Measles are an infectious disease caused by the Morbilivirus genus of viruses. The history of measles can be recorded back to the early age of men when mankind was unaware of the disastrous effects of measles. With particular focus on the European countries of the current world, we can have an organized view of the natural course of measles outbreaks in the European region.
There are several pieces of literature available illustrating the general spread and outbreaks of the measles disease in the European areas but an organized document with specific focus on a few primary landmarks of the European contingent are scarce. Therefore, the following piece of literature has been specifically accumulated to shed light on the various outbreaks of measles cases in Europe over the past ten years:
The vast expanse of the area of Europe had witnessed an overall rise in the outbreak of measles since the year 2011. The outbreaks were particularly focused among the regions of France, Romania and Ukraine. The considerable outbreaks that were reported were in the year 2013 in the regions of Georgia, Turkey, the United Kingdom, Russia and Azerbaijan and the cases continue to increase to date. other regions which have been reported to be have harbored outbreaks of measles attacks include regions of the Netherlands, Belgium and Germany.
In the UK, with regard to it being a developed country, measles outbreaks have been contained successfully over the past 10 years. This was due to the development and introduction of vaccination programmes by the WHO. Regardless of the effective vaccination endeavors, the rates for the uptakes of the vaccination programmes continued to deteriorate specifically in the regions of the UK and the European countries. The latest report by the CIDSC states that a record of 1494 total cases of measles outbreaks in a variety of areas stretching from London to Hertfordshire and the South Midlands including areas of Wales have been reported.
In Lyon, situated in the Rhone-Alpes area of France, the largest outbreak of measles was recorded in 2010 – 2011. Data was accumulated from the virology department of Lyon University Hospitals (LUH). In a general overview, a total of 407 cases were identified. The maximum proportion of the outbreak had affected infants of less than one year of age. The remainder was fulfilled by teenagers and young adults among the age periods of 17-29 years. Furthermore, 72 cases of the total 407 patients were diagnosed as complicated cases and 13 cases of women who were pregnant.
Furthermore, between the time periods of January 2008 and April 2011, approximately 17,000 cases of measles outbreak were recorded in the regions of France. Out of the total cases recorded, two patients died in the year 2010 due to the outbreak. Between the time periods of January 2011 to October 2011, approximately 14,000 cases, alone, were reported in the area of France which initiated the commencement of an awareness strike regarding MMR vaccinations.
With consideration to Bulgaria, in the year 2009, in the month of April, a sudden and dense outbreak of the measles virus was recorded. The prevalence rate of the outbreak in question was 23,791 patients approximately. In the time period mentioned, almost 24 people died as a result of suffering from measles. The report of the dead victims was accumulated on 28th July, in the year of 2010. After the infection had formed a hold on the region of Bulgaria, the strain continued to spread to other surrounding countries like Turkey, Greece, Germany, Macedonia and other Countries of the European region.
With respect to Germany, 368 total cases were reported from a time period of July, in the year of 2011 to June, in the year of 2012. According to above mentioned statistics, the approximate cases per 100,000 were 0.45 when considering the limited time period of July, 2011 to June, 2012.
With respect to the time periods of 1st January, in the year 2011 and 31st December, in the same year, a total of 1607 cases of measles were diagnosed and recorded in the country of Germany. 918 of the total cases which were identified were laboratory-identified while the remaining 571 cases were epidemiologically related to laboratory-identified cases of the outbreak. The maximum number of cases, which were diagnosed, they were recorded with an incidence among the federal locations of Hessen, Berlin, Baden-Wurttemberg and Bavaria. Specifically, the separate number of cases identified in Hessen were 122, 524 cases in Baden-Wurttemberg, 160 cases in Berlin and 436 in Bavaria.
The data accumulated showed diverse variation between the vast western and eastern federal states of Germany. The number of cases which were recorded, they were among infants and children of one year of age. Therefore, the incidence rates were higher in Children of one year of age (14.3 per 100,000) and infants with 11.4 per 100,000). The data accumulated per 100,000 cases varied from 6.1 to 8.7 in other groups of children identified over a variable age group.
