BELIZE CITY, Thurs. Feb. 26, 2015–On Wednesday, February 25, the Belize Ministry of Health issued a measles advisory, indicating that it had been informed by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) of an outbreak of measles at the Disneyland Resort in California, USA, with additional cases being reported in Canada and one case related to the Disneyland outbreak being reported in Mexico.

Most Belizeans don’t know what measles is; that is because it has reportedly been eliminated from Belize since 1991, according to Health officials here.

WHO explains that, “Measles starts with fever, runny nose, cough, red eyes and sore throat. It’s followed by a rash that spreads over the body. [The] Measles virus is highly contagious and spreads through the air through coughing and sneezing.”

Initial symptoms usually appear 10–12 days after infection. While there is no specific treatment for measles, most people recover within 2-3 weeks. Sadly, measles can cause serious complications in children who are malnourished or in persons with weak immune systems, and some cases have been known to result in death.

Whereas the Belize advisory points to the outbreak in the US, which has reported more than 130 cases since the outbreak was sparked by multiple infections at Disneyland late last year, it does not say anything about the thousands of cases which are being reported in Europe.

Belize receives more than a million tourists each year and the primary markets for tourists are the US and Europe. In fact, two of the European countries grappling with the outbreak (Italy and Germany) are listed among those from which persons travel frequently to Belize.

Director of Health Services, Dr. Michael Pitts, who acquired natural immunity after having contracted it in his youth, says that an immunization rate of 90 to 95% is needed to maintain herd immunity in Belize.

The Ministry notes that vaccination coverage against measles (given in a triple shot which is also designated for immunization against mumps and rubella) has been greater than 95% over the last 10 years. It went on to say that the vaccine is available throughout Belize.

“…an individual occasionally bears a significant burden for the benefit provided to the rest of the population… it is fair and reasonable that a community that is protected by a vaccination programme accepts responsibility for and provides compensation to those who are injured by it:” WHO report

Simultaneously with the release of the measles advisory in Belize, the World Health Organization, which has called for the global elimination of measles by this year, 2015, urged stepped-up vaccination efforts in Europe, where far more cases of measles have been reported than in the US and adjacent countries. WHO says that 7 countries in Europe have reported 22,149 cases of measles, in 2014 and in 2015.

“The priority is now to control current outbreaks in all affected countries through immunization activities targeting people at risk,” concludes Dr. Nedret Emiroglu, Deputy Director of the Division of Communicable Diseases at the WHO Regional Office for Europe. “At the same time, all countries, with no exception, need to keep a very high coverage of regular measles vaccination, so that similar outbreaks won’t happen again in our Region, and measles can be eliminated once and for all,” she noted.

Cases of measles have been cropping up in the US for several years, and the 2014-2015 outbreak is not the worst in recent history. In the US, 154 people from 17 states and Washington DC were reported to have measles between January 1 and February 20, 2015, with 77% of the cases linked to the Disneyland outbreak according to data published by the US Centers for Disease Control. There were far more cases reported in the US the prior year, including one large outbreak of 383 cases. The 288 measles cases reported during January 1–May 23, 2014 represented the highest number of measles cases reported for that period since 1994, said the CDC.

Although DHS Pitts told us that as long as a person is vaccinated with the MMR, they won’t get measles, we told him that we’ve learned otherwise – that the shot is not a 100% guarantee against contracting the disease.

In the US and Europe, people who opt out of vaccinating are largely blamed for spreading the disease in the US, although official CDC data indicates that some persons who have received up to three MMR vaccine shots have still turned up with the disease, although they are a minority of cases.

The Government of Belize purchases the MMR vaccine through the World Health Organization (WHO) and its Americas arm — the Pan American Health Organization (PAHO), and Dr. Natalia Beer, Technical Advisory for Maternal and Child Health, told our newspaper that the quality standards of vaccines are monitored by PAHO.

During the course of our research for this story, we asked persons we met on the street, as well as persons who participated in our online survey, to indicate whether they were properly informed of the potential risks of taking the MMR vaccine before it was administered to their child. We learned that in the majority of cases they were not. Beer indicated that they do advise people of the most common side effects, which include fever and swelling at the injection site; however, the CDC lists moderate and even severe problems that could be associated with the vaccine, which include seizures, coma and possible brain damage.

We have received multiple reports from persons who indicated that their child or a child they know experienced adverse reactions, including developing a full body rash. Beer told us that over the last 10 years, “one or two cases” of major adverse reactions were reported in Belize, but she said that such incidences are “very minimal.” She and DHS Pitts did indicate to us that at the least the Ministry could introduce a vaccine information sheet for parents, so they could be more fully apprised of the range of potential side effects of the vaccines, which will mean that when they say ‘yes’ to the vaccines, it would be based on informed consent.

In Belize, although vaccines are not required by law, they are required for enrollment in mainstream schools, as early as kindergarten, and the Government provides financial incentives to families who vaccinate their children.

In the US, it is the law for parents to be given a complete vaccine information sheet, which also details the potential side effects. Billions of dollars are set aside in a state-run compensation fund to settle claims for adverse vaccine reactions, including deaths. That country pays out on average US$100 million a year for vaccine injury and death, with each person receiving on average US$700,000. In the US, the most a claimant is paid for a vaccine-related death is US$250,000. Most vaccine injury claims are rejected, including all claims suggesting that the vaccines cause autism in children.

Similarly, other developed countries have established compensation funds to cover vaccine injury, and two years ago, an Italian judge granted an award to a mother who claimed that her child had developed autism and other complications after being administered the MMR.

Developing countries such as Belize and the rest of the Caribbean have no such fund in place to compensate for possible vaccine injury and/or death.

(Measles photo courtesy: http://www.infectionlandscapes.org)