Measles is a worldwide
spread infection triggered by the measles virus. Characteristic for
measles is
an influenza- style early stage and an exanthematous central stage. Due
to its
high infectiousness measles is
mostly a children’s disease. They leave a
lifelong immunity.
The disease is diagnosed
through its symptoms, especially through its characteristic skin
lesions. Measles
is treated symptomatically. 10-20% of
all people infected with measles in
industrialised countries will suffer from complications due to the virus.
These
complications are of special importance because they are not only
frequent but
also increasingly lethal. Measles infection can be prevented by
vaccination.
Measles appear
worldwide and
mostly occur with toddlers and school children because of their high
rate of
infectiousness. While in Germany in the 1990s 50,000 infections were
calculated, the number of registered infections has constantly dropped
down to
under 1,000, due to consequent vaccination of children. 0.1% of all
infections
lead to life threatening complications.
Measles pathogen is the human
pathogen RNS measles virus, which only infects humans. Infected and
acutely ill
people are the natural reservoir for the measles virus. The virus
prefers cells
of the immune and nerve system. At the same time, amongst others, giant
cells
develop, which are already detectable in the nose secretion at the
pre-stage of
the disease. Incubation period averages between eight and twelve days.
The measles virus is transmitted
by droplet infection, e.g. by coughing, sneezing or speaking.
The virus
remains infectious for two hours in the air. Portal of entry are mucous
membranes of respiratory organs and the conjunctiva of the eye. The
risk of
virulance is extremely high. Main risk of virulance is roughly five
days
before until four days after the appearance of the exanthema. 99 out of
100
infected people fall ill.
Two stages, consequent upon each
other, can be discerned with measles: the prodomal stage,
proceeding
with influenza-like symptoms and the exanthema stage with its
characteristic skin lesions.
As with most virus infections, at
present there is no measles specific drug available, in
contrast to
bacterial infections, where there are antibiotics. Therefore, therapy
has to be
effected symptomatically. Main focus are nursing measures and bed rest
in
darkened rooms because of the conjunctivitis.
Possible complications with
measles occur relatively often, especially in children
under the
age of five years and adults over twenty years of age. Further
danger of
complications results from a temporary weakening of the immune defense.
Air passages, organs of the
abdominal cavity and the brain can be affected by complications
inflicted by
the measles virus. Bronchits and pneunomia can
develop in the air passages, both being
responsible for up to 25% of death cases. At the abdominal cavity there
is
often a swelling of the lymph nodes, which causes great pain, can be
registered. Of special meaning is the measles related appendicitis which in
most cases requires an operation.
One greatly feared complication is
a brain infection triggered by the measles, the measles encephalitis, which
forms until up to ten days after the appearance of the exanthema. It
occurs
with roughly 0.1% of all cases and causes disturbance of consciousness,
cramps,
epileptic seizures as well as paralyzation. A few cases are at risk of
permanent
damages. These damages range from persistent paralyzation to mental
disability.
At around 25%, the death rate (mortality) of
measles encephalitis is rather high. A rare complication is the
subacute sclerosing panencephalitis (SSPE),
a degenerative disease of the
central nervous system (CNS) caused by the measles virus, which breaks
out
years later. It is lethal in almost all cases.
The only reliable prophylaxis against
measles with its severe complications is the two times vaccination.
It
provides lifelong immunity. After many serious “children’s
diseases”
(eg. diphteria, whooping cough, polio) could be repressed through the
consequential
use of vaccination, measles at present are the most important
vaccination
preventable (preventable through vaccination) childhood disease.
The STIKO (permanent
vaccination commission at the Robert Koch Institute in Berlin, Germany)
recommends vaccination against measles
with a combined vaccine, which immunises against mumps and rubella as
well (MMR
vaccination). The correct point in time for the first MMR vaccination
is at twelve
months of age.
Before that, the maternal antibodies
still present in the blood could endanger the success of the
vaccination. The
necessary second MMR vaccination can be given four weeks after the
first
vaccination at the earliest. However, it should have been carried out
by the
end of the second year of life at the latest, before the second
birthday.
Double-vaccination is essential since with five to ten percent of all
children
the active substances are not effective at the first time. These
vaccinations
can be caught up on at any age, there is no age limit for the measles
(mumps,
rubella) vaccination. In general, the costs for the vaccination are
covered by
the health insurance companies before the age of eighteen.
The vaccination is well compatible. Approximately 10% of vaccinations lead to light reactions
within the
first three days after the jab (light pain, red skin, swelling) at the
point of
injection. Between the seventh and twelfth day after the vaccination,
light fever
(15-20%) and light measles-style rash (5%) can occur. With one out of
3,000
vaccinated children, fever convulsions which are harmless in most cases
appear.
In order to eliminate this, the pediatrician might recommend taking an
antipyretic medicine (suppository) after the seventh day following the
vaccination.
Severe consequences of the vaccination
are extremely rare, by far more scarce
than with measles itself.
Health authorities explicitly warn
against so-called measles parties. At these parties healthy
younger
children are brought together with contaminated measles-infected
children. That
way the children are supposed to experience measles at an age where the
frequency of especially dangerous side effects is inferior. In view of
the
still remaining risks of the measles disease and the availability of an
effective and compatible vaccine, this practice is irresponsible.
The World Health
Organization WHO has obligated its member countries to
the goal to exterminate measles up to the year of 2010. To
reach that
goal, 95% of the population needs to be vaccinated. However,
the vaccination rate in Germany does not hold out to
that. In 2004, 93.5% of
all school children received their first vaccination but only 65.7%
received
the second vaccination as well. There are especially high vaccination
voids
among the children who are today twelve up to eighteen years old.