, the infection rate fell significantly with the increasing number of vaccinated children. Suddenly there were many children who, although not vaccinated themselves, no longer came into contact with the measles virus due to the partial herd protection. They grew up without immune protection. And even now, as adults, they can fall ill at any time.

Constantly new waves of measles

Whether vaccination skepticism or carelessness - the vaccination gaps in the population have visible consequences. Measles waves occur again and again around the world. Currently in the eastern states of the USA and in Austria, where dozens of people have fallen ill in the last few days, most of them in Styria. The virus was probably introduced from Ukraine, where an epidemic has been raging for months. According to the WHO, more than 44,000 people there contracted measles in 2018.

Compulsory vaccination for Germany

In the future, children and certain occupational groups will also be required to be vaccinated against measles in Germany. For example teachers, kindergarten teachers and medical staff. In other European countries, compulsory vaccination has long been a reality. Including France and Italy, which after a dramatic measles wave in 2002 have now also included this vaccination in the catalog of mandatory vaccinations.

Protecting children comes first

Proponents of compulsory vaccination in Germany had argued that protecting children from serious infections had priority - similar to the obligation to wear seat belts in the car and, if necessary, against the will of the parents. In addition, this is the only way to eliminate measles in this country.

"People die of diseases that would have been eradicated long ago if all parents behaved equally responsibly," says Dr. Thomas Fischbach, President of the Federal Association of Children and Adolescent Doctors, in a statement.

Not only vaccination opponents are against compulsory vaccination

Opponents of mandatory vaccination are by no means only vaccine skeptics. Well-known experts have also spoken out against it. This even includes RKI President Wieler, who is after all Germany's top epidemic protector.

Because the compulsory vaccination only applies to children and not to the most severely affected group of those born after 1970, he writes in a guest article in the medical newspaper. This part of the population should be better educated. Wieler also recommends removing bureaucratic hurdles. So that, for example, the pediatrician could vaccinate unvaccinated parents right away.

Inform and remind

Instead of compulsory vaccination, he and other experts wanted to make doctors more aware of the problem. Whether as parents or on their own account: "People trust people, not institutions," said infectiologist Prof. Horst von Bernuth from the Berlin Charité, according to a report in the Ärztezeitung.

Doctors should be more motivated to, for example, specifically ask adults from the critical cohorts about their vaccination status. Von Bernuth says: “Two thirds of the people who do not get themselves and their children vaccinated have simply forgotten. You really only needed a reminder. "

This article was updated on July 17, 2019 in response to the legislative decision on compulsory measles vaccination.

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