TOPICS: Protecting children from a serious threat

Measles is a leading cause of childhood death. According to WHO, more than half a million deaths occurred mostly in children during 2003 with 38 per cent in South-East Asian countries, next to Africa. Fortunately, in Nepal a nationwide measles campaign since 2004 is reported to have reduced the number of measles cases from 206 in 2004 to 74 as of mid-July 2005, with only five deaths. It has, however, been reported that the outbreaks of German measles (Rubella) have superseded all other forms.

Interestingly, this trend has been observed both in Nepal and Bangladesh. On serological test in a Kathmandu laboratory, out of 840 specimens, 71 per cent were found to contain measles and seven per cent Rubella during 2004. By mid-July 2005 out of 210 tested specimens, only eight per cent were of measles against 59 per cent of Rubella. No information is available on the follow-up of Rubella epidemic. Bangladesh and Indonesia have recorded 40 per cent of Rubella cases now against 11 per cent and 16 per cent respectively in 2004. Bhutan, Myanmar, Sri Lanka and Thailand also recorded some increase in Rubella. This may be a warning for a serious Rubella outbreak in many countries, including Nepal and Bangladesh this winter.

It is important to understand how serious measles infections are. Both are caused by viral infection and can affect children and adolescents. The causative organism enters the respiratory tract through droplets infection. The symptoms of measles are fever, cough, running nose, red eyes, rash on face and head, which persist for about a week. About 30 per cent may suffer from complications like diarrhoea, pneumonia, eye or ear infection, encephalitis. The severity of infection is seen more in malnourished children. Pregnant women can suffer from premature birth, low weight of new borns and even abortion. The disease can be prevented with measles vaccination. On the other hand, German measles is usually mild and is not a killer disease. Generally, the outbreaks occur in the winter and spring seasons and spread easily among the young by entering their respiratory tracts. There is slight fever lasting for about 24 hours and a rash appears on the face and neck lasting for two or three days. Though this is a mild infection, the consequences can be very serious for women during early pregnancy. The chance of giving birth to a deformed baby may be as high as 80 per cent. The consequences include spontaneous abortion, stillbirth and even Congenital Rubella Syndr-ome, which is characterised by multiple defects, particularly in brain, heart, eyes and ears in the newborn.

Meticulous follow-up of cases of foetal wastage and newborn babies in outbreak areas is necessary. The societal cost of complications can be unimaginable. It is essential for the government to study the situation seriously and consider replacing measles vaccine with MR — an effective combination of measles and Rubella. Though more expensive than measles vaccine, the advantages far outweigh the cost in preventing serious birth defects.