Gist: Adults are not immune to measles – Expert  (Read 2882 times)

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Adults are not immune to measles – Expert
by ayo2 « on: December 03, 2014, 08:41:38 AM »

A consultant medical microbiologist and infectious diseases physician, University of Ilorin Teaching Hospital, Dr. Fadeyi Abayomi, speaks with MOTUNRAYO JOEL, on measles and its attendant risks

What is measles?

Measles is a highly infectious human disease caused by the measles virus. It is a leading cause of vaccine-preventable death and illness worldwide. Measles affects up to two million people yearly killing about 400, 000. It spreads through droplet particles generated mainly through sneezing or coughing by an infected person which is subsequently inspired by other people. The disease starts as an infection of the respiratory system and can spread to all the parts of the human body. Measles can be quickly identified through the typical skin rash it produces described as maculopapular.

Who are those prone to the disease?

Measles infection is a disease of unimmunised persons especially children though adults may also be infected particularly when they develop defects in their cellular immunity as may be found in people with HIV infection and cancers. Immunisation can be achieved by vaccination. However, it is not all persons who are vaccinated that are immunised. A vaccinated and immunised person will develop humoral line of body defence in form of specific antibodies and cellular mode of body defence particularly involving some set of lymphocytes (CD8 positive lymphocytes) through which the body can eliminate the measles virus following subsequent exposures preventing a new infection. People who were infected and recovered from the disease are also protected from re-infection because they develop the necessary body defence mechanisms against it.

How does it spread?

Transmission of measles is air borne. It means measles virus-laden droplets spread the infection through the air. The infected droplet spreading the measles virus are the globules of water containing the virus generated mostly during coughing and sneezing. Once produced, these droplet particles can travel far through the air to infect new persons. This is the reason for the higher prevalence of the disease during dry season and conditions of low humidity. Anyone who breathes in the virus-laden droplet and is not protected, I mean not immunised, is bound to develop the disease.

How can one know he or she has contracted the disease?

Diagnosis of measles infection is best made by the physicians who are trained for this purpose. It is advisable that people should report all manner of illnesses to the hospital particularly when any form of rash is noticed on the skin. Measles disease can be identified by the typical maculopapular rash it produces. This rash starts along the hair line on the head and spreads progressively to involve the chest, the trunk, and down the limbs. The rash appears as light pink, discrete maculopapules and coalesces to form blotches, becoming brownish as it progresses. As the rash advances down the body, it begins to fade on the face resolving with desquamation.

It is important to know that measles do not present with rash alone. Before the appearance of the typical rash is the incubation period which may take up to 12 days or more. The incubation period is the time interval between when an individual contacts the virus and manifestation of the first symptom. The incubation period is followed by what we call the prodromal phase which is characterised by fever, sneezing, coughing, running nose, redness of the eyes and the appearance of Koplik’s spots in the mouth. Koplik’s spots are characteristically found in measles infection and consist of small, bluish-white ulcerations on the thin tissue lining the mouth which we call epithelium opposite the lower big tooth: the molars. These Koplik’s spots usually appear about two days before the rash. The fever, sneezing, coughing, running nose and redness of the eyes are most marked when the rash is at its peak but subside rapidly thereafter.

How can one protect oneself and family from measles?

The best form of protection available is attained through vaccination. All children are entitled to vaccination in Nigeria against measles at about the age of nine months. Parents should therefore endeavour to ensure that their wards are vaccinated at this period of their life. It is important to remember again that not every vaccinated person is immunised. The immunisation is what is desired and should be accomplished with vaccination. Barriers to immunisation following vaccination are many but the most important perhaps for us as a people is the break in cold chain which alters the potency of the vaccine. The cold chain refers to the cold temperature under which vaccines are kept to preserve their quality. We need electricity and special packaging to attain this which is often time not available. This is one of the possible reasons a vaccinated child may come down with measles infection in spite of the vaccination received. It is important that such issues are addressed in our setting. Failure of vaccination of children and vaccine failure are the main reasons for the persistence of measles in human population. We should take note that immunity to measles virus, once developed, is retained throughout life.

What should one do if one comes into contact with someone infected with measles?

In as much as one has been vaccinated and effectively immunised, there is no need for any fear following contact with persons infected with measles. Babies who have not received immunisation are generally at risk following contact. Unfortunately at present, there is no post-exposure prophylaxis for measles infection. The best approach is to prevent the at-risk group from making contact with the infected particularly during the prodromal phase of the disease when they are shedding the virus heavily in their nasal secretions. During measles outbreak in nurseries, babies should stay at home. It is also important that persons coughing and sneezing comply with some etiquette. Cough etiquette demands that people cover their mouth with handkerchief during cough/sneezing and take away their head from other people’s face within their vicinity. Cough etiquette can be taught at schools but it is associated with a challenge of compliance among very young children who are likely to spread the virus.

What is the measles, mumps and rubella vaccine?

The MMR vaccine is a vaccine given to prevent three different kinds of infections namely, measles, mumps and rubella infections caused by measles, mumps and rubella viruses respectively. It is thus a polyvalent measles vaccine because it contains multiple antigens capable of inducing immunity to multiple diseases or infections. The vaccine is not available in Nigeria but it has the advantage of giving a single vaccine to stimulate immunity against three different diseases. A newer version of the vaccine has varicella virus added making it protective against varicella and chicken pox virus infections. This new version of polyvalent measles vaccine is tagged MMRV vaccine. The measles vaccine given in Nigeria simply contains line attenuated measles virus and is protective against measles infection. It is thus a monovalent measles vaccine because it contains a single type of antigen capable of inducing immunity to a type of disease. The polyvalent measles vaccine cannot be administered before the age of 12 months by which time many Nigerian babies would have contracted measles and perhaps developed its complications.

How effective is MMR?

MMR is effective protection against measles, mumps and rubella infections. Similarly, the measles vaccine we have in our country is very efficient in inhibiting measles infection. The main challenge with vaccination, which is not limited to measles vaccine alone but affecting all vaccines, is that of maintenance of potency through provision of cold chains. The irregular power supply and perhaps our attitude and perception contributed to this as well. We must ensure functional immunisation to have a healthy population.

Who should not receive the MMR vaccination?

No one is exempted from taking the measles, mumps and rubella vaccine because it is a live attenuated vaccine. However, it is recommended that pregnant women be vaccinated with caution and those with depressed immunity should not take the vaccine. The measles vaccine available and used in Nigeria is given at about nine months of life which is when measles infection is just about most prevalent among children. All children should be vaccinated.

Does it have adverse reactions?

MMR vaccine as well as the type of measles vaccine given in our country is safe. Following vaccination, there is usually a kind of immediate body reponse to the vaccine in form of fever and some swelling at the site of injecting the vaccine. This is normal and will subside on its own although parents are advised to give some analgesic, not more than paracetamol, to their babies to ameliorate this form of body response.

What about reactions to MMR?

Adverse reactions to vaccines are uncommon. People should not avoid vaccination because of such reactions. They will be doing themselves a great dis-service if they do so. Everyone should be vaccinated against vaccine-preventable diseases.

Is measles exclusively a child’s disease?

Measles is not exclusively a child’s disease. It is a disease that affects people who are not immunised. It can occur at any age in these people. The reason we see measles as a child disease is that the newly born have some passive immunity; I mean specific antibodies, from their immunised mothers which is protective but weans off shortly before the age of nine months. Therefore, any baby not vaccinated at about this time will be at risk of the infection.

Source: Punch


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