Doris Obinna
Little Udauk had high fever and cough, which kept her restless for days. According to her mother, Mrs. Itua Achibong, the cough refused to subside despite her daughter’s use of cough syrup.
Mrs. Achibong said: “We noticed that she had fever and we treated it. After some days, the fever returned, with cough this time. Thereafter, started seeing rashes on her body. We then suspected measles and took her to the health centre.
“At the health centre, she was diagnosed of measles and some drugs were administered. She was also immunised.”
Across he country, many kids are suffering measles, a respiratory infection caused by the measles virus. Measles is usually prevented through immunization for children at specified months and age in their lives. It is rare for children immunized against measles to suffer the ailment. However, where it occurs, it is usually mild.
Before immunisation was available, measles occurred in springtime epidemics, usually in cycles of two or three years.
Infants are generally protected from measles for six to eight months after birth, due to immunity that was passed on from their mothers. Older children are usually immunised against measles, according to state and school health regulations.
Currently, outbreaks of measles are occurring most often on college campuses, among young persons who have either not been adequately immunised against measles or whose immunity has decreased since childhood.
Measles, also called rubeola, is best known for its typical skin rash. It is, however, primarily a respiratory infection. The first symptoms are irritability, runny nose, eyes that are red and sensitive to light, hacking cough, and a fever as high as 105 degrees Fahrenheit (40.6 degrees Celsius).
One special identifying sign of measles is Koplik’s spots. These are small, red, irregularly shaped spots with blue-white centres found inside the mouth. Koplik’s spots usually appear one to two days before the measles rash and may be noticed by a doctor looking for the cause of a child’s fever and cough.
Measles can lead to many different complications: croup, bronchitis, bronchiolitis, pneumonia, conjunctivitis, myocarditis, hepatitis, and encephalitis. It can also make the body more susceptible to ear infections or pneumonias caused by bacteria.
According to World Health Organisation (WHO), measles also known as morbilli, rubeola or red measles, is one of the leading causes of death among young children and is still common in many developing countries, particularly in parts of Africa and Asia. The overwhelming majority (more than 95 per cent) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.
Measles is a highly contagious respiratory disease caused by a virus. It spreads through the air through coughing and sneezing. It starts with a fever, runny nose, cough, red eyes, and sore throat, and followed by a rash that spreads all over the body. It is a contagious viral illness that causes a skin rash and fever.
According to a Paediatrician, Dr. Adeola Animasahun, measles affects both children and adult, but it is not so common in adult. “It is a fatal disease. Yes, it could be very fatal, especially in people that are not immunised. For those that are immunised, they have some level of protection; so even when they have it a lot of the time, it is usually not too serious. It is not really the measles itself that kills, but the complication that develop as a result of the measles. For example, it is a viral illness at the end of the day; it affects all system of the body and can have one complication or the other in any of the system affected,” she said.
A measles outbreak is currently sweeping across the world. Among the countries affected by the current epidemic are the United Arab Emirates, the Democratic Republic of Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand and Ukraine. Also, there are cases in the United States of America, Israel, Thailand and Tunisia, with the disease spreading fast among clusters of unvaccinated people.
In Nigeria, recently, it was reported that Katsina, Borno and Yobe states have taken the lead as cases of measles surge by 700 per cent in Africa for the first three months of 2019, compared to 2018.
Every state in Nigeria has recorded a case of measles in 2019, with a total of 2,113 suspected cases reported from 34 states in a single week – the last week of March.
The Nigerian Centre for Disease Control has reported almost 6, 000 cases of measles and 15 deaths in Nigeria since the beginning of 2019, twice as much as last year for the same period, with more than 3, 600 cases, the vast majority among children under five. Despite the vaccination campaign conducted in February, the number of cases continues to rise. The State Ministry of Health and health partners plan a second round of vaccination campaign.
“Every unvaccinated young child is at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person who has not been vaccinated or was vaccinated but did not develop immunity can become infected,” Animasahun said.
