“The fact that measles outbreaks are occurring at the highest levels we’ve seen in a generation is unthinkable when we have a safe, cost-effective, and proven vaccine. No child should die from a vaccine-preventable disease.” – Elizabeth Cousens, President and Chief Executive Officer of the United Nations Foundation.
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Eighteen-month-old Jessie was an active, playful toddler. Then, one day, he was struck down with a high fever, severe coughing, diarrhea, vomiting and a red rash on his face and chest.
When Jessie started gasping for breath on the sixth day of his illness, his parents rushed him to a hospital. The doctor diagnosed pneumonia, a complication of measles. Although he was given intravenous fluids and antibiotics, his condition worsened. Two days after admission, Jessie died.
Sarah, the boy’s mother, later told doctors she didn’t realize that measles was life-threatening. She hadn’t had Jessie vaccinated against the disease even though she lived just over a kilometer away from a health center. “If only I had known,” she said.
With vaccines available for measles, the acute bacterial respiratory infection should have been part of history already – but such is not the case.
In fact, an increase in measles cases in the first two months of 2022 is “a worrying sign” of a heightened risk for the spread of vaccine-preventable diseases and could trigger larger outbreaks, particularly of measles, warn two United Nations agencies.
“Pandemic-related disruptions, increasing inequalities in access to vaccines, and the diversion of resources from routine immunization are leaving too many children without protection against measles and other vaccine-preventable diseases,” said the World Health Organization (WHO) and the UN Children’s Fund (UNICEF).
The risk for large outbreaks has increased as communities relax social distancing practices and other preventive measures for coronavirus disease 2019 (COVID-19) implemented during the height of the pandemic.
In addition, disruptions in routine immunization and COVID-19 vaccination services, lack of clean water and sanitation, and overcrowding increase the risk of vaccine-preventable disease outbreaks, the two UN agencies pointed out.
Around the world, almost 17,338 measles cases were reported in January and February 2022, compared to 9,665 during the first two months of 2021. “As measles is very contagious, cases tend to show up quickly when vaccination levels decline,” the two agencies explained.
Both WHO and UNICEF are concerned that outbreaks of measles could also forewarn outbreaks of other diseases that do not spread as rapidly.
“Measles is more than a dangerous and potentially deadly disease. It is also an early indication that there are gaps in our global immunization coverage, gaps vulnerable children cannot afford,” said Dr. Catherine Russell, UNICEF Executive Director.
“It is encouraging that people in many communities are beginning to feel protected enough from COVID-19 to return to more social activities,” she added. “But doing so in places where children are not receiving routine vaccination creates the perfect storm for the spread of a disease like measles.”
It must be recalled that there were measles outbreaks worldwide during 2017 to 2019. In the Western Pacific Region, the largest outbreak happened in the Philippines, where first-dose measles-containing vaccine coverage had reduced to 75% in 2018.
“Outbreak clusters were first reported in the southern island of Mindanao in September 2017, followed by the National Capital Region (NCR),” The Lancet reported. “A measles outbreak was declared in five regions, including the NCR, in February 2018. In the following weeks, outbreaks reached 17 regions.”
At the peak of the epidemic, measles care units were established to support overcrowded hospitals.
“This ward would only accommodate 50 patients,” Dr. Ferdinand de Guzman, the head of family medicine at San Lazaro Hospital in Manila, was quoted as saying by npr.org. “But at the height of the outbreak, (there were) 300 patients per ward.”
Measles was once common throughout the world. Explosive outbreaks would occur, particularly in institutional settings or military barracks. But in 1963, the measles vaccine was introduced, which greatly reduced the incidence.
Measles has often been described as “the simplest of all infectious diseases.” It is probably the most “visible” infection due to a consistent clinical picture and the fact that virtually everyone contracted it before vaccination was introduced in the early 1960s.
Also called rubeola, measles is a highly contagious viral disease. It usually affects children but can occur at any age in susceptible persons. A person who has been infected with measles becomes immune for life.
The measles virus is not the same virus that causes German measles, or rubella. “The virus is spread by droplets from the mouth or throat secretions,” explained Dr. Donald M. Vickery and Dr. James F. Fries, authors of Take Care of Yourself.
The measles virus, which remains suspended in their air for several hours, can only be killed by sunlight. It is very active during the cold months, particularly December to January.
“This is the reason there are more cases in congested urban slums,” Dr. Enrique Tayag, an epidemiologist and official of the Department of Health. “The virus spreads more easily among family members living in cramped rooms and, later, to the overcrowded community.”
