Category: Measles

Introduction

Measles virus (MEV)- induced neurologic disease is associated with the community acquired infection of disease, whereas most important rubella virus (RV)-induced neurologic disease is associated with congenital disease. There are lots of safe and effective vaccines exists. Mev, the etiologic agent of measles, is a member of the Morbillivirus genus of the Paramyxoviridae family of non-segmented, negative -stranded, enveloped RNA viruses. There are several morbilliviruses and each has a relatively restricted host range. Morbilliviruses have six structural proteins. MeV transmission from person to person is by the the respiratory route. The virus spreads from the from the initial site of replication in the respiratory tract to local draining lymph nodes. In 2005, a measles, mumps, rubella and varicella virus combination vaccine (MMRV) was licensed for use in the United States for children 12 months through 12 years of age. In accordance with the 2006 Advisory Committee on Immunization Practices’ (ACIP) general preference for combination vaccines [1] ,MMRV use was preferred over measles, mumps, and rubella vaccine and varicella vaccine administered as separate injections (MMR+V).

Measles is a suitable candidate virus for eradication: Measles eradication defined as the interruption in the transmission of measles globally so that vaccination can be stopped is possible theoretically because no animal reservoir is known to exists and measles vaccine is highly effective. Before measles vaccine was introduced, around 5.7 million people worldwide died each year of measles by 1995 this total fallen by 88%. Eradication of the measles virus would obviate the need for the continuous monitoring of changes in measles vaccination. These epidemiology changes include shift in the age distribution of measles towards older and children and the fact the babies born to mothers whose immunity is not natural but induced by vaccine have a shorter period of passive protection. According to WHO, in Latin America, the age group 1-14 years was selected because catch-up campaigns were being carried out about 15 years after large scale of vaccination. In many countries where vaccination coverages is low and the incidence of measles is high, school children are likely to have natural immunity.

MEASLES

Measles shares these features with smallpox, which has been eradicted globally, but, as predicted, measles eradication is proving more difficult — partly because it is much more infectious than smallpox and partly because there is a window of vulnerability between the duration of protection by maternal antibody (and concomitant resistance to measles vaccination) and attainment of the age of 12 months, at which time vaccination is assured of being effective. Because of the inevitability of repeated reintroduction of infection, countrywide elimination does not constitute a satisfactory outcome, except as a preliminary step to global eradication. Some innovative measures for improving vaccine coverage capitalize on strategies developed during the poliomyelitis eradication campaign. In addition to its intrinsic importance, a campaign to eradicate measles by mass vaccination with a combined vaccine may simplify the eradication of rubella and, potentially, mumps as well.

There are two types of measles vaccine currently available that is (MMR and MMRV). The Measles mumps rubella (MMR) vaccine offers protection against three disease – measles ,mumps and rubella in a single combined injection. This vaccine given to children as a series of 2 doses. The first dose is given at 12 month of age and the second dose ar 4to 6years of age. In the others side, MMR have side effects like minor fever and mild rash Moderate pain

And stiffness of the joints, allergic reaction which cause hives, swelling, and trouble breathing. The other one is Measles, mumps, rubella and varicella (MMRV) vaccine is given as an injection into the the top of the arm. The possible side effects pain redness and swelling, moderate or high fever – in children up to 39 degree Celsius or above as well as cough and puffy nose. Respondents were provided an informational statement on the risk of febrile seizures after MMRV compared to MMR+V in 12-15 month olds at the beginning of the survey Using yes/no questions and 4- and 5-point Likert scales, the survey assessed knowledge, beliefs, attitudes, and intended practices regarding MMRV and febrile seizures. The survey wasadministered via mail or Internet (Vovici, Dulles VA) using a tailored approach [7] .

RUBELLA

Rubella, or German measles, is an RNA virus in the genus Rubivirus within the Togaviridae family. It is a human disease with no animal reservoirs. The incidence of rubella cases is highest from late winter to early spring.3 The number of rubella cases has progressively declined in the United States since the prevaccine era due to mass immunization programs and, as of 2004, is no longer endemic.3 Rubella remains endemic in other countries with a dramatic increase in cases reported during 2009 versus during 2000. The World Health Organization reported that rubella cases in the African Region and the South-East Asian Region alone increased from 865 to 17,388 and from 1165 to 17,208 during 2000 and 2009, respectively. These regions represent a significant number of the 121,344 global cases of rubella reported by the World Health Organization during 2009; neither region has any specific goals to control rubella outbreaks. Rubella eradication will not be possible unless global immunization policies (eg, immunization registries) are implemented and enforced. Acquired rubella infection may be asymptomatic or subclinical in up to half of those exposed, especially in children.3,4,6, Of the peoplewho clinically manifest the disease, symptoms are mild and self-limiting. A prodromal stage of 1 to 5 days is represented by a low-grade fever, malaise, lymphadenopathy, and an upper respiratory infection. Forchheimer spots (petechiae on the soft palate) may precede or accompany the rash.3,6. The rash is mild and maculopapular, beginning on the face and extending downwards; it occurs approximately 14 to 17 days after exposure and typically lasts 3 days. Rubella frequently leads to arthralgia/arthritis in women (up to 70%). Although joint symptoms, along with conjunctivitis, are more common complications in the obstetric patient, encephalitis (1/6000 cases) may develop, affecting female adults more frequently than men or children.3,4. The response rate was 73% (620/849), with 76% (321/425) of pediatricians and 71% (299/424) of family physicians responding. Response rates were 72% (200/279) for the mail group and 74% (420/570) for the Internet group.

Respondents were similar to non-respondents with minor differences for family physicians in gender, practice location, and practice region. This study has limitations. First, MMRV was not available at the time of the survey; therefore, we asked physicians to answer assuming adequate supplies of MMRV, MMR, andvaricella vaccine. Second, the information provided within the survey may have resulted in a reporting bias, resulting in over-reporting in the rates of awareness of febrile seizure risk associated with MMRV. Third, we present data on self-report of intended vaccination practices and not observed practice. Finally, the physicians surveyed may not have accurately assessed parental perceptions.