Causes
Research shows that measles is caused by infection with the rubeola virus. The virus lives in the mucus of the nose and throat of an infected child or adult.
The disease is contagious for four days before the rash appears, and it continues to be contagious for about four to five days after.
Infection spreads through physical contact with an infected person, being near infected people if they cough or sneeze and touching a surface that has infected droplets of mucus and then putting fingers into the mouth, or rubbing the nose or eyes
The virus remains active on an object for two hours, confirming this, a medical expert said: “The virus remains active and contagious in the air or on infected surfaces for up to two hours. In infected persons, it is active from four days prior to the onset of the rash to four days after the rash erupts.”
Signs and symptoms
Experts said fever peaks with the appearance of the rash, which typically begins on the forehead, then spreads downward over the face, neck, and body.
According to them, the child is particularly ill-looking during the first days of the rash. It usually takes about three days for the rash to make its way down to the feet.
Dr. Animasahun said: “Once the rash appears on the legs and feet, symptoms usually subside within two days. The rash itself looks like large flat red to brown blotches that often flow into one another to completely cover the skin, especially on the face and shoulders. The rash fades in the same order that it appeared – forehead first and feet last. The total time for the rash, from beginning to end, head to toe, is usually about six days. As the rash disappears, the healing skin may look brown temporarily, before it sheds in a finely textured peel.
“Immediately these signs are noticed, mothers should present such child to the health centres before they get to the stages where they start convulsing and as much as possible avoid self medication because a lot of time it causes more havoc.”
The outcome of the disease, according to Dr. Goke Akinrogunde, varies from mild (usually the case in the well-fed child and vaccinated) to severe (usually in the malnourished or immunosuppressed patient).
He said: “Small white spots usually develop inside the mouth a day or so later. A harsh dry cough usually follows; poor appetite – going off food – tiredness, and aches and pains are usual, diarrhoea is common; vomiting is not unusual; a red blotchy rash normally develops about three to four days after the first symptoms.
“The rash has the characteristic of both flattened skin decolourising and small pimples-like, what is medically referred to as maculopapulary rash. It usually starts on the head and neck, and spreads down the body. It takes 2-3 days to cover most of the body. The rash often turns a brownish colour and gradually fades over a few days. The rash may be accompanied with itching. Affected children are usually unwell and miserable for three to five days.
“After this, the fever tends to ease, and then the rash fades. The other symptoms gradually ease and go. Most children are better within 7-10 days. An irritating cough may persist for several days after other symptoms have gone. Some people mistake rashes caused by other viruses for measles. Measles is not just a mild red rash that soon goes. It is important to note that the measles virus causes an unpleasant, and sometimes serious, illness. The rash is just one part of this illness. Symptoms and complications of measles are usually most severe in adults.”
Treatment
There is no specific antiviral treatment for measles virus. If there are no complications, the doctor will recommend rest and plenty of fluids to prevent dehydration. However, early presentation has also helped in managing measles.
Dr. Animasahun said: “Again, administration of Vitamin A is important. This has been found to reduce the mortality rate to 50 per cent. It has so far been proven to be potent in treating measles. Above all, immunisation is the key to prevent and eradicate measles.
“Adults who are unsure whether they have had measles or been vaccinated, particularly if they work with children, can have the Measles, Mumps and Rubella (MMR) vaccine on the National Health Service (NHS) from their General Practitioner (GP).”
The following measures may help: If the child’s temperature is high, they should be kept cool, but not too cold. Tylenol or Ibuprofen can help control fever, aches, and pains. Children under 16 years should not take aspirin.
People should avoid smoking near the child. Sunglasses, keeping the lights dim or the room darkened may enhance comfort levels, as measles increases sensitivity to light. If there is crustiness around the eyes, gently clean with a warm, damp cloth.
Cough medicines will not relieve a measles cough. Humidifiers or placing a bowl of water in the room may help. If the child is over 12 months, a glass of warm water with a teaspoon of lemon juice and two teaspoons of honey may help. Do not give honey to infants.
