Measles: illness, transmission, care &  the vaccine

INDEX TO PARAGRAPHS

Description

Transmission, incubation period and contagion

Symptoms and duration

Complications and risk factors

Seeing a doctor

Recovery and convalescence

Care and natural supportive treatment

Prevention of complications

Fever: hydration and care

Homeopathy

Natural remedies

The vaccine against measles

Description and some facts

 

RUBEOLA (wild measles) is a highly contagious paramyxovirus infection. Fear of measles is the fear of complications from measles. In healthy nourished children, measles will come and go in .... Contracting wild measles provides LIFELONG immunity but vaccine-induced protection wanes. Susceptibility to complications from measles infection is primarily malnutrition [4], babies under one, especially babies who are and were not breastfed, children who are immune compromised and on immune suppressing medication (for example, for HIV and cancer). It is because of these vulnerable populations that the theory that if 95% of the population is vaccinated, the vulnerable population will be protected by 'herd immunity'. It is in certain areas of the world where malnutrition and poverty are rife that complications from measles and other infections are  most prevalent.

  • At the beginning, one dose of the measles vaccine was said to produce life-long immunity. This was due to the fact that measles was still circulating in the partially vaccinated population, providing natural boosters. [5]

  • A second dose and later, and in some areas, another dose of the measles vaccine before school entry is recommended. Some countries give one vaccine after one year of age, and the second dose before school entry.

  • South Africa has pushed the first dose of measles vaccine from 18 months (in the early 1980's)  down to 1 year, then down to 9 months and now down to 6 months.

  • South Africa gives one dose at 6 months, and 2 further doses and more in vaccine campaigns. The first dose at 6 months is called a 'priming' dose and will not protect a baby from measles if confronted with it, but .... ??? [citation] [some exp of Aaby in africa]

  • Breast milk antibodies wane quickly (within maximum of 2 months if the mother was herself vaccinated, leaving South African babies (worldwide actually) vulnerable until and if they are able to develop a good immune response to the vaccine after one year of age. [2]

  • Now, it is recommended that a woman has a dose before falling pregnant. (The MMR for protecting the pregnant mom from measles or rubella (German measles) and in the hope, that transplacental immunity and breast milk will convey some immunity to the baby before the baby is ready to receive their first measles vaccine.) [2] [citation needed]

  • A couple more short facts needed here

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Transmission, incubation period and contagion

The measles virus is transmitted via respiratory droplets from the nasopharynx, produced by sneeze or cough during prodromal period or direct contact with nasal or throat secretions from an infected person and the virus can survive for up to 2 hours in a room after the infected individual has left.

Infected people are contagious about 4 days before and for 4 days after rash onset and transmission commonly occurs before people know they have it.  The asymptomatic incubation period averages 10 to 14 days from time of exposure to onset of symptoms.  Exposure to rash onset averages 14 days (with a range of 7–21 days) 

Symptoms and duration

The infection develops over a period of two to three weeks:

Infection and incubation. 

For the first 10 to 14 days after you're infected, the measles virus incubates. The individual is asymptomatic and can unknowingly spread the virus to others.

Nonspecific response. 

Symptoms may begin with a mild to moderate fever,  lethargy,  runny nose, sore throat, persistent cough and red irritated eyes (conjunctivitis).  A Headache, swollen lymph nodes  and neck ache may accompany the symptoms. This stage could easily be confused with other illnesses.

Koplik spots

Koplik spots may be seen in the mouth, they present as blueish-white spots that contrast against the bright red background of the buccal mucosa in the mouth.  These posts are characteristic of measles infection and help confirm the case.  However, the spots are often missed as they only appear 1–2 days before the rash to 1–2 days after the rash. [6]

Acute illness and rash. 

The maculopapular rash appears as small red spots which may be slightly raised. The rash usually begins at the hairline, then moves to the face and upper neck. Over the following  days, the rash proceeds downward and outward, eventually reaching the hands and feet.  The rash may appear in tight clusters giving the skin a splotchy red appearance. 

As the rash progresses the fever rises sharply, often as high as 41 C.  Finally the rash gradually recedes, fading from the face downwards.