Conclusion

Measles–mumps–rubella–varicella (MMRV) vaccine is associated with increased febrile seizure risk compared with measles–mumps–rubella and varicella vaccine given separately (MMR + V) in children 12–15-month old. We assessed knowledge regarding MMRV and febrile seizures, intended practices, and factors influencing the decision to recommend MMRV. After receiving data regarding febrile

seizure risk after MMRV, few physicians report they would recommend MMRV to a healthy 12–15-month-old child.

Reference

1. Dowdle WR, Hopkins DR. eds. The eradication of infectious diseases: report of the Dahlem Workshop on the Eradication of Infectious Diseases. Chichester, John Wiley & Sons, 1998.
2. de Quadros CA et al. Measles eradication: experience in the Americas. In: Global Disease Elimination and Eradication as Public Health Strategies. Bulletin of the World Health Organization, 1998, 76 (Suppl. 2): 47-52.
3. Strode GK. ed. Yellow fever. New York, McGraw-Hill, 1951.
4. Tsai TF. Yellow fever (fact sheet). In: Global Disease Elimination and Eradication as Public Health Strategies. Bulletin of the World Health Organization, 1998, 76 (Suppl. 2): 158-159.
5. Hull HF et al. Perspectives from the global poliomyelitis eradication initiative. In: Global Disease Elimination and Eradication as Public Health Strategies. Bulletin of the World Health Organization, 1998, 76 (Suppl. 2): 42-46.
6. The carter center Announcement for 2017 Guinea case tools jan 19,2018 accessed.
7. The carter center Disease considered as candidate for the global eradiction by the international task force for the Disease Eradication.
8. Kipps A, Dick G, Moodie JW. Measles and the central nervous system Lancet,1983;2:1406-1410.
9. Mustafa MM, Weitman SD, Winick NJ, Bellini WJ, Timmons CF, Siegel JD. Subacute measles encephalitis in the young immunocompromised host: report of two cases diagnosed by polymerase chain reaction and treated with ribavirin and review of the literature. Clin Infect Dis.1993;16 :654– 660.
10. Atkinson W, Wolfe S, Hamborsky J. Measles. Epidemiology and Prevention of Vaccine-Preventable Diseases. 2011 Washington, DC Public Health Foundation:173-192.
11. Atkinson W, Wolfe S, Hamborsky J. Mumps. Epidemiology and Prevention of Vaccine-Preventable Diseases. 201112th ed Washington, DC Public Health Foundation:205-214.

Rationale:

In 2006, the National Centre for Biotechnology released an abstract asserting that, ‘In in the 21st century, mass vaccination and routine immunization remains a necessary alliance for attaining both national and international goals in the control of vaccine-preventable disease’ (D, Heymann. 2006), to support the claim of ‘Mass vaccination programs are successful in the control of diseases’. For all human existence, diseases and infections have subsisted and have affected bodily functions and to the extent of death without proper treatment. Up until the 1930s where vaccines were introduced for various diseases including diphtheria, tetanus and tuberculosis (College of Physicians of Philadelphia, n.d.), these infectious diseases were extremely hazardous and fatal. Vaccines prevent these diseases infecting the body in future scenarios where the disease can issue critical damage to the vital functions of the body. In Australia and many first world countries, vaccines are heavily advised and provided for any citizen with minimal charge, mainly for infants and young children who are the focal victims of many of these diseases between 12 and 18 months. Programs are in place such as the ‘National Immunisation Program Australia’, for vaccines provided to individuals ranging from infants, to adulthood free of charge (Australian Government, 2019). Focusing on young children, specifically under 5, the main diseases concerning this age bracket include; chicken pox, measles, mumps and rubella (Health Direct, 2018). As vaccines are extremely versatile, these diseases can all be prevented with the correct vaccinations. For this specific investigation, measles is the principal disease analysed, specifically in young children. As vaccinations fight against these injurious diseases, without this form of defence, the mortality rate increases. The mortality rate is defined as the frequency of deaths in a defined group (Collin’s Dictionary, n.d.). This can be refined further to children under five, known as the child mortality rate where it is the probability of dying between birth and five years old expressed per 1000 live births (UNICEF, n.d.). By receiving these vaccines at a young age, should improve the overall child mortality rate.

This key information was refined into one question that defines the investigation:

Do mandatory vaccinations of young children under the age of 5, against the disease measles, contain the spread of this disease and therefore decrease the child mortality rate in Australia?

Background:

Numerous vaccines are provided in contemporary times, all of which contribute to the control of diseases and contracting the virus’s numerous times. This is attained by the vaccine injecting dead or debilitated antigens in the bloodstream, where the immune system continues to produce antibodies to fight the disease; these antibodies will then breakdown leaving immune cells to prevent these diseases affecting the host in impending cases (S, Pappas. 2010). The MMRV (measles-mumps-rubella-varicella) vaccine (Australian Immunisation Handbook, 2019) is utilised for mumps, rubella, and measles alike, and two doses will provide immunity against the harmful viruses (NHS, 2018). The MMRV vaccine was introduced in Australia in 1989, however, the singular measles vaccine was introduced 20 years before MMRV in 1969 (Health Victoria, n.d.).

To provide a brief definition to familiarise the chosen disease, measles (rubeola) is a highly contagious disease transferred through the air and particles, via coughing and sneezing, and can last up to two hours in the particular contaminated space (CDC, 2018). According to CDC (Centre of Control and Disease Prevention), there is a 90% chance of catching measles if not vaccinated and are then consequently contaminated which can lead to a number of health complications and fatality. For the MMRV vaccine to work, as stated above, antibodies are produced in the immune system to fight the injected enfeebled, live measles virus found in the bloodstream, thus causing immunity to the diseases for impending cases (NHS, 2018).

Statistics and visual data will be included to support this claim and question with relevant and authenticated evidence from verified sources. It is evident with the provided evidence and graphs that the overarching trend is that vaccines decrease the mortality rate due to measles over the course of several years. Figures are also included to support this theory when discussing the data.

