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 vaccine available for measles, the acute bacterial respiratory infection should have been part of history already—but such is not the case.
In fact, it has returned as a major public health threat. In Davao City, for instance, 22 of the 45 people who were confirmed with measles died. EDGE Davao reporter Ralph Lawrence Llemit reported: “The Davao City Health Office has recorded a total number of 602 suspected measles cases during the first three quarters of 2018, ending in September. During the period in review, 22 of the 45 confirmed cases died of the disease.”
But its not only in Davao City where cases of measles surged. It is happening all over the country. According to Dr. Ana Lisa Ong-Lim, head of the Pediatric Infectious Diseases Society of the Philippines, more than half—69 percent, that is—of children with measles this year “proved to have had no immunization, for reasons such as their parents’ refusal,” Reuters reported.
The international dispatch quoted the lady physician saying that politics behind the controversial anti-dengue vaccine could be “partly blamed for the low trust in the government’s mass immunization program.” There were instances where health workers doing the program were labelled as “killers” in some areas.
Dr. Lulu Bravo, of the Philippine Foundation for Vaccination, was very alarmed with this recent development. In a meeting on media reporting on vaccines, she was quoted as saying: “We have almost eradicated measles, but we are now seeing a rise in cases, because the trust in vaccines is declining this year. This is disturbing.”
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 “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 become 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 remain 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 slum,” 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.”
Drs. Vickery and Fries said measles may be spread during the period from three to six days before the appearance of the rash to several days after. Symptoms begin in a susceptible person approximately eight to 12 days after exposure to the virus.
According to the two American doctors, measles starts with fever, weakness, a dry “brassy” cough and inflamed eyes that are itchy, red and sensitive to sunlight.
Another early sign of measles is the appearance of the fine white spots on a red base inside the mouth opposite the molar teeth (known among medical personnel as Koplik’s spots). These fade as the skin rash appears.
The rash begins on about the fifth day as a pink, blotchy, flat rash. The rash first appears around the hairline, on the face, on the neck and behind the ears. The spots, which fade when pressure is applied (early in the illness), become somewhat darker and tend to merge into larger red patches as they mature.
The rash spreads from head to chest to abdomen and finally to the arms and legs. It lasts from four to seven days and may be accompanied by mild itching. There may be some light-brown coloring to skin lesions as the illness progresses.
There are a number of complications that arise as a result of measles. Sore throats, bronchitis (inflammation of the air passages), laryngitis, meningitis, middle ear infections and bacterial pneumonia are all common.
Many of these complicating infections are due to bacteria and will require antibiotic treatment. Pneumonia can be life-threatening.
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.
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 percent of the community against it.
Vaccines are not perfect, but they are highly effective. “Normally, vaccines are at least 80 percent effective—that is, 8 out of 10 children vaccinated will develop antibodies against the infection and be protected,” said Dr. C. John Clemens, former medical officer with the Geneva-based World Health Organization.
Although no medical intervention is 100-percent 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.”