Milan, 26 August 2024 – “Hi, I’m calling from ATS from Milan, were you on such and such a flight from Paris?” The phone call comes unexpectedly one morning in August, to inform the traveler that on his own plane there was a person with measles, ask him if he has had it or if he is vaccinated and, if not, suggest an appointment to get vaccinated for free the next day. A quick consultation with the mother and vaccination booklet follows: the passenger is younghe had the trivalent Mpr (measles, mumps, rubella) as a child, no problem. Scenes from a post-pandemic world in which infectious diseases are traced, to the extent possible. Imagine the most contagious of all, an old acquaintance that is transmitted by air and whose R0 between 12 and 18 – that is, a sick person can infect up to 18 people – the coronavirus has only come close to with the post-Omicron variants (the basic version of 2020 reached a reproduction number of 3).
The tracking
For a non-immunized person through the vaccine or for having had measles “being even not very close to a contagious individual without protection represents a risk of contracting this virus – explains Marino Faccini, director of the Department of Hygiene and Health Prevention of the Metropolitan Health Protection Agency -. For this reason it is always carried out the tracing of “flight contacts”, with communication to the ministry and the proposal, in the event of exposure of a person who is not certain of being already immunized, to get vaccinated as soon as possible with a preferential lane”.
Recovery after the pandemic
Measles is one of the infectious diseases that have raised their heads after the pandemic break, when isolation, closed schools and masks caused the circulation of viruses and bacteria to collapse: the Ats Metropolitana report on the first six months of 2024 records 52 cases between the provinces of Milan and Lodi, more than ten times the five that had been recorded in all of 2023; the same number (five) in 2022 and 2021, in 2020 there had been ten. Since the beginning of the year, measles has started running again at a speed that is once again approaching, although not equaling, that of 2019, the “epidemic year” in which 190 sick people were counted between the metropolitan city and the Lodi area.
The post-pandemic rebound also involved other infectious diseases monitored in the report. Not all of them: chickenpox, which between Milan and Lodi had affected 5,457 people in 2019 to progressively plummet to 769 cases in 2020, 150 in 2021 and 168 in 2022, with 158 infections in six months is about to remain in line with the 330 discovered in 2023. But here, underlines Dr. Faccini, there is the hand of the vaccine, mandatory for newborns from 2017 onwards and added to the Mpr, now Mprv, which is administered between 12 and 15 months with a booster at 5-6 years “and has led to a strong reduction in the disease”.
On the contrary, scarlet fever, pathology of bacterial origin (it is caused by group A beta-haemolytic streptococcus) for which there is no vaccine, It started again in a big way last year already and with 2,687 infections from January to June 2024 it could exceed the 4,871 total cases of 2023; which were already twenty or even forty times those of the pandemic years (371 in 2020, 103 in 2021 and 264 in 2022), but also almost triple the 1,681 of 2019. “The reduced circulation of the pathogen due to the restrictions has meant that many children have not had it – explains the expert -. So now it is spreading more”.
The risk for adults
The measles anomaly, with respect to scarlet fever which “mainly affects children under ten years of age”, is that “the vast majority of those who get sick are adults. The average age of our infected is 32 years, the age group with the highest number of cases is that of thirty-forty year olds, together with children under one year of age who cannot yet be vaccinated”. Paradoxically, it is the parents, or in any case the adults who infect them, unlike what usually happens with “childhood” diseases. The “big ones”, like newborns and infants, “they are also the age groups most affected by complications of measles such as pneumonia, hepatitis, encephalitis – clarifies the director of Prevention of the ATS -. At least a third of adults who contract it end up hospitalized”.
The Middle Generation
At the base of the surge there is a measles generation gap in immunization of the population, which however, Faccini underlines, is not due to a recent collapse in childhood vaccinations, nor to the after-effects of the one of about ten years ago, caused by the global hoax about a correlation with autism on which many charlatans and some doctors, some of whom were later struck off, profited. “That crisis has been overcome with the introduction of compulsory school vaccination in 2017 – explains Faccini –. Today, coverage among children exceeds 95%it is very high even among young people up to twenty years old. Between twenty and thirty it progressively drops to 70%; among thirty and forty year olds it is low, because the vaccine was introduced in Italy in the 1980s but at the beginning very few people did it”. At the same time these generations They lived in a world where measles circulated less, thanks to the vaccination coverage of the later ones and the natural immunization of the previous ones who contracted it as children (with the associated risks, at the time infant mortality was much higher); and today discoveries are being made.
The vaccine offer
Even knowing if you are immune it is not a given: “It is difficult for a thirty-forty year old to have access to his vaccination record, and memories, even those of his parents, are not always reliable – observes Faccini –. When in doubt, it is better to get vaccinated: it’s free, just go to a vaccination center without needing a prescription”. Statistically today an adult Milanese should fear measles more than monkeypox, which “here is very marginal: so far we have only had cases of type 2 at “extended” sexual transmission (skin contact, ndr), none serious. The unknown concerns a possible arrival of clade 1, but we have no certainty about its different transmissibility or mortality. At the moment measles worries us much more than monkeypox.”