Kate O'Connell (Dublin Bay South, Fine Gael)
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This issue concerns the outbreak of measles in north County Dublin in the last few weeks. It has happened a few times in recent years and is an issue I feel strongly about as a pharmacist. From a public health policy point of view, vaccination would be considered, after water sanitation, as the single greatest success story in terms of health worldwide in modern times. The concern here is that very few people are actively working now who have seen measles and witnessed families lose children at a young age. Once a disease disappears, the burden of that disease can quickly be forgotten. I am sure there are people around these Houses who remember children being born and dying very quickly but, while death is obviously very serious, measles can also cause brain damage, blindness, deafness and many complications due to secondary infections.

Today, for the benefit of the Minister for Health, I want to identify areas where we have been complacent, given this has led to an increased number of cases.

Continued high vaccination rates are vital if we are to ensure a sustained protection of the population from diseases. Facts and science save lives while miscommunication and untruths destroy them, given how they have been shown to affect vaccination rates. This country has faced challenges with the HPV vaccine, so it would be regrettable if we were to let our vaccination rate drop below approximately 95%, which is considered the point at which the population is afforded herd immunity.

A small issue arises regarding vulnerable communities, for example, those with limited education levels or language barriers and migrants from countries where health policies and vaccination protocols are different. Speaking professionally, I know that some communities have cultural fears of engaging with our State institutions, medical people and people in positions of authority because their status within this country might not be ideal. The Minister of State should address these groups in particular, given that they may not have access to the same information, knowledge or history that some of us in this country have, for the betterment of their health as well as the health of the wider population.

Recently, doses were offered to pupils in an attempt to increase the vaccination rate, but there must be a public health process whereby we highlight to people who have never encountered measles and only know it as a word what it is, how bad it can be, how to identify it, how contagious it is and how difficult it is to contain. Someone can get measles just by being in a room that a person with measles has been in. People do not even need to have direct contact.

Catherine Byrne (Dublin South Central, Fine Gael)
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I thank the Deputy for giving me the opportunity to update the House on this matter. Measles is an acute and serious viral infection and is highly infectious. As Deputies are aware, there is an ongoing measles outbreak in north Dublin and Meath. The HSE east's department of public health has been notified of eight confirmed cases of measles in the north Dublin area and five in County Meath, predominantly among children. Other cases are under investigation. The source of the measles outbreak has not yet been identified. Confirmation of further cases associated with this outbreak can be expected in the coming weeks as contact tracing and other measures proceed.

An outbreak control team has been convened to investigate and control the spread of this potentially serious illness. The local HSE departments of public health, where the cases are identified, are investigating and implementing control and communication measures with local GPs, hospitals and others in the relevant communities. NGO groups working in those communities have been alerted and asked to share information through their networks about this outbreak.

An alert has been sent throughout the health system, including to emergency departments, consultants in microbiology and paediatrics, hospital managers, directors of public health nursing, and GPs. Hospitals and health care facilities are requested to raise awareness among staff in order that the triage and isolation of suspect cases is achieved, thereby helping to prevent the further spread. Suspect cases should be notified to HSE departments of public health and samples should be sent to the national virus reference laboratory to facilitate rapid diagnosis. All people identified as contacts of the measles cases are being notified and advised of the risk by departments of public health.

Immunisation is regarded as one of the safest and most effective health care interventions, and the importance of vaccination is acknowledged globally. Diseases that used to be common around the world can now be prevented by vaccination. Vaccination is effective in preventing measles. In Ireland, measles immunisation was introduced in 1985. In 1988, the MMR vaccine, which combines measles, mumps and rubella vaccines, replaced the single measles vaccine. The MMR vaccine is available free of charge as part of the primary childhood immunisation schedule. In 2016, vaccination rates for MMR at 24 months were 93% and have been above 90% since 2008.

In recent years, however, and due to the success of our programme, many vaccine-preventable diseases have become so infrequent that we have lost the collective memory of how serious and deadly some childhood illnesses can be. The lack of awareness of measles and its infectiousness may have contributed to the spread in the current outbreak. Although the uptake rate is high, this outbreak and a number of prominent measles cases last year demonstrate that we must not be complacent. Since the only protection against measles is vaccination, I encourage parents and guardians of all children and teenagers who have not been immunised yet to protect their children by getting them vaccinated. Young adults who have not been immunised should also get this important vaccine.

I will address some of the other issues that the Deputy raised after her next contribution.

Kate O'Connell (Dublin Bay South, Fine Gael)
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I thank the Minister of State. In the wider European context and given the movement of people, there have been 44 deaths owing to measles in EU countries since 2016. Disease does not know borders, so I would be anxious for the Department to examine countries where there have been increased rates of measles and consider how to control the burden of disease in the context of people from elsewhere coming to this country and vice versa.

Related to this is the issue of Brexit, our relationship with the NHS in the UK in terms of the potential border and our level of sharing of data on disease control, particularly as regards measles.

It is worth noting at this cold time of the year when older people and immunocompromised people tend to get sick that this is not just a baby or small child issue. Of those who got measles in 2016, only 58% were unvaccinated. Just because someone is vaccinated does not mean that he or she is safe, so this is everyone's problem. Anyone who is immunocompromised, old, sick or otherwise vulnerable is especially at risk. As I have stated at the Committee on Health, if there is a measles outbreak in this country, trolleys will be the least of our worries. We will have sick people with HIV and autoimmune diseases dying from a disease that had effectively been wiped out in this country. Trying to control the condition should be a priority for the Department.

Catherine Byrne (Dublin South Central, Fine Gael)
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I acknowledge the importance of vaccinations. The Deputy is right, in that not only children can be infected, but also adults. Unfortunately, people have died and will continue dying if outbreaks are allowed in any country.

Thanks to the increase in the MMR vaccination uptake rate in Ireland in the past decade, measles had become relatively rare. However, 43 cases were notified in 2016, the bulk of which were part of an outbreak associated with an imported case. In 2015, there were six measles cases, the lowest annual number reported since 1948 and a significant decrease on the 33 cases in 2014.

Yesterday, I met people from the Department of Health and the HSE to discuss the outbreak in the north inner city and Meath. I assure the Deputy that everything is being done on the ground and in the Department and the HSE to notify people of the risks associated with not getting their children the MMR vaccine. The public health awareness work of local GPs and district nurses has taken on board the alert issued by the Department and the HSE. We will continue to monitor the situation. I hope that, in the coming weeks and months, we will be able to identify the source of the outbreak and continue working with health care facilities and staff around the country to raise awareness of this deadly disease, particularly as it relates to young babies.

4 o’clock

I want to keep the Deputy informed of progress on a regular basis. As soon as I have more information, I will relay it to her.