Signs and symptoms of measles appear around 10 to 14 days after exposure to the virus. According to the Mayo Clinic, those who have measles will experience the following: fever, dry cough, runny nose, sore throat, and inflamed eyes. Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek may also be present. The most apparent: a skin rash made up of large, flat blotches that often flow into one another.
“A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days,” the Mayo Clinic explains.
The US Centers for Disease Control and Prevention (CDC) says complications of measles may include ear infection (occur in about one of every 10 children with measles and can result in permanent hearing loss), bronchitis, laryngitis, and diarrhea (reported in less than one out of 10 people with measles).
Many of these complicating infections are due to bacteria and will require antibiotic treatment. Pneumonia, an infection that inflames the air sacs in one or both lungs, can be life-threatening. “The air sacs may fill with fluid or pus causing cough with phlegm or pus, fever, chills, and difficulty breathing,” the Mayo Clinic says.
The CDC says that as many as one out of every 20 children with measles get pneumonia, the most common cause of death from measles in young children. “The Philippines is one of the 15 countries that together account for 75% of childhood pneumonia cases worldwide,” the WHO reports. “In children under 5 years, pneumonia is the leading cause of mortality.”
A very serious problem that can lead to permanent damage is measles encephalitis (infection of the brain). Life-support measures and treatment of seizures may be necessary when this rare complication occurs.
A long-term but very rare complication is the subacute sclerosing panencephalitis (SSPE). “This fatal disease of the central nervous system results from a measles virus infection acquired earlier in life,” CDC says. “SSPE generally develops 7 to 10 years after a person has measles, even though the person seems to have fully recovered from the illness.”
Women who are pregnant are advised to take special care to avoid contracting measles “because the disease can cause preterm labor, low birth weight and maternal death,” Mayo Clinic pinpoints.
Even in countries with good health services, measles can be very serious, particularly in young children, according to Dr. Peter Strebel from the Department of Immunization, Vaccines and Biologicals at the WHO.
“Measles still causes an estimated 197, 000 deaths each year around the world, the majority of them children under the age of five. Parents and doctors need to be reminded that measles is a highly contagious disease,” he said
Symptomatic measures are all that is needed for uncomplicated measles, according to Dr. Vickery and Fries. Acetaminophen, aspirin or paracetamol should be used to keep the fever down, and a vaporizer can be used for the cough.
Dim lighting in the room is often more comfortable because of the eyes’ sensitivity to light. In general, the person feels “measley.” The patient should be isolated until the end of the contagious period.
Dr. Tayag said the patient can be nursed at home but must be continuously monitored. If this is not possible, it is recommended that the patient be taken to a hospital.
The widely-read Where There Is No Doctor shares the following home treatment:
* The child should stay in bed, drink lots of liquids and be given nutritious food. If he cannot swallow solid food, give him liquids like soup. If a baby cannot be breastfed, give breast milk in a spoon.
* If possible, give vitamin A to prevent eye damage.
* If earache develops, give an antibiotic.
* If signs of pneumonia, meningitis or severe pain in the ear or stomach develop, get medical help.
Although highly contagious, measles is a preventable disease. This can be done by immunizing 90% of the community against it.
In order for the measles outbreak that happened in 2019 won’t happen again, the city government of Davao City conducted a roll out of city-wide measles immunization. Members and volunteers of the City Health Office (CHO) conducted immunization activity in fixed posts like barangay health centers, health stations, nutrition posts and temporary posts such as covered courts (instead of the previous house-to-house strategy).
“This is to ensure the proper screening and precautionary safety protocols since the measles vaccination is administered through injection, not drops. There must be proper immunization sites,” said Dr. Julinda Acosta, CHO technical division head.
Parents should not be afraid of having their children vaccinated. Vaccines may not be perfect, but they are highly effective.
“Normally, vaccines are at least 80% effective – that is, eight out of 10 children vaccinated will develop antibodies against the infection and be protected,” says Dr. C. John Clemens, former WHO medical officer.
Although no medical intervention is 100% safe, the risk of serious side effects from vaccines, such as severe allergic reactions, is low.
“Any vaccine can cause side effects,” the Mayo Clinic points out. “Usually, these side effects are minor — low-grade fever, fussiness and soreness at the injection site. Some vaccines cause a temporary headache, fatigue or loss of appetite.
“Rarely, a child might experience a severe allergic reaction or a neurological side effect, such as a seizure. Although these rare side effects are a concern, the risk of a vaccine causing serious harm or death is extremely small. The benefits of getting a vaccine are much greater than the possible side effects for almost all children,” it adds.
