Measles have has been stamped out in some countries - but not in Germany. A new wave of infection has rolled through Germany, prompting renewed discussion about compulsory vaccinations.
A brownish-pink rash is the typical symptom of a measles infection, but not the only one and certainly not the worst. High fever, a runny nose and a cough also often accompany it. The problem is that it weakens the immune system, making those suffering an acute measles infection more susceptible to more serious illnesses, such as pneumonia or encephalitis, both of which can be fatal. Worldwide, complications from a measles infection end in 200,000 fatalities each year.
While measles infections are virtually non-existent in the United States, for example, there have been of late from 122 to 2,308 each year in Germany - some resulting in fatalities. Currently, the virus is spreading primarily in Berlin and Bavaria, with Germany's Ministry of Health reporting more than 900 cases in the first half of 2013.
How can this be, given that vaccinations against measles have been administrated for more than three decades? While the rate of administering the so-called MMR vaccine - which aims to immunize against measles, mumps and rubella - has risen in recent years, many parents during the 1990s in particular chose to not have their children vaccinated. Which means that young people between the ages of 15 and 30 are the main ones at risk of catching one of the viruses, said Annette Mankertz, director of the National Reference Center for Measles, Mumps, Rubella at Germany's Robert Koch Institute.
According to the German Medical Association, children should be vaccinated twice: once between 11 and 14 months of age and a second time four to six weeks later. In 2011, the rate for the first vaccination was 96.6 percent; the second, at 92.1 percent. A second vaccination provides almost full protection against infection. Experts estimate that a vaccination rate of 95 percent worldwide could permanently wipe out the virus.
To prevent future measles outbreaks in Germany, Health Minister Daniel Bahr has brought compulsory vaccinations to the table. Mandatory vaccines were established in the country in the past - in 1874, against smallpox. Other industrialized countries have stricter laws these days. In the United States, proof of the double-MMR vaccine must be shown before a child enters school. Vaccinations in Scandinavian countries are voluntary; there, explained Mankertz, so-called health nurses discuss the subject with families and encourage vaccinations.
Wolfram Hartmann, President of the German Pediatric Society, calls unequivocally for a compulsory measles vaccine. The current wave of infections shows that physicians cannot depend on parents voluntarily having their children vaccinated.
The legal framework offering such a compulsory vaccine is the German Protection against Infectious Diseases Act. With this, the government has the possibility of establishing mandatory vaccines for children at risk of catching extremely dangerous diseases.
Childhood diseases important for the immune system?
Michael Friedl, chairman of the Association of Doctors for Individualized Vaccination Decisions, disagrees with compulsory vaccines. Since illness is always an individual process, decisions around it must be left up to the individual, he thinks.
The alternative practitioner is not generally against measles vaccines, rather is critical of administering them during childhood years. In his opinion, measles - like other illnesses that prompt high fevers - serve an important function. For one thing, experiencing such an illness allows children to better understand their bodies. For another, it helps to strengthen the immune system.
Children can deal well with fever up to the age of seven, Friedl noted. "With many illnesses or disease that causes major problems for adults, the complication rate in the childhood years - if they receive proper medical treatment, which for me includes allowing them to sustain higher fevers - is extremely low," said Friedl.
Vaccines also have risks
Annette Mankertz, for her part, said that "strengthening one's immune system" does not necessarily mean subjecting it to the measles virus. More important, she said, is that the vaccine could save thousands of lives. And, vaccinated people are not only protecting themselves, but also other people.
Still, since the measles vaccine uses live attenuated viruses, side effects can occur. In one in ten cases, fever and headache can result - or, less frequently, fever cramps. "Cerebral inflammation is also a risk with such a vaccination," Mankertz said. But the risk is only one in a million, she noted - which makes it one thousand times less likely than in an actual measles infection.
Measles are extremely contagious. The virus spreads through respiration, or contact with fluids from an infected person's nose and mouth, such as while speaking, coughing or sneezing. The contact does not have to be direct, as the virus can remain active for hours.
Measles infections are particularly dangerous for infants under one year of age. "One in 5,000 infants develops subacute sclerosing panencephalitis. This degenerative encephalitis, if not treated in its intial stage, is always fatal. Parents whose children receive such a diagnosis can only watch them die," said Mankertz.