Irish Pharmacist Sheena Mitchell, owner of totalhealth pharmacy in Milltown, Dublin and the Wondercare.ie health platform is calling on the Minister for Health and all relevant government departments to urgently allow the MMR vaccine to be delivered by community pharmacists.
Sadly, last week the death of a person due to a Measles infection occurred in Ireland. This is a huge tragedy for any family to cope with, but harder still when the spotlight is on their recent movements given the highly contagious nature of the disease. If an unvaccinated person comes into contact with the Measles, they are highly likely to become infected with the virus where the side effects are serious and can be fatal.
The HSE recognise that we need to act fast and have accelerated their Measles health campaign from vaccinations in the young, to a widespread vaccination catch-up programme to include anyone in doubt as to their vaccination status.
Pharmacist Sheena Mitchell is a big supporter of the MMR vaccination campaign and says:
“It is encouraging to see the government moving quickly to try and get back to our pre-Covid levels of herd immunity status. We have a real opportunity to boost our population’s vaccination rate to even higher than our pre pandemic levels of 95%.”
“Thanks to the latest announcements, this catch-up programme is not just about children who may have missed their first or booster MMR vaccines during Covid. We now have a unique chance to capture those adults who did not receive one or both vaccinations when they were young due to vaccination hesitancy and misinformation.”
“This can’t all fall at the GPs doorstep. Pharmacists want to help. We have shown how valuable a role the community pharmacist can play in giving the Covid-19 vaccine during the pandemic, and again more recently with the flu vaccinations that were given to large groups in schools. Pharmacists are a qualified accessible healthcare resource in the community who should be used to help safeguard against a Measles outbreak.”
Measles Outbreak
The World Health Organisation reports 42,200 cases of Measles across 41 member states in Europe in 2023 compared to 941 cases in total for 2022. Worryingly this upward spike in reported cases has accelerated even further in recent weeks.
School holidays and travel abroad increases this risk of a Measles outbreak here at home since an infected person will be contagious for around four days before the familiar Measles rash appears and the person is isolated.
The Measles virus lingers and remains active in the air and on surfaces for up to two hours. So, unlike other viruses that are passed through coughs or sneeze excretions, Measles is active and contagious for far longer. An unvaccinated person could enter a room and breathe the same air as an infected person who left that room an hour or two previously and still catch the virus.
To illustrate just how infectious this disease is look at another airborne disease, the flu. One sick child with flu will pass the virus to between one to four unvaccinated people. By comparison, one sick child with Measles will pass the virus to between 12-14 unvaccinated people.
Catch-up Vaccination
Ireland used to have a vaccination rate of over 95% for Measles, Mumps and Rubella, thanks to the widespread uptake of the MMR vaccine. However, this has dropped to around 87% nationally in the last year and under 80% in some parts of the country due. If you're unsure if you or your child received the MMR, you should contact your GP or local health office to check the status of your vaccination.
In Ireland, infants receive their first MMR vaccine at 12-months as part of the National Childhood Immunisation Schedule. They receive their second booster vaccination in junior infants class in school, where the child is around 5-years old. The only exception to this would be children living in Sligo, Leitrim or Donegal - these counties do not offer school vaccinations in junior infants and so vaccination should occur at age 4-5yrs at the child’s GP.
The good news is the MMR vaccine for Measles will start working in 2-3 days and it is 90% effective after the first dose and 99% effective for life-long immunity after the second dose.
The HSE advise that many adults born before 1978 will have contracted measles as a child and so will have natural immunity. However, if you were born after 1985, you may not have received your first or booster MMR dose due to vaccine hesitancy. The best way to check your vaccine status is with your GP or local health office.
Symptoms of Measles
Typical symptoms of Measles include a high fever, and flu-like symptoms of runny nose, dry cough, sneezing, and red watery sore eyes. They may also be sensitive to light and experience a loss in appetite. The red measles skin rash usually breaks out around three to four days after the initial symptoms begin for this highly contagious disease. It often starts at the head, usually around the ears or hairline, with small pink spots that get bigger joining together as the rash spreads down the body.
