Emerging Measles Epidemic: A Preventable Crisis

The past few months have seen a rising crescendo of news articles highlighting a growing global measles epidemic and crisis. The following list is drawn from just the BBC alone.

  1. 20 August 2018: Measles cases reach record high in Europe
  2. 15 February 2019: Measles is evil. We have to vaccinate
  3. 25 March 2019: The measles has made my life
  4. 27 March 2019: US County declares measles outbreak emergency.
  5. 27 March 2019: Explaining the US measles outbreak
  6. 5 April 2019: Measles: How a preventable disease returned from the past
  7. 9 April 2019: New York measles emergency declared in Brooklyn
  8. 24 April 2019: Measles: Greater Manchester outbreak rises to 47 cases
  9. 26 April 2019: Measles outbreak: Trump tells Americans to “get their shots”

The sad reality is that this is a crisis that could largely have been prevented in the developed world. UNICEF reports that, globally, over the past 8 years an average of 21.1 million children have missed out on essential measles vaccines each year, giving a total of approximately 169 million unvaccinated children in that time period alone. In high-income countries, the statistics make for some sobering reading. The raw data over this time period is shown on the following table, courtesy of UNICEF.

The United States is significantly over-represented, as the equivalent doughnut chart shows below.

The reasons for failures to achieve required measles vaccination rates are varied. Measles has had a hard time because of the influence of disproven scare stories linking the MMR vaccine with autism. This misinformation has led to increasing fear or skepticism about the vaccine.

In low and middle-income countries, on the other hand, the causes are related to poor governance, poor health systems, complacency, logistic and economic challenges. Data from 2017 alone show that the countries that contributed the most were Nigeria, India, Pakistan, Indonesia and Ethiopia.

UNICEF highlights that two doses of the measles vaccine are essential to protect children from the disease. However, the global coverage of the first dose of the measles vaccine was reported at 85 per cent in 2017, a figure that has remained relatively constant over the last decade despite population growth. Global coverage for the second dose is much lower, at 67 per cent. The World Health Organization recommends a threshold of 95 per cent immunization coverage to achieve so-called ‘herd immunity’.

The BBC has a useful video that discusses vaccines, particularly the measles vaccine, in some detail. It is helpful to watch and is added below for reader convenience.

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Eat Breakfast. It’s Good for You

A recent study has provided a quantitative measure of the benefits of breakfast: Regularly skipping breakfast almost doubles your risk of having a heart attack or stroke.

Many people regularly skip breakfast in the mistaken belief that this helps them lose weight and reduce their cardiovascular risks in the long term. However, this is not the case.

The study by Rong and others was a prospective, nationally representative study of 6,550 adults 40 to 75 years of age. Among the 6,550 participants (mean age 53.2 years; 48.0% male), 5.1% never consumed breakfast, 10.9% rarely consumed breakfast, 25.0% consumed breakfast some days, and 59.0% consumed breakfast every day. It was adjusted for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, body mass index, and cardiovascular risk factors. It found that participants who never consumed breakfast compared with those consuming breakfast everyday had hazard ratios of 1.87 (95% confidence interval: 1.14 to 3.04) for cardiovascular mortality and 1.19 (95% confidence interval: 0.99 to 1.42) for all-cause mortality.

In other words, regularly eating breakfast significantly improves your cardiovascular health.

Llandudno on a Day Trip

I recently paid a visit to the town of Llandudno. Situated on the coast of North Wales, the town boasts an immaculate seafront, a well-maintained stony and sandy beach, a vibrant pier, an impressive headland (the Great Orme) with awe-inspiring views of the sea and the Snowdon mountain range, cable cars, a vibrant pier and a quaint holiday feel that envelopes you in the sense that you are in exotic territory, yet entirely at home.

 

The promenade, for the most part, is separated from the sea by a stony beach that is less than forty metres wide. This lends the beach to the enjoyable challenge of throwing pebbles on the sea to bounce them or see how far they can go.

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As would be expected in any modern city with such a clean beach, the seafront has a lot of hotels, all of which looked well-presented. I did not stay in any of them and therefore cannot give an opinion as to the standards of accommodation, service or food quality.

At the top end of the esplanade, just before the pier, is a sandy beach that appeared to be popular with holiday makers on the sunny day on which I had visited.

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While stone-throwing and lying on the beach are free, there are a number of other non-free activities on offer. Among these are boat rides as can be seen below:

 

There is an option of a fast boat or a more sedate ride on a bigger vessel.

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The pier itself juts into the sea about a mile and has the obligatory food kiosks, arcades and amusements rides that you might expect. It also presents commanding views of the seafront and the activities by the beach, as the following 360-degree video attempts to show.

For those concerned about parking, there are parking charges along the seafront, but further into the town there is free parking for up to 90minutes if you are prepared to walk for about five to ten minutes to the seafront; not that you should mind because the town itself has a cosy, local village look.

Once you leave the town and the beach you can choose to drive round the headland known locally as the Great Orme, which is about a file mile drive. Should you choose to take a detour, and I would encourage you to, you can go up to the summit and catch magnificent views of the surroundings for miles around. The following time lapse gives an indication of some of the challenges of the drive, including the narrow roads and the need to give way to oncoming traffic on the way to the summit.

The rewards of perseverance are the following splendid views on a fine day.

The Orme itself is littered with old mines and packs a surprise or two, including cable cars and an occasional fresh water spring, such as this one.

In summary, Llandudno is a great place to visit for a day or even a few days, as are undoubtedly other parts of North Wales. There are other activities I did not engage in or photograph, such as walking up the mountain, going on the cable cars, riding on the train at the summit or going on the ski slopes. These will have to be reserved for another day.