Measles overview

It is thought to be harmless. However, measles poses a major danger, particularly to children under-five years of age. At the present time, mortality related to this disease has dropped significantly; there were over 164,000 deaths in 2008 (450 deaths per day), compared to 733,000 deaths in 2000 and 2.5 million in 1980.

The current strategy to reduce measles-related mortality is based on the objective to immunize the most children, by administering two doses (two injections) instead of one. An inexpensive vaccine (under 0.30 ââ?š¬) has existed for 30 years. It is effective for about 85% of the children vaccinated and provides protection for several decades. The more children immunized, the more the circulation of the virus is limited, and consequently, the more the risks are limited for the unprotected population (the older portion).

A viral disease Measles, a viral illness, propagates through infected droplets emitted by sneezing, coughing, and direct contact with nasal or oropharyngeal secretions of infected individuals. Measles primarily affects children and causes a fever and skin rash.

There are significant risks of complications: ear infections, pneumonia, diarrhea, malnutrition, and encephalitis (inflammation of the brain). These complications can result in seizures, blindness, mental retardation, and even death.
In the absence of treatment, measles results in the death of 5% to 20% of those with the disease. Furthermore, those that recover are still subject to a high risk of mortality in the twelve months that follow the disease. However, once an individual has had measles, he or she is no longer at risk; the disease affords lifelong protection.

Epidemics In the face of this extremely contagious disease, epidemics in 2010 are once again common in multiple countries. Immunization coverage (the proportion of children immunized out of all the children in the age group who should be immunized) should be very high and then maintained at this level to limit the number of cases and deaths and to prevent the onset of epidemics.

The vaccine is effective for about 85% of children immunized: out of 100 immunized children, 15 will be non-responders and as such unprotected. If these non-responders do not receive a second dose, and if in addition a portion of the children are unvaccinated, a larger and larger group is formed as time goes by, and eventually becomes large enough for an outbreak to occur. On average, an immunization coverage of 80% will translate into occasional cases and deaths and a risk of outbreaks every five years or more. At 60% coverage, there are more cases and deaths; outbreaks occur frequently – about every three years.

When MSF stages an intervention on measles outbreaks, our teams strengthen epidemiological surveillance and patient care (treatment of symptoms, malnutrition secondary to measles, etc.) and strive to conduct an immunization campaign in coordination with local officials. MSF has shown that the emergency vaccination of children saves lives.

An effective and inexpensive vaccine There is no cure for the measles virus. To care for the sick, their symptoms must be managed and complications prevented. The treatment is simple and relies on acetaminophen, antibiotics, ophthalmic ointments, and vitamin A to prevent ophthalmic complications and diarrhea. Nutritional support is necessary because measles is a major risk factor for malnutrition.

The best way to reduce measles-related mortality is to strengthen prevention. The present strategy recommends two doses (two injections) instead of one in order to “catch-up” with those who did not receive the routine immunization and also to catch-up with the non-responders (85% vaccine efficacy).
This objective is carried out through:

  • routine immunization targeting children from 9 to 12 months of age;
  • national immunization campaigns at regular intervals (every two to five years); SIA (supplementary immunization activities) for children 9 months to 5 years of age.