Addressing the global surge in measles cases: An overview for pharmacists

“....This is the canary in the coal mine that routine vaccination rates have fallen since the pandemic.”- Ajit Johal BSP RPhThe consequences of measles infection extend beyond momentary health threats, encompassing severe illness, fatalities, even long-term neurological disorders. As we explore the recent global surge of measles infections, and its many repercussions, it becomes evident that the role of healthcare professionals, particularly that of pharmacists, is of utmost importance when it comes to not only educating the public on the benefits of vaccination but also providing clinical services that aid in identifying potential gaps in immunization in the community.Measles resurgence: a global concernMeasles is a highly contagious virus that is easily spread through the air, and can cause severe illness, especially in those under the age of 5 and over 20. Most recently, there has been a 30 fold rise of measles cases in Europe in addition to the multiple outbreaks we are currently hearing about in the United States. Here in Canada, we have seen multiple warnings of measles exposures on flights coming into Ontario from various countries in the final weeks of 2023, and again, in January of 2024.Signs and symptoms The symptoms of measles infection can appear anywhere from seven to 14 days after exposure, with the most common being fever, runny nose, cough, drowsiness, irritability, and red, watery eyes. Within two to three days of the first sign of symptoms, individuals can develop small white spots on the inside of the mouth known as “Koplik spots.” Approximately three to five days after the first appearance of symptoms, the typical measles rash appears, usually on the face, and from there it may spread downwards throughout the rest of the body.Measles transmission: understanding the reproductive numberIn terms of numbers, each person with measles will, on average, infect 12-18 other people in a totally susceptible population. This is also known as the reproductive number. For reference, the reproductive number of SARS-CoV-2 has generally hovered around three to six at any given time during the pandemic, which is why, with reduced vaccination rates, or among people with weakened immune systems, measles can and will tend to spread “like wildfire.” Measles consequences: beyond immediate health threatsMeasles can have several serious consequences, including death. We do know that nearly 1-3 in every 1000 unvaccinated children will sadly die from measles.What many people do not know is that measles can also cause the immune system to essentially “forget” about past infections, otherwise known as Immune Amnesia.There is a fascinating article about this in Reuters that helps to explain the research that exposed this aspect of measles infection:“In one study, they sequenced antibody genes from 26 children, before and then 40 to 50 days after measles infection, and found that specific antibodies that had been built up against other diseases had disappeared from the children's blood.Results from the second study found that measles infection destroyed between 11% and 73% of the children's protective antibodies - the blood proteins that "remember" past encounters with viruses and help the body avoid repeat infections - leaving them vulnerable to infections they had previously been immune to.”Essentially, both these studies help explain why children seem much more prone to acquire other diseases after recovering from measles infection. Complications and long-term effects: subacute sclerosing panencephalitisSome of the possible complications from measles include pneumonia, encephalitis, and complications during pregnancy.There is also a rare, yet profoundly serious latent effect that may manifest long after children have recovered from measles infection – a condition known as Subacute sclerosing panencephalitis (SSPE). This is a progressive and painful disorder of the central nervous system that occurs approximately 7-10 years after infection. SSPE is a debilitating condition that can occur in an otherwise healthy child though it appears to be more common in individuals who had measles infection before age of 2. The erosion of herd immunity Herd immunity refers to “resistance to the spread of an infectious disease within a population that is based on pre-existing immunity of a high proportion of individuals as a result of previous infection or vaccination.” We do know that “the level of vaccination needed to achieve herd immunity varies by disease but ranges from 83 to 95 percent."For the last two years in a row the United States has been below the herd immunity threshold for measles vaccination which is 95%. We know that when MMR (measles, mumps, rubella) vaccination rates drop, we lose the protective effect of herd immunity and indeed we are seeing pockets of populations, notably in the US, that are increasingly choosing not to vaccinate their children (and even their pets!) against some of these potentially deadly diseases.Expert insights: Pharmacist Ajit Johal warns of falling vaccination rates post-pandemic“Measles is an unfortunate example of why we not only need high vaccination rates but also why they need to stay high” states Ajit Johal, pharmacist and clinical director of Immunize.io. As much as I would like to think that I am a good vaccine educator, the best educator is, sadly, the disease itself. With the return of measles, this is the canary in the coal mine that routine vaccination rates have fallen since the pandemic. Reasons for not vaccinating can be multifaceted, but one is challenges in accessing vaccination. Pharmacists in British Columbia can administer publicly funded measles, mumps, rubella (MMR) vaccine, which played an important role in containing the 2014 outbreak in the Fraser Valley. Fraser Health takes extraordinary steps to contain measles outbreak | BC Gov News Having pharmacists as accessible and knowledgeable providers of all routine and recommended vaccines can help improve vaccination rates. Other jurisdictions in Canada should note that the mobilization of community pharmacists to deliver record numbers of COVID-19 vaccines should also be leveraged to contain and ultimately prevent vaccine-preventable disease outbreaks.” The pharmacist as a public health advocateThere are most certainly families who are coming into their local pharmacy on a consistent basis who are not up to date on their vaccinations. In addition, there are multiple reasons why children who were born during the pandemic may have slipped through the cracks and may not be up to date on their vaccines - accessibility is one of these issues, and misinformation or lack of education may be another. As one of the most trusted and accessible healthcare professionals, it is undeniable that Pharmacists can make incredibly significant contributions to public health when it comes to respectfully starting this conversation, recognizing possible gaps in immunization, and ensuring our communities continue to be protected from vaccine preventable diseases like measles both now and in the future.Lindsay Dixon is a pharmacist, consultant, health content creator, and public health ambassador for Heart Pharmacy Group. She is also the Founder of Friendly Pharmacy 5 & CreateRx. Access expert interviews and evidence-based health content at your fingertips on the Friendly Pharmacy 5 Channel, also on Spotify and Apple Podcasts. For collaborations or consulting services: www.friendlypharmacy5.com

Addressing the global surge in measles cases: An overview for pharmacists

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