Rubeola (Rougeole in French) - Measles!!

....Our first experience dealing with measles was in 1977,  during our first mission trip to Liberia. Complications of measles were the most common cause of death in children way back then. We did not see measles again until quite recently!

 .....2 year old Imran looks and feels sick but us actually doing a bit better. He has conjunctivitis with one eye matted shut. His lips and mouth are quite sore and have a Gentian violet coating to give some antisepsis. A nasogastric tube is in place to give him fluids. He is also receiving a broad antibiotic intravenously, tetracycline eye drops, and vitamin A.

.....The picture below shows his rash better. It has gotten scaly and crusty in a few places.

....Imran is in an 8 by 12 foot room at the back of the hospital with 4 or 5 other children with measles - that is as close to "isolation" as we can get here.

Before the measles vaccine was introduced in 1967, over 90% of children and adolescents under age 15 experienced measles. The vaccine reduced the number of cases by over 99% and the US was declared “measles free” in 2002! Since then, isolated outbreaks have occurred and there were 118 cases reported in 2017.

Humans are the only reservoir for measles. The virus, rubeola, is highly contageous and 90% exposed to it contract measles. It is spread by the respiratory and personal contact routes. Virus-containing droplets can survive for up to 2 hours after a cough or sneeze which helps explain this.

During the 1-3 week incubation period, the virus spreads from the respiratory tract to the bloodstream and then throughout the body. Patients develop what looks like a typical “viral syndrome” with fever, cough, runny nose, and conjunctivitis (eye irritation). A few days later, the typical rash occurs, starting on the face and then spreading downward. A few days after that, the rash begins to darken and fade and the child improves. The contagious period begins 5 days before the rash appears and for a few days after the rash is first seen.

Complications occur in a third of cases including pneumonia, diarrhea, and occasion brain involvement.  Diarrhea is the most common complication while pneumonia is the most common cause of measles-associated death and is reported in 6% of cases in developed countries but is higher in developing countries like Niger where excellent healthcare, good nutrition, and reliable access to clean water are sometimes not available.

Treatment for measles is supportive care – there is no cure. Children are given tylenol to control fever, antibiotic eye drops if their eyes are inflamed, antibiotics if there is any hint of pneumonia or other infection, and generous fluid intake especially if there is diarrhea. Nutrition is stressed and children are given a couple doses of Vitamin A which helps their eyes. Unless the child is critically ill, it is better for them to be cared for at home so that they do not infect others in the hospital. Here in Niger, children tend to come in later in their disease and often are malnourished and suffering from diarrhea or pneumonia from the outset.....all of which lessens the chance for a quick recovery.

In the US, children are given their first dose of measles vaccine at age 12-15 months. Not all children get an immune response to the first dose so children are given a "booster" at age 4-5 years, before they go to school.

 In Niger, the 2 doses are recommended at 9 and 16 months. The World Health Organization has estimated  that about 80% of children get their first dose here but only about 40% have received a second dose.  While the government supplies most of the vaccines, some children are not immunized due to lack of parental education about the benefits, issues with transportation to the vaccination centers, and issues with healthcare infrastructure.

Global measles vaccination is estimated to have prevented more than 20 million deaths during the past 15 years!