The occurrence of measles has become a lot less common since vaccination during childhood became compulsory more than 30 years ago. However, despite advances in healthcare and the infection’s relative rarity these days, measles remains a potentially-deadly infection that should still be taken seriously by parents when it comes to safeguarding their little ones.
Measles is caused by a virus of the influenza family. While the initial measles symptoms are somewhat similar to a bad cold or flu, the differentiation is the tell-tale rash. Nowadays, the vast majority of parents are not really aware of what measles really is, apart from the fact that it is a childhood illness. They know it has a rash and is infectious, but that’s about it. They have probably never seen it and don’t know anyone who has had it.
The measles referred to in this article is a highly contagious respiratory viral infection that is also known as rubeola, and which is almost as contagious as smallpox. Back in the 1940s and 1950s, measles was a major killer worldwide – even if it was not fatal, it became widely known throughout medical circles as being the most dangerous children’s rash-producing disease. Back in the pre-independence days of Singapore’s history, children who were down with measles would sometimes even be allowed to mix with other healthy, uninfected children, as their parents hoped that by catching the disease, their kids would then have natural immunity against the disease as adults.
However, that risky behaviour was soon to change when the measles vaccine became available in 1963. Another breakthrough followed when the MMR (measles, mumps and rubella) combination vaccine was licensed in the USA in 1971, followed a year later in the UK. In Singapore, the Infectious Diseases Act (IDA) was enacted in Parliament in 1976, and came into force on 1 August 1977; compulsory vaccination against measles was implemented in 1981.
Under the IDA and the National Childhood Immunisation Schedule, it is compulsory for parents and guardians to have their child vaccinated against diphtheria and measles. The penalty for non-compliance is a fine of up to $500 for the first offence and up to $1,000 for the second or subsequent offence.
Babies must go for their first MMR dose at the age of 12 months. The follow-up and final dose can be administered when the child is aged between 15-18 months. Typically, the MMR vaccine is available free at polyclinics for children who are Singapore citizens.
The last major worldwide outbreak of measles was back in 2003, when over 30 million cases were reported, killing about half a million! Although measles is commonly thought of as a childhood illness, it can in fact be contracted at any age as the infection spreads easily among people who have never been vaccinated.
In May this year, the Ministry of Health issued a reminder to all parents to “bring their children for vaccination if they have not done so, or missed the vaccination schedule.” This was after a total of 50 measles cases were reported as of 21 May this year, as compared to just 17 cases in 2015 during the same period. Of these cases, 17 of them were babies under the age of one, who were not due for the MMR vaccination, while 14 cases were between the ages of one to six years old who had missed their MMR vaccination altogether. Another three cases were children who had received only one dose of MMR vaccination and not their second dose.
Such news continues to show that measles remains a serious medical condition that can quickly escalate out of control if precautionary measures are not strictly adhered to. Indeed, measles is still one of the major causes of death in children worldwide, with an average of over 600,000 cases reported annually. Children have around a 99 percent chance of contracting the disease if they come into contact with an infected person. The main cause of death in around 60 percent of measles cases is pneumonia.
Even when measles does not kill, the illness poses several serious risks of side-effects. For example, children will have a higher-than-average chance of developing hearing problems, or worse, contracting meningitis or encephalitis. The chances of the latter happening are only one out of every thousand individuals, but still, no parent would want their child to be that unfortunate statistic.
As a parent you should learn how to recognise measles symptoms, as well as the order which symptoms appear, and when to call a doctor. If your child has already had the disease, or is immunised, you probably don’t need to know this, but being aware of the most important measles symptoms and when to get medical help is still useful information to know.
While diagnosing measles off the bat may not be easy initially since it also shares similar symptoms with many other childhood infections, parents should still remain vigilant and aware as all infections typically have at least one dominant symptom which is particular to that disease.
Measles frequently starts with symptoms similar to those of a cold or the flu.
1. First there might be a runny nose and a case of the sniffles, followed by a sore throat. A typical “barking” cough can then develop. It still might not occur to parents that the child could be having measles. Later, the patient’s eyes will swell up, may become watery and get red and sore looking. Parents can now suspect measles as a possibility.
2. A slight increase in temperature will develop, and will increase to around 39°C. The child may become sensitive to light; at this point parents may decide to bring the child to the doctor despite the symptoms not being affirmatively indicative of measles. Most parents will still regard these symptoms as the onset of a cold or flu.
3. Koplik spots - You may not notice this, but about two to three days after the first symptoms appear, your child will get small spots on the inside of the cheek, round about the molars, called Koplik spots. These look like small red bumps with tiny grains of sand or salt in the middle. These may last less than a day and sometimes even appear within the first 36 hours. Once there is evidence of Koplik spots, measles can be definitely confirmed as no other infection will feature this symptom. However, these tiny lesions will disappear once the main rashes begin to appear.
5. Apparent recovery - Your child’s fever will have abated by now, and stabilised to a temperature of 37–38°C. Parents who are as yet unaware that their child has caught measles may mistakenly think that recovery is just around the corner.
6. The main rash starts to appear about one or two days after the emergence of the Koplik spots. The rash will present as small spots which merge together to form bigger blotches that are red or reddish-brown in colour.
7. The rash appears on the forehead around the hairline first, then gradually spreads to the neck, body, arms and legs. By now, almost every parent would have brought their child to the clinic, and a doctor would have given the measles diagnosis based on this visual observation as well as the earlier symptoms. On rare occasions, the doctor may order a saliva swab or blood test to positively identify the measles virus through a laboratory detection of measles-specific immunoglobulin M (IgM) antibodies.
8. As the rash begins to spread to other areas of the body, your child’s temperature may spike again, this time to over 40°C, which may be alarming for some parents, who no doubt will be concerned that the fever has returned with a vengeance. Don’t worry excessively, however, as the high fever is a definite signal that your child’s immune system is actively fighting the virus, which will be dying out by now.
9. The main measles rash usually lasts about four days to a week before beginning to disappear from the head downwards. About 10 days will have lapsed from the first signs of the earliest symptoms to the disappearance of the rash. However, a person ill with measles is already infectious from about four days before the rash is visible, to about four days into its noticeable appearance, so the condition is still contagious even though the patient may not show symptoms.
However, if you really cannot avoid going to such places, ensure that your child wears an appropriate surgical mask, especially if he is under 12 months old and yet to receive his first MMR dose.
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