The increase in the number of measles cases in Israel began in March, but up until three months ago it appeared that the numbers were only slightly higher than normal. Now the local health care institution believes the country is undergoing a serious outbreak of one of the world's most infectious diseases – one that has killed an 18-month-old child last week.
The local situation is related to a sharp and simultaneous increase in the incidence of measles in Europe, but here the disease can settle in "pockets" of unvaccinated people in certain cities and neighborhoods.
What is measles?
Measles is caused by a virus from the morbillivirus family, and affects only humans rather than animals, unlike many other infectious diseases. Although an effective vaccine against it has existed since the 1960s, measles is still common and is one of the most contagious diseases of all, with a 90% risk of infection among unvaccinated people. The virus is highly infectious because it can survive for a long time outdoors: when someone with the disease coughs, sneezes or talks, infected droplets are sprayed into the air, which are then inhaled by other people. After infection, the virus attacks the immune system; usually incubates for a period of eight to 12 days before symptoms occur.
What are the symptoms?
Signs and symptoms include high fever, runny nose, cough, red eyes and sensitivity to light. Four or five days after the onset of these symptoms (which are common to many conditions), a dark red rash appears on the skin. It usually starts at the neck and spreads to the face, body and extremities.
The rash begins as individual spots, but these usually converge to a rash that covers large areas of the body. On the third day after it appears, the eruption begins to disappear and begins to resemble the small, dense flowers of the squill plant – Hatzav in Hebrew, and that is why the Hebrew name of the disease is Hatzevet. At this point, the patient usually begins to feel better, although the progress of the disease varies in certain cases.
What are the complications and risks?
Besides being extremely contagious, measles is dangerous because there is no remedy for it. The disease can damage the respiratory and nervous systems. One third of patients will develop middle ear infections, diarrhea or inflammation of the cornea. A rare complication, which can occur up to 10 years after infection, is a degenerative brain condition that causes severe and irreversible damage to the central nervous system, including mental deterioration and seizures. One in a thousand cases of measles is fatal.
Why is there an outbreak now?
Measles is transmitted only among humans and, as there is an effective vaccine to prevent it, the outbreak is exclusively caused by humans. If the rate of immunization in a population falls, however, the collective immunity provided to unvaccinated individuals by all vaccinated persons – known as "herd immunity" – is impaired. Larger parts of the population are exposed to the disease and the risk of an outbreak increases.
The source of the current outbreak in Israel is attributed to outbreaks last year in several European countries, which also saw a drop in inoculation rates – countries that Israelis usually visit, such as Italy, Britain, Ukraine and Romania. Since then, the number of European cases has skyrocketed to 40,000 and more than 40 people have died.
But the situation did not arise here because some unvaccinated person was infected abroad and brought the disease back home. The overall measles vaccination rate in Israel exceeds 95% – but there are some densely populated communities and neighborhoods with much lower vaccinations rates. According to the Ministry of Health, in some neighborhoods of Jerusalem, for example, the vaccination rate is only 55%. As a result, there has been an increase in the number of measles cases in the country as a whole: from 40 cases throughout the year 2017 to 1,334 cases so far this year.
Is this the first time Israel has faced this outbreak in measles cases?
In the 1950s, before there was a vaccine, there were thousands of cases reported annually. Since 1967, when inoculation became part of the protocol of the Ministry of Health, there has been a consistent decline in the number of cases for some tens of years. Still, there were other outbreaks. In 2003, for example, 60 young Israelis contracted measles within two weeks and one of them died. The last major outbreak occurred in 2008, when in a few months 1,452 cases were reported among unvaccinated people, most of them in the Jerusalem area.
How effective is the measles vaccine?
Like other vaccines, the measles vaccine has two purposes – to protect the person from being infected, to prevent the spread of the disease, and to protect at-risk populations that can not be vaccinated for medical reasons. The two doses of the vaccine that are part of the protocol offer 97% protection against the disease. The shot is given at the age of one year and again at age 6 as part of a quadruple vaccine that covers rubella (German measles), mumps and chicken pox.
What does the Ministry of Health do when a measles case is discovered?
In recent months, the health facility has monitored all cases of infection, whether the patient was discovered on a flight, in a hospital, at school, or elsewhere. Once the symptoms appear and a case of the disease is suspected, a sample of the patient's blood is sent to a laboratory to determine if the measles is indeed present; At the same time, medical teams try to locate all those who came in contact with the person and determine if he has been vaccinated and what is the condition of his immune system. In many cases, the Ministry of Health or hospital doctors will call those exposed for preventive treatment, that is, to be inoculated.
The race to identify each case has become more intense as the disease spreads. Doctors in Jerusalem, where so many cases of measles have been registered, are finding it difficult to track the identification and treatment of patients. The Health Ministry is focusing its efforts on raising the immunization rate in ultra-Orthodox neighborhoods by extending reception hours at Tipat Halav's infant clinics. A vehicle belonging to the Natali health service has also made the rounds to facilitate access to the vaccines.
What other measures are being taken?
The Ministry of Health has banned unvaccinated persons from hospital departments considered particularly sensitive, such as neonatal units, intensive care, oncology, hemato-oncology, etc. In addition, the ministry is considering banning unvaccinated children from schools and is verifying that inoculation now given to children in one year can be routinely administered at 9 months.
If someone who is not vaccinated is exposed to measles, can anything be done to decrease their intensity?
Yes, but you have to act immediately. Preventive first-aid care involves administering the live virus vaccine within 72 hours after exposure, but someone who can not get the active vaccine can get a passive vaccine that will produce antibodies to the disease within six days.
When should someone be vaccinated or update their vaccines?
The Ministry of Health is calling on adults who have never had measles and never received two shots of the vaccine to be vaccinated. The vaccine should be given in two doses at least four weeks apart. This recommendation does not apply to those born before 1956.
The ministry is also advising parents who received the first shot not to wait for the second dose until they reach school age, but for the child to be inoculated immediately, as long as four weeks have passed since the first dose. The ministry is also advising that people traveling abroad with doubts about their immunity be inoculated before leaving Israel, even if it takes two weeks for the vaccine to have a full effect. If you are traveling with a baby between 6 and 11 months of age, the child should receive the first shot before leaving.
Persons born in Israel between 1957 and 1977 are considered unvaccinated or partially vaccinated, since during those years only one vaccine was given and not all received. These people are advised to be inoculated now.
Who should not be vaccinated?
The Ministry of Health says the following people should not be vaccinated: pregnant women; a person with a high fever; a person who has had an allergic reaction to a previous vaccine; someone who has sensitivity to one of the components of the vaccine; and people whose immune system is seriously compromised.