RESURGENCE OF GLOBAL MEASLES OUTBREAKS AFTER CORONA PANDEMIC

In 1998 in United Kingdom, a discredited study showed an incorrect link between bowel disease or autism and MMR vaccine. Due to this finding, there was a drop in vaccination administration which raised the number of measles cases after that. Now the pandemic of Corona also results in drop of measles vaccination which can trigger the measles outbreaks. World health organization (WHO) and CDC (disease control and prevention) warn the world about the contagious disease MEASLES which is the disease of childhood and can be fatal in children. Although it can infect the unimmunized adult too. If preventive measures have not been taken to control the measles, then world has to face ‘GLOBAL MEASLES OUTBREAKS’. According to WHO and CDC, after the pandemic of Corona the rising cases of MEASLES became the global threat. 

WHY MEASLES HAS BECOME HEALTH THREAT FOR WORLD?

The reason behind is that the pandemic of Corona affects the vaccinations of various kind of disease which results delayed in vaccination or missed vaccination dose and leave many children without protection against many vaccines preventable diseases. Among these diseases, measles is the extremely contagious and vaccine preventable disease. Around 9 persons out of 10 may have measles if they are not protected against measles. Rising cases of MEASLES could trigger another global outbreak. Decline in vaccination level tend to rise in measles cases. Approximately forty million children are deprived of vaccination due to Corona pandemic. During the last year, there is increase rate of measles cases from 19% to 35%. There is no specific medication available for measles disease but only the vaccine can provide approximately 95 % protection from the disease. Gaps in global vaccination coverage, globally disrupted surveillance system is the main reason for the resurgence of deadly disease measles. Due to to weaken immunity children can get pneumonia and diarrhea. So, we can say that measles outbreaks are the fore warning of other disease out breaks also. According to CDC and WHO, all the countries have to take immediate action to control measles. Otherwise, world has to face bigger outbreaks after Corona pandemic. Measles was under control before Corona pandemic but it cases are again increasing day by day. Worldwide around 1 lac 28 thousand deaths have been reported and in America, Europe and Africa report of measles cases are rising with passage of time.

Now, we will take a brief overview about measles,

WHAT IS MEASLES?

Measles is highly contagious, acute respiratory illness and vaccine preventable disease caused by measles virus. It is also known as rubeola.

HOW MEASLES SPREAD?

Measles virus live in the nose and throat of infected person. When infected person breathes, sneezing, talking or coughing then there is release of infectious droplets into air where they can stay for about an hour or these infectious droplets can land on surface where they stay for several hours. When a healthy person inhaled these infectious droplets then they will get measles or when a person after touching the infected surface, touch their nose, eyes and put finger into mouth became infected with virus.

SIGN AND SYMPTOMS OF MEASLES

Sign and symptoms of measles includes rash, fever, inflamed eyes (conjunctivitis), sore throat, cough, white spots inside mouth and runny nose. 

WHAT ARE RISK FACTORS FOR CATCHING MEASLES INFECTION

There are 3 main risk factors for measles disease.

Deficiency of Vitamin A (increased severity of infection).

If vaccination against measles not done.

Traveling to places where risk of getting measles infection exists.

STAGES OF MEASLES INFECTION

Measles virus after entering into body, incubate itself into the body for around 10 to 14 days. During this period there is no sign and symptoms of disease. This period is known as incubation period. After the incubation period the sign and symptoms start to appear which looks like a generalize illness. Nonspecific sign and symptoms include mild to moderate fever, sore throat, runny nose, persistent cough and inflamed eyes. The nonspecific sign and symptoms will last for 2-3 days. After this, classic sign of measles that is skin rash start to appear. The face breakout first then it spread down slowly to arms, chest, back and over the thighs, legs and feet. At this stage, fever rises as high as 104 to 105.8F (40 to 41C). After this recovery from disease begin. The rash last for about 7 days and fade up gradually. First fade up from the face and later on from other parts of body. 

COMPLICATION / COMORBIDITIES ASSOCIATED WITH MEASLES

Diarrhea and vomiting (result in severe dehydration).

Bronchitis (inflammation of inner lining of lungs), laryngitis (inflammation of voice box) and croup (inflammation of air ways).

Encephalitis (swelling of brain and can be fatal).

Ear infection (can cause bacterial ear infection).

Pneumonia (may cause infection of lungs and can be fatal).

