Episode Transcript
[00:00:04] Speaker A: Hello and welcome to a Wonder Care podcast. My name is Sheena Mitchell and I am a pharmacist mum of three and here to guide you through all of your family health care needs.
This week, because of all of the chat and questions I've been getting surrounding the measles and the MMR, I wanted to hop lots of the main frequently asked questions into one episode. Today I'll be talking about the HC catchup program. I'll be talking about what to do if you have missed dose or even two of the MMOR. I'll be explaining why it's important to vaccinate and what you should do if you're pregnant or immunocompromised. Importantly, I'll also be discussing the recommendations surrounding travel and measles. I know we've just come out of midterm break, but actually now is the time to start thinking about your summer plans so that you can make sure if you're traveling this year, you can do so safely. First of all, I just want to explain the current lay of the land so everyone understands just why this is so important.
According to the WHO, in the european region we have a 45 fold rise in measles cases. So in 2022 we had 940 cases. And this is the alarming part. In 2023 we had more than 42,000 cases, and that was just up until the end of November. We also know that the result of the pandemic is that there was an average drop of around 5% in vaccination rates across Europe. Dr. Sidarta, data from the WHO explains that measles is a perfect example of how a small drop in vaccination coverage can cause outbreaks due to its extremely infectious nature. Any of you who've been following me on Instagram, my Instagram account is at IRL, will have heard me talk about just how infectious it is, and it is important to know. One of the stats is that if you have the flu, it's likely that you'll spread it to one to four people. And we know that flu certainly spreads itself quickly enough around communities once it gets going. If you have measles, you're likely to spread it to anywhere between twelve to 18 people. So it is significantly more infectious than flu. It's also different because it lives in the air for up to 2 hours after a person has left the room. If I send my child, who I might suspect has hay fever or is just complaining of a tiny bit of a runny nose, initially I send them into school and they're in a classroom. Pretty much every child that's in that room that isn't vaccinated is going to catch their infection. So when you think about how easy it is to spread, it's no wonder that we've had such exponential growth in the european region. There's been cases in Austria, Estonia, Germany, Greece, Hungary, Iceland, Ireland, obviously Italy, Portugal, Romania, Spain and more countries. We know that in the UK, they've had to announce a medical incident, and that's because in 2023 alone, they had 368 cases, and in January alone, they had 127. A lot of this has been in the West Midlands, around 13%. But actually, 7% of the cases were in London, somewhere, that irish people travel really regularly. And while 67% of the cases were in children under 1020, 4% were in young adults over the age of 15 years of age. Another thing to bear in mind, especially after midterm break, with all the potential travel that's going on, is that spring is coming. And unfortunately, there is a seasonal element to measles. And while, yes, it rumbles away in the background all year round, spring is actually the time of year that it spreads most easily. With so many cases in Europe, and with Europe being such a destination for family travel, it's really important that we start to prepare and think about that now before the summer comes. So, with the current HSE catch up program, up until last week, the catch up program was only available for children up to and including ten years of age. So, really, that covers anyone who, over the course of the pandemic or just prior to that, who had missed one or two doses, they were able to go and get that free of charge, off the GP. Obviously, there are a lot of adults who grew up in the 80s or 90s who may also have missed one or two doses for a variety of reasons, whether it be vaccine hesitancy or misinformation, or possibly they missed that day in school, or they had a medical condition at the time, which means that when the HSE were vaccinating, they weren't eligible to receive it. So, for me, as a pharmacist online, it's become really obvious that there's a big demand for the MMR catch up program outside of the 14 month to ten year age group. I started shouting online about this last week, and by Friday, I had gotten a message from a lovely GP who reached out with some communications that they had received in their GP surgery. And I have since found this information confirmed on the HC website. And unfortunately, it's my opinion that this has not been effectively communicated to all gps or all healthcare professionals. The situation is that there are no private MMR vaccines available. So for me in my pharmacy, I cannot order either of the brands of MMOr that are available in Ireland. They are purely restricted to HSE stock. This means that gps who are participating in the catch up program can only administer the vaccine to those in the eligible cohort. And in most of the online information, unless you go digging around, it still says just up to ten years. But on an faq document that went out to doctors or is available to doctors that I found online, it says the following the current fee schedule for MMR is limited to children aged between 14 months and ten years, but in the current circumstances, that limitation has been lifted and gps may administer both doses to all ages where patients present for