Measles outbreak — a cause for concern

A measles outbreak was confirmed in Nepalgunj Sub-Metropolitan City (SMC) earlier in January.

Thereafter, two districts in Koshi (58), one in Madhes (103), three in Lumbini (388) and one in Karnali (62), and three in Sudurpaschim (79) have reported 690 measles cases between November 24, 2022, and March 10, 2023 — 86% of the cases involved children under the age of 15, reports World Health Organisation (WHO).

Banke reported as many as 327 cases, Mahottari 103, Surkhet 62, Bardiya 49, Kailali 39, Sunsari 34, Kanchanpur 27, Morang 24, Bajura 13 and Dang 12.

The risk of spread has been assessed as high at the national and moderate at the regional level.

Health experts attribute a number of factors, including low rates of vaccination against measles, internal migration, a lack of knowledge about the significance of vaccinations, and government indifference to frequent outbreaks. 

In addition, the micro plan and outreach session sites for regular immunisations were not developed with community involvement, which resulted in a dearth of outreach session sites.

An immune gap has developed in populations as a result of low vaccination coverage brought on by the COVID-19-induced lockdowns. 

Despite the advent of a secure and cost-effective vaccine, an estimated 128,000 people — mostly children under the age of five years, died globally from measles in 2021.

Measles is a highly contagious disease caused by the measles virus. When an infected individual coughs or sneezes, airborne respiratory droplets that disseminate in minutes transmit the virus from person to person. Direct contact with contaminated secretions can also cause transmission. The virus remains active and contagious in the air or on infected surfaces for up to two hours.

Symptoms usually develop with a runny nose, cough, red and watery eyes, and small white spots inside the cheeks. A rash erupts after several days, usually on the face and upper neck. The rash spreads over about three days, eventually reaching the hands and feet, and lasts five to six days before fading.

On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).

The virus first infects the respiratory tract before spreading to other organs. 

Serious complications such as blindness, encephalitis (an infection that causes brain swelling), severe diarrhea and related dehydration, ear infections, or pneumonia are more common in children under five years or adults over 30 years of age.

There is no specific antiviral treatment for measles and most people recover within two or three weeks.

An effective and safe vaccine is available for the prevention and control of measles which averted 56 million deaths between 2000 and 2021.

The first dose of the measles-containing vaccination (MCV1) is administered at the age of nine months, and the second dose of the measles-containing vaccine (MCV2) is administered at the age of 15 months. 

To stop the spread of measles, WHO recommends 95% of the population must be vaccinated with MCV1 and MCV2. It also suggests strengthening integrated epidemiological surveillance of measles and rubella in order to achieve the timely detection of all suspected cases in public, private, and social security healthcare facilities.

Supportive care, including proper diet, and enough fluid intake restores important nutrients lost due to diarrhea or vomiting, which can lessen the severity of complications from measles.

Besides immunisation, early action by the public and the appropriate government entity is vital to stop the virus from spreading further within the community.