An important symptom to watch out for in detecting measles early in their infection is inside your child’s mouth. Look for small white or blue/grey spots on the inner lining of their cheeks and near their throat. These are known as Koplik spots which will be evident in about 70% of cases and can appear up to four days before the widespread skin rash occurs.
Treatment
If you suspect your child has measles, it is essential that you contact your GP straight away as it is a notifiable disease to the HSE. This will also crucially allow your doctor to keep in touch with you and monitor your child for any complications. The people who are most susceptible to measles and its complications are; children under one year of age, pregnant women, and people with immunodeficiency.
Fever and routine symptoms of measles can be treated like a flu using paracetamol and ibuprofen as appropriate for your child. Dry cough remedies can be given depending on your child's age, and it is essential that you ensure they stay hydrated.
Frequently Asked Questions
Will the MMR vaccine be free from my GP now that the catch-up programme has been extended to everyone? Yes, however not all GPs are partaking in the catch-up programme due to already pressurised schedules. With two-thirds of GP’s in the West of Ireland already not able to take on new patients, this is a serious cause for concern. Community Pharmacists are ideally placed to help with MMR catch-up vaccination programme as there is one in every locality. Stay up-to-date on this issue by following Pharmacist Sheena Mitchell on @wondercare_Irl on Instagram, where she will be actively updating her followers as new information becomes available.
Will GPs offer a blood test to check for antibodies if there is no evidence or records available regarding vaccination status for either a child or adult?
No, blood tests will not be offered if a patient is in doubt as to their vaccination status. The official health guidance is for GPs to offer a third booster MMR vaccine as it is more efficient and safer to do so. Blood tests would be costly and time consuming to do on every unsure parent. Many patients now looking for reassurance would have been children when their vaccination did or did not occur. They would have had no autonomy or choice with regards their vaccination and many of their parents are unsure of their vaccination status or no longer alive to confirm the information.
I am worried about my baby contracting Measles. Why do I have to wait until they are 12-months old before getting the vaccine?
Firstly, your baby will most likely have some early immunity to Measles from you, given to them in utero. This immunity will be strongest if you have natural immunity from having had measles yourself, rather than simply from your own vaccination status. This passive immunity does wane however and so the HSE advise that the first dose of the MMR vaccine is given at 12-months of age. The manufacturer advises that vaccination can take place from 9-months however the vaccination programme reflects the fact that the data for vaccination at this age shows only 72.3% efficacy compared to 90.6% at 12-months of age.
I am due to travel within Europe in the coming weeks and I would like to get my baby vaccinated early to protect them against Measles infection. Will my GP give my baby the MMR vaccine early for this reason?
The official guidance for MMR vaccination for those travelling to areas where measles is endemic or where outbreaks are occurring is the following:
- Infants under 6-months are considered to still have some immunity from their mother. The vaccine is not approved for use under 6-months of age.
- Infants aged 6-months to less than 12-months of age can receive one dose of MMR vaccine. A dose given at less than 12-months of age does not replace the dose recommended at 12-months of age. If a dose of MMR vaccine is given before the first birthday, either because of travel to an endemic country or because of a local outbreak, two further doses should be given at 12-months of age or older (at least four weeks after the first dose) and at 4 to 5 years of age.
Children aged 12-months and older:
- If unvaccinated should receive two doses of MMR vaccine separated by at least four weeks. To ensure optimal protection, the second dose should be given two or more weeks prior to travel.
- For those who have received one dose of MMR vaccine, they should receive a second dose four or more weeks later and ideally two or more weeks prior to travel.
- Teenagers and adults without evidence of measles vaccination should receive two doses of MMR vaccine separated by at least four weeks.
I am breastfeeding, will it give Measles immunity to my child until they are old enough for the vaccine?
Breastfeeding offers significant protection against measles infection for your baby for as long as you keep it up. It will vary from person to person depending on the strength of the mother’s immunity though.
Do I need to cocoon my young baby now that Measles is officially in Ireland?