The rash turns from red to brownish in colour, and some may experience itching, fine scaling and flaking skin. A person is contagious from around four days before the rash appears to the first 4 days after rash appeared.

Complications and risk factors

Recovery and convalescence

 

Treatment

 

Treatment should be supportive and aimed at reducing the risk of complications, helping speed recovery and providing comfort.  A naturopathic or homeopathic doctor will be the best health care provider to support one though the measles infection as their approach works with our body to efficiently clear the infection without suppressing the beneficial immune responses. It is EXTREMELY important to allow the body to eliminate the measles virus thoroughly. Medications taken to suppress the symptoms of viral elimination (a fever, a cough, a runny nose etc) will just prolong the disease process and allow the virus to go deeper which can potentially lead to more invasive infection with complications. To get a better understanding of the importance of our immune response please read our article here.

While fighting the measles infection, the body uses a lot of energy, leaving the patient feeling fatigued, so rest, quiet and sleep are important. This way the body is freed to fight off the virus. Avoid heavy meals and provide homemade nutritious, easy to digest broths. Vitamin A supplementation is recommended only in children who are malnourished as the measles virus rapidly depletes our vitamin A reserves. 

 

Home remedies include:

-Herbal remedies like olive leaf extract it echinacea

-Vitamin C

Homeopathic support 

The measles vaccine

 

When vaccination against measles was first introduced, vaccine-induced protection seemed to provide life-long immunity.  This was probably due to the fact that measles was still circulating in the partially vaccinated population, providing natural boosters. As measles incidence declined (which was declining anyway, but vaccination definitely speeded this up), these natural occurring boosting opportunities also declined, explaining why several doses of the vaccine are now required. In South Africa we have pushed the measles vaccine from 18 months of age (in the early 1980's)  down to 1 year, then again down to 9 months and now down to 6 months, despite the fact that babies under 6 months of age remain vulnerable. 

Consequently, due to waning immunity and vaccine failure, previously vaccinated adults are now vulnerable to infection - the disease has been pushed to an age where severity of illness increases and complications are greater. [1]   The other concern is small babies are now susceptible to measles infection as mothers do not have their natural immunity and are unable to pass on antibodies via the placenta while their babies are in utero. This is called passive immunity and offers temporary protection to the baby during its first few vulnerable months of life.

It is important for developing countries to maintain this natural immunity as it is within these demographics that malnourished and immune-compromised individuals are at even greater risk,  especially those receiving  immunosuppressive treatments like antiretro viral drugs or medication for tuberculosis.  Vitamin A deficiency and diets devoid of micronutrients also put these populations at greater risk of measles related complications [2]

​​Historically, long term breastfeeding from mothers who had had wild measles protected their infants with anti-measles IgA antibodies during the most vulnerable months [3]. The transplacental antibodies wane, they last between 2 months (mothers who have vaccine-induced antibodies) and up to 12 months (mothers who have antibodies from wild measles. [4]​  In addition to the immunologic components, breast milk contains several nonspecific factors that have antimicrobial effects. [5] We cannot over-emphasize the importance of breastfeeding, formula is incapable of recreating the protective components of breastmilk.

Due to vaccination, measles is occurring in younger and younger babies and in the opposite spectrum - adults. This explains why the age of measles vaccination has been lowered over the years. Ideally we need to rebuild our natural circulating immunity so true herd immunity is re-established. It is impossible for vaccination to recreate mother natures balance, herd immunity is only attained through natural exposure and continual immune boosting upon re-exposure to the cyclical wild measles outbreaks.

South Africa's measles timeline:

  • 1979 - Measles  declared a notifiable disease.

  • 1975 - Measles vaccine was first introduced to the childhood schedule , available for purchase on the private schedule only. 

  • 1980,s - During the 1980's, we experienced 15 000 to 20 000 cases per year with a death rate averaging 0.00001%. [6]

  • 1983 - Measles vaccination introduced into the government schedule.

