While the local transmission of measles ceased in Sri Lanka in May 2016, a few imported cases in 2017 in different parts of the country alerted the health authorities of the risks of ‘imported measles’ due to international travel and tourism.
The Sunday Observer spoke to Consultant Epidemiologist, Ministry of Health, Dr Deepa Gamage to seek more information about this contagious disease and what the Ministry of Health is doing to prevent its resurgence.
Excerpts…
Q. Measles outbreaks have been reported in various parts of the world. What is the situation in Sri Lanka?
A. Measles transmission had stopped in Sri Lanka in May 2016. But when outbreaks occur around the world as is happening now, the disease can be transmitted to our country if the local population is not properly protected against it. We have experienced a few imported cases in 2017 to date in different parts of the country but not a continued transmission within. However, due to international travel and tourism it is difficult to stop the importation of measles, and we have to make efforts to stop within country transmission.
Q. What exactly is measles?
A. Measles is a disease caused by a virus. It causes fever and rash, with some other signs and symptoms.
Q. Many of the early symptoms like fever, runny nose, cough are similar to flu. How can you tell the difference?
A. Measles is different to viral flu. Fever is followed by a skin rash, 2-3 days after fever. Reddish brown small spots over the skin usually start on the face and neck and then spread all over the body (we call it maculopapular rash). The affected can also get red eyes, cough, runny nose and very small greyish white spots in the inner cheeks. These are basic disease symptoms and could progress into complications.
Q. How does it spread?
A. Measles is highly contagious and the virus can easily and quickly spread through contact with an infected person. The virus lives in the mucous of the infected person’s nose and throat. It is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs or sneezes.
A susceptible person being near an infected person, exposed to cough or sneeze, touches surface with droplets of infected person’s mucous and then touches nose, eyes or mouth with contaminated fingers could spread the disease.
Q. How close should you be to be infected?
A. Measles being one of the most contagious of all infectious diseases, almost nine out of 10 susceptible persons with close contact to a measles patient would develop the disease. The virus can remain on surfaces and in rooms where an infected person stays for nearly two hours and spread to others up to two hours after the infected person leaves the area.
Q. Who are those most at risk of getting measles?
A. Anybody who is not protected for measles either by receiving two doses of measles containing vaccines or those who have not got the infection before are at risk.
But, people at high risk for severe illness and complications from measles include infants and children over 5 years, adults over 20 years, pregnant women, people with compromised immune systems, such as leukemia and HIV infection.
Q. When a very young child gets measles what can happen?
A. When very young children are affected:
• One out of 1,000 measles cases could develop acute encephalitis, resulting in permanent brain damage.
• One or two out of 1,000 children who become infected could die due to respiratory and neurologic complications
• Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal degenerative neurological disease characterized by behavioural and intellectual deterioration and seizures that generally develop seven to 10 years after measles infection
Q. Is diarrhoea a complication in the very young who get measles.
A. Common measles complications include ear infections and diarrhoea. Ear infections occur in about one out of every 10 children with measles and could result in permanent hearing loss.
Q. Is it a notifiable disease?
A. Yes, measles and rubella are both mandatory notifiable diseases. Both can present reddish spotted rash called maculopapular rash. Therefore, all “fever and maculopapular rash” cases are now notifiable diseases, since 2017.
Q. What is the treatment procedure?
A. Severe cases can get symptomatic treatment such as treatment for fever, but maintaining adequate hydration, nutrition and supplements of vitamin A will be given by the treating specialist consultants or medical officers. Complications if any will be attended by them. A very effective preventive vaccine is available to prevent the disease.
Q. If a person gets symptoms that look like measles, what should he do?
A. Immediately see a qualified medical officer, and keep away from public places as it can spread to others. Also provide necessary information for essential notifications and laboratory confirmations, comply with area Public Health Inspector (PHI) and Medical Officer of Health (MOH) during case report investigations.
If one remains at home without getting treatment in mild cases of fever and rash, please inform your area MOH, Public Health Midwife (PHM) or PHI.
Q. How is the disease diagnosed?
A. All suspected cases need to be tested at a national recognized laboratory for measles testing which is the Medical Research Institute laboratory.
Samples of suspected cases from all government hospitals, MOH offices at field level investigations and from the private sector for measles surveillance are tested for confirmation at the MRI laboratory. This is required as measles is a disease considered for elimination by 2020 in Sri Lanka.
Q. What is the best time to get tested?
A. There are two tests, to identify the measles virus and the virus type, for which nose and throat swabs need to be collected within the first week of the onset of the rash. Blood can be tested to determine measles infection (Measles IgM) up to one month.
Q. Once diagnosed, and found positive does the patient need to be hospitalised?
A. It is not essential to hospitalize unless the disease is severe and requires special care. It is necessary to isolate patient whether in hospital or at home because of the highly infectious nature of the disease which could cause an outbreak.
Q. How do you prevent the disease? Is there a measles vaccine? To whom is it given?
A. Measles vaccine available as MMR vaccine gives protection for mumps, measles and rubella.
Measles vaccine started in Sri Lanka in 1984, for 9 month old infants and continues to date offering additional doses to those who were born up to 1993, and during the early years of 2002-2003.
Further two doses of measles containing vaccine have been given through the National Immunization Program for all born after 1998.
Q. When and why did you decide to introduce the 2nd dose of measles vaccine?
A. Receiving only one dose would not provide adequate immunity or protection, but by receiving a 2nd dose adequate immunity will remain lifelong.
Q. You have also introduced the rubella vaccine. Why?
A. Rubella vaccine is included in the same MMR vaccine now. Rubella is also a viral disease, the clinical picture of which is similar to measles but milder. But if contracted during pregnancy it causes serious disease conditions and complications.
Q. How does rubella affect a pregnant mother?
A. If the pregnant mother gets rubella, the baby would be affected and the condition is known as “Congenital Rubella Syndrome” (CRS).
This is a condition where a baby is born with many congenital abnormalities.
Q. What are the health impacts of CRS on an unborn child?
A. The unborn child could die or be born with congenital abnormalities such as small head, eye problems including blindness, ear problems including deafness, heart problems, and other organ problems which can remain causing long term problems to the child.
 Women with little children at a clinic |
Q. What is your present Immunisation Schedule for measles and rubella vaccination?
A. MMR vaccine is first given at the age of nine months and the 2nd dose at the age of three years.
If any woman of reproductive age has not received rubella containing vaccine during her childhood, one dose of MMR is given, at least three months before becoming pregnant.
Q. Your message to all parents with regard to vaccination?
A. Make sure you vaccinate your children with two doses of MMR vaccine. Check your baby’s card (Child Health Development Record) to identify that two doses of measles containing vaccines have been given.
If not, meet your nearest MOH or PHM in the area and get both MMR vaccine doses to ensure adequate protection. If not disease consequences would be serious for your child and your child could transmit as a source of infection to others in the community.