Immunization best to avoid measles

Donya Betancourt, Pediatrician, drdonya@hotmail.com

In this second part of a three-article series, we will discuss the complications that can arise from measles, and the treatment and prevention of measles.

A number of different types of complications, some of them very serious, even fatal, can and do occur with measles. Bacterial infections such as pneumonia, ear infections (otitis media), and other bacterial infections are common complications.

People with measles are vulnerable to streptococcal infections. Measles can reactivate and worsen tuberculosis (TB), while immunodeficient patients may develop a grave progressive pneumonia without a rash.

Acute thrombocytopenic purpura, which results in low blood platelet levels (important blood-clotting elements) with severe bleeding, constitutes a potentially serious complication during the acute phase of measles.

Brain inflammation (encephalitis) occurs in one in every 1,000 cases. It starts up to three weeks after the onset of the rash and presents symptoms consisting of high fever, convulsions and coma. It may run a blessedly short course with full recovery within a week. Or it may eventuate into central nervous system impairment or death.

Subacute sclerosing panencephalitis (SSPE): The measles virus causes subacute sclerosing panencephalitis (SSPE), a chronic brain disease of children and adolescents that occurs months or often years after an attack of measles, causing convulsions, motor abnormalities, mental retardation and, usually, death.

Prognosis of measles, without complications: measles has a low mortality rate when it occurs in normal, well-nourished, healthy children.

Unfortunately, complications are not rare with measles and they increase the degree of morbidity (illness). And some of the complications of measles such as measles encephalitis and subacute sclerosing panencephalitis carry an appreciable mortality rate.

There is no current treatment for measles, other than prevention. Measles can and should be prevented by immunization at 12 months of age, with the child receiving a booster shot at five years of age.

The reason for this recommendation is so as to ensure that schoolchildren are fully immunized against measles, mumps and rubella. There have been recurrent outbreaks of measles (and some outbreaks of rubella) in school-age children.

Although most of the children in these outbreaks had one MMR shot, a single shot does not give complete immunity against measles to all children.

The change in timing of the second immunization, it is hoped, will help wipe out measles (and mumps and rubella, too). How does one become immune to measles?

A child born to a mother who had measles receives immunity from its mother lasting most of the first year of life. One attack of measles provides lifelong immunity, and proper vaccination confers lifelong protection against measles.

If your child is fully immunized, measles is unlikely but not impossible.

You should always contact your child's doctor when your child has a cough and fever with a rash. If a child who has not been protected is exposed, the attack can still be prevented or made milder if an immunoglobulin is given within three days of exposure or if gamma globulin is given within six days of exposure. A couple of months later, when the gamma globulin effect has worn off, it is very important to have the child immunized against measles.

The population at high risk from measles includes:

* Infants too young to have been immunized (less than 1 year of age).

* Those who refuse vaccination.

* Those who received immune globulin near the time of measles vaccination.

* Persons vaccinated with an inactivated vaccine (available from 1963-1967)

* Those who have not been revaccinated for measles.

I am not suggesting what parents should do as regards the vaccination of their children. However I have observed and dealt with the trauma and complications caused by preventable disease. It is in my opinion far better to take a chance of experiencing unproven side effects from a proven vaccine than to invite preventable disease to our children by keeping them unnecessarily exposed.

I firmly believe prevention is always better than treatment.