Evidence:

Measles is known globally as an infectious epidemic where this disease can contaminate any individual within range and that has not had the appropriate defences such as the general vaccine, MMRV. Viewing statistics, including data from the late 20th century, successfully depicts how this vaccine has decreased the number of deaths caused by measles over the years recorded. Between 2000 and 2017, an 80% decrease in deaths by measles globally was accounted for due to scheduled vaccinations (WHO, 2019). As well as, an estimated 21.1 million deaths prevented due to MMRV in recent years of the 21st century (WHO, 2019). Illustrated in figure 1 below sourced from the ‘Centres for Disease Control and Prevention’, from 1985 to 2016, death by measles rapidly decreased after vaccinations were introduced. With inevitable fluctuations in certain years such as 1987 and 1992, this illustrates outbreaks in the disease, most likely from less vaccinations causing measles to spread. The overarching trend exhibited in measles deaths globally is a steady decrease, where from 2007 and onwards, deaths are under 200,000, compared to the beginning in 1985 where deaths were 1,000,000 times greater at 1,200,000 (CDC, 2018). Thus, showing how vaccinations assisted in this rapid decline in deaths due to measles.

Figure 1 – Number of deaths caused by measles and vaccine prevention Source: (CDC, 2018)

As stated specifically in the research question, the child mortality rate in children under 5 in Australia is the focal topic to successfully answer this investigation. From the Australian Institute of Health and Welfare from 2010, measles outbreaks were recorded between 1950 and 1990 to evidently depict how the vaccine eliminated numerous deaths due to this disease. The ‘Australian Department of Health’ have also indicated that after 1994, measles cases have been progressively decreasing over the years (Australian Department of Health, n.d.). Before MMRV was introduced, and in any case, it is rather apparent that infants and young children are more susceptible to this disease due to a weaker and undeveloped immune system that is seen as an easier target for diseases, as the correct ‘defences’ are easier to overcome, as well as frequent contact with bacterial substances from other children (Ashish, 2017). It is unmistakably noticeable that deaths in children under five were remarkably high from 1950 to 1969, where the measles vaccine was not yet introduced where deaths reached nearly 4.5 per 100,000. After 1969, an abrupt regression is patent where deaths peaked and declined in one single year after the vaccine. From 1970 to 1990, deaths due to measles were on a continuous and constant decrease, although evident increases in deaths are prevalent, the overall inclination descends over time. This illustrates the child mortality rate descending rapidly where the measles vaccine effectively prevents innumerable deaths of children under five and controls the spread of this disease on a mass spectrum.

Figure 2 – Deaths caused by measles in Australia for children under 5 years Source: (AIHW, 2010)

In 2007, sourced from the ‘Department of health in Australia’, 94.1% of 2 year olds were fully immunised with MMRV, and 89.1% of 5 year olds (Department of Health, 2009). Provided in figure 3, more recent data regarding hospitalisation and deaths, focusing on the scope concerning the youth of Australia, was sourced to substantiate the principal claim and refined question. As the double dose of measles, known as MMRV, was later introduced in 1989 (Health Victoria, n.d.), hospitalisations and deaths due to measles declined even more than previously with the single dose of measles vaccine. As young children are still increasingly affected and prone to diseases rather than older children and above, hospitalisations and deaths are still greater than that of citizens five years and older, as illustrated below. Hospitalizations plummeted from 250 per million to 50 per million in one single year between 1994 and 1995, where a constant decrease is publicised up to recent years including 2016. It is also apparent in the graph to the right exemplifying deaths in younger children, where a decline is established circa 1947, and was almost eliminated after the mass vaccination program, known as NIP (National Immunisation Program), was introduced in 1975 (Australian Departments of Health, 2019). This evidence found supports the claim chosen where mass vaccination programs do in fact assist in the control and spread of diseases, as well as decreasing the overall child mortality rate in Australia.

Figure 3 – Hospitalisations and deaths in Australia for children in recent years Source: (AIHW, n.d.)

Evaluation:

Quality of Evidence:

To successfully support the specified claim and research question with the utmost accuracy, extensive research was conducted where a variety of evidence was accumulated and utilised. However, collecting evidence from unreliable sources can jeopardise the legitimacy of this task. On the other hand, all significant evidence originated and was sourced from either government based or approved websites and organisations such as ‘AIHW’, ‘Australian Department of Health’, and ‘CDC’. Thus, all evidence, graphs, and statistics have been approved by higher authorities with the correct qualifications that justify the validity of the evidence provided to further support the focal topic of the investigation. As well as, all sources implemented agreed on the pivotal claim on how vaccines do in fact control the spread of diseases and decrease mortality rates with no bias perceived. Therefore, providing reliable evidence to support this investigation.

Limitations and Improvements:

Although all data and evidence is accurate and directly cited from the Australian government, obtaining data and statistics from recent years became an increasingly challenging task with limited data from recent years. Data from the 1940s to 1990s was simplistic and easy to obtain, however, data would only cover to approximately 2010, and on the rare occasion, up to 2016. This was a limiting factor as data from earlier years could only support this claim so far, as evidence from recent years could not be sourced to further validate the claim and respective research question. Evidence was collected thoroughly and with minimal error by government bodies with surveys, censuses, reporting from health services and registrations which did not limit but rather improve this investigation by implementing authenticated data. However, data collection was not limited to a specific area as data was across Australia was processed, as well as globally.

Improvements, however, can be applied to increase how valid and reliable this analysis is. Although a specific and considered research question was developed, certain aspects can be further analysed to support the theme. Conducting further investigations into data that was collected in Australia in the last three years so the claim and question is supported with current evidence that validates how vaccines are still currently functioning correctly. As well as, a detailed analysis into all effects of vaccines on the human body for different age brackets due to differences in the functioning immune system and other vital structures. Considering the factor that some diseases are becoming immune to the vaccine can be investigated and added to justify some fluctuations in data throughout the years.

