Measles:
What is it? Why are we concerned?
What is Measles
Measles is a highly infectious disease caused by the Morbillivirus. The virus is spread from person to person through droplets in the air (coughing, sneezing). The virus can survive for up to 2 hours in air, but is rapidly destroyed by heat and light. Symptoms take between 10 and 14 days to show after infection and include: fever; cough; runny nose; and inflammation of the eye. A rash begins on the face and upper neck, than becomes generalised. Complications of measles include inflammations of the ear (otitis media), lung (pneumonia) and brain (encephalitis), which can lead to brain damage and death. Approximately one child in every 1,000 who contracts measles will develop encephalitis. For every 10 children who contract encephalitis, one will die and up to four will have permanent brain damage. Subacute sclerosingpanencephalitis (SSPE) is a rare late complication of measles, occurring approximately seven years after infection, which causes progressive brain damage and is always fatal. Measles infection during pregnancy can result in miscarriage and premature delivery.
Treatment
There is no specific treatment for measles. It is a viral infection. Treatment involves treating the symptoms and complications. Confirmation of the diagnosis is important as it allows prompt public health follow up of other people who are at risk of measles. Notifying your doctor that you suspect measles prior to visiting the practice is important, so that infection control measures can be taken.
Why are we concerned?
Measles is very distressing to the child, parent or adult that contracts the disease. Complications of pneumonia are more likely in the young, whilst complications from encephalitis are more frequently seen in adults. Protection from vaccination is safer than contracting the disease. The primary reason for the increased transmission and outbreaks of measles in regions is failure to vaccinate; this can be by parents’ choice, disruption of vaccine supply and changes in the immunisation programs. Two doses of MMR containing vaccine are recommended.
Previous experiences, nationally and internationally have seen a resurgence of measles infections in areas were vaccination for measles has declined. Whilst Australia overall has a vaccination rate of 94% there are some communities were immunisation rates are extremely low.
Children under 12 months- too young to be vaccinated for Measles
Previous measles outbreaks, one recently in Sydney (2012) highlighted the risk of transmission of the disease occurring in those not fully vaccinated and those too young to be vaccinated. Young babies receive a protective antibody from their mother against measles, are not generally at risk. However, this maternal protection wanes from about 6-9 months. In Australia, the first Measles vaccination (Measles, Mumps and Rubella vaccine) is recommended at 12 months of age. The child is susceptible to measles infection during the period of waning maternal antibodies until MMR vaccination. During a measles outbreak the local Public Health Unit may advisecommunities to vaccinate babies at 9 months to protect young infants at risk. But because maternal antibodies are known to persist in some infants until approximately 11 months of age, two MMR vaccines are still required after 12 months of age as existing maternal antibodies can affect the child’s own antibodies to provide long term protective against measles.
Recent Measles outbreaks
In 2011 Europe had a re-emergence of measles that caused great strain on the medical and public health system. There were more than 26,000 cases of measles in 36 European countries from January-October 2011, with more than 14,000 of those in France.These outbreaks have caused nine deaths, including six in France, and 7288 hospitalizations. Infection occurred predominately among children and young adults who had not been vaccinated. Countries responded to the outbreak by modifying the vaccination schedule; reducing the age of first MMR vaccination, and offering vaccination clinics.
According to recent European Surveillance System, a service of the ECDC, data for Measles infection shows 82 percent had never receivedthevaccine, 13 percent had received one dose, and 4 percent had received two or more doses.
Measles outbreaks: Ukraine 11,231 cases from January to April 2011;Quebec, Canada, reported 742 cases, 89 requiring hospitalisation.UKreported 1,365 cases in the first 6 months of 2013. Overall 283 (21%) of all cases were admitted to hospital; 39 reported complications including pneumonia, meningitis and gastroenteritis.The Netherlands reported 1,266 cases, 82, or 6.5 %, required hospitalisation. Nearly all of the patients, 96.5%, had not been vaccinated and another 3.2 % had only received partial vaccinations.
Australia: In 2012 there were 172 cases of measles in NSW. It was started when a young adult infected with measles, returned from overseas and passed the virus onto to susceptible people. Most cases occurred in Sydney. The highest notification rate was in children less than 5 years of age, most of these were children under 12 months of age, infected prior to the recommended 12 month MMR vaccination. There were also high rates of measles in the 15 to 19 year age group, with several high schools affected.
Video of a personal story of measles Shotbyshot Story galley: Measles - Rachel’s story
References
- WHO weekly epidemiological record 2 Dec 2011
- European Monthly surveillance Report Vol 3 August 2011
WHO Measles outbreaks: Regions of the Americas, Europe and Africa
Measles cases
NSW Health measles data
Health Protection report UK
Get in touch / Rachelle DeakerProgram Officer, Immunisationt02 6622 4453 f 02 6622 3185