Mass Vaccinations in Measles: Analytical Essay

Mass Vaccinations in Measles

Claim

Mass vaccination programs are successful in the control of diseases.

Rationale

‘A disease is an abnormal condition affecting a living organism… generally understood to be medical conditions that involve a pathological process associated with a specific set of symptoms.’ (Healio, 2012). Infectious diseases are caused by organisms also known as pathogens; bacteria, viruses, fungi, and parasites. Pathogens can be transmitted either through physical contact, inhalation, indirect contact, and food contamination. (Mayo Clinic, 2019). Infectious diseases occur when ‘the cells in your body are damaged as a result of infection and signs and symptoms of an illness appear.’ (The National Academies, 2019). Pathogenic organisms disrupt the immune system in various ways. Viruses disrupt cell function and kill cells completely. Bacteria crowd the host cell by continuously multiplying, create paralyzing toxins and kill cell tissues. Fungus is inhaled and then multiplied into different cells which then can end fatally if not treated. Parasites enter the body through either ingesting infected food or animal encounters. Once inside the body they enter into the bloodstream, continuously multiplying before than destroying red blood cells. (The National Academies, 2019). To reduce and ultimately eradicate diseases and the affect they have on the human population vaccinations have been created and put into place. ‘A vaccine is a biological preparation that improves immunity to a particular disease.’ (WHO, 2019). Vaccinations contain disease-causing microorganisms often conducted from an agent that is either weakened or killed from a specific microbe, toxin or surface proteins resembling a selected disease (WHO, 2019). Vaccines work by injecting a dead or weakened antigen into the body stimulating an immune response. From there cells in the body called lymphocytes, produce antibodies (protein molecules) to fight the disease. The immune system has memory cells than ‘remembers' the antibody for future infection (Pappas, 2010). ‘Mass immunization involves delivering immunizations to a large number of people at one or more locations in a short interval of time. These programs can be used to counter contagious outbreaks, adopted as a repeated means of sustained healthcare delivery, or applied where many people move through a specific place in a short interval of time.’ (JD & RL., 2006). In Australia mass vaccination programs have been in place for decades, vaccinating children against a variety of diseases. One program in specific is vaccinating children at the age of two for measles, mumps, and rubella. This leads to the question; Does having a mass vaccination program against measles in children significantly reduce the number of outbreaks?

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Background

‘Measles is a very contagious respiratory infection. It causes a total-body skin rash and flu-like symptoms. Also called Rubeola is caused by a virus, so there's no specific medical treatment for it.’ (Elana Pearl Ben-Joseph, 2019). Measles are contracted through the process of an infected person coughing ‘aerosolized droplets’ that then are inhaled by another person. The virus first disrupts the host's lung tissue before infecting immune cells macrophages and dendritic cells (early defense cells). The infected cells then transfer to B and T cells where they then use surface proteins as an entry point into the blood. The virus then targets the ‘spleen, lymph nodes, liver, thymus, skin, and lunges'. This virus stays in circulation through the process of coughing. (Shultz, 2015). The measles vaccine is given in the first year of a child’s life and then again at age four. Measles are highly common in children under the age of five and therefore can be highly dangerous if they are not vaccinated. It takes several days for your body to increase antibody production to fight the virus. Unfortunately, several days is too long for viruses such as measles and as by the time the body can produce enough antibodies the virus has spread and killed the human inhabitant. (Pappas, 2010).

Evidence

Table 1- Percentage of children immunized at 24 months of age by vaccine and state or territory for the birth cohort 1 July 2015 to 30 June 2016, AIR data as of 30 September 2018.

