Featured Image: A syringe returning the vaccine for animals to the test tube as a way to avoid air bubbles after a first extraction. Credit: Wellcome Collection
Written by Jordyn Austin
The importance of public health in London grew in the late 19th and 20th centuries. With this new emphasis on public health, came the Medical Officers of Health (MOH) in London and their reports on the various boroughs. Many of these reports mention the infectious disease measles in some way, usually the amount of people or children who were infected and also means of treating/preventing it. The mode of treatment once they reached the hospital was not clearly outlined in the reports from what I could find. There were, however, examples of home remedies like those mentioned in the MOH Finsbury 1910 and MOH Kensington 1898 reports. The first MOH claims that in poorer areas, mothers would attempt treating the disease. The ways in which they did this included not washing the sick children “for fear of driving the rash inwardly” (MOH for Finsbury, 69). This might have been an exaggeration and putting down of poor women, but if these treatments were put into use, we can see an example of the humoral approach to medicine. The second MOH example referred to these ladies as “every old woman” and described their measles remedy as simply drinking saffron tea (MOH for Kensington, 32).
Even today it seems that the treatment of measles consists of just helping your body get through it by means of boosting your immune system and treating symptoms. Since the treatment is not very helpful in some cases, the important substance when it comes to measles is not one that treats it but rather prevents it. Reports written a couple decades after the previously reports describe the use of a measles serum to help people obtain immunity. This serum came from patients that were in the recovery stage of the illness or those that had already gotten over it and helped prevent the disease or weaken an attack’s severity. The idea of the serum resembles that of a vaccine, and the actual initiation of the search for a vaccination against measles began in the early 1960s. The United States and United Kingdom differed due to the fact that the U.S. had an urgent approach, yet the UK chose the “randomized trial data” approach (Hendriks and Blume, 1393). An example of this UK method was seen in the MOH report for Willesden in 1964 explaining that children born in 1963 were included in a vaccine trial to help determine if this specific vaccine would be included in an immunization program.
Further trials were performed in various boroughs throughout the ends of the 1960s to determine the efficiency of the current vaccines. In 1964, the MOH for Ealing reported that 1,200 children from sixteen boroughs were given vaccines and the results showed that they were 5-8 times less likely to catch measles after the vaccination. Following the 1994/95 investigations, it was decided in 1966 the vaccinations were “effective and acceptable” which gave hope that by the next year, general practitioners would offer the vaccine at welfare centers (MOH for Hackney, 32). These results summarized in the MOH reports came from the first report of the Medical Research Council (MRC)’s trial which was published in the British Medical Journal (Public Health England). It was determined in 1967 that the acceptable method of prevention was giving the vaccine to children in their second year of life by means of one dose of killed measles virus followed by a dose of live measles virus four weeks later or solely an injection of live measles virus. The illness was best prevented by a “live, attenuated measles virus vaccine” (MOH for Barnet, 132). There was much debate of whether to use a killed or live virus in the vaccine. The disadvantages of using a live virus was that it needed to be attenuated enough to not be “reactogenic”, while the disadvantage of the killed virus was that it might not have long-term effects and if someone were to catch measles later on in life, there could be worse complications (Hendriks and Blume, 1394).
A second report on the MRC trial was published again in the British Medical Journal in 1968, coinciding with the first introduction of the measles vaccine in the UK (Public Health England). Prior to this introduction, measles vaccines were for trials. Although the vaccine was proving effective, especially more so than no prevention method at all, it underwent many trial and error before making its way to the vaccine we know today. The vaccine that was in use was suspended in March of 1969 and another strain was not introduced until the end of the year. Even if the vaccine was not as effective in preventing measles as what we use in the present, there was still evidence that suggested children would benefit from receiving the vaccine if they had “not already had an attack of the disease or been immunised against it” (MOH for Bromley, 57). The incidence of the disease in 1970 was higher than expected, such as in the borough of Hillingdon, which was surprising even without a vaccination program present. However, what I found most important in this specific MOH report was the fact that the implementation of the measles vaccine changed the “natural history of the disease” by stopping the bi-annual outbreak pattern (MOH for Hillingdon, 16). The full effects of this history change would not be seen until later on because even after the vaccination against measles was introduced in 1968, very low coverage from 1968-1980s prevented the interruption of the spread of measles (Hand).
The measles vaccine that we know and receive today, is a vaccination against the three diseases known as measles, mumps, and rubella (MMR). This vaccine was not introduced until 1988 and proved to be the turning point in the prevention of measles. With the introduction of the MMR vaccine, coverage levels reached “excess ninety percent” while the amount of transmissions and notifications decreased substantially (Hand). Although this vaccine drastically helped lower the risk of measles transmission, there were still a “pool of susceptibles” that did not allow for total elimination of outbreak risks (Public Health England). Eventually a second dose was put into the routine vaccination program at pre-school age, which further helped reduce transmission. Due to the MMR vaccine and modern medicine, we could be at a place where measles outbreaks might ideally be irradiated, but the same risk of possible outbreak exists today due to lack of vaccinations and coverage of the MMR vaccine.
Hand, Jane. “Childhood Vaccination and the NHS” People’s History of the NHS. Centre for the History of Medicine, University of Warwick, April 25, 2016.
Hendriks, Jan, and Stuart Blume. “Measles Vaccination Before the Measles-Mumps-Rubella Vaccine.” American Journal of Public Health. American Public Health Association, August 2013. 103(8): 1393–1401.
“50 Years of Measles Vaccination in the UK by Public Health England on Exposure” Public Health England. Exposure, October 15, 2018.