Romania measles outbreak: is mandatory vaccination the answer?

Gary Finnegan

Gary Finnegan

September 12th, 2017

Gary Finnegan
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‘Measles has killed 33 people in two years prompting the government to act.’

Romania has a serious problem. Childhood vaccination rates are too low to protect the population against highly-infectious diseases such as measles. Since January 2016, 8,937 measles cases have been recorded in Romania.

Most people infected by the measles virus recover well. Some (around 10%), however, are hospitalised due to complications. In rare cases, these complications can cause long-term problems which are fatal. And some people die in the acute phase.

In 2016, 12 people in Romania died following measles. In 2017, 21 people had been reported to have died between January and August amid major measles outbreaks. As some complications of measles can take years to develop, the full impact of recent outbreaks is still unknown.

Epidemiological update: Measles - monitoring European outbreaks, 1 September 2017

Data from the European Centre for Disease Prevention & Control (ECDC) shows that Romania has by far the most serious and persistent measles problem in Europe. The country with the second highest number of measles cases is Italy where more than 4,000 cases have been recorded this year from January to August. Three deaths have been confirmed in Italy.

Last month, the Italian parliament passed a law making 10 childhood vaccines compulsory – including the MMR vaccine which protects against measles, mumps and rubella. Now Romania looks set to follow suit.

New rules

In an effort to push back against anti-vaccine campaigners – led in part by influential celebrities and some religious groups – the government has prepared legislation that would effectively make it mandatory to follow the National Immunisation Schedule.

The draft law says consent for vaccination is presumed and that parents seeking to opt out on behalf of their children must do so in writing. They may face heavy fines as a result – with one report suggesting penalties of €2,200 could be on the horizon. The average take-home salary in Romania is estimated to be €465.

Mandatory vaccination for health workers – public and private – have also been included in the draft law which will be debated in the months ahead.

For some vaccines which are already mandatory, including the vaccine against hepatitis B, Romania has faced regular supply shortages. Some doctors have reported occasional challenges keeping MMR vaccines in stock.

A European problem

Romania and Italy are not the only European countries experiencing measles outbreaks. The ECDC says that all EU/EEA countries have reported measles cases this year, except for Latvia, Liechtenstein, Malta and Norway.

In its latest report, the agency highlights 32 cases in Germany since mid-August 2017, taking the total for the year to 860 – a huge increase on the 224 cases reported by German authorities for the same period in 2016. Ireland also reported two measles cases in mid-August, bringing its total number of cases to eight for the year to August. The UK has recorded 17 cases in 2017.

View from Romania: GPs fighting back against ‘gossip’

The spread of pseudoscience and ‘gossip’ through the media is a major challenge to public health, according Dr Valeria Herdea, President of AREPMF, a professional medical organisation. Her organisation has been touring the country working with GPs to communicate with parents about the need for immunization.

“We still have in the media, gossip shows with different celebrities of dubious taste, who provide all kind of ‘magic methods’ for child immunity, without vaccination, but who capture public attention much more than scientific information,” she told Vaccines Today. This is increasing the percentage of those who became suddenly anti-vaccination or at least hesitant.” Dr Herdea says that 20 years ago, vaccination rates were above 95%. Today, she believes uptake fluctuates between 75% and 80%.

There have also been problems with vaccine supply, Dr Herdea adds. “In the past year, we have had problems with accessing hexavalent and tetravalent vaccines, as well as MMR.” This, she adds, is a challenge for GPs and risks undermining the doctor-patient relationship. “We are educating our patients about the benefits of vaccination but then when they come to be vaccinated we find we don’t have the supply and all we can do is apologise,” Dr Herdea says.