Berlin and Warsaw could be rocked by an aggressive outbreak of measles in the coming years, scientists fear.
Researchers claim the capital cities of Germany and Poland share similarities to the Dutch Bible Belt (DBB) in the Netherlands.
There have been large measles outbreaks almost every 12 years in the area, home to thousands of orthodox-protestants.
There are low vaccination rates in the DBB and high rates of measles in adults, which is when the infection is more dangerous.
Experts in Poland have warned low vaccination rates can also be found in Berlin and Warsaw, as well as ‘other urban places’.
Both cities, home to millions, also have high immigration levels – a risk factor because vaccination rates can be much lower among some migrant communities.
The Jagiellonian University Medical College team, led by Dr Bartosz Lisowski, warned the virus is constantly evolving to pose more of a threat.
Researchers claim the capital cities of Germany and Poland share similarities to the Dutch Bible Belt (DBB) in the Netherlands and are at risk of a measles outbreak
Writing in a journal, they warned how large-scale vaccination drives are needed to reduce the risk of humanity returning to ‘the Dark Ages’.
They said: ‘Many urban areas are like the DBB in that they have a total population of a few million and about 200 schools over which susceptible children are distributed.
‘As vaccination rates in the developed world are decreasing, the situation in the DBB is duplicated in other places.
‘In the DBB with every subsequent measles outbreak since 1988 there have been more adult patients and concurrently more hospitalizations.
‘This is a worrisome trend and it may be what is to come on a wider scale if vaccination rates keep dropping and the developed world takes a small step back towards the Dark Ages.’
The researchers added, at the same time, viruses ‘will most likely evolve to make these outbreaks larger and longer lasting’.
In Warsaw, where five per cent of the Polish population live, there is a population of around 2million and 351 small schools.
‘The anti-vaccination movement is rapidly gaining ground in Poland,’ the researchers wrote in the scientific journal Biosystems.
‘Vaccination coverage is falling at increasing speed and has recently dropped below the critical 95 per cent.’
The DBB, which stretches from which stretches 124miles (200km) in length from Middelburg in the south-west to Zwolle in the east, was struck by measles in 1988, 1999 and 2013
WHAT IS MEASLES, WHAT ARE THE SYMPTOMS AND HOW CAN YOU CATCH IT?
Measles is a highly contagious viral infection that spreads easily from an injected person by coughing, sneezing or even just breathing.
Symptoms develop between six and 19 days after infection, and include a runny nose, cough, sore eyes, a fever and a rash.
The rash appears as red and blotchy marks on the hairline that travel down over several days, turning brown and eventually fading.
Some children complain of disliking bright lights or develop white spots with red backgrounds on their tongue.
In one in 15 cases, measles can cause life-threatening complications including pneumonia, convulsions and encephalitis.
Dr Ava Easton, chief executive of the Encephalitis Society told MailOnline: ‘Measles can be very serious.
‘[It] can cause encephalitis which is inflammation of the brain.
‘Encephalitis can result in death or disability.’
Treatment focuses on staying hydrated, resting and taking painkillers, if necessary.
Measles can be prevented by receiving two vaccinations, the first at 13 months old and the second at three years and four months to five years old.
Source: Great Ormond Street Hospital
Warsaw, the capital of Poland, has similarities to the Dutch Bible Belt which could put it under threat of a measles outbreak, according to the researchers
Berlin, in Germany, had a measles outbreak in 2015 due to parents not vaccinating their children and and unvaccinated immigrants from areas like Syria and the former Yugoslavia
Dr Lisowski and colleagues estimate there are around 8,000 unvaccinated children of school age living in the Polish city, famous for its stunning architecture.
A large number of Warsaw’s foreign residents come from Ukraine, the researchers added, where vaccination rates have dropped to 50 per cent.
As an estimate, there are 10,000 additional susceptible children coming from Ukraine on top of the already 8,000 not vaccinated in Warsaw.
‘The total number of susceptibles thus comes to about 18,000,’ Dr Lisowski and colleagues added in the report.
WHEN WERE THE MEASLES OUTBREAKS IN THE BIBLE BELT AND HOW IS THE NETHERLANDS AFFECTED?
The Dutch Bible Belt has a length of about two hundred kilometers and a width of several tens of kilometers.
About 250,000 orthodox protestants are for the most part clustered in about 30 midsize towns.
The researchers worked out how many people were susceptible to measles in each outbreak:
In 1988, there were 25,000 susceptibles in the age group five to 22 years old.
Measles outbreaks of similar duration and size occurred again in 1999 and in 2013.
It is reasonable to assume that these outbreaks also started when the number of susceptibles again reached about 25,000.
