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Measles Vaccine -- Timing is Everything
Most women have had either measles, or the measles vaccine, at some time in their lives. They have antibodies against measles in their blood, and these pass through the placenta to the baby during the last weeks of pregnancy. Thus, the baby is born with immunity to measles (and several other diseases).
These antibodies persist in the blood for 6 to 15 months, varying from child to child. As long as they are present, the measles vaccine, if given, is unable to act. Ideally, therefore, we should give the vaccine at 15 months of age, when we are sure there will be no antibodies left. This is what is done in most developed countries.
In countries where measles is widespread, children have a high chance of getting it if left unvaccinated for 15 months. Since Measles is often severe in young children, the vaccine is recommended at the age of 9 months in India. We assume that most children will have lost their maternal antibodies by this age, and will develop immunity to measles after the vaccine. During an epidemic of measles, the vaccine is sometimes given to children as young as six months of age.
The Indian Academy of Pediatrics recommends a dose of MMR (measles, mumps and rubella) vaccine at the age of 15 months. This second dose of measles vaccine will cover those few children who did not benefit from the 9 month dose.
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Before the vaccine became available, this disease killed millions of children around the world every year. Measles is a viral disease that lasts only a few days but leaves the surviving children weakened for months afterwards. We do not yet have an effective drug against this viral disease.
The disease starts with fever, cough, and sticky eyes. The child has a sore mouth, making eating difficult. Diarrhoea usually occurs, and can be severe. The typical rash appears after 2-3 days of fever.
The rash is red, and flat to slightly raised. It always appears first on the head and neck, and progresses down the body in orderly fashion, taking about two or three days to reach the feet. It fades in the same sequence. The fever is very high when the rash is present, and often drops abruptly after the rash has reached the feet.
Measles is a viral disease and we do not have a treatment for it. The acute attack is treated with rest and fever medicines. Since the appetite is reduced, a lot of liquids must be offered to the child at small intervals. Cough syrups do not usually help much.
Measles is feared for its complications, both acute and long term. During the acute attack of measles or shortly after, the child may suffer pneumonia, encephalitis (inflammation of the brain), ear infection, and infections elsewhere. Measles reduces the immunity of the child, and this effect persists for several weeks, allowing him to fall prey to various infections. Among these infections, tuberculosis is important.
Pneumonia may be because of the measles virus itself, or because of a secondary bacterial infection. Encephalitis occurs in 1-2/1,000 cases, and can be fatal.
A delayed complication is Subacute Sclerosing Panencephalitis (SSPE), which affects the brain several years after the original measles attack. Though a rare complication, it is much feared because of its incurable nature. It is relentlessly progressive and invariably fatal.
SSPE usually first manifests itself as a deterioration in school performance. The child has changes in behaviour, becomes lethargic, and loses interest in activities. Frank seizures are uncommon, but most affected children go through a stage when they have myoclonic jerks affecting the whole body. As the disease progresses, these children become comatose, and may develop rigidity of the body. The course of the disease may be as short as a few months, to as long as ten years.
Measles can be prevented by the use of the measles vaccine. At least one dose should be given to every child (see box).
Last revision: July 15, 2007
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