The Necessity to Immunise against Measles in New Zealand
Measles is an extremely contagious disease, caused by a paramyxovirus virus. In New Zealand, the first measles vaccine was introduced in 1969. In 1990, it was replaced by the MMR vaccine, combining measles, mumps and rubella vaccines.
Symptoms
After being exposed to measles, it take about 12 days for the first symptom to show. First symptoms are cold-like symptoms, meaning a dry cough, a runny nose, a fever (temperatures can get over 38.5C), and a headache. Some people may get sore and watery pink eyes (conjunctivitis) normally lasting around 3 days. Koplik spots, which are small white spots, may be seen behind the inner cheek. It is possible for some to be sensitive to light. 2-5 days after the first symptoms, a rash appears, beginning from the hairline (on the face or behind the ears) and this gradually spreads down the body. It lasts for around one week. People are most contagious around 5 days before and 5 days after the rash.
Transmission of virus
Measles are mostly transmitted via droplet transmission. Infectious droplets are coughed out, sneezed out or outputted by just talking. They can survive for up to 2 hours in the air. Because of this, even by breathing within a metre of an infected person can lead to catching measles. Measles can be transmitted via indirect contact as well. Indirect transmission is when the virus is transmitted to another person through contaminated objects, such as used tissues.
Normally, the virus enters the body through the mouth and nose because they are major entry points for airborne diseases. Entry occurs during breathing, drinking and eating. Also, especially for children, entry occurs when they place contaminated fingers or objects into the mouth or nose.
How the virus makes the person unwell
Most viruses including measles make the person unwell by reproducing. The measles virus would first attach themselves onto a host cell via their protein coat. The first host cell in contact with measles would typically come from the lung tissue, such as the immune cell macrophage. The measles virus injects their genetic contents or entire structure into the host cell through a hole that forms in the cell wall. Once the virus is inside, it instructs the cell to make viral proteins and nucleic acids, exhausting the cell’s resources. These form into new measles viruses. Once infected, the host cell travels to the lymph nodes. When there are too many viruses in the cell, it bursts, releasing the virus to other cells in the lymph nodes. When the cells in the lymph nodes are infected, they travel around the body and the viral reproduction process happens again and again. When the cells burst, they let the virus be released into the bloodstream, leading the virus into the spleen, the liver, the lungs etc. When the measles virus infects the lung cells, they cause a dry cough which keeps the virus infecting others in the person’s community.
How the body responds to measles
The most obvious symptom of having measles is the red blotchy rash. This is a sign of inflammation in the skin. As the virus enters the bloodstream (discussed above), capillaries in the skin are infected. Immune cells detect this infection and release chemicals that are aimed to destroy the virus that is invading, and summon other immune cells to help. Examples of these chemicals are nitric oxide and histamines. However, these chemicals cause damage to host cells and cause them to swell. This results in the itchy rash.
Measles weakens the immune system’s ability to protect the body fully, because many immune cells are trying to fight off the virus. This lowers the body’s strength to fight other diseases, such as bacterial infections, for many years. For this reason, up to 30% of people who have had measles develop complications. Commonly, these people get ear infections, pneumonia, and diarrhoea. In very rare cases, there can be severe problems such as blood clotting and inflammation of the brain. During pregnancy, measles can cause miscarriages, low birth-weight babies and premature labour.
People with diagnosed weak immune systems have a bigger chance of getting serious diseases. Most of the time, these people can’t be immunised and rely on the people around them to be instead.
How immunisation works
Antibiotics won’t work against measles because it is caused by a virus. Therefore, only immunisation can prevent measles, when given at the right time.
All vaccines aim to prevent viruses from infecting the human body. Certain vaccines can give immunity from a specific disease. Vaccines are created so that they don’t give the disease to the individual, but still stimulate their immune system.
In New Zealand, the MMR vaccine is used. It works (like all vaccines) by preparing the immune system to fight off measles, without causing any symptoms. As it is a live vaccine, it is made up of weakened or attenuated measles, mumps and rubella viruses. After the vaccine is given to the person by an inject under the skin (subcutaneous injection), the weakened viruses replicate inside them. This stimulates cells in the immune system like lymphocytes to produce antibodies. Antibodies are what fight off the virus. Once they are immunised against measles, individuals now have an immune system that is capable of producing the right antibodies required to fight off the measles virus if it tries to infect them at a later stage. The idea of herd immunity is that if everyone is immunised against measles, the virus can’t spread. Vaccines don’t cause problems in people who are healthy. If it does cause symptoms, it is milder than the disease.