Extensions:

Extensions to further assist in justifying the topic and provide a more thorough insight into mass vaccinations and how it does in fact control diseases efficiently can be stated. Although a specific and narrow research question was advised and necessary, comparing various diseases and the child mortality rate for each can advance this investigation, such as comparing measles with polio. Observing numerous countries with measles data and comparing will also extend the investigation further and can be discussed why one country may have a higher mortality rate than another. As well as, age brackets and the corresponding mortality rates and how measles affects each age range in various manners.

Conclusion:

To conclude, the chosen claim on vaccines and infectious diseases, and the developed research question can be successfully supported and answered with maximum authenticity. From valid sites, reliable evidence and data was collected to justify the overall investigation, the considered trend in all sources supports and suggests how mass vaccination programs are in fact successful at controlling the spread of infectious diseases. As well as, reinforcing the question where vaccinating young children decreases the child mortality rate and contains the spread of measles to others. Relevant data was evident, which therefore suggests that mass vaccinations does in fact assist in controlling the spread of diseases through the use of reliable sources.

References:

1. Ashish (2017) Why do Children and the elderly get so sick easily? [online] Available at: https://www.scienceabc.com/humans/why-do-children-and-the-elderly-get-sick-so-easily.html [Accessed on 14 Aug. 2019]
2. Australian Institute of Health and Welfare (n.d.) Measles in Australia [online] Available at: https://www.aihw.gov.au/getmedia/c828baef-75d9-4295-9cc9-b3d50d7153a2/aihw-phe-236_Measles.pdf.aspx [Accessed on 12 Aug. 2019]
3. Australian Department of Health (2019) National Immunisation Program Schedule [online] Available at: https://www.health.gov.au/health-topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule [Accessed on 16 July. 2019]
4. Australian Department of Health (2019) Rubella [online] Available at: https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/rubella [Accessed on 23 July. 2019]
5. Better Health (2018) Measles [online] Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/measles [Accessed on 16 July. 2019]
6. Better Health (2018) Vaccines [online] Available at: https://www.betterhealth.vic.gov.au/health/healthyliving/vaccines [Accessed on 16 July. 2019]
7. Centre for Disease Control and prevention (2018) Measles Transmissions [online] Available at: https://www.cdc.gov/measles/transmission.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmeasles%2Fabout%2Ftransmission.html [Accessed on 18 July. 2019]
8. Centre for Disease Control and Prevention (2019) Measles statistics [online] Available at: https://www.cdc.gov/measles/downloads/measlesdataandstatsslideset.pdf [Accessed on 16 July. 2019]
9. College of Physicians of Philadelphia (n.d.) History of Vaccines [online] Available at: https://www.historyofvaccines.org/timeline/all [Accessed on 16 July. 2019]
10. Collins English Dictionary (n.d.) Mortality Rate [online] Available at: https://www.collinsdictionary.com/dictionary/english/mortality-rate [Accessed on 18 July. 2019]
11. Health Direct (2018) Measles [online] Available at: https://www.healthdirect.gov.au/childhood-illnesses [Accessed on 18 July. 2019]
12. Health Victoria (n.d.) Vaccine History Timeline [online] Available at: https://www2.health.vic.gov.au/public-health/immunisation/immunisation-schedule-vaccine-eligibility-criteria/vaccine-history-timeline [Accessed on 24 July. 2019]
13. National Health Service (2018) MMRV vaccine overview [online] Available at: https://www.nhs.uk/conditions/vaccinations/mmr-vaccine/ [Accessed on 23 July. 2019]
14. S. Pappas (2010) How do Vaccines work? [online] Available at: https://www.livescience.com/32617-how-do-vaccines-work.html [Accessed on 18 July. 2019]
15. UNICEF (n.d.) Basic Indicators [online] Available at: https://www.unicef.org/infobycountry/stats_popup1.html [Accessed on 18 July. 2019]
16. World Health Organisation (2019) Measles [online] Available at: https://www.who.int/news-room/fact-sheets/detail/measles [Accessed on 16 July. 2019]

Mass Vaccinations in Measles

Claim

Mass vaccination programs are successful in the control of diseases.

Rationale

‘A disease is an abnormal condition affecting a living organism… generally understood to be medical conditions that involve a pathological process associated with a specific set of symptoms.’ (Healio, 2012). Infectious diseases are caused by organisms also known as pathogens; bacteria, viruses, fungi, and parasites. Pathogens can be transmitted either through physical contact, inhalation, indirect contact, and food contamination. (Mayo Clinic, 2019). Infectious diseases occur when ‘the cells in your body are damaged as a result of infection and signs and symptoms of an illness appear.’ (The National Academies, 2019). Pathogenic organisms disrupt the immune system in various ways. Viruses disrupt cell function and kill cells completely. Bacteria crowd the host cell by continuously multiplying, create paralyzing toxins and kill cell tissues. Fungus is inhaled and then multiplied into different cells which then can end fatally if not treated. Parasites enter the body through either ingesting infected food or animal encounters. Once inside the body they enter into the bloodstream, continuously multiplying before than destroying red blood cells. (The National Academies, 2019). To reduce and ultimately eradicate diseases and the affect they have on the human population vaccinations have been created and put into place. ‘A vaccine is a biological preparation that improves immunity to a particular disease.’ (WHO, 2019). Vaccinations contain disease-causing microorganisms often conducted from an agent that is either weakened or killed from a specific microbe, toxin or surface proteins resembling a selected disease (WHO, 2019). Vaccines work by injecting a dead or weakened antigen into the body stimulating an immune response. From there cells in the body called lymphocytes, produce antibodies (protein molecules) to fight the disease. The immune system has memory cells than ‘remembers’ the antibody for future infection (Pappas, 2010). ‘Mass immunization involves delivering immunizations to a large number of people at one or more locations in a short interval of time. These programs can be used to counter contagious outbreaks, adopted as a repeated means of sustained healthcare delivery, or applied where many people move through a specific place in a short interval of time.’ (JD & RL., 2006). In Australia mass vaccination programs have been in place for decades, vaccinating children against a variety of diseases. One program in specific is vaccinating children at the age of two for measles, mumps, and rubella. This leads to the question; Does having a mass vaccination program against measles in children significantly reduce the number of outbreaks?

