Measles is a very contagious and serious disease caused by a virus.
In 1980, before widespread use of the vaccine, measles caused about 2.6 million deaths a year. Globally it remains a leading cause of death in young children, despite the fact that there is a safe and effective vaccine. It is estimated that in 2015 134,200 people died because of this cause, the majority of them under 5 years.
Recently anti-vaccine activists spark the worst measles outbreak in decades in the United States. These activists repeatedly invited Andrew Wakefield, the founder of the modern anti-vaccine movement, to talk to worried parents about of his now discredited theory that the MMR vaccine triggers autism.
Measles is caused by a virus of the paramyxovirus family and is usually transmitted through direct contact and air. The virus infects the respiratory tract and spreads to the rest of the body. It is a human disease that does not affect animals. The intensification of vaccination activities has played a decisive role in reducing measles deaths. It is estimated that between 2000 and 2015 the measles vaccine prevented 20.3 million deaths. Worldwide, measles deaths have fallen by 79 per cent, from 651,600 in 2000 to 134,200 in 2015.
Clinical manifestations
The first sign of measles is usually high fever, which begins about 10 to 12 days after exposure to the virus and lasts between 4 and 7 days. In the initial phase, the patient may present rhinorrhea, cough, watery, red eyes, and small white patches on the inner face of the cheeks.
After several days, a rash appears, usually on the face and upper neck, which extends in about 3 days, eventually affecting the hands and feet. The rash lasts 5 to 6 days, and then fades. The interval between exposure to the virus and the occurrence of rash ranges from 7 to 18 days (mean of 14 days).
Most deaths are due to complications of measles, which are more common in children under 5 and adults over 20 years of age. The most serious are blindness, encephalitis (infection accompanied by cerebral edema), severe diarrhea (which can lead to dehydration), ear infections and serious respiratory infections such as pneumonia. Serious cases are especially common in malnourished young children, especially those who do not receive enough vitamin A or whose immune system is weakened by HIV / AIDS or other diseases.
In populations with high levels of malnutrition and lack of adequate health care, measles can kill 10% of cases. The infection can also cause serious complications in pregnant women and even because of abortion or premature birth. Those who recover from measles become immune for life.
Populations at risk
Unvaccinated small children are at highest risk for measles and its complications, including death. Pregnant women without vaccination also constitute an important risk group. However, anyone who is not immunized (that is, who has not been vaccinated and has not suffered the disease) can become infected.
Measles outbreaks can be especially deadly in countries experiencing natural disasters or conflict, or recovering from them. Damage to health infrastructure and health services disrupts routine immunization, and overcrowding in refugee and internally displaced person camps greatly increase the risk of infection.
Transmission
The measles virus is very contagious and is spread by coughing and sneezing, intimate personal contact or direct contact with infected nasal or pharyngeal secretions. The virus present in the air or on infected surfaces remains active and contagious for periods up to 2 hours, and can be transmitted by an infected inidual from 4 days before to 4 days after the onset of the rash.
Treatment
There is no specific antiviral treatment against measles virus. Severe complications of measles can be avoided with supportive treatment to ensure good nutrition, adequate fluid intake and treatment of dehydration with WHO recommended oral rehydration solutions (to replenish fluids and other essential lose with diarrhea or vomiting). Antibiotics should be prescribed to treat pneumonia and infections of the ears and eyes.
All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements with a 24-hour interval between the two. This treatment is effective in restoring vitamin A levels, which during illness are usually low even in well nourished children, and can help prevent eye injuries and blindness. In addition, vitamin A supplements have been shown to reduce measles mortality by 50%.
Prevention
Systematic vaccination of children against measles, combined with mass immunization campaigns in countries with high incidence and mortality are key public health strategies to reduce global measles mortality. The measles vaccine, which has been used for more than 50 years, is safe, effective and cheap. Immunizing a child against measles costs approximately less than US $ 1.
The measles vaccine is usually combined with rubella and/or mumps vaccines in countries where these diseases are a problem. Its efficacy is similar whether administered alone or combined with these vaccines. Adding rubella vaccine to the measles vaccine is only a small increase in cost and allows sharing of vaccination and administration costs.
By 2015, approximately 85 per cent of the world’s child population received a dose of measles vaccine before the age of one year of life through regular health services. In 2000, that percentage was 73%. To guarantee immunity and prevent possible outbreaks, two doses of the vaccine are recommended, as approximately 15% of children do not gain immunity with the first dose.
Global Strategic Plan against Measles and Rubella 2012-2020
In 2012 the Measles and Rubella Initiative (ISR) presented a new Global Strategic Plan against Measles and Rubella for the period 2012-2020. The plan defines clear strategies for country immunization managers, in collaboration with national and international partners, to achieve the control and elimination targets for both diseases by 2015 and 2020.
The objectives of the plan by the end of 2015 are:
- Reduce global measles deaths by 95% or more, compared to 2000 figures.
- Achieve regional goals for the elimination of measles and congenital rubella syndrome.
- The target for the end of 2020 is:
- Achieve the elimination of measles and rubella in at least five WHO regions.
- Protect your family, your children!!!
Dr. Oscar Uribe
OCC Health Care
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