No, that is not necessary. The HSE are encouraging those without sufficient immunity through the first or subsequent booster vaccination to avail of the catch-up programme for the MMR vaccine. This will improve overall herd immunity in the community to 95% vaccinated as per WHO guidelines, and this will protect the most vulnerable. If there is a Measles outbreak, the HSE will issue localised advice to the public accordingly.
I’m pregnant and my blood test showed no or low immunity to Rubella. What should I do if I come into close contact with Measles?
If your Rubella immunity was low during pregnancy this can indicate low Measles immunity. If you’re at risk of catching Measles following close contact, a treatment called human normal immunoglobulin (HNIG) can be given within six days of exposure to the virus. It can be given to babies under six months of age, pregnant women who have not been fully vaccinated or had measles before, or people with weakened immune systems. If you have no reason to believe you have been in close contact with Measles, then your GP can administer a booster dose of the MMR vaccine to you after your baby has been born.
I’m breastfeeding at the moment, can I get the MMR vaccine?
Yes, the HSE recommend the MMR vaccine if you showed no Rubella immunity during routine pregnancy health checks, whether you are breastfeeding or not. The MMR vaccine is cautioned by the manufacturer during breastfeeding only due to limited testing, it is not contraindicated for use. The MMR given after pregnancy provides protection against Rubella infection in any future pregnancies. It is a live vaccine however, and so any new pregnancy must be avoided for one month following vaccination.
How long will the first MMR vaccination take to work?
Antibodies will start to be produced from as early as 2-3 days. The MMR vaccine will usually be fully effective from 2-3 weeks, although the official line from the manufacturer is 6-weeks for 90.6% efficacy.
Can someone vaccinated against Measles carry the virus and pass it to someone unvaccinated?
The virus can live in the air and on surfaces for up to two hours, so it is important to wash your hands regularly if you are around an unvaccinated or immunocompromised person. A fully vaccinated person will not replicate it in their body which means they will not be shedding the virus even if they came into contact with it. This makes it very unlikely that they would bring the virus home. The vaccine offers a high level of efficacy, but no vaccination is 100% effective and so ideally, we reach herd, or collective immunity, by achieving the WHO recommendation of over 95% uptake. This is why the current MMR vaccination catch-up programme is so important.
Do children have to be vaccinated to attend creche?
In Ireland, the law does not require a child to be vaccinated to attend a childcare service or educational setting. However, vaccination records must be maintained by childcare providers so that they can offer tailored advice and protection to all service users and staff if there is an outbreak of an infectious disease.
How long is someone with Measles contagious?
A person with the Measles infection would be contagious for four days prior to the rash onset and for four days after the rash appeared. The first signs of infection are flu-like symptoms, then the spots in the mouth, and finally the skin rash.
Are Measles and German Measles the same virus?
No, they are different. German Measles is the common name for the Rubella virus. Rubella is less contagious than Measles and it is riskiest to those in pregnancy. The MMR vaccine protects you against Measles, Mumps and Rubella viruses. Rubella is a notifiable disease and to date there has been no known outbreaks in Ireland.
Should I get my child vaccinated with their second booster MMR vaccine before they are offered it in junior infants in school?
No, there is no need to speed up the second vaccination to achieve 99% immunity at the moment. If there is a Measles outbreak in Ireland, this advice may change and will be directed at a local level by the HSE. Your child already has over 90% immunity from their first vaccination.
Can you still get vaccinated against Measles if you have an egg allergy?
In the past, some children missed out on some vaccinations due to an egg allergy. We now know that a reaction to this element of the vaccine is very rare and as a result children with even a severe egg allergy are routinely vaccinated. However, it is still important to make your doctor or a nurse aware.
Ask Your Pharmacist
There is a host of Measles infographics and up-to-date advice available for families at @wondercare_Irl on Instagram. The Measles situation is being actively monitored and as new information become available it will be posted here in a clear and informative way.
Your community pharmacist is uniquely positioned as an accessible healthcare professional in your community. Your pharmacist can offer advice on the various at-home treatments available to you and your family and recommend when to visit your GP.
Tune into the WonderCare.ie Podcast for more expert advice and tips to safeguard your family’s health. Find a WonderCare Podcast on iTunes, Spotify or wherever you stream your podcasts.
