Measles outbreak in Czech Republic as vaccination rate drops below protective threshold

The World Health Organization is ringing alarm bells as an increasing number of European countries, including the Czech Republic are fighting an outbreak of measles. Measles cases in Europe tripled in 2018, and the reasons are the same - immunization hesitancy which has interfered with maintaining a high coverage rate in the population and greater movement of people.

Measles, photo: CDC PHIL, Free Domain

The WHO reports that before the measles vaccine was introduced in 1963, major outbreaks were a common global occurrence, with two to three outbreaks occurring annually. These outbreaks led to approximately 2.6 million deaths each year. Since the MMR vaccine was introduced the numbers decrease to almost zero, and in countries with a high coverage rate of around 95 percent measles were practically eradicated.

In the last decade, doctors have registered an increase again around Europe and more recently in the US. This is directly linked to the fact that an increasing number of parents are refusing to get their children vaccinated for fear of side effects. The link between low vaccination rates and outbreaks is well established and is documented by WHO data on immunization rates and outbreaks. France, Italy, Greece and Romania are suffering severe epidemics; the Baltic and Scandinavian countries have very few cases – some months they record zero cases.

In the Czech Republic the outbreaks are fairly recent. In 2016 there were just 7 cases registered. In 2017 it was 142 cases and in 2018 it was 182 cases. In January and February of this year the number has already reached close to 100 cases, with 70 of them registered in Prague.

Epidemiologist Zdenka Jagrová says that given the growing hesitancy to immunization in Europe and the spread of the disease from country to country, the situation is serious.

Hana Cabrnochová, photo: archive of Hana Cabrnochová

“Measles are a highly contagious disease. We truly fear what would happen if the number of infected people continues to grow.”

Although the virus is easily prevented through vaccination with two doses of the measles, mumps and rubella (MMR) vaccine, an unsupported link between autism and MMR vaccination persists and has resulted in many parents refusing to get their children vaccinated. A high coverage rate in the population –which protects everyone effectively- is an immunization rate of 95 percent. In 2007 the Czech Republic had an immunization rate of 98 percent. However since 2013 it has dropped steadily. In 2017 it was just 84 percent. And now it is reported to be as low as 73 percent in some areas. According to Hana Cabrnochová, the deputy chair of the Czech Immunization Association, parents are seriously underestimating the risk of refusing to get their children vaccinated.

“The risks are now grossly underestimated. Older generations knew how serious measles were. It was not uncommon that children died of measles in the past. And if these pockets with lowered vaccine rates spread and the measles come back with vengeance we will face a danger which we thought we would never again find ourselves in.”

In the Czech Republic immunization is compulsory, but only on paper. Although doctors inform parents about the danger of refusing to get their child immunized, there is little they can do if the parent refuses, apart from having them sign a paper stating their decision and the fact that they had been informed of the risks. A court ruling by the Czech Supreme Court in 2010 established that parents cannot be in any way punished for refusing to get their child vaccinated.

The Czech Immunization Association is now launching a counter-offensive to the anti-immunization sites that discourage people from getting their children vaccinated. It is planning to set up a web page where specialists will provide detailed information regarding immunization and the risks as well as the risks of not getting a vaccine. Deputy Health Minister Roman Prymula says such a move is long overdue.

Roman Prymula, photo: Adam Kebrt / Czech Radio

“We will set up web pages and use the health ministry’s own web page to fight the rumors that are spreading, claims that immunization is linked to autism and other health problems, which has never been proven. We want to impress on people that measles are not a harmless childhood disease and that even today one in a thousand patients die. That is not something we want to bring back.”

Health Minister Adam Vojtěch also says it is time to take effective action. He wants a blanket immunization for all doctors and nurses who work in departments where the risk of contracting measles is high, such as ER. The decision was made in view of the growing number of cases and the fact that last year the ER department in Motol, the country’s biggest hospital, had to close down after several employees contracted the measles from a patient.

“We cannot wait for such a thing to happen again in Prague, Ostrava or elsewhere. Given that there is a serious risk for health workers in certain departments then I want to see them protected by blanket immunization.”

Illustrative photo: Ondřej Manda / Czech Radio

Deputy Health Minister Roman Prymula says that the ministry has issue this as a recommendation but is ready to make it an order should the situation get worse. All the big hospitals in Prague, Ostrava and Brno have welcomed the recommendation and Motol Hospital in Prague has already started acting on it. Hana Roháčová, head of the Infectious Diseases Department at Prague’s Bulovka Hospital says that given developments in the last two to three years the decision seems sensible.

“I will certainly support it. It is just a question of logistics, acquiring enough vaccines and so on. I personally consider it a very sensible decision.”

According to WHO statistics for Europe over 41, 000 children and adults were infected with measles in the first 6 months of 2018, leading to 37 deaths. They primarily occurred in unvaccinated populations in both adults and children.