By Dr. Alina Akhyar, Weekly Pulse Magazine, September 16, 2013
Most of us think that measles is an infectious disease that usually afflicts children. That is absolutely correct. Measles, also known as rubeola, is a highly contagious disease that typically affects children from ages 7 to 14, however it can occur in any age group.
Measles is caused by a virus that travels through respiratory droplets in the air. Incubating for 7-14 days within its host, it causes symptoms like a cough, bloodshot eyes and a runny nose before giving rise to a characteristic high-grade fever and a rash on the body along with white spots on the inside of the mouth. The rash develops around 14 days after exposure to the disease. It consists of small, slightly raised spots on the entire body that begin to appear on the head and neck region and travel down to the torso, legs and feet. The condition typically resolves after 10-14 days. If the child’s health is good and living conditions are sanitary, recovery often occurs without complications. Nevertheless, it is necessary to consult a doctor whenever a child has fever along with a rash.
The mainstay of treatment for this condition is supportive and is based on administration of intravenous infusions and antipyretic drugs. But patients suffering from complications require antibiotics as well. The World Health Organization (WHO) also advises providing vitamin A supplements to reduce the risk of death.
In immunocompromised or malnourished children, measles can lead to several complications. Measles depresses a person’s immunity, which can result in a bacterial super infection. Most frequently, such an infection affects the lungs, causing pneumonia either due to the virus itself or due to the resulting bacterial infection. Besides the lungs, the virus can affect the liver, intestines, pancreas, eyes, ears or the lining of the brain. While older children and previously healthy children recover without any complaint, smaller and malnourished children can easily die. Even today measles kills several hundred thousand children under the age of 5 every year, making it a potentially fatal disease.
Fortunately, measles can easily be prevented through vaccination. The vaccine given to prevent measles is a combined vaccine called Measles Mumps Rubella (MMR) that also contains vaccines against mumps and rubella. People who are not immunized against measles are at risk of suffering from the disease themselves and risk transmitting the disease to other unimmunized children.
About a century ago in England, every year 500,000 children suffered from measles and about a 100 perished annually. It was not until 1968 that the vaccine was invented, which led to a steady decrease in the number of infections and deaths. Now, there are only a few hundred reported cases of measles per year in England.
In Pakistan, however, we have witnessed an increase in the number of measles cases, especially in 2012 and 2013. According to a report published by WHO, in the year 2012 the number of confirmed cases of measles were 8,048. In 2013, the number of cases confirmed through July was 5,740. Local sources report much higher numbers, claiming that more than 20,000 people have contracted measles, with 200 dying from the disease.
The population of Pakistan suffers from many issues, including poverty, illiteracy and poor transportation. As a result, people are often not able to afford medical advice and treatment, or are unable to reach medical facilities. Some people also refuse to vaccinate themselves or their children due to social taboo or mistrust of the vaccination.
To remove these barriers, the Government of Pakistan has been making efforts to reduce the cost of medical treatment and medications, bring medical help door to door to give children vaccines, and educate people about the value and importance of immunizations. But a significant gap remains between planning to prevent measles and actually preventing it.
These issues are being addressed by the Ministry of Health and several non-governmental organizations. Among these the foremost is the Global Alliance for Vaccines and Immunization (GAVI), which is working to promote immunization all over the world. Another organization partnering with this umbrella agency to prevent measles by immunization is Aga Khan Health Services Pakistan (AKHSP), which is implementing immunization activities in Sindh. It is hoped that thanks to these concerted, collaborative efforts, measles cases will soon be greatly reduced in Pakistan.
Dr. Alina Akhyar is currently leading Pakistan CSOs Coalition for Health & Immunization (PCCHI) as the “Team Leader”.