We separate myth from truth and explore how best to prevent and treat measles. By Sister Burgie Ireland
When it comes to measles also called rubeola, babies, children and pregnant women are most at risk. This is due to the complications. Babies who get rubeola can be left with permanent, life-debilitating complications such as blindness or brain damage. The rubeola virus also wipes out all previously developed immunity leaving babies and young children vulnerable to life-threatening infections like pneumonia. A pregnant woman who is infected with the virus risks passing it on to her unborn baby, having a miscarriage or stillbirth. Babies can be born with congenital measles and its complications.
Doctor Melinda Suchard, who heads the Centre for Vaccines and Immunology at the National Institute for Communicable Diseases, calls rubeola “one of the most infectious diseases known to mankind.
“It has been with us since at least the 7th century and despite effective global immunisation programmes, outbreaks still occur – especially in Africa,” she explains.
The measles virus, a paramyxovirus, spreads quickly because it’s carried in the air and inhaled by victims – especially when large groups of people gather in places like shopping malls and concerts. The risk of a measles outbreak is higher when children go to play school or crèche. This risk can be reduced, or avoided, when large groups are vaccinated. This is called ‘herd immunity’ and the National Department of Health has spent a big bite of its budget on the Expanded Programme on Immunisation (EPI) over the last few years. The objective of the programme is to eliminate measles by 2020.
Why is measles such a dangerous disease?
Although rubeola is an unpleasant childhood illness, it’s not usually serious. It’s the complications of this disease you need to worry about. Although serious complications are rare, every child who has had the virus will have compromised immunity for at least the next two years. This vulnerability to other infections is where the danger lies. A cough could develop into bronchitis with chronic bronchiectasis or pneumonia and permanent lung damage. The common cold could become otitis media, encephalitis or meningitis risking permanent brain damage. When babies and children have compromised immune systems caused by other infections or even by poverty and poor nutrition, their risks of infection complications worsen.
What should you do if you are exposed to the virus?
If you are pregnant and haven’t had measles, or been vaccinated against it, and know that you have been exposed to the virus, you should get an immune globulin shot within six days to try and prevent the virus from developing.
If you are not sure whether you have been exposed to the virus, or whether you have had measles or been vaccinated against it, you should get a blood test. Depending on the results and stage of pregnancy, a doctor will advise accordingly.
Ideally, testing for measles antibodies should be done before you fall pregnant. If the blood test shows no antibodies, you should be vaccinated before conceiving. The measles vaccine cannot be given during pregnancy since it’s a live vaccine and could cause some of the measles complications to develop in both you and your unborn baby.
How do you know if you have been exposed to the virus?
Rubeola begins with typical flu-like symptoms:
- Runny nose
- Red eyes
- Three to five days later, a fine body rash appears, beginning at the head and quickly spreading to the body, arms and legs. This rash begins with little white spots on the lining of the cheeks called Koplik’s spots, followed by brownish-red spots behind the ears. This rash spreads to the face and body. Symptoms (when there are no complications) usually clear after one or two weeks.
What should you do if your baby or child gets the virus?
- Check your baby’s temperature. If he has a fever, control this with tepid sponging and an antipyrexial such as paediatric Panado.
- Phone your doctor – visiting the consulting rooms or clinic could spread the virus so your doctor will advise you on what to do. Measles is a notifiable disease and will require a blood test (it cannot be differentiated from other childhood rash illnesses by symptoms and signs alone, it requires a confirmatory blood test).
- Keep your child at home and away from other children as well as pregnant women.
- Prevent dehydration by offering small and frequent amounts of liquids.
- Keep your child comfortable, treat symptoms and look out for complications.
- Only send your child back to school when the rash has faded.
- Don’t send your child to school if he has a fever – always wait until the fever has subsided as this could be the first symptom of measles.
Preventing rubeola − why immunise?
Measles (aka rubeola) infects about 20 million people around the world every year, killing more than
140 000 – mostly children. Measles outbreaks still happen – especially in Africa where immunisation programmes may be neglected.
Where there are effective immunisation programmes, the threat can be prevented.
Doctor Suchard reminds us that people are quick to forget how devastating the outbreak of an infectious disease can be. “History is rife with recorded plagues of measles, with huge swathes of civilisations wiped out when the disease was brought into previously unexposed communities such as Cuba, Honduras and Mexico in the 1500s and Hawaii and Fiji in the 1800s. In some African societies, naming a newborn was delayed until the measles season had passed. There have been large measles outbreaks in Africa – in 2009 to 2011 South Africa had 18 000 cases, in 2013 and 2014 there were 89 000 cases in the Democratic Republic of the Congo, and 52 000 cases in Nigeria.” This report by Dr Suchard was published in the South African Journal of Infectious Diseases, 2015.
Are immunisations safe?
The first rubeola vaccine was introduced in the ‘60s. This ‘inactivated’ (killed virus) vaccination was not very effective, so a live attenuated or modified ‘safe live virus’ vaccine became available and has been used ever since. This vaccine is currently given to babies at six or nine months and again between 12 to 18 months as a booster dose.
In the late ‘90s panic that the measles, mumps and rubella (MMR) vaccine causes autism broke out when false reporting and research was published in The Lancet medical journal. As a result, vaccination rates in the UK and Ireland dropped and outbreaks of measles and mumps occurred, causing unnecessary deaths and severe permanent injuries.
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