TREATMENT OF MEASLES INFECTION

If someone get measles infection then treatment of measles is symptomatic like the other viral infection. During this period acetaminophen is prescribed to relieve fever. Drink a lot of water to prevent from dehydration due to vomiting and diarrhea. Rest is very important to boost immunity. Vitamin A supplements reduce symptoms severity and severity of complications associated with measles.  humidifier helps in ease of cough and relieving sore throat.

SOMEONE AFTER RECOVERING FROM MEASLES IS SUPPOSE TO BE IMMUNIZED OR NOT?

Yeah, person is immunized after getting recovery from measles infection because antibodies against measles has been developed naturally. 

Washing hand practice before and after meal and before touching eyes, nose and mouth is also a helpful preventive measure against measles infection spreading.

AT WHAT STAGES, PATIENT OF MEASLES SUPPOSE TO BE CONTAGIOUS?

Four days before starting rashes and four days after fading of rashes. The total period is about for 8 days.

DIFFERENCE BETWEEN MMR AND MMRV VACCINE

MMR is effective against 3 viruses which are measles, mumps and rubella while MMRV is effective against measles, mumps, rubella and chicken pox. 

MMR (MEASLES, MUMPS AND RUBELLA VACCINE)

A combined live measles, mumps and rubella vaccine (MMR) aims to eliminate measles, mumps and rubella and congenital rubella syndrome also. Every child should receive two doses of MMR vaccine by entry to primary school, unless there is valid contra -indication. MMR vaccine should be given irrespective of previous measles, mumps and rubella infection.

HOW LONG MEASLES VACCINE PROVIDE PROTECTION AGAINST MEASLES?

Two doses of measles vaccine provide lifelong protection against measles which is approximately 97%. After vaccination, if measles happened then symptoms are not severe one.

AT WHAT AGE, MMR VACCINE SHOULD BE GIVEN TO CHILDREN?

The first dose of MMR vaccine is given to children aged 13 months. A second dose is given before starting school at 3-5 years of age.

HOW THE MMR VACCINE SHOULD BE ADMINISTER DURING MEASLES OUTBREAKS?

When the protection against measles is required urgently like during measles outbreak, the second dose of MMR vaccine can be given 1 month after the first dose. 

CAN ROUTINE DOSE OF MMR VACCINE BE GIVEN TO CHILDREN WHO RECEIVED THEIR SECOND DOSE EARLIER DURING MEASLES OUTBREAKS? 

If second dose is given before 18 months of age, the children should still receive the routine dose before starting school at 3-5 years of age.

IF A YOUNG ADULT RECEIVE ONLY A SINGLE DOSE OF VACCINE, THEN WHAT SHOULD DO?

If a young adult who has received only a single dose of MMR in childhood, a second dose is recommended to achieve full protection.

IF SUSPECTABLE AGED OVER 6 MONTHS ARE IN CONTACTS OF A CASEWHAT SHOULD DO?

MMR vaccine may also be used in the control of outbreaks of measles of exposure to infection, these children should still receive routine MMR vaccination at the recommended ages.

IF HOUSEHOLD CONTACT OF CASE FOR CHHILDREN AGED 6 to 9 MONTHS, WHAT SHOULD DO?

In that case immunoglobulin is given.

UNIMMUNIZES ADULT / CILDREN FOR INTERNATIONAL TRAVEL

Unimmunized adult should receive MMR vaccine before traveling to areas where measles threat exists. If children aged 6 months, then one dose of vaccine should be given and the children twelve months and above the twelve months should receive two doses of vaccine before travel.

CONTRA INDICATION TO MMR VACCINE INCLUDES,

Children with severe immunosuppression.

Children who have received another live vaccine by injection within 4 weeks.

Children who have had an anaphylactic reaction to excipients such as gelatin and neomycin.

If given to women, pregnancy should be avoided for 2 months.

MMR vaccine should not be given within 3 months of an immunoglobulin injection because response to measles component may be reduced. 

SIDE EFFECTS OF MMR VACCINE

Idiopathic thrombocytopenia occurs rarely following MMR vaccination, usually within 6 weeks of the dose. Consider risk to benefits ratio of vaccine, the risk of developing low platelets count is less than developing measles infection if vaccine is not given. 

Seizures also reported in rare cases.

CONCLUSION

Steady vaccination rate is the only way to get protection from the measles infection. Drop in vaccination level increase the resurgence of measles and especially after Corona pandemic measles is global threat for world. There needs a spirit to work day and night to beat fore warn of measles outbreaks and increase vaccination definitely helpful in preventing the world from measles outbreaks.