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http://www.nytimes.com/2003/02/08/international/08IRIS.html?tntemail0

As Vaccination Rates Decline in Ireland, Cases of Measles Soar

By BRIAN LAVERY

UBLIN, Feb. 7 — When a British scientist published research five years ago suggesting a link between autism and a common childhood measles vaccine, the news caused a wave of fear among parents and a steep decline in vaccination rates.

Subsequent studies debunked his findings, and British health authorities worked hard to make sure that more than 90 percent of children 12 to 15 months old were vaccinated each year.

Prime Minister Tony Blair even turned the vaccination of his son into a news media event.

Across the Irish Sea, however, public health officials blame latent fears about the M.M.R. vaccine — for measles, mumps and rubella — for a measles outbreak. The vaccination rate has fallen to 63 percent in parts of Dublin and 72 percent nationally; the internationally accepted level for controlling the disease is 95 percent.

Over six weeks in December and January, the National Disease Surveillance Center recorded 100 cases of measles. It typically sees about 30. Its director, Dr. Darina O'Flanagan, issued a national advisory and sought a meeting with the government health minister to revise immunization strategies. Now, two weeks later, 100 more cases have been recorded.

"I'm seriously worried," Dr. O'Flanagan said in a telephone interview. Ireland has "topped the list" of European countries with measles outbreaks in recent years, and "it's not an enviable position to be in," she said.

But some Irish doctors say low immunization levels here are a chronic problem, citing overworked health workers and an outdated system that makes it hard to track children who need vaccinations.

"It goes back generations; we've always had an appalling vaccination rate in Ireland," said Dr. Maurice Gueret, a general practitioner in Dublin. The widely publicized fear that the M.M.R. vaccine causes autism is "a convenient way for the health authorities to let themselves off for the fact that we're very, very bad about vaccinating our children," he said.

A measles epidemic last struck Ireland in 2000, when 1,603 children were infected, 350 were hospitalized and 3 died. The disease has been all but eliminated in the United States, where only a handful of cases are reported each year, and those usually are sick people coming into the country.

Dr. O'Flanagan met with Micheal Martin, the health minister, on Thursday to discuss the possible use of American and Australian strategies, like mandatory immunizations for children before they can attend elementary school, and increased welfare benefits for low-income families when their children are vaccinated.

Officials called for increased education to overcome apathy and public skepticism about official health services, said Dr. James Reilly, chairman of the Irish Medical Organization's committee for general practitioners. High-profile scandals, like one involving blood products contaminated with H.I.V. and hepatitis C, have tarnished the health service's reputation in recent years.

Another part of the problem is that Ireland's regional public health bodies are large, unwieldy organizations that are also responsible for a range of social services that deflect resources from purely medical issues like immunizations. Vaccination records are largely kept on paper, and regions with computerized systems are incompatible with one another, making it difficult to follow unvaccinated children when their families move.

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.