Background

‘Measles is a very contagious respiratory infection. It causes a total-body skin rash and flu-like symptoms. Also called Rubeola is caused by a virus, so there’s no specific medical treatment for it.’ (Elana Pearl Ben-Joseph, 2019). Measles are contracted through the process of an infected person coughing ‘aerosolized droplets’ that then are inhaled by another person. The virus first disrupts the host’s lung tissue before infecting immune cells macrophages and dendritic cells (early defense cells). The infected cells then transfer to B and T cells where they then use surface proteins as an entry point into the blood. The virus then targets the ‘spleen, lymph nodes, liver, thymus, skin, and lunges’. This virus stays in circulation through the process of coughing. (Shultz, 2015). The measles vaccine is given in the first year of a child’s life and then again at age four. Measles are highly common in children under the age of five and therefore can be highly dangerous if they are not vaccinated. It takes several days for your body to increase antibody production to fight the virus. Unfortunately, several days is too long for viruses such as measles and as by the time the body can produce enough antibodies the virus has spread and killed the human inhabitant. (Pappas, 2010).

Evidence

Table 1- Percentage of children immunized at 24 months of age by vaccine and state or territory for the birth cohort 1 July 2015 to 30 June 2016, AIR data as of 30 September 2018.

State or territory

Number of children

Diphtheria, tetanus, pertussis (%)

Polio (%)

Haemophilus influenza type b (%)

Measles, mumps, rubella (%)

ACT

5,834

94.4

97.1

96.6

94.7

NSW

100,895

93

96.4

95.2

93.2

VIC

81,046

93.7

96.9

96

94

QLD

63,071

93.4

96.5

95.8

93.8

SA

19,914

93.2

96.5

95.5

93.7

WA

35,206

91.6

96.2

95

92

TAS

5,946

93.5

96.5

95.4

94.1

NT

3,547

91.5

96.7

95.5

92.1

Australia

315,459

93.1

96.6

95.6

93.5

http://ncirs.org.au/health-professionals 1ttp://ncirs.org.au/health-professionals/coverage-data-and-reports

Table one demonstrates the percentage of children in Australia during the period between July 1, 2015 – 30 June 2016 immunized at 2 years of age. The graph shows the number of children and the percentages across all the states and territories along with a total Australian percentage. The lowest percentage rate is in WA with 92% while ACT tops the chart with 94.7%. All percentages are above 92% demonstrating a high vaccination rate across Australia.

Graph 1- notification rates (notifications per million population) for measles, by age, Australia, 1991 to 2017. http://www9.health.gov.au/cda/source/cda 1

Graph one is a representation of the change in several cases of measles over a period of 26 years (1991-2017). The graph is categorized into 0-4 years (orange), 5 years and over (grey) and unknown age (yellow). It can be seen in the graph that a high rate of children five years and over have reported with measles over the period. The number of cases increased drastically in 1993 and 1994 due to the introduction of a second vaccination ‘the introduction of a second dose of MMR for school-aged children in late 1992.’ (AIHW, 2019). The numbers would have drastically increased due to the bodies of children not having the antibodies to fight the disease. After the two years, the conception rate decreased drastically falling even further than before and even nearly becoming completely eradicated.

Graph 2- Mortality Numbers of Deaths Due to Measles, Australia, 1907-2016 http://www9.health.gov.au/cda/source/cda 2

Graph two plots out the mortality rates of measles through the period of 1907-2016. The graph follows a different pattern to graph one; the earlier years are extremely high with a rate of 500 in 1921 slowly decreasing in 1946 before completely dropping out to zero in 2000. This graph coincides with graph one as it shows the mortality rates from the people infected with the virus. Like graph one there are no cases of mortality during the 2000s.

Table 2 – First Round and Second Rounds Child Health Days Package, Target Age Group, and Outcome (Number of Reached and Percentage) in 2009, Somalia. https://www.jstor.org/stable/41230476 1

Table 2 is a representation of the first and second round of vaccinations in Somalia across several different age groups. When studying the table, it is clear to see that the measles vaccine is one of the highest immunizations across children with 85% first round and 82% second round. The target age group is from 9-59months which is 1-5 years of age, a critical point in when a child needs to be vaccinated.

Graph 3 – comparison between Australia and Somalia immunization rates (12-24months) 2017 https://data.worldbank.org/indicator/SH. 1

Graph three is a comparison between Australia and Somalia. Somalia is a third world country in Africa limited to their resources and only recently having access to a vaccination program. ‘During this intervention, around 4.5 million children were vaccinated. As a result of the nationwide immunization campaign conducted, as of April 2019, Somalia witnessed a decline in the trend of cases reported this year.’ (EMWHO, 2019) . The graph demonstrates a comparison of immunizations rates between the two countries in the period of 1980-2017. From the graph, it is evident that Australia has a higher percentage rate across the whole period, from an average of 70% in 1984-1986 compared to Somalia’s 5%- 30% jump. The graph also outlines the struggle of maintaining a vaccination program that Somalia has faced due to the data continuously staggering. Somalia’s data continuously staggers before plateauing out from 2010 on with a rate of 45%. It can be concluded that Australia has had a much higher success rate with a ‘straighter’ line and a rate that is always dramatically higher than Somalia’s.

Graph 4 – Incidence of suspected measles cases, reported measles routine immunization coverage, and timing of selected measles control activities by year, Somalia 2005-2009. https://www.jstor.org/stable/41230476 2

Graph four is a conjoined graph detailing and comparing the number of vaccinations and the number of reported cases of measles in Somalia between 2005 and 2009. The column graph is the number of reported cases of measles while the dotted line with points is the percentage of people immunized. The ‘catch up program’ has also been highlighted in the graph. After the catch-up program, it can be seen that the number of cases has decreased. From the graph, it can be concluded that the lower the percentage of people vaccinated the lower the cases of measles reported. This is possible due to the vaccination ‘MMR vaccines contain live measles, mumps and rubella viruses that have been weakened (attenuated). These stimulate the immune system but do not cause disease in healthy people.’ (University of Oxford, 2019), and the people of Somalia being extremely unhealthy people ‘The health care system in Somalia remains weak, poorly resourced and inequitably Distributed. Health expenditure remains very low and there is a critical shortage of health workers. As a result, around 3.2 million women and men in Somalia require emergency health services.’ (WHO, 2015).