The first dose of the MMR vaccine protects 90-95% of people against measles. A second dose is provided to increase the amount to 99%. Usually, two doses are recommended because measles is so contagious.
The MMR vaccine is given in New Zealand as a part of the childhood immunisation schedule, usually at 15 months and 4 years. it is fully funded for all children ages 12 months and over, and also adults born in 1969 and after who haven’t had two doses yet. Anyone born before 1969 would have usually gained natural immunity from having measles as a child.
Two points of view
Sonya Bateson works at the Bay of Plenty Times as the head of news. She is a millennial who feels strongly for immunisations. In an opinion article on the NZ Herald website written in 2017, she stated that she was angry that children and adults are being left vulnerable to serious diseases because of some myths about vaccines. The myth she was talking about was the link between the MMR vaccine and autism.
She talked about the movie Vaxxed, which was directed by a former doctor named Andrew Wakefield, claiming that there existed a conspiracy covering the link between autism and several vaccines. She explains how a study was published in a widely respected medical journal by Wakefield and his colleagues, and how since then, vaccination rates immediately dropped.
Then she brings out evidence of there being no link, such as a study by the University of Sydney involving more than 1.25 million children. She brought up the fact that it was discovered that lab reports by Wakefield were altered, and that the medical council in the UK found Wakefield guilty of professional misconduct. He had his licence removed and was removed off the medical register.
She then brings the context to New Zealand, talking about how the Ministry of Health has proven that strict procedures regarding safety are followed when vaccines are made, and the manufacturer has to demonstrate that the vaccine is safe to use. At the end of her article, she said she was angry that after all this evidence, people still believe Wakefield’s claims and refuse to vaccinate themselves.
In an article titled What’s worse: Measles or the vaccine? Katherine Smith writes about the pros and cons of vaccines. There is no other information provided about her, just that she is an author at Natural Medicine. Linked from the article are the other articles she has written, such as Vaccinated or unvaccinated… who is healthier? and Two children die in Samoa within minutes of MMR vaccination.
It is obvious she is against vaccines, and subsequently against the entire Ministry of Health. She states that they use “relentless, often factually inaccurate propaganda” that “exploits parental anxiety about their children’s health” to increase vaccination rates.
Her first point is that vaccines are unhealthy because when vaccinated children enter adulthood, the level of antibodies in their system decreases. She states that there are concerns that when recipients reach middle-age, they are no longer immune. She emphasised how this could cause health problems because adults who have measles are often more ill than children.
This leads to her second point which is how it negatively impacts pregnant women and babies. She states that many mothers now have missed out on getting natural immunity from when they were young, and the effects of their immunisation from when they were children could have decreased. Therefore, during their pregnancies, they are susceptible to the measles virus. Moreover, she states that mothers who have low levels of antibodies can’t pass a lot of antibodies to their babies. This is unlike mothers who have natural immunity and can give their baby one year of passive immunity. She argued that lacking this immunity, newly-born babies are now vulnerable to the measles virus.
Own position
My stance on the immunisation issue against measles is that we should all be vaccinated. I think that by vaccinating everyone, there is a smaller chance of complications resulting from measles in New Zealand. We live in a time where diseases cannot be totally eliminated because people are constantly travelling overseas and bringing diseases with them.
The Ministry of Health advises that people who are going to travel overseas should check that they are immunised against measles. While cases in New Zealand are rare because endemic measles has been eliminated here, the disease often can be brought into New Zealand by travellers upon return/arrival from overseas. Because regular epidemics still occur in many other countries, all travellers must be immunised to prevent the risk of causing an outbreak.
For those who think vaccines are dangerous, they are designed specifically not to be. There are many regulations that oversee the production of vaccines in all countries. There is strong data from many investigators that vaccines are in fact harmless. In fact, vaccines are among the safest in all medicines.
Measles in incredibly infectious. One infected person is able to pass the disease to up to 18 more people. If you are not vaccinated, you are capable of catching measles and spreading it to those around you. Among those around you, 30% develop complications. If we want to prevent an outbreak of measles so that people can remain safe and healthy, everyone needs to be vaccinated.
My recommendation for action is to keep persuading people to get vaccinated, and to get their children vaccinated. This is because 1. Measles always has the chance of coming into New Zealand by overseas travellers – unless they are immunised. 2. The vaccine is safe to use. 3. Measles is too infectious, meaning that a lot of people can develop complications from just a few people having the disease. I believe the government is doing their job correctly by advocating for people to get vaccinated, and their childhood immunisation schedule is working. Also, the fact that they have made it free for the people who need it is also very helpful, as it helps the people get vaccinated and it helps everyone around those people to be safe from catching measles.
