In April this year the department of health issued a nationwide measles alert, informing the public that five cases had been reported in the Tshwane (Pretoria) Health District of Gauteng Province. The daily movement of people across municipal and provincial borders became a major cause for concern as it meant the disease would be extremely difficult to contain.
Measles is considered to be one of the most contagious diseases in the world. It is spread through physical contact with an infected person, but is also airborne; the measles virus can remain active and contagious for up to two hours on surfaces or in the air. It is also considered a dangerous disease, particularly for small children. In 2007 the World Health Organisation (WHO) reported 197 000 deaths worldwide, predominantly occurring in children under 5 years, although this figure is an impressive drop of 74% from the 750 000 infections in 2000.
UK measles outbreak
The concern over the transferral of measles across our national borders only points to a greater international hazard that is brewing. A 2009 outbreak of the disease in the United Kingdom, specifically England and Wales, has been rapidly spreading; as of July, 4 141 cases of measles had been reported within the two countries.
It is suspected that public ignorance about the status of the disease has largely contributed to this problem; many parents are under the impression that measles has been eradicated and therefore do not have their children vaccinated against it. Ironically this only leads to the further spread of the disease. Due to the susceptibility of measles in the UK, it is a pre-requisite for all foreign prospective post-graduate students to be immunised with a measles, mumps and rubella (MMR) vaccination before entering the country.
While the infection seems to be worse in Wales, the daily global travel to and from England exposes the international community, particularly underdeveloped countries, to a fairly high risk of outbreaks. According to the Airports Council International, London's Heathrow Airport is the third busiest airport in the world, measured by the number of passengers passing through.
Outbreak left 300 dead in Burkina Faso
The situation in the UK is no doubt very worrying but an outbreak that has occurred in Burkina Faso this year is positively alarming. The United Nations Office for the Co-ordination of Humanitarian Affairs reported 51 000 cases and 300 deaths from measles on 30 June 2009. This marks the largest outbreak of the disease that the country has seen in ten years.
“Although the UK outbreak demonstrates the exception, as a rule developed countries generally vaccinate all children against measles. Attempts are made to follow the same practice in underdeveloped countries but due to a deficiency of resources, this is almost impossible. As measles is present in both developed and undeveloped countries, travellers need to be vigilant about their own safety from the disease,” says Dr Pete Vincent, Netcare Travel Clinics.
In South Africa we immunise children with the MMR at 9 months and then again at 18 months, or at 15 months followed by a booster at age 5. It is important that parents and guardians ensure that their babies receive the measles vaccine, or check that they have already received it on medical records.
Early symptoms of measles are typically similar to those of a respiratory tract infection; fever, runny nose and coughing. However, as this stage of the illness is the most infectious, parents and guardians must be fastidious for the sake of the child’s health as well as for that of other children.
Measles is commonly associated with the severe rash which ensues during the first 2 to 4 days of illness. Prior to this, Kopliks spots (small spots with white or bluish-white centres, resembling ”grains of salt sprinkled on a red background”) can be seen on the inside of the patient’s cheeks. When the rash does appear it commonly begins behind the ears and on the cheeks and then spreads to the trunk and upper extremities of the body. In cases involving patients suffering from malnutrition, severe skin exfoliation can develop.
Chronic cases of measles can be accompanied by ear infection, diarrhoea, pneumonia, and even encephalitis (infection of the brain) which can lead to brain damage. However, nutrition plays a very important role in the treatment of the disease; certain complications can be avoided by an increased intake of nutrients and adequate hydration.
Aside from the heightened risk of contracting other serious illnesses and the uncomfortable nature of its symptoms, measles poses a fatal danger to small children. Thus it is important that people immunise their children, as well as themselves if necessary, particularly if they are going to be travelling, as not only does the disease threaten their own health but also that of others. Before travelling it is imperative that you ascertain your measles status and protect yourself accordingly through immunisation. For this reason we recommend that anyone planning a trip should consult with their doctor or travel clinic.
(Source: Netcare Travel Clinics, August 2009)
Measles – more than a spot of bother