Several surveys have been carried out over a period of time to identify the impact of measles outbreaks in Belgium using multicohort models, seroprevalence data, vaccine data and social contact data from all the regions of Belgium. the findings of the surveys enlisted a number of factors which include propositions that outbreaks were limited to time periods when school was an on-going process and were reduced in times of holidays, the outbreak potential covers the whole of the country, the people who are at high risk include infants, teenagers and adults of a younger age and spatial heterogeneity in outbreak potential is seen.
As a result of investigations conducted over the past years, it has been found that regardless of all the measles outbreaks occurring in the UK, the Netherlands and France, Belgium remains to be potentially lower at risk and harbors seldom number of cases which were successfully diagnosed as cases of measles. In short, no potential outbreaks have been recorded which were of considerable value. Approximately, 30 cases were diagnosed in the year of 2013 in Belgium, only.
When questioning the Netherlands, any measles outbreak did not propagate to a larger area. the most affected areas within the Netherlands were said to be the Dutch Bible Belt where a whole horde of families of limited vaccination coverage exist (from <80% to 90%-95%) due to their religious beliefs. The measles outbreak was limited to that area and did not spread to the areas where the population was properly vaccinated against the invading pathogen.
With respect to Italy, a history of a considerable outbreak of measles was reported in the year 2008. By the year 2010, approximately 30, 367 cases had been identified in 32 countries of the European region with special focus on Italy. The measles outbreaks have been highly irregular oer the past few years, affecting the unimmunized population. 2151 cases have been identified over the time period from July, in the year of 2009 to September, 2010. Furthermore, 133 more cases were recorded in the first five months of the year of 2012.
Considering the latest outbreaks of the measles disease in the confines of Italy, the latest outbreak was seen in the province of Bolzano, in the month of July, in the year of 2011. The outbreak affected 600 patients and more due to its intensity of spread. Another outbreak commenced in the month of September in the year 2007, specifically in the area of Piemonte situated in Northern Italy. This outbreak affected young adults, mainly. The update in the month of May, In the year 2008 reported a complete set of 1000 cases as a result of the outbreak which started in the year 2007.
In the time period of January and March, in the year 2008, another outbreak occurred in the area of Apulia situated in Southeastern italy. This outbreak affected 16 people. Furthermore, in the time period of November, in the year 2006 and January of the year 2007, another outbreak commenced affecting 18 individuals. Additionally, in the time period of June and September, of the year 2006, about three hordes of patients with measles were diagnosed in Roma/Sinti species. These cases from three diverse Italian areas which included the Lazio situated in Central Italy, the Autonomous Province of Bolzano-South Tyrol situated in Northern Italy and the Island of Sardinia situated in Southwest Italy.
Additionally, from January to April, in the year of 2006, another outbreak was seen in the province of Grosseto in Toscana (Tuscany). This particular epidemic affected 40 cases which included individuals who were teenagers and adults who were young and had received limited or no immunization. The colors of spring of the year 2003 saw yet another measles outbreak in the region of Abruzzo, Puglia and Calabria. Comparatively, a considerably intense outbreak was seen in Campania in the month of April, in the year 2002, affecting 99 cases of individuals who were already suffering from pneumonia, 15 patients of encephalitis. This outbreak led to four deaths among the affected individuals. The targeted part of the population was mostly young, between the age gaps of 5 years to 14 years.
Adaptive And Innate Immunology Differences
The immune system provides an important mechanism by which the body is able to defend itself against potential pathogens. The immune system is composed of two integrated systems, the innate immune system which provides rapid recognition and elimination of potential pathogens and the adaptive immune system, which has developed and evolved in order to protect the body against a broader range of infectious agents (Bonilla and Oettgen 2010). There has been a vast amount of literature produced into how the immune system brings about an immune response and it is now thought of as being divided into innate and adaptive immunity. The following essay will give a summary of how the innate and adaptive immune systems work but also as to why they are thought of as two distinct branches of immunity and also to question whether they are actually as different as it is suggested?
