Nigerian children and the threat of measles

Over the years, measles has remained one of the most deadly infectious diseases known to man. An airborne virus, measles is transmitted by respiratory droplets from the nose, mouth, or throat of an infected person and a leading cause of death among children world-wide. In Africa, about 13million cases and 650,000 deaths occur annually, with sub-Saharan Africa having the highest morbidity and mortality.

Nigeria has the largest population in Africa with over 140 million people and measles is the fifth leading cause of under-five child mortality and 50 per cent of deaths of all vaccine preventable diseases in the country. Measles infection and mortality was found to occur all year round irrespective of whether it was rainy or dry season, reinforcing measles endemicity in this part of West African.

Despite the efforts of governments, World Health Organisation, WHO, and United Nations International Children Emergency Fund’s (UNICEF’s) measles-reduction strategy, and the partnership of other international organizations supporting measles reduction, certain states have continued to face recurrent epidemics.

What is worrisome to health authorities in the country and should be of serious concern to everyone is that the measles virus can spread in a person four days before the onset of the telltale rash, making people with the virus to become contagious ever before they are actually aware that they had measles. Another fact that makes measles virus really scary is that it can live on surfaces for up to two hours and in an unimmunized population, one person with measles can infect 12 to 18 others.

This is way higher than other scary viruses like Ebola and HIV. With Ebola, one case usually leads to two others while in the case of HIV; one case leads to another four.  A person with measles can cough in a room, and — if you are unvaccinated — hours later, you could catch the virus from the droplets in the air that they left behind. This accounts for why everybody must be a change agent and social mobilizer propagating measles immunization rather than being merely contended after getting our own children vaccinated.

According to the Centre for Disease Control (CDC), the horrible mathematics of measles looks like this: one out of every 20 children with measles gets pneumonia; one in 1,000 will develop encephalitis (swelling of the brain); and one or two in 1,000 children will die. The optimal age for infantile measles vaccination is an important health issue since maternal antibodies may neutralize the vaccine antigen before a specific immune response develops. Delaying vaccination, on the other hand, may increase the risk of complicated disease. Getting only one dose of the vaccine instead of the recommended two also seems to increase people’s chances of getting measles if they are ever exposed.

However, as a child approaches 14 years, incidence of measles reduces to 0%, confirming WHO’s position that measles is a childhood problem and of huge concern in developing nations such as Nigeria. Usually, after an incubation period of 10 to 12 days, measles comes on as a fever, cough, stuffy nose, and bloodshot and watery eyes. Loss of appetite and malaise are equally common signs of measles. Several days after these initial symptoms, an uncomfortable spotty, rash begins to spread all over the body, starting on the face and neck, and moving downward. The rash usually lasts for three to five days and then fades away.

In uncomplicated cases, people who get measles start to recover as soon as the rash appears and feel back to normal in about two to three weeks. But up to 40 percent of patients have complications from the virus. These usually occur in children under-5, in adults over 20, and in anybody else who is undernourished or having low immunity.

The most common complication from the measles is pneumonia, which accounts for most measles-related deaths. Less frequently, measles can lead to blindness, croup, mouth ulcers, ear infections, or severe diarrhoea. Some children develop encephalitis (swelling of the brain), which can lead to convulsions, loss of hearing, and mental retardation. Again, these complications mostly arise in people whose immune systems are already weakened because of their age, pre-existing diseases or malnutrition.

With a vaccine, measles is prevented through the combination of MMR (measles, mumps, and rubella) shot. Immunity from the vaccine lasts for decades. The vaccine is known to be extremely safe and very effective. It contains a live but weakened version of the virus, and it causes the immune system to produce antibodies against the virus. Should you be exposed to actual measles, those antibodies will then fire up to protect against the disease.

The measles virus could theoretically be wiped off the face of the planet, never to infect another human again. That is because it fits the profile of diseases that can be eradicated. People, and not animals, are the only carriers of the virus (so eradication wouldn’t require killing off an entire animal species). Steps being taken in Lagos State to eradicate the disease include promotion of exclusive breastfeeding of babies for the first six months, routine immunization of children and putting measures in place to ensure that the schedule is completed by the child’s first birthday (measles vaccine at 9 months), ensuring the administration of Vitamin A from the age of six months for mothers that register in the health facilities.

Fortunately, a 5-day measles immunization follow up campaign has been scheduled to hold nationwide till the first week of February to give all children age 9 months to 5 years vaccine against measles irrespective of their immunization status. In Lagos State, the measles follow- up campaign shall take place in all Primary Health Care Centres across the state and other designated posts such as markets, bales houses, schools, churches, mosques etc. Parents need to take action by taking their children within age range to get vaccinated and get a card after vaccination. On the part of care givers, it should be known that child survival is not by accident. As such, everyone should avail of this opportunity to immunize against measles.

For governments across the country, more budgetary provision should be made for measles vaccination efforts in so that infrastructures will be in place that will also serve as a frame-work for other vaccine-preventable disease interventions, as the health institutions are weak at the primary and secondary levels, especially in remote and rural areas. Maintenance of cold chain for vaccines should also be a priority as temperatures vary, and so does the time taken to get to some vaccination locations which reduces vaccine quality as a result of thawing. Internally Displaced People at various camps in the country should also be covered by states where such exist.

The life of every child is very important and anything that will ensure its survival must not be treated with a kid gloves. With measles, poverty and ignorance can’t be an excuse any longer. Measles vaccine is free all over the country and governments at all level are also doing their best in creating awareness. It is now left to parents to play their own part by making their children available for immunization.

Rasak Musbau

 

Musbau is of the Features Unit, Lagos State Ministry of Information & Strategy, Alausa, Ikeja.