Immunisation exercise helps in preventing measles

Experts have recommended regular immunisation to ward off attacks of measles among children.Described as a very contagious respiratory infection, health experts said the illness causes skin rash and flu-like symptoms. It is caused by infection from the rubeola virus, which lives in the mucus of an infected person’s nose and throat. Rashes appear four days after the disease had been contacted.

Immunisation is the only effective preventive measure against measles, and that live attenuated measles vaccine induces an immune response similar to naturally acquired immunity, which can be boosted by challenge from wild or vaccine virus, experts say.

An infectious Disease Specialist, Paediatric Consultant at Lagos University Teaching Hospital (LUTH), Dr. Adekunle Akinbami, explained that treatment of measles is usually supportive. She said: “Antipyretic like acetaminophen for fever and oral Vitamin A are given. For those with complications, which are usually the cause of death, you treat as required. Antibiotics are given for pneumonia, a common complication, and oral salt solution for diarrhoea.

“Diagnosis of measles is mostly clinical. Fever, purulent red eyes, cough, coryza, redness with white particles called koplik spot is seen in the mouth. This is specific in measles but may not be seen. Then a pattern rash occurs. The rash in measles starts from the hairline and spreads downward to the face, neck, trunk and limbs.

“In case of outbreaks or non-specific symptoms, laboratory diagnosis can be made. This is a serological test with identification of measles specific IgM (immunoglobulin M) or IgG. Measles affect both sexes. It is commoner in children below five years.

“Acetaminophen is given for fever. The child has to be assessed by a doctor, who will examine for likely complications and treat accordingly. The child must be isolated, as he/she should not go to school and other gatherings where children are. Oftentimes, children have uncomplicated measles without parental knowledge that it was measles. This also occurs in schools and crèches.”

“Measles is preventable. Parents should ensure vaccination of their children. Spread of measles infection to other children occurs usually before diagnosis is made in affected child. This is because spread of the infection occurs at the early stage, when specific symptoms like the rash have not developed. So, immunisation is key to acquisition and spread of measles virus infection. Schools should routinely evaluate students’ immunisation status by checking the immunisation cards. Booster doses should also be taken.”

Former President, Association of Resident Doctors, Lagos University Teaching Hospital, Dr. Olubunmi Omojowolo, said measles vaccine is at least 95 per cent effective and seroconversion rates are close to 100 per cent. Primary vaccine failure of the first dose at 12 months of age or older occurs in up to five per cent of people, but 95 per cent of first dose failures will seroconvert from a second dose.

He said: “Maternal antibodies are the most common cause of primary vaccine failure. The age of first immunisation with measles vaccine must balance the chance of seroconversion with the risk of infection. This is why, in countries with endemic measles, the first dose of measles containing vaccine (MCV) is given as early as nine months, often complemented by another dose during the second year of life. 

“Experience and modelling show that two doses of measles vaccine is required to interrupt indigenous transmission and achieve herd immunity. A single dose in the second year of life will induce immunity in about 95 per cent of immunised people.

“This means that 100 per cent uptake would be required to achieve the desired 95 per cent immunity level. However, about 95 per cent of those who fail to respond to a first dose develop immunity from a second dose and hence the benefit of a second dose. “In Nigeria, immunisation programmes today promote a two-dose measles immunisation schedule with the first dose given during the second year of life and the second dose at an older age that differs between countries. Measles vaccine is most commonly administered as part of a combination of live attenuated vaccines that include measles, mumps, rubella and varicella (MMR or MMRV). Combination vaccines have been shown to elicit the same immune response as individual vaccines.”

“Vaccinating individuals who are already immune to one or more of the antigens in the combination vaccine, either from previous immunisation or natural infection, is not associated with any increased risk of adverse events

“Signs and symptoms of measles include running nose, conjunctivitis, swollen eyelids and inflamed eyes, watery eyes, photophobia, or sensitivity to light, sneezing, a reddish-brown rash, or very small grayish-white spots with bluish-white centres in the mouth, inside of cheeks and throat and generalised body aches, among others. Symptoms will appear about nine to 11 days after initial infection.

“There is often a fever, which can range from mild to severe, up to 40.6 degrees centigrade. It can last several days, and it may fall and then rise again when the rash appears. The reddish-brown rash appears around three to four days after initial symptoms. This can last for over a week.”