Jane McCredie: Forgotten tolls

IN the 19th century, the options for treating measles were limited — bed rest in a darkened room, light food (“diluted milk, vegetable soups, and meal gruels”), perhaps a wet pack.

The main challenge for doctors was to prevent respiratory complications such as bronchopneumonia and there, according to Dr Dawson Williams’ 1898 textbook, Medical diseases of infancy and childhood, “cleanliness and ventilation [were] of the first importance”.

The death rate was very high in children under 2 years of age — “even over 50 per cent in some epidemics”, wrote Dr Williams, a physician at the East London Hospital for Children.

It can be easy to forget the toll infectious disease exacted in the era before vaccination, but the people of Wales have recently received a sharp reminder.

A measles epidemic centred on Swansea has seen nearly 1000 cases reported in recent months, including the death of a 25-year-old man who had contracted the disease (though cause of death has still to be confirmed).

“We have seen in the last few days that measles can be potentially fatal and no one should be complacent about the severity of measles. It can kill”, a representative of Public Health Wales told The Guardian last week.

The picture is much bleaker in the developing world. In the Democratic Republic of the Congo, thousands of children have been treated for measles in the past year and Medecins sans Frontieres (MSF) estimates the mortality rate may be as high as 25%.

“We see lots of small, recently dug graves along the roads”, says MSF team manager Nathalie Gielen. “We counted 35 dead in one village. A father told us that he had lost seven children in three weeks. Travelling from village to village, we hear just one word: measles.”

MSF says it has vaccinated more than 440 000 children in the country in the past year, though logistical issues such as inadequate transport and an unreliable cold chain make it impossible to provide full coverage.

There has been a rush on vaccination in Wales too, with 10 000 non-routine immunisations conducted in just one week this month.

The situation in Wales could be called a developed world problem. In Africa, children die at least partly because a cheap and effective vaccine cannot be delivered due to inadequate infrastructure.

In the UK, you have an epidemic that many are attributing to the scare campaigns waged around immunisation, in general, and the measles/mumps/rubella (MMR) vaccine in particular.

Scottish GP Dr Margaret McCartney wrote in the BMJ last week about the way media reporting can affect behaviour, focusing particularly on what she describes as a campaign against the MMR vaccine conducted in 1997 by the South Wales Evening Post.

The newspaper’s “Parents’ fight for facts” campaign saw more than 25 stories published about the vaccine, many of them questioning its safety.

One story about a child with autism, for example, was headlined “Families tell of drastic changes in their children after vaccination. Tot’s smiles faded after jab”.

This, of course, was in the days when the now disproven link between the MMR vaccine and autism was being widely reported in some sectors of the media.

Dr McCartney cites a study that found uptake of the vaccine in the Post’s circulation area fell from 91% before the campaign to 77.4% a year later.

That doesn’t prove a causal relationship, but the young adults now contracting measles in Swansea would belong to that under-vaccinated cohort.

It’s a sad reminder that we in the West so often squander health opportunities that are denied to those in less prosperous parts of the world.

Jane McCredie is a Sydney-based science and medicine writer.