State or territory

Number of children

Diphtheria, tetanus, pertussis (%)

Polio (%)

Haemophilus influenza type b (%)

Measles, mumps, rubella (%)

ACT

5,834

94.4

97.1

96.6

94.7

NSW

100,895

93

96.4

95.2

93.2

VIC

81,046

93.7

96.9

96

94

QLD

63,071

93.4

96.5

95.8

93.8

SA

19,914

93.2

96.5

95.5

93.7

WA

35,206

91.6

96.2

95

92

TAS

5,946

93.5

96.5

95.4

94.1

NT

3,547

91.5

96.7

95.5

92.1

Australia

315,459

93.1

96.6

95.6

93.5

http://ncirs.org.au/health-professionals 1ttp://ncirs.org.au/health-professionals/coverage-data-and-reports

Table one demonstrates the percentage of children in Australia during the period between July 1, 2015 – 30 June 2016 immunized at 2 years of age. The graph shows the number of children and the percentages across all the states and territories along with a total Australian percentage. The lowest percentage rate is in WA with 92% while ACT tops the chart with 94.7%. All percentages are above 92% demonstrating a high vaccination rate across Australia.

Graph 1- notification rates (notifications per million population) for measles, by age, Australia, 1991 to 2017. http://www9.health.gov.au/cda/source/cda 1

Graph one is a representation of the change in several cases of measles over a period of 26 years (1991-2017). The graph is categorized into 0-4 years (orange), 5 years and over (grey) and unknown age (yellow). It can be seen in the graph that a high rate of children five years and over have reported with measles over the period. The number of cases increased drastically in 1993 and 1994 due to the introduction of a second vaccination ‘the introduction of a second dose of MMR for school-aged children in late 1992.' (AIHW, 2019). The numbers would have drastically increased due to the bodies of children not having the antibodies to fight the disease. After the two years, the conception rate decreased drastically falling even further than before and even nearly becoming completely eradicated.

Graph 2- Mortality Numbers of Deaths Due to Measles, Australia, 1907-2016 http://www9.health.gov.au/cda/source/cda 2

Graph two plots out the mortality rates of measles through the period of 1907-2016. The graph follows a different pattern to graph one; the earlier years are extremely high with a rate of 500 in 1921 slowly decreasing in 1946 before completely dropping out to zero in 2000. This graph coincides with graph one as it shows the mortality rates from the people infected with the virus. Like graph one there are no cases of mortality during the 2000s.

Table 2 - First Round and Second Rounds Child Health Days Package, Target Age Group, and Outcome (Number of Reached and Percentage) in 2009, Somalia. https://www.jstor.org/stable/41230476 1

Table 2 is a representation of the first and second round of vaccinations in Somalia across several different age groups. When studying the table, it is clear to see that the measles vaccine is one of the highest immunizations across children with 85% first round and 82% second round. The target age group is from 9-59months which is 1-5 years of age, a critical point in when a child needs to be vaccinated.

Graph 3 – comparison between Australia and Somalia immunization rates (12-24months) 2017 https://data.worldbank.org/indicator/SH. 1

Graph three is a comparison between Australia and Somalia. Somalia is a third world country in Africa limited to their resources and only recently having access to a vaccination program. ‘During this intervention, around 4.5 million children were vaccinated. As a result of the nationwide immunization campaign conducted, as of April 2019, Somalia witnessed a decline in the trend of cases reported this year.’ (EMWHO, 2019) . The graph demonstrates a comparison of immunizations rates between the two countries in the period of 1980-2017. From the graph, it is evident that Australia has a higher percentage rate across the whole period, from an average of 70% in 1984-1986 compared to Somalia's 5%- 30% jump. The graph also outlines the struggle of maintaining a vaccination program that Somalia has faced due to the data continuously staggering. Somalia's data continuously staggers before plateauing out from 2010 on with a rate of 45%. It can be concluded that Australia has had a much higher success rate with a ‘straighter' line and a rate that is always dramatically higher than Somalia's.

