Text by Henrylito D. Tacio
Photos: verywell and NPR.org
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) were 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 the air for several hours, can only be killed by sunlight. It is very active during the cold months, particularly from 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.”
Drs. Vickery and Fries said measles may have 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, 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.
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 are 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 activities 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.