A tale of two vaccines: yellow fever and measles

Yellow fever and measles, mumps and rubella (MMR) are both live vaccines used regularly in the pre-travel consultation. While the safety of MMR has been the subject of extensive global debate: resulting in a decrease in numbers vaccinated and an increase in confirmed measles and mumps being reported: yellow fever is consistently recommended to travellers without much thought to the consequences. The deaths of two travellers during the past 12 months, who had received yellow fever vaccine during their pre-travel consultation, has thrown the safety of yellow fever vaccine into sharp relief.

Measles

Measles is an extremely infectious virus spread from person-to-person by aerosol transmission. It remains an important cause of infant mortality globally despite a safe and effective vaccine being available. Initial symptoms which appear 10-12 days post infection include pyrexia, runny nose, bloodshot eyes and small white spots, known as Koplik’s spots, which appear inside the mouth on the oral mucosa. A fine maculopapular rash appears two days later, starting on the face and neck, and moving swiftly downwards. The most serious complications include blindness, deafness, encephalitis, severe diarrhoea with resultant dehydration and pneumonia. While deaths from measles infection has dramatically reduced, from 500,000 in 2000 to 89,000 in 2016, measles remains common in many developing countries with an estimated seven million children affected by the disease during 2016.¹ However, during the last 12 months an increasing number of measles cases, thought to be as a result of parents choosing not to immunise their children, is being reported globally.