vaccination. Both children resident in Ireland and refugees and applicants seeking protection in Ireland are included. Adults born in Ireland before 1978 are likely to have had measles infection and so would not require vaccination. End quote. So there you have it. I have this printed out because while this document was updated on the 9 February last week, because at this date I'm just not quite sure that I trust it won't just disappear again. I suppose I'm kind of left wondering why the HSE are being so cagey with this information. Is it because they're afraid they can't cope with the amount of people who will be requesting vaccination? And if that's the case, why are they not taking pharmacists up on an offer that I put forward, that we take part in the vaccination catch up program for the MMR, I surveyed 200 of my fellow community pharmacist colleagues who currently offer vaccines for things like flu and Covid. And all 200 of those pharmacists were absolutely willing to take part in the catch up program. Now, there's over 850 vaccinating pharmacies in Ireland. I didn't survey every one of them. I think 200 is a fair sample, especially when the result is 100%. Yes, community pharmacists are experienced and competent vaccinators. Why the hell are we not using them to follow the ECDC and WHO advice, which is expect a rise in cases and do what you can to get your population vaccinated. Our vaccination rate has dropped from over 93%, which was already shy of the 95% recommended by the World Health Organization to prevent outbreaks of measles. But it was shy of 2% already before the pandemic. And since the pandemic, it's dropped to a stark 87%. Now, that's on average. There's a lot of variance geographically, so some counties fall so far below the recommended 95% by the WHO that it's actually frightening. Louth, for example, they're at 77%. Mead, where I live myself, 78.5%. Donegal, 81.2%. Dublin, basically northwest, north, central, north, all falling between 85 and 87%. This goes on same issue in Cavan, Monahan, West Cork, Carlo, Kilkenny and Waterford. Really and truly, we need to focus for once on being a proactive health system. This week, I posted a story about our health service being referred to as an illness service instead of a health service. And I wholeheartedly and sadly agree with that. It is the case we put out fires when really we should stop them being lit in the first place. For once, can we safeguard public health? For once can we be proactive and actually just get the job done without talking about it for months and months and months? It's not just deaths that are a problem with measles. There's significant complications. Let me put it into context. Up to 6% of patients will develop pneumonia. And pneumonia can be really serious in children. Seven to 9% will develop a condition called otitis media, and this is otherwise known as an ear infection. These ear infections can be serious. And while it's really hard to find data on this, we know that children under five can suffer from various levels of deafness, or it can go on to affect their speech acquisition. In the US, they estimate that this will affect five to 10% of people who suffer from measles. Then we have 8% of people who are going to suffer from diarrhea and as a result of that, potentially dehydration. And after that, we start to get into the really, really serious ones, where anywhere between 0.5 and 1% of patients will suffer from a post infection encephalitis. So this is basically inflammation of the brain, and it's a really serious disease and it can have long term consequences. So it can take months or years for you to fully recover from this condition. One in 100,000 people will suffer from something called sspe. And this is a really rare, thankfully but fatal, degenerative central nervous system disease, and it's caused by a persistent infection with a mutant measles virus. It's quite scary, this one, because the onset can happen significantly after the infection. So on average, it's about seven years later. And it mostly affects children who contracted the virus before they were two years of age. And then obviously there's the fatality case. Fatality in measles is anywhere between one to three per thousand cases. Most at risk are children under five who are unvaccinated, but also immunocompromised individuals. And it really is pneumonia that accounts for 60% of measles associated deaths. The most striking thing that we have to remember is that the complications and deaths from measles are preventable. This vaccine is actually amazing. Like for the flu vaccine, you're looking at a protection rate of 50% to 70%, and that's considered a really good, reliable vaccine. For the MMOr, it's actually over 90% effective after the first dose, which children should receive at twelve months of age. After that, when they receive their second dose in junior infants, it's over 99% effective. So we can change the future. We have the resources. We just aren't implementing a common sense approach and a proactive attitude to healthcare. For me personally as a mother, that's not good enough. My three children are vaccinated, but maybe I'm a bit more motivated. I found out recently that I never had the MMR as a child because I had an egg allergy, and at that time that was considered a contraindication. We now know that actually it's really unlikely to have any reaction to the MMR if you have an egg allergy, and so you can absolutely get the vaccine if you're living with an egg allergy. However, now that I'm here in adulthood, I am immunocompromised due to a degenerative autoimmune disease which affects my spine, called ankyizing spondylitis. Because of that