• Linda Von Zeuner

Measles, or in the words of Roald Dahl, "A dangerous illness"







I read an interesting article from the New York times the other day (well, actually my dad sent it to me!) about how Measles rates are soaring this year as a result of decreasing vaccinations. Measles deaths worldwide rose to their highest level in 23 years which is an astounding rise for a vaccine preventable disease and and that could grow as the corona virus pandemic continues to disrupt immunization.


Recently there has been a few new Measles cases reported (probably some more unreported as well) in South Africa which is most likely attributed to failure to attend clinics for vaccinations due to lockdown.





The global death tally for 2019 (207500) was 50% higher than just three years ago- and take note, that is for 2019, not even 2020 when Covid-19 even disrupted immunizations further.


Public health experts are of opinion that the soaring numbers are the consequent of years of insufficient vaccination coverage. The great worry however is that the pandemic will exacerbate the spread of measles, which is even more contagious than Covid -19.



So, why are all the health care workers going on and on about measles?







  • Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.

  • In 2015, there were 134 200 measles deaths globally – about 367 deaths every day or 15 deaths every hour.

  • Measles vaccination resulted in a 79% drop in measles deaths between 2000 and 2015 worldwide.

  • In 2015, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000.

  • During 2000-2015, measles vaccination prevented an estimated 20.3 million deaths making measles vaccine one of the best buys in public health.

  • Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.




The disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 134 200 people died from measles in 2015 – mostly children under the age of 5.

Accelerated immunization activities have had a major impact on reducing measles deaths. During 2000-2015, measles vaccination prevented an estimated 20.3 million deaths. Global measles deaths have decreased by 79% from an estimated 651 600 in 2000* to 134 200 in 2015.


SO,

What exactly is measles? And why do people fear it so? I mean, it is kind of just a rash and a cold, right?


Measles is an acute highly contagious virus caused by Rubeola virus.



The case definition of measles consists of:


Fever and typical rash (we call it maculopapular which essentially means red and raised) WITH

o COUGHING

o A RUNNY NOSE

o CONJUNCTIVITS (red eyes)




The incubation period is 8- 14 days from exposure to first symptoms.


The natural progression normally takes place in the following order:


1. Prodromal phase (3-5 days) : Fever, runny nose, a cough and conjunctivitis

2. Koplik spots (white lesions in the mouth) with a typical red rash 3-5 days later

3. Fading of rash after three days

4. If a fever is still present when the rash starts fading complications are to be expected.



Complications include:


• Pneumonia

• Croup

• Stomatitis (mouth ulcers)

• Feeding difficulties

• Diarrhoea and dehydration

• Otitis media

• Corneal ulceration and blindness

• Encephalitis

• SSPE (subacute sclerosing panencephalitis)


SSPE is is a rare complication of measles with progressive brain inflammation that may only present 10- 20 years after being infected with Measles. The condition primarily affects children, teens, and young adults. No cure for SSPE exists, and the condition is almost always fatal and very devastating. SSPE is NOT caused by vaccine strains


Treatment is supportive, and consists of strict isolation ,high dosages of Vitamin A to prevent corneal ulceration, and the rest of the complications are treated in an appropriate fashion eg antibiotics for secondary infection, pain relief for oral ulcers, rehydration for diarrhoea, nebulisation for croup etc.


If you are immunised, you are protected from measles. If you are unimmunised, older than 6 months and it is less than 72 hours after exposure you can still be immunised.

If you are unimmunised and it is 3-6 days after exposure or you are less than 6 months old you can receive a Measles immunoglobulin which is not the same as a vaccine but I will not bore you with the details.






A little bit about the history of measles


The first cases of measles are written about as early as the 11th and 12th centuries when the measles virus diverged from the Rhinderpest virus (cattle measles that has been eradicated by vaccination). The first accounts of it was in the Middle Eastern countries and invaders and explorers from America bought it back to the USA with them.


It became a notifiable disease in 1912 requiring all health care workers to report measles cases. It is estimated 3 to 4 million people in the United States were infected each year before the development of the vaccine. Also each year, among reported cases, an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain) from measles. Despite the improvement in sanitation and hygiene, measles cases did not decrease until a vaccine was developed for the first time in 1963.

There is not much data available from Africa and other developing countries with regards to measles death rate unfortunately before the vaccine. One can only assume that it was much worse than the USA.







A fraudulent study was produced in 1998 by Andrew Wakefield (who since lost his medical license) who claimed that the MMR vaccine causes autism. Despite numerous studies proving him wrong,,including a large Danish study recently on over half a million children, it still acted as a catalyst for the anti vaccination movement.




So, to conclude.


Measles is devastating, highly contagious and DEADLY. It can however be easily eradicated with a well coordinated approach between health facilities and parents. The vaccine gives life long immunity and if we were to vaccinate everyone, it would mean that we can wipe measles off the face off the earth.

Instead, we are seeing numbers surging (in fact, the highest we have had in 23 years) as more parents are choosing not to immunise their children, decisions based on misinformation that is being spread through the internet with no solid evidence to base it upon.



This is a quote written by Roald Dahl, urging parents to immunise after his daughter died of Measles when she was 7 years old.



Measles: A Dangerous Illness



Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn't do anything.
"Are you feeling all right?" I asked her.
"I feel all sleepy," she said.
In an hour, she was unconscious. In twelve hours she was dead.
The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.
On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.
It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunised are putting the lives of those children at risk. In America, where measles immunisation is compulsory, measles like smallpox, has been virtually wiped out.
Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunised, we still have a hundred thousand cases of measles every year. Out of those, more than 10,000 will suffer side effects of one kind or another. At least 10,000 will develop ear or chest infections. About 20 will die.
LET THAT SINK IN.
Every year around 20 children will die in Britain from measles.
So what about the risks that your children will run from being immunised?
They are almost non-existent. Listen to this. In a district of around 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunisation! That is about a million to one chance. I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation.
So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunised.
The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunisation should beg their parents to arrange for them to have one as soon as possible.
Incidentally, I dedicated two of my books to Olivia, the first was 'James and the Giant Peach'. That was when she was still alive. The second was 'The BFG', dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children.


References

al, W. e. (2017). Standard treatment guidelines and Essential medicine list for South Africa. National Department of Health.

CDC. (n.d.). Retrieved from History of measles: https://www.cdc.gov/measles/about/history.html#:~:text=In%20the%209th%20century%2C%20a,in%20the%20blood%20of%20patients.

History of Vaccines. (n.d.). Retrieved from Brief history of vaccines: https://www.historyofvaccines.org/content/blog/brief-history-measles

Kibel, M. (n.d.). Child health for all. Oxford.

Wittenberg, D. (2009). Coovadia's Paediatrics and child health.

World Health organisation. (n.d.). Retrieved from Health topics: Measles: https://www.afro.who.int/health-topics/measles


All images purchased via Shutterstock, freely available on Wix, the WHO and Medscape.


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