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Making Sense of ... Measles

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Measles

What is measles?

Measles is a highly contagious disease caused by the Morbillivirus.

Where is measles usually found?

Measles appears in every country; though its incidence has been limited by a vaccination program

How common is measles?

Measles is now rare in the industrialized world, but it remains endemic in many developing countries. More than 20 million people per year are catch measles.

How is measles transmitted?

Measles is a highly communicable illness, transmitted by direct contact with infectious droplets or by airborne spread. The incubation period of measles from exposure to rash onset is generally 14 days (range 7-18).

Patients are usually contagious from 4 days before until 4 days after the onset of the rash.

Is there a genetic / familial / hereditary factor?

There is evidence that the risk re-infection has a familial component, some people failing to build an immunity to the disease.

Who is most at risk from measles?

  • Those who have not been exposed to the disease (children in endemic areas)
  • Those who have not been vaccinated.

Vitamin A deficiency is an added risk factor for malnourished people in endemic areas.

What are the symptoms of measles?

Almost all non-immune children contract measles following exposure to the virus (day 0).

A high fever is the first sign of disease onset (day10 to 12). The fever may last for anything from one to seven days. The fever may be accompanied by cough, a runny nose, irritation of the eyes and white spots on inside of the cheeks.

On or about day 14, a rash appears on the face and upper neck. The rash spreads, reaching the hands and feet after two to three days. The measles rash lasts for five to six days before gradually fading. The rash occurs, on average, at day 14 after exposure to the virus, with a range of seven to 18 days.

Abdominal symptoms, including nausea and vomiting, abdominal pain and diarrhoea can occur.

Symptoms usually last for about 14 days, and affected children should stay away from school for five days after the onset of the rash.

What are the complications and long term effects of measles?

Potential complications can be fatal, even in otherwise healthy children.

Possible complications include otitis media, pneumonia, hepatitis and conjunctivitis.

Encephalitis can develop a few days after the rash has appeared (risk: about 1 in 5000), and can leave residual brain damage in up to 25% of cases.

Subacute sclerosing panencephalitis (SSPE) may develop many years after measles. It is eventually fatal, but very rare, (fewer than 1 in 100,000).

Measles infection during pregnancy is not associated with congenital malformations. But there is a higher incidence of spontaneous abortion and premature delivery, and the mother is risk for serious complications such as pneumonia and encephalitis.

What is the mortality rate for measles?

Up to a quarter of a million deaths occur are estimated to occur each year due to measles, though statistics are unreliable, as most are in the poorest nations, where access to immunization is lacking or limited. In 2006, the distribution has been approximated as follows:

Africa36,000 
Americas< 1000 
Eastern Mediterranean23,000 
Europe< 1000 
South-East Asia 178,000 
Western Pacific5,000 

How is measles diagnosed?

Measles is usually diagnosed from the combination of symptoms; the characteristic rash and the spots inside the mouth. Laboratory confirmation can be made by a blood or saliva test.

Is there a treatment for measles?

There is no specific treatment for measles, but general measures, such as drinking plenty of fluids, and resting are usually advised, plus specific measures for syptoms as they arise.

Is there a way to prevent infection?

Vaccination is the only effective prevention.

There is a very effective - and inexpensive - vaccine against measles.

What is the protocol for measles vaccination?

The WHO and UNICEF have an ambitious program aimed to reduce the incidence and mortality rates of measles. The program is based on four principles;

  1. Routine immunization services should reach at least 90% of children every year, everywhere (at the age of nine months or shortly afterwards).
  2. A 'second opportunity' is provided to all who failed to receive a previous dose of measles vaccine, as well as in those who were vaccinated but failed to develop immunity (up to 15% of children vaccinated at nine months).
  3. Measles surveillance includes blood testing from suspected cases; prompt recognition of measles outbreaks is essential to assure an effective response.
  4. Improved clinical management of measles, including vitamin A supplements and effective treatment of complications.

Are there adverse reactions to the measles vaccine?

A 'normal' side effect of the measles vaccine is a rash, occuring 7-10 days after immunization; allergic reactions can oocur, usually related to the use of chicken eggs (or similar protiens) as part of the manufacturing process. Allergy to the vaccination itself is very rare.

In many countries measles vaccine is delivered as part of a combination, which has been challenged on theoretical grounds, but with little substantive evidence. One persistent allegation is an increase in the incidence of autism among those vaccinated. At the time of writing, no firm evidence has been found to support this, though much of the evidence against it is based on manipulation of statistics to support nation immunization programs; so the main casualty of the 'campaign' has been science itself, prostituted for political ends.

The 'triple vaccine' has been challenged on side effect issues, civil liberties and religious grounds, leading to a drop in the take-up rate, and a subsequent increase in the incidence of the disease where it had been eradicated, including substantial areas of Europe.

In summary, the vaccine itself is unchallenged.

There is a broad consensus that vaccine combinations are safe, but this is not universally accepted, with opponents basing their criticism on a theoretical 'immune system overload'. Most of the evidence on both sides is poor research, and /or open to interpretation, and / or its independence is in severe doubt.

There is absolutely no doubt of political interference, for example, UK parents seeking the single vaccine finding a series of ludicrous obtacles placed before them. This does not, of course, prove anything about the vaccine itself, merely the stupidity and inflexibility of politicians.

Can measles be controlled environmentally?

A comprehensive immunization program is probably the only effective way to manage this disease; isolation is largely futile, as the disease will almost certainly have been passed on to any non-immunised children before the disease shows in an infected person.

What can be learned from history?

Measles has been described for over a thousand years, with its effects, mortality risks, and the risk of horrendous after effects being well understood.Since the 1960s, when vaccination began to have widespread benefit, the disease and its effects have become vanishingly rare in many countries, and personal experience of the horror has been largely confined to poorer nations. One of the luxuries of living n a wealthy country is the ability to place civil liberties above health risks, and the return of measles, albeit in fairly low numbers, is a direct result.

Eradication of the dsease is still possible, but made more difficult by those who seek to preserve the right to catch it. And pass it on.

Bibliography and Further Information Sources

If your question has not been answered, email me at the address below, and I'll try to get the information you seek.

If this article hasn't answered your question, email me at the address below, and I'll try to get the information you seek. I regret I cannot assist with individual cases or essays and school projects, but if it's something I've missed, I'll be happy to try and help.

Article written by Andrew Heenan BA (Hons), RGN, RMN

 

First Published: 23 May 2008
Last updated: 25 April 2011
© Andrew Heenan 2008 et seq
 

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