The innate immune system is an evolutionary defence mechanism which serves as protection against a diverse threat of pathogens and microbes (Shanker 2010). It includes the anatomical and physiological barriers such as lactic and fatty acids present on the surface of the skin providing a low pH, however this essay will concentrate on the mechanisms in place for a penetrating pathogen (Turvey and Broide 2010). The two main phagocytic cells involved are polymorphonuclear neutrophills and mononuclear macrophages (Beutler 2004). An activated macrophage has three ways in which it may respond to a pathogen: it may engulf a pathogen and then use lysosomal enzymes to destroy it, it may remove a pathogen from interstitial fluid by binding to it and finally it may destroy the pathogen by releasing toxic necrosis factors such as nitric oxide or hydrogen peroxide (Martini and Nath 2009). Neutrophills function as patrolling cells present in the blood stream looking for any foreign material to initiate an immune response, they contain granules which contain peroxidise, alkaline and acid phosphatases which are used digest and phagocytose invading microbes (Lydyard, Whelan and Fanger 2004). Eosinphils and basophils are less abundant than neutrophils and are able to target proteins which have been coated with antibodies (Martini et al Nath 2009).The third main cell type of the innate system is the natural killer (NK) cell used for immunological surveillance and the destruction of abnormal virus infected cells (Martini and Nath 2009); they recognise the MHC class I which is usually down regulated in virus infected cells and hence activates killer activation receptors to initiate natural cell killing of the infected cell; on the other hand if the NK cell binds to an uninfected cell the killer inhibitory receptors recognise the leader peptides presented by the MHC class I and this provides a negative signal to the NK cell preventing it from killing the healthy self cell (Lydyard, Whelan and Fanger 2004). Macrophages and neutrophils are involved in the first mechanism of innate immunity which is phagocytosis, receptors on the plasma membrane of the phagocyte bind to the surface of the pathogen, a vesicle is then formed which contains the bound target and is then digested via the fusion of the vesicle with lysosomes or peroximsomes (Martini and Nath 2009). The second mechanism that the innate immune system adopts in order to ensure efficient elimination of invading microbes is opsonisation which is the process of making a microbe easier to phagocytose using the complement system (Lydyard, Whelan and Fanger 2004). The complement system is made up of 20 soluble glycoprotein’s which react sequentially with each other to form a cascade of molecular events resulting in the active fragment C3 (Lydyard, Whelan and Fanger 2004). These complement proteins binding to the surface of pathogens attract neutophils and macrophages to the area, macrophage membranes contain receptors which recognise and bind to the complement proteins and also to any bound antibodies, these antibodies involved are called opsonins and so this results in opsonisation and the pathogens are more easily engulfed (Berg et.al 2007). Activated complement proteins also promote the release of histamine from by basophils and mast cells which stimulates inflammation, which is the process by which the body deals with the invasion of a microbe or physical insult (Martini and Nath 2009).
Here you can see how the membrane has been interrupted
In contrast to the innate immune system the cells of the adaptive immune system involve T and B lymphocytes (Bonilla and Oettgen 2010 ). Each T cell produced goes through a selection process, T cells which recognise and bind strongly to self antigens and MHC are killed off by phagocytic macrophages in order to prevent a self immune reaction (Lydyard, Whelan and Fanger 2004). Once the selection process is complete the T cells complete maturation into either T helper (Th) cells or T cytotoxic (Tc) cells in the lymphoid tissue (Lydyard, Whelan and Fanger 2004). Tc cells attack antigens directly both chemically and physically by releasing perforin which destroys the plasma membrane, shown by figure one, secreting toxic lymphotoxin which kills the target cell and finally Tc cells have the ability to activate genes in the target cells nucleus which signal for the target cell to die (Martini and Nath 2009). B cells are activated by Th helper cells so they are able to proliferate and develop into plasma cells which secrete and produce large quantities of antibodies specific to a complementary antigen (Bonilla and Oettgen 2010). The antibody does not bind to the entire surface of the antigen it binds to specific regions which are termed antigenic determinant sites, shown by figure two, once this binding is complete this results in an antigen-antibody complex which leads to several pathogen destruction and elimination mechanisms: Firstly the attraction of eosinophils, neutrophils and macrophages which are able to phagocytose the pathogen, on binding of the antibody to the antigen the antibody molecule changes shape which opens up areas for complement protein binding, shown by figure three, which leads to opsonisation, stimulation of basophils and mast cells which promotes inflammation and finally antibodies may bind to specific sites on viruses and bacterial toxins which were the sites used to attach to the host and so this results in neutralisation (Martini and Nath 2009). http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi?book=stryer