BERLIN — An 18-month-old boy has died of measles in Berlin, the first known death in an outbreak of the disease that has seen more than 570 cases in the German capital since October.
An autopsy on the child, who died on Feb. 18 and wasn’t immunized against measles, showed he had an unspecified medical condition, but it wouldn’t have led to his death without the measles infection, the Charite hospital said Tuesday.
Authorities believe the outbreak began with a child asylum-seeker from Bosnia and spread to the wider population partly because many older adults in Germany were never immunized and many younger adults received only one vaccine instead of two, as is now recommended for full protection. About half of those infected were adults, officials said.
Although it’s rare for measles to be fatal in developed countries, the disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine.
The virus kills up to 10 percent of children infected in developing countries that have high levels of malnutrition and poor health care. Approximately 145,700 people died from measles in 2013, mostly children under the age of 5, according to the World Health Organization. Most measles deaths are caused by complications associated with the disease.
Measles is highly contagious and health officials say more than 95 percent of a population needs to be vaccinated to prevent outbreaks. Vaccination rates across Europe fell after a now-discredited study that suggested a link between autism and the vaccine for measles, mumps and rubella.
Health officials recommend immunization in children at 12 to 15 months of age, followed by a second dose for full protection. The second shot can be given either one month later or before the child starts school, at 4 to 6 years old, according to the Centers for Disease Control in the United States, which adopted the two-dose protocol in 1989.
“There’s a misconception that measles does not kill in developed countries, but it unfortunately still happens,” said Dr. David Elliman, an immunization expert at Britain’s Royal College of Paediatrics and Child Health, citing similar deaths in the U.K. in recent years, mostly among people with other health problems, like asthma.
Elliman said measles kills about 1 in every 1,000 people in developed countries and that the death in Germany wasn’t entirely unexpected given the size of the outbreak.
Berlin last had a major measles outbreak, with 493 cases, in 2013.
Germany’s health minister, Hermann Groehe, called Monday for increased efforts to ensure children are vaccinated and said that if that fails, authorities might consider making immunizations mandatory, though he said that isn’t currently on the agenda.
Groehe has criticized the “irrational scaremongering” of some vaccination opponents, though local officials say many of those infected in Berlin appear to simply have been unaware of the risk rather than opposed to vaccination.
Other experts were unconvinced a mandatory vaccination policy would work.
“That could end up backfiring on you, if people are absolutely opposed to getting the vaccine,” said Adam Finn, a professor of pediatrics at Britain’s University of Bristol, who said the idea of compelling parents to vaccinate their children was controversial.
“Everyone is agreed that getting the vaccine is the best way to stop outbreaks, but how we get people to do that is another story,” he said. “I’m not sure making vaccination mandatory is the solution.”
Finn said the relatively large number of adults infected in the current outbreak in Berlin exposes problems in previous immunization programs. A 2013 study found vaccination rates among young adults 18-29 of around 80 percent, while less than 4 percent of people ages 60-64 were vaccinated.
The measles vaccine was only developed about 50 years ago, which would explain why many older adults weren’t immunized. Germany has had a nationwide recommendation of a two-shot regimen only since 1991, so many younger adults may not have received the second dose.
By contrast, vaccination rates are high for young children. The Robert Koch Institute, Germany’s equivalent of the Centers for Disease Control, says that 97 percent of children had received one measles shot and 92 percent the full two doses by about age 7 in 2012, the last year for which figures are available. A decade earlier, only around a third of children had received a second shot.
The German outbreak coincides with smaller ones in the United States tied to Disneyland in California and an Illinois day care center, which led to less than 150 cases in all. Officials say at least two cases in Berlin have been linked to the U.S. — one who developed symptoms there before traveling to Germany and another who developed the infection after returning.
A Berlin high school was closed Monday because a student had measles, but reopened Tuesday. Officials checked students’ and teachers’ vaccination records and a local health official, Sibyll Klotz, said five students who couldn’t show they were properly vaccinated were sent home, the DPA news agency reported.