Evaluation

There are very few issues regarding the evidence provided. One issue is there is no data set that represents the measles mortality rate in Somalia. This may be due to a lack of study in the country as a result of insufficient resources and knowledge of the extent at which measles has affected Somalia. Subsequently, the one graph that is inexistent in the report limits the validity of the argument.

Another issue is that table 2 and graph 4 do not align with their evidence. Both the table and graph demonstrate vaccination percentages for children in Somalia during 2009. Table two states that 85% of children were vaccinated in 2009 while graph four indicates that only 59% were vaccinated. Consequently, these two data sets limit the reliability of the evidence provided. All graphs and tables are limited to vaccination rates and cases of measles. They lack depth and do not include hospitalizations, cases after measles vaccines, treated cases and death rate of vaccinated children. This would broaden the investigation and help determine a more definitive conclusion.

Further studies across all infectious diseases and their vaccines could have been investigated. Having further studies in vaccines and diseases will increase the reliability of the report and help further support the claim. Alongside further studies of diseases and their vaccines, an extension of countries varying from first world and third world will also further extend the investigation and increase the reliability.

Conclusion

In conclusion the claim that mass vaccination programs are successful in the control of diseases is supported. This was supported in this investigation that mass vaccination programs do significantly reduce the number of measles outbreaks in children. The evidence provided; mortality rates in Australia, vaccination rate and number of cases in both Australia and Somalia have supported the question and the claim. This is due to the evidence providing data in which demonstrates that vaccinations do decrease the number of outbreaks of measles.

References

1. AIHW. (2019). Retrieved from https://www.aihw.gov.au/getmedia/c828baef-75d9-4295-9cc9-b3d50d7153a2/aihw-phe-236_Measles.pdf.aspx
2. Elana Pearl Ben-Joseph, M. (2019, March). Retrieved from https://kidshealth.org/en/parents/measles.html
3. EMWHO. (2019). WHO Eastern Mediterranean. Retrieved from http://www.emro.who.int/som/somalia-news/vaccines-are-saving-millions-of-lives-of-children-in-somalia.html
4. Healio. (2012, June 14). Retrieved from https://www.healio.com/infectious-disease/news/online/%7B53e2cad9-f420-4d59-ad86-6a61e8d7586f%7D/what-are-diseases
5. JD, G., & RL., N. (2006). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16989263
6. Mayo Clinic. (2019). Retrieved from https://www.mayoclinic.org/diseases-conditions/infectious-diseases/symptoms-causes/syc-20351173
7. Pappas, S. (2010, June 1). Retrieved from https://www.livescience.com/32617-how-do-vaccines-work.html
8. Shultz, D. (2015, Jan 30). Retrieved from https://www.sciencemag.org/news/2015/01/what-does-measles-actually-do
9. The National Academies. (2019). Retrieved from http://needtoknow.nas.edu/id/infection/how-pathogens-make-us-sick/
10. University of Oxford. (2019). Retrieved from http://vk.ovg.ox.ac.uk/mmr-vaccine
11. WHO. (2019). Retrieved from https://www.who.int/topics/vaccines/en/
12. WHO. (2015). Retrieved from https://www.who.int/hac/donorinfo/somalia.pdf

Introduction

Measles is a dangerous and highly contagious viral disease causing major morbidity and mortality among children and adults if not controlled by the vaccine (Gay et al., 1995). Measles is one of the most disturbing and unpleasant communicable diseases that can cause serious illness with many complications, including the caused of millions of deaths globally (Griffin, 2012). Before measles vaccination was introduced, more than 100 deaths are reported annually in the United Kingdom (Jansen et al., 2003). Measles vaccination in England was introduced in 1968 and ever since, vaccine uptake has risen higher and the immunization coverage is widely achieved among the population, leading to the reduction of measles cases and death drastically (Manikkavasagan and Ramsay, 2009).

Over the past year, despite the availability of free and effective vaccination programme, there has been a constant increase in measles cases across England (Smith, 2018). Outbreaks have been confirmed in Birmingham and other four areas across the country where all cases are as a result of children and adults haven’t received the 2 recommended doses of measles, mumps, and rubella (MMR) vaccine (Michael, 2017). Gastañaduy et al., (2018) stated, “In elimination settings, a single measles case is a public health priority.” In this context, there is a high need to communicate the significance of vaccine uptake among all non-immunized people especially among parents of young children and increase public awareness to prevent and the spread of the disease among communities (Smith, 2018). This report will focus on educational and health campaign on preschool children that are at high risk of measles disease.

Epidemiology and disease burden:

Measles virus is particularly infectious that can be easily transmitted from one person to another via the airborne respiratory droplets spread by coughing and sneezing or through direct contact with an infected person (Moss and Griffin, 2012; WHO, 2019). The sign and symptoms include high fever, runny nose, conjunctivitis, cough and rashes usually appears about 10 to 14 days after exposure. Complications include respiratory and neurological diseases such as pneumonia and encephalitis (Sanondaf UK, 2019; WHO, 2019). Measles is virtually the most spreadable diseases with an average case capable of infecting between 12 and 20 other vulnerable people and 90% secondary infection rate in susceptible exposes individual (Michael, 2017).

In 2017, the World Health Organization (WHO) stated that the UK had attained measles elimination base on the report from 2014-2016 (see table 1.) However, the measles elimination status has not been maintained with the recent new development on measles outbreaks (PHE, 2019a). There have been multiple outbreaks within European countries and the recent measles cases is linked to the outbreak in Europe mainly in Italy and Romania (Michael, 2017; PHE, 2018). The number of reported measles cases in England has escalated from 284 cases in 2017 to 991 confirmed cases in 2018 (PHE, 2019a). Since then, there have been a series of outbreak in the west midlands especially in Birmingham.

