Measles makes a comeback

WHILE measles is a preventable disease for which a safe and cost-effective vaccine is readily available, the disease remains one of the leading causes of death among young children globally, claiming 134 200 lives in 2015, according to the World Health Organization (WHO).

Tragically, of these deaths, most are children under the age of five.“WHO has estimated that the measles vaccination prevented an estimated 20.3-million deaths internationally between the years of 2000 and 2015. This highlights the importance of using this vaccine to protect you and your family,” said Dr Anchen Laubscher of Netcare, one of South Africa’s leading private hospital chains.

Recent outbreak

Many parents might remember receiving notifications from their children’s schools about a measles outbreak earlier this year. In February this year, a local outbreak was confirmed in Stellenbosch by the Western Cape Department of Health, followed shortly by a high alert being issued by the the National Institute of Communicable Diseases (NICD) in March following an outbreak of measles in the south of Johannesburg.

A further 17 cases of measles were confirmed in Gauteng early in May. According to the Gauteng Department of Health, most of these individuals had not been vaccinated against the disease and 10 of the cases were linked to a single family who had not been vaccinated, apparently for religious reasons.

A general countrywide vaccination campaign resulted in many schools sending out permission slips to ensure all children receive the benefit of state vaccinations to prevent the type of outbreaks which have been seen in the past.

“South Africa’s last major measles outbreak occurred between 2009 and 2011 when some 18 000 cases were reported, and these recent cases are a most concerning trend,” observed Dr Laubscher.

Highly contagious

Measles, or Rubella, is a highly contagious viral disease and is one of the most dangerous of all childhood illnesses, according to Dr Laubscher. Measles causes a rash and fever and occurs mostly during winter and spring. It is generally prevalent among young children but can be contracted at any age.

“Babies younger than one year of age, malnourished individuals or people whose immune systems are compromised, are particularly at risk of developing severe complications from measles. The most mortalities occur in people under the age of five and over the age of 20,” cautioned Laubscher.

Why the comeback?

“The comeback of measles in many parts of the world can be attributed to a number of factors,” adds Laubscher. “One is that many people, particularly those in poorer countries, are not able to access adequate healthcare resources.

“This results in some babies and toddlers missing their six-month, one-year or even both vaccines. In some cases, the first dose is given at six months and the parents or caregivers simply forget the one-year follow-up dose.”

“Furthermore, some individuals today have concerns regarding the safety of vaccinations, while others have religious reasons for not vaccinating.

“There is also a great deal of conflicting and inaccurate information about vaccines, and as a result, some parents do not take their children to be vaccinated. This means that a number of people are not adequately protected against the disease.

“Parents who suspect their child may have measles should take all the necessary precautions for the sake of the child’s health and to safeguard the health of other children. The same applies to adults who suspect they may not be protected against the disease,” she says.

Proactive health authorities

“Our health authorities have been extremely proactive in combating the spread of the virus by alerting clinicians, as well as the public, countrywide as to the risk and early recognition signs of the disease,” explained Laubscher.

The recent spike in cases in Gauteng led the Department of Health to embark on a mass vaccination campaign at schools and crèches to prevent an outbreak of measles. This campaign aims to ensure that all children in schools and crèches are given a dose of the measles vaccination regardless of whether or not they were immunised as a baby.

Measles is targeted for elimination‚ which means the DoH aims to stop the spread of the disease within South Africa by 2020. Measles vaccines are provided for free within the state system and are usually given to children in a first dose at age six months and then again in a second dose at 12 months.

What to watch for

According to Laubscher, the early symptoms of measles are not dissimilar to that of a respiratory tract infection. They include high fever, a runny nose and coughing. It should be noted that at this stage the illness is already infectious.

Proper coughing hygiene where children are taught to cough into their sleeves rather than on to their hands which they then use to touch things and each other before properly washing their hands is important in helping prevent transmissions which are spread through respiratory droplets.

Once a person becomes infected it usually takes between seven to 14 days before symptoms appear. After three to four days symptoms should subside and the rash should fade. The illness becomes infectious from the onset of first symptoms until four days after the rash appears, so children who have had measles should be kept away from school and separate from others for the duration of this period.

“Measles is commonly associated with the severe rash that ensues between the first two to four days of illness. Prior to this, Koplik spots, which are small spots with white or bluish-white centres resembling grains of salt sprinkled on a red background, can be seen on the inside of the patient’s cheeks. When the rash does appear it commonly begins behind the ears and on the cheeks and then spreads to the trunk and upper extremities of the body.”

Dangerous for young children

“Anyone who is not vaccinated against measles is at risk of getting infected. Aside from the uncomfortable nature of the symptoms of the primary disease, measles poses a very real danger to especially small children and individuals with compromised immune systems, all of whom are at risk of developing serious complications,” warned Laubscer.

According to the Centre for Disease Control and Prevention (CDC), one in four patients who contract measles requires hospitalisation. Common complications include diarrhoea (1 in every 10 cases) and ear infection (1 in every 10 cases). A severe ear infection can potentially lead to permanent hearing loss, and diarrhoea to extreme dehydration, especially in those children who are malnourished.

Serious and potentially life-threatening complications of measles include pneumonia and encephalitis, a condition affecting the brain that can potentially cause permanent neurological disability. Encephalitis can persist and become a lifelong impairment.

“Not only does this highly infectious disease threaten one’s own health but also that of others. It is therefore imperative that people immunise themselves, as well as their children, if they have not already done so,” said the doctor.

Protecting your family

“It is essential that infants who are six months of age and older be protected against measles by receiving one dose of the MMR vaccine. Infants who get one dose of the MMR vaccine before their first birthday should get two more doses – one dose between 12 and 15 months of age and another dose at least 28 days later,” advised Laubscher.

“Children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days. Teenagers and adults who have not yet had the measles should get two doses of the MMR vaccine, separated by at least 28 days.”

“Vaccines cause only the occasional mild adverse reaction in some individuals. However, they also provide protection against some very dangerous diseases – measles being but one. It is vital that children and travellers get vaccinated so that they can be protected,” she said.

“Vaccines are one of the biggest public health success stories of our time. Because South African immunisation rates are high, many vaccine-preventable diseases do not have the visibility they once had, and most parents are therefore not aware of just how dangerous these diseases can be,” she said.