An outbreak of measles in California, which has spread to 14 US states, has brought the disease back into the spotlight and reopened the row about vaccination. Dr Josephine Fagan gives us the facts.
In 2013, there were 145,700 measles deaths world-wide, according to WHO (that’s 400 per day); most were small children who lived in countries with poor health care.
Thanks to immunisation, measles is rare in the UK. But recent falls in vaccination have contributed to outbreaks such as that in Swansea, where more than a thousand cases were reported.
What is measles?
A highly contagious, potentially fatal, viral illness for which there is no specific treatment. It can be prevented by a safe cost-effective vaccine that is free on the NHS.
How is measles spread?
By coughing, sneezing and close contact with an infected person. The virus can also live outside the body for up to two hours and can be picked up from contaminated surfaces, such as door handles.
What are the symptoms?
As the virus multiplies in the throat and lungs, initial signs include:
• Fever, runny nose, sneezing
• Small white spots in the mouth and throat, (called Koplik’s spots).
• A dry cough, (which may persist after other symptoms have gone)
• Aches and pains, decreased appetite and energy
• Diarrhoea and vomiting
The rash appears two to four days after the initial symptoms and generally lasts a week. Spots usually start behind the ears then spread to the head, neck and the rest of the body. Small and red, at first, the spots get bigger, darker and often join together, before fading.
What are the possible complications?
Serious complications are more common in under-fives and adults over 20, especially if they also have immune system problems such as leukaemia and HIV/AIDS.
Most deaths occur in places where malnutrition is rife, (especially Vitamin A deficiency). But there are still occasional UK deaths from measles complications (usually unimmunised children).
More common complications include:
• Bronchitis and croup
• Ear infections
Less common complications include:
• Squints (the virus may damage the nerves/muscles of the eye)
• Febrile convulsions
• Encephalitis, which may cause brain damage and death
• Hepatitis (liver inflammation)
• Pregnant women with measles are at risk of miscarriage, pre-term delivery and other complications.
• A very rare, potentially fatal, brain condition called subacute sclerosing panencephalitis can develop several years after getting measles.
What if you suspect you or your child has measles?
See your GP (phone ahead, so you can avoid contact with other patients).
Your doctor may take a sample of saliva to confirm the diagnosis.
Measles is a notifiable disease, which means your doctors is legally obliged to report all cases to the UK Health Protection Agency.
How is measles treated?
Keep cool and hydrated. Paracetamol and ibuprofen may help fevers and aches and pains. Antibiotics are not usually prescribed.
How is measles prevented?
• MMR vaccination is the best method
• So-called ‘herd immunity’ may offer some protection. This is when most of the population, (or ‘herd’), is vaccinated, making it difficult for viruses to spread. In the UK, this would require 95% of people to be vaccinated. Deciding against vaccination, therefore, has a real impact on local communities; it also leaves unimmunised individuals at risk of infection when visiting countries with low herd immunity.
• If you’ve had measles, you usually have life-long immunity.
What is the MMR vaccine?
It’s a combined vaccine against measles, mumps and rubella, (German measles) which was introduced into the UK in 1988 and is given as part of the routine NHS childhood immunisation programme. Two doses are required: one at approximately 13 months of age, followed by a preschool booster.
Babies under six months of age are not routinely given MMR because antibodies passed on to them by their mothers can make the vaccine less effective.
Can the MMR vaccine be given to older children/adults?
Yes. MMR is available on the NHS to anyone who has missed one, or both, doses. (People born between 1980 and 1990 may not have been vaccinated against mumps, and those born between 1970 and 1979 may only have received one dose of measles vaccine.)
Women should avoid falling pregnant for one month after vaccination.
What about separate vaccines against measles, mumps and rubella?
These are not available on the NHS. Vaccinating this way would mean six separate injections with delays between each, increasing infection risk and the likelihood of not completing a full vaccination program.
Is the MMR vaccine effective?
Very: it protects 99% of people from measles alone.
Who shouldn’t have MMR?
There are very few medical contraindications to MMR. But, as a general rule, it should not be given to:
• Pregnant women
• People who have had an injection of immunoglobulin, or any other blood product, within the previous 3 months
• People who have previously had severe allergic reactions to gelatine, or an antibiotic called neomycin
• People with a weak immune system/undergoing treatment for cancer
Does MMR cause autism?
In 1998, Dr Andrew Wakefield published a paper in The Lancet, claiming a link between MMR vaccination and autism. This work has been completely discredited and Dr Wakefield struck-off. Subsequent studies have not established any link between MMR vaccine and autism or bowel disease.
Does the MMR vaccine have any side-effects?
Some people may develop a mild form of measles or mumps for a couple of days.
Very few people may develop an allergic reaction to the vaccine.
In rare cases, small bruise-like spots may appear weeks after immunisation, in which case you should consult your doctor.
What’s the take home message?
Roald Dahl, having described the death of his daughter, Olivia, from measles at the age of seven, wrote: “I know how happy she would be if only she could know that her death helped to save a good deal of illness and death among other children.”
And yet, in California, over 100 children recently contracted measles in an outbreak thought to have started in Disneyland. The ensuing debate about vaccination turned political when Republican presidential hopeful, Rand Paul, not only backed ‘anti-vaxxers’, but went further, saying, “I’ve heard of many tragic cases of walking talking children who wound up with profound mental disorders after vaccines.”
Hilary Clinton, meanwhile, provided the voice of reason. “The Earth is round, the sky is blue, and vaccines work,” she tweeted. “Let’s protect all our kids.”
Josephine works as a doctor in urgent and primary care. She’s also a bit of a globetrotter, is working on her first novel, and loves the colour purple.