A fever can lead to dehydration, so the child should drink plenty of fluids. A child who is in the contagious stage should stay away from school and avoid close contact with others, especially those who are not immunised or have never had measles.
Those with a Vitamin A deficiency and children under two years who have measles may benefit from Vitamin A supplements. These can help prevent complications, but they should only be taken without a doctor’s agreement.
Antibiotics will not help against the measles virus, but they may sometimes be prescribed if an additional bacterial infection develops.
Prevention
Measles is prevented by a vaccine that can be given before or within three days after exposure to the disease. In most children, measles vaccine is given as part of the mumps-measles-rubella immunisations (MMR) – one given at age 15 months, and the second at 11 to 12 years. Measles vaccine is not usually given to infants younger than 13 months old, except in times of measles outbreaks. In this case, a dose of measles vaccine alone may be given at nine months, followed by the usual MMR immunisation at 15 months.
Measles vaccine made before 1979 may not have been as effective as vaccine made today. Because of this, doctors often recommend that persons vaccinated before 1980 receive another measles vaccination if a measles outbreak occurs in their area, especially if they are in school. A blood test can be performed to determine a person’s immunity and whether they need another immunisation.
Measles vaccine should not be given to pregnant women, or to persons with active tuberculosis, leukemia, and lymphoma or depressed immune systems. Also, persons with severe allergies to eggs or to the antibiotic neomycin, may risk life-threatening reactions to measles vaccine.
Measles vaccine occasionally causes side effects in persons with no underlying health problems. In about 10 per cent of cases there is a fever between five and 12 days after vaccination, and in about five per cent of cases there is a rash.
In special situations (pregnant women, infants, persons with cancer, tuberculosis or depressed immune systems), persons exposed to measles can also be protected from infection by an injection of antibodies called gamma globulin.
Gamma globulin is given within six days of exposure, and it either prevents measles or makes symptoms less severe.
As is the case with all immunisation schedules, there are important exceptions and special circumstances. Your doctor should have the most current information regarding recommendations about the measles immunisation.
Complications
A paediatrician said: “if you talk about one of the most feared complication, it is encephalitis. In other words, when somebody is infected, especially a person that is not immunized, the virus can affect the brain and cause what is called encephalitis – infection of the brain and you know that the brain controls all parts of the body; so if the brain is affected, a lot of the time they become unconscious, they have convulsion and other complications may arise from that.
Animasahun said: “Another complication is pneumonia and in fact, most times it kills the child. Those complications are common in those that are immune-compromised, especially children that are malnourished, and not immunised. When that happens, it affects the child’s breathing and then goes into heart failure; the child can die from that. Also it causes diarrhoea in them that makes them dehydrated, which if not well controlled on time could lead to the child’s demise; so it could be fatal.”
A minimum of two vaccinations dosage is recommended, according to Nigeria timetable. The first is given around the age of nine months and the second can come one month after the first one combined with mumps and rubella virus around 15 to 18 months of age.
When to see a doctor
Call your child’s doctor immediately if you suspect that your child has measles. Also, call your doctor if your child has been exposed to measles and your child is an infant and taking medicines that depress the immune system or has tuberculosis, cancer or a disease that affects the immune system.
If your child has measles, ask your doctor what to watch for. Keep track of your child’s temperature and call your doctor if it goes above 103 degrees Fahrenheit (39.4 degrees Celsius). Let your doctor know if your child has an earache, since this may be a sign of a bacterial infection.
Call your doctor if a child with measles has signs that a lung infection (pneumonia) may be starting. These signs may include: breathing that is difficult or very fast; a cough that lasts for more than four or five days or that brings up discolored mucus; lips or nails that are bluish or gray.
Immediately call your doctor if your child has any of the following: severe headache; stiff neck; convulsion (seizure); severe drowsiness; difficulty waking up or loss of consciousness.