Measles

Measles

Key factsmeasles

Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
In 2008, there were 164 000 measles deaths globally – nearly 450 deaths every day or 18 deaths every hour.
More than 95% of measles deaths occur in low-income countries with weak health infrastructures.
Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2008 worldwide.
In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.

Measles is a highly contagious, serious disease caused by a virus.

It remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. An estimated 164 000 people died from measles in 2008 – mostly children under the age of five.

Measles is caused by a virus in the paramyxovirus family. The measles virus normally grows in the cells that line the back of the throat and lungs. Measles is a human disease and is not known to occur in animals.

Targeted vaccination campaigns have had a major impact on reducing measles deaths. From 2000 to 2008 nearly 700 million children aged 9 months to 14 years who live in high risk countries were vaccinated against the disease. Global measles deaths decreased by 78% during this period.

Signs and symptoms

The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands and feet. The rash lasts for five to six days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).
Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.
Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care.
People who recover from measles are immune for the rest of their lives.

Who is at risk?

Unvaccinated young children are at highest risk of measles and its complications, including death. Any non-immune person (who has not been vaccinated or previously recovered from the disease) can become infected.

Measles is still common in many developing countries – particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

Transmission
The highly contagious virus is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions.

The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts.

Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children.

In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection.

Treatment

Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.
All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.

Prevention

Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for over 40 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a child against measles.
The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form.
In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.

Global health response

The fourth Millennium Development Goal (MDG 4) aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015. Recognizing the potential of measles vaccination to reduce child mortality, and given that measles vaccination coverage can be considered a marker of access to child health services, routine measles vaccination coverage has been selected as an indicator of progress towards achieving MDG 4.
The Measles Initiative is a collaborative effort of WHO, UNICEF, the American Red Cross, the United States Centers for Disease Control and Prevention, and the United Nations Foundation. The Initiative, together with other public and private partners, plays a key role in advancing the global measles strategy. This strategy includes:

1. Strong routine immunization for children by their first birthday.
2. A 'second opportunity' for measles immunization through mass vaccination campaigns, to ensure that all children receive at least one dose.
3. Effective surveillance in all countries to quickly recognize and respond to measles outbreaks.
4. Better treatment of measles cases, to include vitamin A supplements, antibiotics if needed, and supportive care that prevents complications.

To read more about the MMR vaccine (Measles, Mumps & Rubella), click here

Are you worried about reports on the link between MMR vaccine and autism? Click here (CDC) to establish the real facts.

 

NEW MEASLES VACCINATION GUIDELINES

Further to recent outbreaks of measles  in several countries that have previously eradicated measles, both WHO and CDC have recently recommended that all travellers should be vaccinated against measles. See the relevant links below:

CDC -- https://www.cdc.gov/measles/travelers.html

WHO - www.who.int/csr/don/2011_04_21/en/index.html

In addition, on the UK govt Foreign Office's website, it does highlight this new entry requirement for El Salvador as follows:
"From 1 July 2011 all travellers to El Salvador, other than children up to six months of age will be required to present written proof that they have been vaccinated against measles and Rubella at least 15 days prior to their trip. The same applies to those travelling from El Salvador to Europe. Those travellers that for medical reasons cannot comply with this requirement will be asked to present the relevant medical certification explaining the reason why the person cannot be vaccinated."

Click here to view the entry requirements.

I would suggest that staff who are travelling to El Salvador be advised of this new entry requirement -- and ensure that they bring written proof of their vaccination status along with them. (For example, documented administration of MMR, laboratory (serologic) proof of immunity, or documentation of physician-diagnosed measles). If such evidence is not available, they should be given the option of receiving the MMR vaccine or risk denial of entry into the country.

WHO website states Travel increases the risk for exposure to measles virus and its further spread into susceptible populations if not vaccinated. To prevent further spread, WHO encourages health authorities to advocate for immunization before travel and to provide immunization through health systems’ immunization services according to existing national immunization schedules.
WHO recommends two doses of measles vaccine for all children and at least one dose prior to international travel for adolescents and adults who are unsure about their immunity status.

Note it is already on our JMS recommendations for Kenya for both adults and children