Table 1: Measles limination status in the UK (PHE, 2019b)

The problem: Measles outbreak in Birmingham

Birmingham is a city in the west midlands of England with about 1,141,400 people in population, out of which 259,000 (22.8%) are children (Council, 2018). According Miller and Rodger (2019) Measles cases in Birmingham has hit a high record of about 97 cases in 2018, more than twice of the reported 47 cases in 2017. The recent epidemiological studies of measles cases illustrated the incidence rate in Birmingham is significantly worse than National average (see figure 2) (PHE, 2018a)

Source: Measles distribution rate in Birmingham (PHE, 2018a).

All most all unvaccinated people contact measles if exposed to the virus.

Evidence and justification

More recent attention has focused on the vaccine uptakes that have placed many children at the risk of measles infection. According to NHS and PHE, Factors that could contribute to the decline in uptakes are poor access to health care, poor out keeping of vaccination reminder by health professionals, antivaccination messages and media misconceptions that led to vaccine hesitancy among some parents (Mahase, 2019). Researchers believe the rise in measles cases was as a result of parents change in behavior and concern about the widespread of debunked link between autism and the vaccine in the early 2000s (PHE, 2013). Parents’ change in behavior is incomprehensible if they are regarded as acting to protect their children from a non-existent risk of vaccination created by bad research and media misconception (Bellaby, 2003). A survey was conducted on vaccine confidence among public and the report in UK discovered that 90% of people still have high confidence that vaccine is safe and effective (Larson et al., 2019).

According to The National Audit Office report, public Health England data revealed that there is a steady decline of vaccination uptakes among preschool children and have estimated about 90,000 children in England of age five are not vaccinated with both MMR vaccine (NAO, 2019). Mahase, (2019) claim that NHS neglected the performance standard set across all preschool vaccinations in England that resulted in massive decline of vaccine uptakes because of the inconsistency in way the GPs and health care professionals reminded parents to vaccinated their children. Furthermore, NAO, (2019) report on investigating preschool vaccination stated that the time and availability of vaccination programs is become difficult for some parents to access vaccination services for their children.

Additionally, PHE, (2018b) revealed a correlation between measles outbreak and travelers. The observed decreased among unvaccinated people could be attributed to travelers’ communities in England. The report stated that the Irish travelers, Gypsies and Roma have the worst outcomes in terms of health status and low immunization coverage compare to other communities. Therefore, to ensure

Measles Vaccination: Effectiveness and Coverage

Measles can be easily prevented by the Measles, mumps and rubella (MMR) vaccine (Smith, 2018). The 2 MMR vaccination dose are widely used in many countries to prevent the spread of the Measles disease. One does of MMR vaccines has about 95% effectiveness at preventing Measles (Bester, 2016). With the first dose, about 90% of induvial are protected and 99% are protected with the second dose (Choi et al.2008). It is believed that measles outbreaks can be ascribed to the drop in vaccine uptake among the population (Jansen et al., 2003). Even with the high coverage of the vaccination in England, Measles still remains a threat to the unvaccinated preschool children. To ensure Measles elimination and protection satisfactory, WHO (2017) recommended the vaccination coverage among the communities in every country should be at least 95%.

However, the data from public health England in 2018 shows that the national measles Population vaccination coverage – MMR for one dose (2 years old) were 90.3% and 86.4% MMR for two doses (5 years old) while the Birmingham coverage of 86.8% and 82.3% fell lower than National level and the target goal. (See figure 3)

Figure 3: vaccination coverage across the population in Birmingham (PHE, 2018a)

Aims and Objectives:

The aim of this report is to design and create an awareness raising campaign that promotes the importance of Measles vaccination among parent of preschool children. Health promotion aims to improve the vaccine coverage and children health in the population by reminding and encouraging parents to get their children vaccinated at every available opportunity.

Campaign Process:

An effective health promotion campaign generally begins with planning and setting a priority by identifying the target audience and as well as setting goals and objectives to be achieved (round at el., 2005). To ensure success in health promotion campaigns, it is important to identify the main problem and solution and ensure the effective use of resources and the right implementation (Corcoran, 2010). A systematic total planning process model will be used to achieved the aim and objectives of the campaign (see figure 4)

Planning is essential to ensure success in health campaigns.

Planning models typically follow a series of steps in a logical order

[image: Figure A1. Total process planning model of social marketing ]

Figure 4: Total process planning model

Scope:

Prior to start a health campaign, it is always important to analyses reliable epidemiological data and conduct an evidence-based research on the risk group to identify the behavioral change and determine the right approach and solutions through a series step of planning (Loti Popescu and Daniel Verman, 2000). The review of the literature on the recent measles outbreak in England shows that Parents are finding it difficult to access vaccination services and get GP appointments to vaccinate their children which has resulted to a decline in vaccination coverage among children (mahase 2019). Therefore, the campaign aimed to target parents as they are mainly responsible in making decision for their children and their attitudes affected the vaccination coverage among children at risk.

