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The measles is back. This year, 52 infections have already been reported in Belgium, which is several times the number of infections in 2022 (eight cases) and 2021 (seven). The most notable outbreak occurred in Sint-Niklaas, where two families formed the nucleus of a group. At least fifteen people were infected in October and November. Five of them, including children, had to be hospitalized because of their serious illness. One adult developed meningitis and ended up in the intensive care unit.
“The first person with measles in this group was an adult woman. It is unclear how she became infected herself,” said Heidi Theeten, an infectious disease doctor who monitored the cluster for the Ministry of Health. “The woman passed the virus on to her family members and a family friend. Infections followed in the children’s elementary school. And when some sick children went to the emergency room, another patient in the waiting room became infected with the virus.”
Measles, not a harmless childhood disease
Before the introduction of measles vaccination in the 1960s, measles epidemics occurred every two to three years. It is estimated that there were deaths worldwide in a bad year of measles 2.6 million people to viral disease. Measles is still one of the most common causes of death in young children.
Some children with measles develop complications such as encephalitis. This can lead to epilepsy or deafness. Measles also weakens the immune system and makes a child more susceptible to other infections for months.
The combined measles-mumps-rubella vaccine (“MMR vaccine”) is given in two doses: at one year of age and in the fourth or fifth grade. Whether you have received the two doses is stated in the vaccination certificate or can be found at mijngezondheid.be. “If it cannot be determined whether you are fully vaccinated, it may make sense to have an additional dose administered to be on the safe side,” says Heidi Theeten.
Anyone who has measles can pass on the virus several days before symptoms appear. The virus is highly contagious, explains Theeten. “The virus remains in the air for up to two hours. It finds anyone who is not immune. If the government had not intervened together with the CLB to detect and isolate all cases and offer additional vaccines, the outbreak in Sint-Niklaas would not have simply stopped.”
Not anti-vaccination, but casual
This year it was also a prize elsewhere in the country. There have been several medium-sized clusters of measles in Brussels, including among children at a school and a hospital. There was also an outbreak in an asylum center in Brussels. According to the Ministry of Health, the majority of people suffering from measles were not vaccinated or not fully vaccinated (see inset). Theeten warns against nonchalance. “In Sint-Niklaas, it wasn’t the anti-vaccination people who were the first to contract measles. It also turned out that the children who contracted the virus at school were not vaccinated due to parental negligence.”
After two very quiet years, measles is making a comeback across Europe. As of October this year, European countries have collectively reported more than 30,000 cases to the World Health Organization (WHO) (see chart). That is 30 times as many as in 2022 (941 cases) and 200 times as many as in 2021 (150). In recent years, measures against Corona have also stopped measles.
But now exactly what has been warned about since 2021 is happening: the world is once again vulnerable to infectious diseases, even more so than before the pandemic. Because in the Corona years there were fewer vaccinations worldwide. It is estimated that more than 1.8 million children in the WHO Europe region missed their measles vaccination between 2020 and 2022, allowing outbreaks to take hold.
In Flanders, the vaccination rate for small children remained high despite Corona. But it was already clear in the years before the Corona crisis that there were gaps in our protection. Those aged 20 to 40 are least protected from measles. They never had the disease and therefore have built up immunity like their parents. Often, 20- to 40-year-olds have received the first dose of the measles vaccine but have forgotten the second. If the virus becomes rampant in other countries and enters via travelers, such protection gaps will not lead to an overwhelming epidemic, but rather to clusters like in Sint-Niklaas.
Dab all the spots with ointment and you will automatically become a mushroom with spots. — © getty images
Child died
Several EU countries are struggling with measles clusters, including Austria, France and Germany. In Romania, the authorities are even talking about a real epidemic. More than 2,000 cases have already been reported there this year. A child has died. The child was younger than a year old and was infected by a sick, unvaccinated brother or sister. The government is now vaccinating infants at 9 months of age, which is younger than usual (see inset).
Before their first birthday, children’s immune systems are not yet ready for vaccination. Babies are therefore only protected if everyone around them is immune. In 2014, a daycare center in Zwijndrecht showed how dangerous a measles outbreak is for very young children. 33 people (mainly children) were infected there. A superior had brought the virus from the Netherlands unnoticed. Twelve children with measles had to be hospitalized. A child suffered from encephalitis, which can lead to disability.
“We cannot prevent the virus from entering our country via travelers,” says Theeten. “That’s why we have to remain vigilant.”
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