What we must know about measles

Vigilant and efficient strategies are required to scale up measles vaccine delivery


Salima Mansoor Kerai June 10, 2015
The writer is a nurse with post-graduate qualifications from Aga Khan University (AKU) and Johns Hopkins University. She is currently serving as a researcher in childhood infectious diseases at AKU

Measles has remained one of the most lethal diseases for mankind throughout history. Since it is a highly contagious and readily communicable disease, it requires just a single host to cause an unbroken chain of acute infections in a population where even fewer than 10 per cent of people might be originally susceptible. The virus is transmitted by aerosolised respiratory droplets and by direct physical contact. The disease is usually characterised by cough, fever, malaise, coryza, conjunctivitis, Kopliks in the oral cavity and maculopapular rashes appearing within 14 days. Vulnerability is higher in children, and increases with malnutrition (vitamin A and zinc deficiency), overcrowded living, and weakened immune system. High fatality of the disease is evident from global statistics which have historically indicated the highest incidence in African and South Asian countries with poor health systems.

Measles is endemic to Pakistan, with periodic epidemics occurring every two to three years. The disease is more common in the country during the winter and spring seasons and there should be special emphasis on vaccination during these seasons. Measles vaccines are available either as monovalent vaccines or in combination with rubella, mumps or varicella vaccines or as measles-containing vaccine (MCV). Additionally, maternal antibodies confer protection to infants against measles during the first few months of life. But infants become increasingly susceptible after the passive immunity offered by the mother fades with times. Therefore, the danger of measles at an early age is so great that the child must be vaccinated soon after it loses maternal protection. This is why the WHO-recommended age of measles vaccination is nine months.

Since 2000, measles deaths have been reduced by 74 per cent by vaccine worldwide. However, despite this remarkable progress in controlling measles, over one million deaths are occurring annually. Measles accounts for 10 per cent of all global mortality causes for children less than five years of age and contributes to around 45 per cent of vaccine-preventable deaths in children less than 15 years of age. The WHO defines eradication as an interruption of measles transmission worldwide as a result of deliberate efforts; a scenario where intervention methods (vaccines) may no longer be needed. Measles, like smallpox and polio, meets the three fundamental criteria calling for complete eradication: human beings are the only reservoir maintaining virus circulation; sensitive and specific diagnostic tests are available; the antigenic stability of the virus. Since measles is monotypic, there is a need for only a monovalent vaccine and simple, affordable and effective vaccine is available worldwide. Which means complete eradication is very much achievable.  Moreover, huge progress towards measles elimination has been made in many parts of the world. In the European region and other countries, such as Australia, Mongolia, New Zealand, the Philippines, the Pacific Island nations and the Arab Gulf states, measles transmission has been interrupted or is at very low levels. It has been observed over the years that measles elimination is more economically beneficial and cost effective than measles control. It has positive impact on health systems. Steps needed for elimination of measles include better collaboration, linkages, and involvement at all levels of governments and among partners; improved immunisation knowledge and micro planning and management skills among healthcare workers; increased community demand for immunisation; and improved data quality and surveillance as shown in a study by London School of Hygiene and Tropical Medicine in 2011.

Since measles continues to pose a great threat to all countries in post-vaccine era as well, its resurgence has undoubtedly put the progress of the nation in achieving MDG goals at stake. Though no definite curative treatment exists for measles, the death or disability in the wake of the wide availability of preventive measures is totally unacceptable. Despite, the provision of free, safe and effective measles vaccine since 1970s, the harrowing transmission of measles has not been halted — particularly in a low and middle income country like Pakistan.  Evidently, vigilant and efficient strategies are required to scale up vaccine delivery. Pakistan needs periodic and improved vaccination uptake programmes, judicious programme planning, a strengthened health system and a sensitive surveillance system to stem the measles epidemic.

Published in The Express Tribune, June 11th, 2015.

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