Graph 4 - Incidence of suspected measles cases, reported measles routine immunization coverage, and timing of selected measles control activities by year, Somalia 2005-2009. https://www.jstor.org/stable/41230476 2

Graph four is a conjoined graph detailing and comparing the number of vaccinations and the number of reported cases of measles in Somalia between 2005 and 2009. The column graph is the number of reported cases of measles while the dotted line with points is the percentage of people immunized. The ‘catch up program' has also been highlighted in the graph. After the catch-up program, it can be seen that the number of cases has decreased. From the graph, it can be concluded that the lower the percentage of people vaccinated the lower the cases of measles reported. This is possible due to the vaccination ‘MMR vaccines contain live measles, mumps and rubella viruses that have been weakened (attenuated). These stimulate the immune system but do not cause disease in healthy people.’ (University of Oxford, 2019), and the people of Somalia being extremely unhealthy people ‘The health care system in Somalia remains weak, poorly resourced and inequitably Distributed. Health expenditure remains very low and there is a critical shortage of health workers. As a result, around 3.2 million women and men in Somalia require emergency health services.' (WHO, 2015).

Evaluation

There are very few issues regarding the evidence provided. One issue is there is no data set that represents the measles mortality rate in Somalia. This may be due to a lack of study in the country as a result of insufficient resources and knowledge of the extent at which measles has affected Somalia. Subsequently, the one graph that is inexistent in the report limits the validity of the argument.

Another issue is that table 2 and graph 4 do not align with their evidence. Both the table and graph demonstrate vaccination percentages for children in Somalia during 2009. Table two states that 85% of children were vaccinated in 2009 while graph four indicates that only 59% were vaccinated. Consequently, these two data sets limit the reliability of the evidence provided. All graphs and tables are limited to vaccination rates and cases of measles. They lack depth and do not include hospitalizations, cases after measles vaccines, treated cases and death rate of vaccinated children. This would broaden the investigation and help determine a more definitive conclusion.

Further studies across all infectious diseases and their vaccines could have been investigated. Having further studies in vaccines and diseases will increase the reliability of the report and help further support the claim. Alongside further studies of diseases and their vaccines, an extension of countries varying from first world and third world will also further extend the investigation and increase the reliability.

Conclusion

In conclusion the claim that mass vaccination programs are successful in the control of diseases is supported. This was supported in this investigation that mass vaccination programs do significantly reduce the number of measles outbreaks in children. The evidence provided; mortality rates in Australia, vaccination rate and number of cases in both Australia and Somalia have supported the question and the claim. This is due to the evidence providing data in which demonstrates that vaccinations do decrease the number of outbreaks of measles.

References

1. AIHW. (2019). Retrieved from https://www.aihw.gov.au/getmedia/c828baef-75d9-4295-9cc9-b3d50d7153a2/aihw-phe-236_Measles.pdf.aspx
2. Elana Pearl Ben-Joseph, M. (2019, March). Retrieved from https://kidshealth.org/en/parents/measles.html
3. EMWHO. (2019). WHO Eastern Mediterranean. Retrieved from http://www.emro.who.int/som/somalia-news/vaccines-are-saving-millions-of-lives-of-children-in-somalia.html
4. Healio. (2012, June 14). Retrieved from https://www.healio.com/infectious-disease/news/online/%7B53e2cad9-f420-4d59-ad86-6a61e8d7586f%7D/what-are-diseases
5. JD, G., & RL., N. (2006). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16989263
6. Mayo Clinic. (2019). Retrieved from https://www.mayoclinic.org/diseases-conditions/infectious-diseases/symptoms-causes/syc-20351173
7. Pappas, S. (2010, June 1). Retrieved from https://www.livescience.com/32617-how-do-vaccines-work.html
8. Shultz, D. (2015, Jan 30). Retrieved from https://www.sciencemag.org/news/2015/01/what-does-measles-actually-do
9. The National Academies. (2019). Retrieved from http://needtoknow.nas.edu/id/infection/how-pathogens-make-us-sick/
10. University of Oxford. (2019). Retrieved from http://vk.ovg.ox.ac.uk/mmr-vaccine
11. WHO. (2019). Retrieved from https://www.who.int/topics/vaccines/en/
12. WHO. (2015). Retrieved from https://www.who.int/hac/donorinfo/somalia.pdf