The rise in the number of measles cases in Israel began in March, but up until three months ago, it appeared that the figures were slightly higher than usual. Now the local health center believes the country is experiencing a serious epidemic of one of the world's most contagious diseases – which led to the death of an 18-month-old child last week.
The local situation is related to the simultaneous, sudden increase in the incidence of measles in Europe, but here the disease can be contained in "pockets" of unvaccinated people in certain cities and neighborhoods.
What is measles?
Measles are caused by a virus from the virus morbillirus family and affects only humans and not animals, as opposed to many other infectious diseases. Although an effective vaccine against it 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 extremely infectious because it can survive a long time in sleep: When someone with the disease coughs, sneezes or talks, the infected droplets are sprayed into the air, which are then inhaled by other people. After infection, the virus attacks the immune system. is usually incubated for between eight to twelve days before the symptoms occur.
What are the symptoms?
Signs and symptoms include high fever, runny nose, cough, red eyes and light sensitivity. Four or five days after the onset of these symptoms (common to many conditions), a dark red rash appears on the skin. Generally it begins in the throat and spreads to the face, body and extremities.
The rash starts as individual signs, but often these converge into a rash that covers large areas of the body. On the third day after her appearance, the rash begins to weaken and begins to resemble the small, dense flowers of the squill – hatzav in Hebrew, and so the Hebrew name of the disease hatzevet. At this point the patient will generally feel better, although the progression of the disease varies in some cases.
What are the complications and risks?
In addition to being extremely contagious, measles is dangerous because there is no cure for it. Disease can harm the respiratory and nervous system. One-third of the sufferers will develop infections in the middle ear, diarrhea or corneal inflammation. A rare complication, which may occur up to 10 years after infection, is a degenerative brain condition that causes serious and irreversible damage to the central nervous system, including mental lesions and epileptic seizures. One in 1,000 cases of measles is fatal.
Why is there an outbreak now?
Measles are transmitted only among humans and because there is an effective vaccine to prevent it, the event is exclusively anthropogenic. However, if the rate of immunization in a population is reduced, the collective immunity provided to non-vaccinated individuals by all vaccinated humans – known as "herd immunity" – is undermined. Larger sections of the population are then exposed to the disease and the risk of inflammation is increasing.
The source of the current epidemic in Israel is due to epidemics last year in several European countries, which have also seen a decline in vaccination rates – countries frequently visited by Israelis such as Italy, England, Ukraine and Romania. Since then, the number of European affairs has risen to 40,000 and more than 40 people have died.
But the situation did not arise here because an unvaccinated person was infected abroad and brought the disease back home. The overall rate of measles vaccination in Israel is over 95% – but there are some densely populated communities and neighborhoods with much lower rates of vaccination. 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 2017 to 1,334 cases so far this year.
Is this the first time Israel faces such an increase in cases of measles?
In the 1950s, before there was a vaccine, there were thousands of cases reported annually. Since 1967, when vaccination became part of the Ministry of Health Protocol, there has been a continuous reduction in the number of cases to a few dozen a year. However, there have been other cases. In 2003, for example, 60 Israeli young people pushed measles within two weeks and one of them died. The last major explosion was in 2008 when, in a few months, 1,452 cases were reported among unvaccinated people, most in the Jerusalem region.
How effective is the measles vaccine?
Like other vaccines, measles vaccine has two purposes – protecting the person from infection and preventing the spread of the disease and protecting people at risk of not being vaccinated for medical reasons. The two doses of the vaccine that are part of the protocol offer 97% protection from the disease. The shot is given at one year old and again at the age of 6 as part of a four-pack vaccine covering red, mumps and chicken pox.
What does the Health Ministry do when a case of measles is discovered?
In recent months, the health center has monitored each case of infection, whether the patient was discovered on a flight, in a hospital, at school or elsewhere. Once the symptoms and suspicious case of the disease occur, a patient's blood sample is sent to a laboratory to see if there is measles, at the same time, the medical teams try to locate all those who come in contact with the person and determine if they were vaccinated and what is the immune status of the system. In many cases, the Ministry of Health or hospital doctors will invite those exposed to prophylactic treatment, ie, to be vaccinated.
The struggle to locate each case has become more intense as the disease spreads. Doctors in Jerusalem, where so many cases of measles have been recorded, have difficulty keeping up with the identification and treatment of patients. The Health Ministry is focusing its efforts on increasing the immunization rate in ultra-Orthodox neighborhoods, extending the reception hours at Tipat Halav Well-Baby clinics. A vehicle belonging to Natali Healthcare also takes rounds to facilitate access to vaccinations.
What other measures are being taken?
The Ministry of Health has banned non-vaccinated persons from hospital departments that are considered particularly sensitive, such as neonatal units, intensive care, oncology, blood-oncology, etc. The ministry also considers banning non-vaccinated children from schools and checks whether vaccination now given to children in one year can be given in 9 months.
If someone not vaccinated is exposed to measles, can something be done to reduce his intensity?
Yes, but you must act immediately. Preventive emergency care involves administering the live virus vaccine within 72 hours of exposure, but someone who can not take the active vaccine can get a pass that will produce antibodies against the disease within six days.
When should one be vaccinated or update his vaccinations?
The Health Ministry calls on adults who have never had measles and never took two shots of the vaccine for vaccination. The vaccine should be administered in two doses for at least four weeks. This recommendation does not apply to those who were born before 1956.
The ministry also advises parents who received their first shot not to wait for the second dose until they reach school age but to vaccinate the child immediately after four weeks after the first dose. The ministry also advises people traveling abroad, who have doubts about their immunity, to be vaccinated before leaving Israel, although it takes two weeks for the full implementation of the vaccine. If you are traveling with a baby aged between 6 and 11 months, the child will have to take the first shot before leaving.
People born in Israel between 1957 and 1977 are considered unvaccinated or only partially vaccinated, since during these years only one vaccination was given and not all of them were taken. Such people are being asked to vaccinate now.
Who should not be vaccinated?
The Health Ministry says the following people should not be vaccinated: Pregnant women. a person with high fever. an individual who has an allergic reaction to a previous vaccine. someone who is sensitive to one of the components of the vaccine. and people whose immune system is seriously compromised.