After surging at the end of last year, measles outbreaks across Europe and Central Asia intensified in the first quarter of 2024, with incidence rates of up to hundreds of times higher than the U.S.
While focus in the U.S. has been on rising numbers of measles cases domestically, it’s Europe and Central Asia where the situation is at crisis level. In the U.S. thus far (as of 11 April) 121 cases have been detected, according to data gathered by the Centers for Disease Control and Prevention. Nationwide, measles cases already are nearly twice the total for all of last year.
But the U.S. situation pales by comparison to what is currently being experienced in parts of Europe and Central Asia.
England and Wales, for example, have reported approximately 4,200 cases of measles so far in 2024, which amounts to 35 times the caseload in the U.S., with a population that is more than five times smaller. This translates into nearly a 200 times higher measles incidence rate than the U.S.
In January, the U.K.’s Health Security Agency declared a “national incident” in response to the rise in cases, signaling the growing public health risk. What’s particularly unsettling is the concurrent rise in childhood vaccine exemptions, which has led to a drop in vaccination rate.
According to the National Health Service England, the measles, mumps and rubella vaccination rate in one of the hot spots for measles outbreaks, the Birmingham region, was around 83% in December 2022. It may have declined since then. To optimally protect the population, a rate of at least 95% is critical. And to illustrate the gravity of the situation, according to UKSHA, only around 50% of children have had their full MMR series in parts of East London.
Measles doesn’t only affect children. Adults can be severely impacted by the disease. In February of this year an Irish man in his 40s died of measles in a Dublin hospital, according to reports in the Irish media. He likely contracted the virus during a trip in January to Birmingham in the U.K.
As the measles outbreaks expand across England, particularly in the London and Birmingham areas, the NHS has launched a series of “catch-up campaigns” this past winter, with pop-up clinics at schools, public health messages disseminated throughout the country and letters being mailed to millions of parents and guardians in the hopes of increasing immunization rates.
In Eastern Europe, a large outbreak in Romania has been ongoing since mid-February 2023, and on 5 December, 2023, the Ministry of Health declared a national measles epidemic. By then, Romania had registered 1,755 cases. The crisis accelerated during the first quarter of 2024. Russia has also been hit hard by measles, with more than 9,300 cases reported as of 12 April, 2024.
Additionally, cases are skyrocketing across Central Asia. A massive nationwide measles outbreak has now spiked to 7,864 cases in Kyrgyzstan as of 8 April, double the number reported last December. The small country has a population of seven million.
And as the Health Ministry in Kyrgyzstan noted, while measles is a vaccine-preventable infection there are many “refusals” of the vaccine in the country. Accordingly, public health officials are urging citizens not to refuse vaccination, reminding people of the serious complications of measles, including encephalitis or brain swelling.
Measles causes an initial flu-like illness with symptoms that include a high fever of over 103 Fahrenheit (39.4 Celsius), copious congestion, red eyes and a rash that spreads around the entire body. Patients can develop ear infections, severe gastrointestinal upset, pneumonia and brain swelling. Moreover, the virus can alter immune memory, wiping out preexisting antibodies.
Peter Hotez, researcher and professor of pediatrics, molecular virology and microbiology at the Baylor College of Medicine, warns of the seriousness of a measles infection which 20% of the time leads to hospitalization.
Public health experts in the U.S. have been sounding the alarm about the potential for waning herd immunity to lead to similarly large outbreaks to the ones in Europe and Central Asia.
The reduced herd immunity is attributed to a gradual decline in immunization rates, as increasing numbers of parents forego vaccinating their children, citing religious or philosophical reasons. In the 2022-2023 school year, nonmedical vaccine exemptions for kindergarteners increased in 41 states, according to the CDC.
The launch of Covid-19 vaccines—and the vast amount of misinformation about them—appears to have prompted more unwarranted concerns about MMR and other childhood vaccinations.
Not that long ago, in the 1960s, measles was the single leading killer of young children globally. Vaccination campaigns significantly reduced mortality. Based on estimates published in the journal The Lancet, the global number of measles deaths in 2020 was 60,700, a 94% decrease from 1,072,800 deaths in 2000, and a 98% drop from 2,600,000 deaths in 1980.
However, in areas with low vaccination rates, measles continued to be a major threat to children’s health in 2020. Consider the 2019-2020 epidemic in the Democratic Republic of the Congo which cost the lives of more than 7,000 children.
The Lancet reported that in the DRC in 2019, 6,045 measles deaths occurred, mostly among children under five years of age. Researchers attributed the high death rate to poor access to healthcare and a high risk of acute malnutrition as a result of the disease. Fatal complications for thousands of children ensued. Furthermore, recent evidence suggests that beyond immune suppression, measles resets the immune system re-exposing children to a variety of infections they were previously protected from.
More than 1,000 additional deaths happened in 2020, and on 24 August, 2020 the outbreak was declared over with the final tally being 380,766 cases and 7,018 deaths.
While the DRC epidemic ended four years ago, measles fatalities worldwide more than doubled from 2020 to 2022, reaching over 136,000, indicating the widespread prevalence of the disease.
It’s important to remind ourselves that what happens overseas can occur in the U.S., too. Even in a wealthy, industrialized nation, when clusters of unvaccinated people are exposed to the measles virus the consequences can be grave. More than three decades ago a large measles outbreak involving predominantly unvaccinated preschool age children occurred in the Philadelphia region. Between November 1990 and March 1991, 486 cases and six measles-associated deaths were recorded among members of two Philadelphia church groups that had requested exemption from vaccination on religious grounds.
The more parents refrain from having their children immunized, the greater the chances infectious diseases such as measles stage a comeback, as we’re witnessing today. The outbreaks across Europe and Central Asia, with incidence rates of up to hundreds of times higher than the U.S., are a stark reminder that with childhood vaccine hesitancy—or simply outright refusal—on the rise in the U.S. the problem here could get much worse.
