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:
| Africa | 36,000 | |
| Americas | < 1000 | |
| Eastern Mediterranean | 23,000 | |
| Europe | < 1000 | |
| South-East Asia | 178,000 | |
| Western Pacific | 5,000 | | 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; - Routine immunization services should
reach at least 90% of children every year, everywhere (at the age of nine months
or shortly afterwards).
- 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).
- Measles surveillance includes blood testing from suspected
cases; prompt recognition of measles outbreaks is essential to assure an effective
response.
- 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.
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
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