Tuesday, 26 July 2011


Published in City Times

Preventing Measles

Measles is an acute, highly communicable viral disease which mostly affects children. Although mainly a disease of children, measles can affect all age groups. Last year in the UAE, the condition almost assumed epidemic proportions amongst young adults, between 15 and 30 years old, probably an age group that was not vaccinated, reveals Dr.Robert Erasmus, Specialist Family Medicine, Welcare Hospital, Dubai.

How is measles caused and are there certain groups of people in whom it is more rife?
Measles is caused by a virus which is contagious. Infection spreads from person to person through air and droplets while coughing or sneezing. It is a dangerous infection, especially among the malnourished children of developing countries (Africa, for instance) where it can assume fatal proportions. However, in well nourished communities, it’s a very mild disease which many children get and they feel feverish for a day or two and they don’t even notice it.
In Africa for instance, where malnutrition is rife, measles is a fatal disease. These kids, all get pneumonia and very few of them survive it.

What are the symptoms of measles and when do they start appearing?
Symptoms usually begin 8-12 days after exposure, and the rash appears about 14 days after exposure. The classical symptoms of measles is fever for four days, often associated with a rundown feeling, cough, red eyes and runny nose. Two to four days after the appearance of fever, the typical red rash develops, beginning on the face and then spreading downwards to the entire body. Once the rash appears, the fever disappears. In some people, grayish spots called Koplik spots may appear on the inside of their mouth just before the rash appears. The rashes may or may not be itchy.

What is the treatment for measles?
The treatment is symptomatic. Anti-pyretics for the fever, good hydration and isolation. In terms of a pregnant woman getting measles, it does not have any effect on the foetus and hence the foetus will not be in any kind of danger.

At what point of time does a patient of measles, becomes contagious for others?
A measles patient is infective for about 3 weeks. They can spread the disease 1-2 days before any symptoms appear or from about 3-5 days before appearance of the rash. They can continue to be contagious until 4-5 days after the rash starts.

What is the correlation between malnutrition and complications from measles?
The correlation lies in the immune system. For an effective immune system, you need an effective protein metabolism. And as soon as you get a lack of proteins, as soon as the body starts using proteins to survive and to make energy, then the antibody levels in the body drop. Since the body can resist viruses only with antibodies, once this level drops, the virus can overcome the system. Also, when you are deficient in proteins, the body is stripped of energy to defend itself against invasion by viruses. Malnutritio is usually a protein energy deficiency. So with these two factors act and reinforce each other in undermining the body’s defenses, leaving it open to secondary infections, with viruses or bacteria. So these children, apart from virus in the lungs, also get secondary bacterial pneumonia.

Are complications from measles possible in healthy children?
Measles usually clears up on its own in 7-10 days. Once you have had a case of the measles, you are almost always immune for the rest of your life. The complication arising in healthy children is extremely low. These complications could include middle ear infection, throat infection or diarrhoea. The disease can be severe, with bronchopneumonia or brain inflammation leading to death in approximately 2 out of every 1,000 cases. \

The throat infection and middle ear infection are manageable with antibiotics, yes?
I would wait at least two weeks before I would treat either infection because it is usually the virus itself that causes it. And in a healthy child, one should not embark on antibiotics too soon. In the malnourished child, it’s a different situation. But unfortunately, these populations do not have access to healthcare and antibiotics. That’s why the mortality rate is so high amongst the malnourished population.

However, WHO has an aim to eradicate measles by the year 2010, like smallpox and polio which is almost eradicated. The basis and secret of management of measles is immunization.

Is measles preventable?
Measles can be prevented with the measles vaccine which is a live attenuated one and is very effective against the disease. It’s given at the ages of 4 ½ months, 6 months and 7 ½ months, followed by a booster at about 18 months. Another booster is given just before children begin going to school. The measles vaccine contains live viruses that have been weakened. The weakened virus stimulate your immune system to build antibodies without causing the disease itself because they are not strong enough to do so. This vaccine has really reduced the prevalence of measles worldwide.

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