condition, I'm on immunosuppressants. So all of a sudden, by chance, I find myself the measles, an MMR advocate, unvaccinated, living in a county where there's only 78% vaccination rate and unable to access the MMR. I'm only telling you my personal story because there are so many people in the same boat. There are people who can't have vaccinations for various reasons, and we really need to be proactive to protect all of those people. The only way that we can do that is by reaching the WHO recommended vaccination rate of 95% or higher. So yes, selfishly, but actually, to be fair to me now, I did start this campaign before I found out about my own vaccination status. But yes, it is important to get vaccinated. Another group of people who can't get vaccinated are those who are pregnant. Now, I do want to reassure any immunocompromised or pregnant women of a couple of things. First of all, if you come in contact with a confirmed case of measles and you're aware of it, or even if it's suspected, you can take yourself off to the GP as soon as you can. Because if you report that to them and flag your concerns about your vaccination status within, ideally, three days, but up to six, they can put you forward for administration of antibodies, which come in the form of something called human normal immunoglobulin. And this can help your immune system to fight the measles infection, even if you have no immunity. So it's just really, really important to be aware of that. It's also important to be aware that people who are pregnant routinely get a rubella immunity check during pregnancy if you have had this, because the rubella vaccine is since 1988 as part of the MMOR, it can often indicate your level of measles immunity. But if during pregnancy, you are told that you don't have substantial rubella immunity, that can just make you a bit more alert to your risk of measles. And remember, as soon as you've had your baby, you're eligible to get the MMR at that stage. And I would definitely recommend doing that. It's safe during breastfeeding, so you can absolutely continue to breastfeed and get your MMR. Unfortunately, that whole little identifying the rubella immunity didn't work for me because, as it turns out, I had wild rubella as a child. So while I took my rubella immunity to mean that I was immune to measles, unfortunately, that wasn't the case. I've been getting a lot of questions about timelines and who's immune and who's not and who should be worried and who should get the vaccine. So I'm going to try and explain this as clearly as I can. So if you were born pre 1978, wild measles was actually fairly rampant. And unfortunately, people did fall foul to the complications, and there would have been deaths from measles at that time. But because you were living in an environment where measles was relatively rampant, you are considered to have lifelong immunity. That is the current HSE guideline. The measles vaccine was actually first introduced in 1985, and then in 1988, it was updated to the MMR. So it was offering protection to measles mumps. Andrew Bella. So anyone who was born from kind of 1984 to 1985 onwards would have had a measles vaccination when they were one. Okay? I think it was somewhere between twelve and 15 months that that was offered, and then for anyone who was born before that. So say in that little window of time between 1978 and 1984, those people would have received a dose of the MMor sometime between ages of ten and 14. Because in 1992 a second dose of MMR was introduced and it was given to kids who were ten to 14. You would have received one vaccine at that point. So in essence, everyone who was born from 1985 onwards has had two vaccines. People who were born between 1978 and 1985 would have received a vaccine when they were ten to 14 in 1992, and anyone born from 1985 would have been offered two doses. An important thing to be aware of is that if you can't remember what vaccines you got when you were one, which is understandable, and your parent or guardian at the time isn't able to tell you or doesn't have a record, which is really normal, and I really totally understand that as a mother of three myself, because I know they've had them all. I know what they've had. But if I had been picking and choosing because of misinformation at the time, sure, I'd have no idea. So the first step would be to contact your GP who looked after your health at that time and find out if they have any record of you receiving an MMR. If you get no results from that or you can't get an answer, you can actually contact your local immunizations office. And there is a link on my instagram at Wondercare Underscore IRL in a highlight called MMR Access campaign to all of the contact details for every different local health organization there so you can ring them and request your information and your vaccine status. That way you know whether or not you need one or two doses of the vaccine, or whether you have full immunity from your two doses. Another thing that has been tricky to find out, and I know a lot of patients who've reached out to me through Instagram have been saying, well, what about if I need my vaccine early because I'm traveling during the summer to european countries and I'm worried because my child is three, so they've had one vaccine, but they haven't had two. The HSE line is that there is no need to give the second dose early in the current climate, so if they've had it at twelve months, they're not going to be offered another one until they are in junior infants. And a question I've had about that is, well, what about if we're traveling? And what if we're going to Europe? What do we do then?
I'm just going to pause for a.