  • 1994 -  the first national vaccination coverage survey estimated that 85% of children (aged 12–23 months) had received at least one dose of measles vaccine; the coverage in the nine provinces of South Africa ranged from 72% to 95%.

  • 1992 - Outbreak of 22 000 cases of measles

  • 1995 -  South Africa implemented a two-dose vaccine schedule (Schwartz strain) at 9 and 18 months of age. 

  • 2003 - Outbreak of  1 676 measles cases

  • 2009 -2011 - 18 434 cases of measles

Citations

 

[1] Changing epidemiology of measles

Changing epidemiology of measles in Africa.

https://www.ncbi.nlm.nih.gov/pubmed/21666163

 

The changing epidemiology of measles in an era of elimination: lessons from health-care-setting transmissions of measles during an outbreak in New South Wales, Australia, 2012.

https://www.ncbi.nlm.nih.gov/pubmed/28246577

 

[2] Early waning of maternal measles antibodies

Early waning of maternal measles antibodies in era of measles elimination: longitudinal study (in highly vaccinated Belgium)

http://www.bmj.com/content/340/bmj.c1626

Measles antibodies in the breast milk of nursing mothers.

Breastfeeding antibodies - in mothers who had wild measles -

“When compared to their offspring, the greater proportion of mothers testing positive for measles antibodies suggests that breast milk protects against measles. Based on these findings, the researchers recommend that all health workers encourage mothers in Nigeria to breastfeed their infants to protect them against measles infection.”

https://www.ncbi.nlm.nih.gov/pubmed/8886155

Waning of Maternal Antibodies Against Measles, Mumps, Rubella, and Varicella in Communities With Contrasting Vaccination Coverage

"Children of mothers vaccinated against measles and, possibly, rubella have lower concentrations of maternal antibodies and lose protection by maternal antibodies at an earlier age than children of mothers in communities that oppose vaccination. This increases the risk of disease transmission in highly vaccinated populations."

https://academic.oup.com/jid/article/208/1/10/796786

Passive transmission and persistence of naturally acquired or vaccine-induced maternal antibodies against measles in newborns:

This paper reviews literature on passively transferred maternal antibodies against measles in infants.

The amount and decay of these antibodies can be a result of changing patterns in society: increasing cohorts of women are vaccinated against measles instead of having naturally acquired immunity, the age of first childbirth is increasing and young adults are less exposed to natural boosters. The concentration and persistence of maternal antibodies differ in infants of women vaccinated against measles versus infants of naturally immune women.

https://www.ncbi.nlm.nih.gov/pubmed/17629601

Breastfeeding, the Immune Response, and Long-term Health

http://jaoa.org/article.aspx?articleid=2093315

Lessons from mother: Long-term impact of antibodies in breast milk on the gut microbiota and intestinal immune system of breastfed offspring.

https://www.ncbi.nlm.nih.gov/pubmed/25483336

 

[3] Measles – Vaccine Risk Statement (VRS)

Physicians for Informed Consent 2017

https://physiciansforinformedconsent.org/measles/vrs/

 

[4] MALNUTRITION - Nutritional status as a predictor of child survival

Nutritional status as a predictor of child survival: summarizing the association and quantifying its global impact - Schroeder &  Brown

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486600/pdf/bullwho00415-0039.pdf

 

[5] Waning immunity creating an increasing measles susceptible populations over time following recommended 2 doses of measles vaccine 

An increasing, potentially measles-susceptible population over time after vaccination in Korea

http://www.sciencedirect.com/science/article/pii/S0264410X17308551

[6] Homeopathic and natural treatments for measles and fevers to minimise risk of complications

EAR ACHE

http://merrilynhope.com/list-of-homeopathic-remedies-for-ear-ache/

 

QUICK HELP FOR CHILDREN’S FEVERS

https://homeopathyplus.com/quick-help-for-childrens-fevers/

[7] Measles elimination in South Africa - campaigns

Impact of the 1996–1997 supplementary measles vaccination campaigns in South Africa

https://academic.oup.com/ije/article/31/5/968/745802#ref-3

Measles elimination in South Africa - policy and implementation

[8] Measles Information

Measles - CDC

https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf