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Measles, mumps and rubella on the rise in Wales and Japan, low vaccination rates blamed


A large outbreak of measles in Wales continues with the number of cases of the airborne, respiratory infection topping 1,400 nationwide with nearly 1,200 cases reported in the city of Swansea, the epicenter of this years outbreak.

The outbreak, since it's beginning, has been blamed on low measles, mumps and rubella (MMR) vaccination rates, particularly among the Welsh country's young population.

Despite more than 50,000 unscheduled MMR vaccinations have been given across Wales since the outbreak of measles began, too few have been given to children and young people aged 10 to 18 and this has been the group hardest hit by the outbreak, according to Public Health Wales.

Health officials say some 35,000 children remain unvaccinated and are risk of not only measles, but mumps, which has began to make its presence known in the country.

Seventy-six mumps cases have been reported so far in 2013. This compares with 77 cases for the whole of 2011 and 88 for the whole of 2012.

The poor MMR vaccination rates in Wales, and other countries for that matter, has been linked , at least in part to the now discredited by Dr Andrew Wakefield in the late 1990s which linked the vaccine with autism.

Dr Meirion Evans of Public Health Wales (PHW) said in April, "the epidemic centered around Swansea is a result of a 10 to 15 year "legacy" of concern about the MMR (measles mumps rubella) jab", implying that the Wakefield Study was a factor.

In Japan, this issue is rubella, or German measles. According to the National Institute of Infectious Diseases in Japan, 672 cases of clinically or laboratory-confirmed rubella were reported throughout Japan, including several cases of congenital rubella syndrome (CRS).

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As Mugen Ujtie, MD, from the National Center for Global Health and Medicine Disease Control and Prevention Center wrote in an email to ProMed Mail in March, "Although MMR vaccine was unfortunately discontinued in 1993, Japan had adopted the policy of vaccinating schoolgirls between 1977 and 1995, as several countries also did."

"Since the beginning of 2013,the rubella cases have been reported predominantly among males aged between 20 and 40 years old in Japan."

Measles or rubeola, is an acute highly communicable viral disease that is characterized by Koplik spots in the cheek or tongue very early in the disease. A couple of days later a red blotchy rash appears first on the face, and then spreads, lasting 4-7 days. Other symptoms include fever, cough and red watery eyes. The patient may be contagious from four days prior to the rash appearance to four days after rash appearance.

The disease is more severe in infants and adults. Complications from measles which is reported in up to 20% of people infected include; seizures, pneumonia, deafness and encephalitis.

Mumps is also an acute viral disease that is characterized by fever and swelling and tenderness in one or more of the salivary glands. Maximum infectiousness occurs between two days prior to onset of illness to four days afterwards.

Complications to mumps may include; orchitis (which has been reported to be a risk factor for testicular cancer), encephalitis and spontaneous abortion. Sterility in males is a rare possible outcome.

Rubella or German measles is a mild, febrile viral disease characterized by a rash and fever. The rash is clinically indistinguishable from those produced by measles, parvovirus B19 and scarlet fever. This highly communicable disease is contagious from about 1 week before and four days after onset of the rash.

Rubella is important because of its ability to cause problems with the developing fetus. Congenital rubella syndrome (CRS) can cause miscarriage; and mental retardation, deafness or cataracts and other birth defects in the newborn.

Photo credit/CDC