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[00:19:52] Speaker A: So for those children who've had a dose at twelve months, and they are going to be traveling during the summer, and there are outbreaks in the country that you are visiting, then actually they should get vaccinated early. And I am not making this up. This is from the National Immunization guidelines and these were updated in January 2024. They state that if a child who is twelve months and older and hasn't received either vaccine, they should receive both before they travel. The two doses of the vaccine will need to have at least four weeks between them. Okay, so that's important to realize because all of a sudden then it's going to take time for your child to be immune. So we know that the two vaccines have to have a minimum of four weeks between them, but we also know that the second vaccine should be given at least two weeks prior to travel. So in total, from dose one to full protection, you're talking a six week period. So you need to be contacting your GP to request that now so that they're protected for the summer. If you've got a child who's over twelve months of age and they've already received their first childhood vaccine of the MMR, and that happens when they get their men b one, they're the two that come together at twelve months, then they should get a second dose once there's been four week gap between that initial vaccine and they should get that dose, ideally a minimum of two weeks prior to travel. The same thing goes for teenagers and adults who don't have any evidence of measle vaccination. So if you have tried to find out your vaccination status and you're still not clear, you should actually get your two doses separated by four weeks. What I would say is that a lot of people are asking, well, I know I got one dose, but I really don't remember getting a booster or I have a record of one dose and I don't know if I got the second. If you are unsure, and this is really important, there is no need for bloods to be taken to check your measles immunity. It's not recommended because actually even having one dose can interfere with the results of a blood test. So actually the advice is that a third dose is actually safer than a missed second dose. So if you're not sure if you've had dose two or not, just go and get it. Again, not a problem. If you have a child under twelve months of age and you're either very concerned about a local outbreak of measles in your area, or you're traveling to an area where there are measles outbreaks and it might just be London or something, then you can request that your child get vaccinated before their twelve month scheduled appointment. The absolute earliest this can be done is six months of age. And if a vaccine is given before they turn twelve months of age, it's discounted. So it will be effective, but it won't be as effective as it would have been if you had waited twelve months. So what happens is if I go in with my ten month old baby because I'm traveling, they'll go and get their vaccine at ten months and then they will go again and get it at twelve months and in junior infants. So it is an additional extra dose. And the reason that that is is because the MMR doesn't actually work to those high standards that I explained at the start of over 90% and 99%, it doesn't work that well if you give it under twelve months of age. So for example, at nine months of age, it's only 70% effective. So it is important to be aware of that. Another thing I want to point out is that if you work with someone or you live near someone or you're friends with someone who has come from another country, they are also eligible to take part in this catch up program. And because rates of vaccination vary from country to country, and schedules vary from country to country, it's a really good idea to ask any people who are new to living in Ireland to check their vaccination status and to avail of our HSE catch up program. Okay. I think that answers most of the questions that have come up about immunisation and catch up program. But I really just want to add that if anyone is talking to any TD or government official or you have a voice in the Department of Health or in any influencer, any friends, friends with Stephen Donnelly maybe, please just say to them that there is a much more efficient way to do this. Community pharmacies are primed and ready to involve ourselves in the MMO catch up program. We want to help. 100% of the 200 pharmacists that I surveyed are willing to take part in this. We understand the risk to our communities and our families. This is an easy vaccine for us to administer, and it is also so important that people get it. Historically, we've had problems convincing people to get the MMR in this country, and that was all down to misinformation. And that is nobody's fault. In fact, it is somebody's fault. It's a Dr. Wakefield's fault who very incorrectly linked autism to the MMR, which has been completely scientifically debunked. It's not true. So we know the MMR is a safe vaccine. No vaccine is without side effects. But actually, I love when people say, oh, well, if you get the MMR, there's a risk of inflammation of the brain. So I want to just put that in context for you. So remember I said earlier that 1% of patients who have actual wild measles will suffer from inflammation in the brain. Okay? This is the complication that can cause months or years for you to recover if you get the MmOr. Yes, there is a risk of inflammation of the brain, but instead of it being one in 100 for the live virus, it's one in 10 million people. So of course there's no perfect solution. But I am telling you now that a one in 10 million chance is something I am a lot more comfortable than a one in 100. Context is everything. The most common side effects to the MMOr are literally a tiny bit of redness and irritation on the vaccination site. Like any vaccine, it is sometimes possible to get a rash after the MMR vaccine, which incidentally, all three of my children did. This rash is not dangerous. It's known as mini measles, and it's not contagious. It usually happens anywhere between six to twelve days after vaccination, and it's absolutely fine. As with any viral vaccine, you can treat any side effects like mild fever or aches and pains with paracetamol or ibuprofen, and at least then you are taking on a measured and calculated risk, one that is much, much less dangerous than the risk of catching wild measles. So please do bear that in mind. Getting vaccinated is the right thing to do. I hope you found this information helpful. I would be really grateful if you could give this podcast a little review. So if you're in Apple podcasts, you can type something in there when you scroll down. Something nice, please. That'd be great. And on Spotify, it's just five star rating. So if you could hit five stars, that would be brilliant. Because anytime it gets reviewed, then the podcast players show it more. And this podcast is all about empowering people with the correct medical information. Because the more we know about conditions, the better action we can take and the more we can protect our families. And for me, if I manage to help even one person do that, then it makes it all worthwhile. Thank you so much for listening close.