The twelve years between 1988 and 2000 supplied 18,000 new susceptibles.
The remaining 7000 susceptibles must originate from before 1988 and must never have been infected during the 1988 outbreak.
The same arithmetic applies to the 2000–2013 period and the 2013 outbreak.
The Dutch health authorities campaign heavily to make parents vaccinate.
However, there are 180 orthodox-protestant primary schools and seven orthodox-protestant secondary schools, of which orthodox children are commonly made to commute long distances in order to attend.
This system mixes geographic boundaries and allows infected students to freely mix with others from a larger range of the Dutch Bible Belt.
All of the orthodox-protestant primary schools together comprise about 40,000 students.
Nowadays, it is estimated that more than 60 per cent of children from orthodox protestant households ultimately gets vaccinated.
Without outbreaks for more than a decade, it is estimated that about 30 per cent of this population is susceptible – around 12,000 unvaccinated children.
‘This number is already close to the about 25,000 susceptibles that appeared to be sufficient to trigger an outbreak in the DBB.
‘There is an obvious course of action for Warsaw and for other Polish cities if they want to ward off outbreaks of the measles.’
The experts added that ‘it is imperative that they organize a large scale effort’ to encourage people to get vaccinated.
Berlin, with a population of 3.5million, was struck by a measles outbreak in 2015, with 1,243 reported cases.
The researchers again suggested the ‘fuel’ came from children of parents who oppose vaccination.
While unvaccinated immigrants and refugees from areas such as Syria and the former Yugoslavia may also have been to blame, the experts said.
The DBB, which stretches from which stretches 124miles (200km) in length from Middelburg in the south-west to Zwolle in the east, was struck by measles in 1988, 1999 and 2013.
Schooling played a large part in the spread each time, as almost every child under the age of ten would get infected.
Of the children who didn’t get infected, they risk being caught out during the next outbreak, when they are an adult and are less able to fight the disease.
In each outbreak, the researchers calculated there were roughly 25,000 susceptible people aged between five and 22.
This is deemed as ‘more than the critical mass that is necessary to initiate an outbreak’ of measles.
Measles, a highly infectious viral illness, first presents as a fever, dry cough, runny nose, and sore throat.
It infects the respiratory tract before spreading throughout the body.
Serious complications, including blindness, encephalitis, severe diarrhoea and pneumonia. In extreme cases, measles can kill.
‘Vaccine hesitancy’, has been listed by the World Health Organization as one of the top threats to global health in 2019.
Under-vaccination has led to outbreaks of diseases not seen in years, including measles, whooping cough and mumps.
According to the World Health Organization, measles has seen a 30 percent increase in cases around the world.
Between September 2017 and August 2018, WHO reported more than 41,000 cases with 40 deaths in EU member states.
And, according to US officials, 349 cases of measles were reported in 26 states – the second greatest toll since it was considered eradicated in the US in 2000.
IS ANDREW WAKEFIELD’S DISCREDITED AUTISM RESEARCH TO BLAME FOR LOW MEASLES VACCINATION RATES?
Andrew Wakefield’s discredited autism research has long been blamed for a drop in measles vaccination rates
In 1995, gastroenterologist Andrew Wakefield published a study in The Lancet showing children who had been vaccinated against MMR were more likely to have bowel disease and autism.
He speculated that being injected with a ‘dead’ form of the measles virus via vaccination causes disruption to intestinal tissue, leading to both of the disorders.
After a 1998 paper further confirmed this finding, Wakefield said: ‘The risk of this particular syndrome [what Wakefield termed ‘autistic enterocolitis’] developing is related to the combined vaccine, the MMR, rather than the single vaccines.’
At the time, Wakefield had a patent for single measles, mumps and rubella vaccines, and was therefore accused of having a conflict of interest.
Nonetheless, MMR vaccination rates in the US and the UK plummeted, until, in 2004 the then-editor of The Lancet Dr Richard Horton described Wakefield’s research as ‘fundamentally flawed’, adding he was paid by attorneys seeking lawsuits against vaccine manufacturers.
The Lancet formally retracted Wakefield’s research paper in 2010.
Three months later, the General Medical Council banned Wakefield from practicing medicine in Britain, stating his research had shown a ‘callous disregard’ for children’s health.
On January 6 2011, The British Medical Journal published a report showing that of the 12 children included in Wakefield’s 1995 study, at most two had autistic symptoms post vaccination, rather than the eight he claimed.
At least two of the children also had developmental delays before they were vaccinated, yet Wakefield’s paper claimed they were all ‘previously normal’.
Further findings revealed none of the children had autism, non-specific colitis or symptoms within days of receiving the MMR vaccine, yet the study claimed six of the participants suffered all three.