A wave of cases in Austria puts the spotlight on anti-vaxxers, the health care system and society’s short memory
Austria has been facing a spike in measles with 76 cases since the beginning of 2019, which is almost as many as in all of 2018. In April, the Klagenfurt public bus system was briefly shut down, reports said, and a high school was closed for several days. Globally measles vaccinations have stalled, according to the World Health Organization (WHO), leading to a 30% uptick in cases since 2017, with “severe and protracted outbreaks” in some countries. With travel and migration, the virus is getting around – and exploiting inoculation gaps here in Europe.
It’s largely a question of numbers: To maintain “herd immunity,” 95% of people must be protected by two doses of the MMR vaccine, the health ministry says, but in Austria only 81% of 2- to 5-year-olds have had the second dose. Among 15- to 30-year-olds, some half a million missed their second shot.
The country’s Epidemiegesetz (Epidemics Act) gives the government certain rights in the case of outbreaks – but Austria does not compel vaccinations of any kind, something specialists fear would risk a backlash. The outcry over proposals that the MMR vaccine be required in the Mutter-Kind-Pass system (Mother-Child-Passport), reported by Die Presse, seem to bear out the theory. More successful was the Austrian Ärztekammer (Medical Chamber) call for health care workers to be fully vaccinated, something now required in many hospitals and clinics.
A public health threat
Many remember when measles was considered just another childhood disease. “If your brother or sister had measles, your mom would put you in the room together, so you would get it,” recalls Dr. Michelle Epstein, a Canadian doctor of clinical immunology at the Experimental Allergy Lab at the Medical University of Vienna.
Today we have a fuller picture of the risks. Recently research has proved that measles makes the immune system “forget” immune responses developed against other infections, for months or even years, making it a “dramatic disease,” according to Prof. Dr. Ursula Wiedermann-Schmidt, who leads the Institute for Specific Prophylactic and Tropical Medicine in Vienna and advises the government on vaccination strategy. Some 20% of cases lead to serious complications, according to the Austrian Impfplan 2019 (Vaccination Plan 2019), and one to two out of 1000 patients suffer life-threatening brain swelling, of whom a third will be permanently brain damaged and a quarter will die. Children under the age of one are at highest risk of SSPE – a disease that corrodes mental and physical functions, and is 100% lethal.
And the disease is highly infectious, such that “everyone who is not immune will get measles,” Wiedermann-Schmidt said. Hence, vaccination. “In light of what we know now, I’m a big advocate,” Epstein agrees. If their doctors give the green light, “all kids should have MMR as soon as possible.” Both doctors decry the resurgent vogue for “measles parties,” which Wiedermann-Schmidt calls “highly asocial.” The risk isn’t just to one’s own kids, she said, but also to “victims who don’t want to be victims” – infants or others with underlying diseases that prevent inoculation.
Twin myths: Dangerous vaccines and safe measles
The “fake news” (as Wiedermann-Schmidt put it) that vaccines are dangerous dates to studies in 1998 and 2000 linking autism to the MMR vaccine – studies that have been repeatedly refuted, according to the Children’s Hospital in Philadelphia. A massive Danish study of over 650,000 children published this year “strongly supports that MMR vaccination does not increase the risk for autism, [and] does not trigger autism in susceptible children,” the authors say.
Blaming anti-vaxxers alone may be too easy, however: Wiedermann-Schmidt also points to coordination gaps between the health ministry, schools, insurance providers and parents. Despite free shots for most children, there is a diffusion of responsibility, she said. School doctors in secondary school, for example, aren’t always mandated to inform pupils and parents about vaccines. “By not having a good system, you give the anti-vaxxers space to be heard,” Wiedermann-Schmidt said, arguing that most parents would be convinced by good consultations.
Short memories are also part of the problem. The success of the MRR shot has been its “biggest enemy,” the Ministry of Health said in an email to Metropole. “This is because most of us no longer remember and thus underestimate the dangerous course of the disease and its complications.” Today’s parents have “lost respect” for many diseases, and instead zoom in on the vaccines’ “very rare, usually mild and short-lived side effects.”
Those unsure of their own immunity should know that for most people without medical records, there’s no harm in getting a new shot, say the experts. MMR vaccines are cost free in Austria – just ask your general practitioner or visit an outpatient clinic.