Social marketing:

Social Marketing approach has been recently used to systematically define people’s needs and impact their behavior change through the application of commercial marketing concepts for the benefits and greater good of the people. (Evans WD1, McCormack and chau et al.,) There are 8 set of social marketing intervention criteria to be accessed in promoting and improving the behavior of children vaccination uptakes among the target audience. (see figure 5)

https://www.ncbi.nlm.nih.gov/pubmed/18556638

https://onlinelibrary.wiley.com/doi/epdf/10.1002/hpja.13

Audience segmentation and insight:

One of the main decisions in social marketing approach is the understanding and segmentation of the target audience. According to ECDC (2010) An effective Health promotion campaign must have a distinctive way of identifying the target audience and identify who is affected. It also vital to know who makes the decisions, whose attitudes and behaviors needs to be changed to achieved the aims of the campaign (ecdc, 2010). PHE (2019) conducted a survey to know the present mindset of parents on vaccination uptakes and the report provided useful facts and highlighted that 95% of the target group still have confidence on vaccination. The report further listed some factors that could be a barrier from reaching the target of vaccination coverage such as difficulty in access to desirable vaccination service for parents and inconsistency in a way of healthcare professions remind parents of their children vaccination. Moreover, there are different attitudes and of different in reasons on why parents missing to have their children vaccinated. For example, some parents still hold a positive attitude towards vaccination but the challenges were the time and availability. According to a survey by the royal society for public health found out that some parents mentioned the availability and timing of vaccination appointments is not desirable and therefore it become a barrier to get their children vaccinated. (NAO, 2019)

The audience are classified into two target group in this campaign. Parents of the children are considered as the primary target group while the GPs and school teachers are secondary target groups. Primary target audience are inhomogeneous and segmenting them in groups requires more research on the socio demographic data of the parents. Therefore, this campaign is planned to encourage and communicate the importance of Measles vaccination particularly among parents of unvaccinated preschool children through the influence of healthcare professionals (GPs) and teachers in schools by offering support and vaccine uptakes.

Behavioral model:

One of the main focus of social marketing intervention in health promotion is the ability to achieve an effective behavioral change that are suitable to people’s settings. The behavior change method promotes health through changes in attitudes, belief and life style of the audience and also proper access to services by developing implemented intervention. As mentioned before, children vaccination depends on the decision and behaviors of their parents and health care professionals play a vital role in influencing parent’s decision. (ecdc, 2010). It is appropriate to consider the GPs as a primary target of communications in influencing parents to a desired behavior change on vaccine uptakes.

In order to persuade and encourage the audience, the health belief model (HBM) is applied in this campaign (see figure). The HBM has been broadly used in health promotion vaccination research to study behaviors and identify people’s perception on the disease and vaccination. The basic stages of health belief model have been summarized in appendix (3). This outline has been used to understand and addressed the desire mindset of the audience by communicating and motivate them to get their children vaccinated. As already mentioned earlier, most parents still have positive view and intention to vaccinate their children. According to survey conducted on health professional who worked in giving vaccination in UK, the respondents acknowledged parents forgetting vaccination appointment is the biggest barrier of vaccination uptake among working age adults and followed by timing and availability of the vaccination services. The campaign focus on implementing strategies and cues actions of communicating vaccination awareness and reminding parents that could increase the vaccination uptakes among children. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405550/

Implementation:

This is the activation of all the plans and strategies that were developed to achieve the aims and objectives of the campaign. Marketing mix is an effective tool to increasing vaccination awareness and places emphasis on the consumer. The health promotion activities require the effective use of marketing mix principles of six P’s that are integrated to satisfy the consumer needs. Figure 6 shows the description of marketing mix.

Strategy description:

The communication and awareness campaign will be conducted in three different types of interventional strategies to be able to convey the message to as many people as possible.

First, health care professionals will be generally informed through emails to seize all opportunity and make efforts in communicating the risk of the disease and importance of vaccination. It is important for the health professionals to use the tools of effective communication to convince parents. Additionally, Health authorities need to inform all GPS and set a requirement to follow up and strengthened the good use of invite – reminder systems for children vaccinations. Evidence have shown that most parents need to be reminded constantly and provision of flexible vaccinations services need to be in place to improve uptakes among busy parents.

Secondly, Schools will be contacted through emails and will be informed to communicate the message of vaccination to parents and priorities children immunization to protect and ensure the safety of the child from the disease.

References:

1. Bellaby, P., 2003. Communication and miscommunication of risk: understanding UK parents’ attitudes to combined MMR vaccination. BMJ 327, 725–728. https://doi.org/10.1136/bmj.327.7417.725
2. Bester, J.C., 2016. Measles and Measles Vaccination: A Review. JAMA Pediatr. 170, 1209–1215. https://doi.org/10.1001/jamapediatrics.2016.1787
3. Corcoran (2010) ‘Planning campaigns’, Nursing Standard, 25(14), pp. 63. doi: 10.7748/ns.25.14.63.s57.
4. Council, B.C., 2018. Population and census [WWW Document]. URL https://www.birmingham.gov.uk/info/20057/about_birmingham/1294/population_and_census/2 (accessed 11.29.19).
5. Gastañaduy, P.A., Banerjee, E., DeBolt, C., Bravo-Alcántara, P., Samad, S.A., Pastor, D., Rota, P.A., Patel, M., Crowcroft, N.S., Durrheim, D.N., 2018. Public health responses during measles outbreaks in elimination settings: Strategies and challenges. Hum. Vaccines Immunother. 14, 2222–2238. https://doi.org/10.1080/21645515.2018.1474310
6. Jansen, V. a. A., Stollenwerk, N., Jensen, H.J., Ramsay, M.E., Edmunds, W.J., Rhodes, C.J., 2003. Measles outbreaks in a population with declining vaccine uptake. Science 301, 804. https://doi.org/10.1126/science.1086726
7. Loti Popescu and Daniel Verman (2000) Strategies for Developing a Health Promotion Campaign.
8. Mahase, E., 2019. Vaccines: poor access and fragmented healthcare could be behind falling uptake, says watchdog. BMJ l6211. https://doi.org/10.1136/bmj.l6211
9. Manikkavasagan, G., Ramsay, M., 2009. Protecting infants against measles in England and Wales: a review. Arch. Dis. Child. 94, 681–685. https://doi.org/10.1136/adc.2008.149880
10. Michael, S., 2017. The UK Battles Measles Outbreak [WWW Document]. Outbreak Obs. URL https://www.outbreakobservatory.org/outbreakthursday-1/12/14/2017/the-uk-battles-measles-outbreak (accessed 11.23.19).
11. Miller, C., Rodger, J., 2019. Double warning for Birmingham parents as measles AND scarlet fever soars – Birmingham Live [WWW Document]. URL https://www.birminghammail.co.uk/news/midlands-news/double-warning-birmingham-parents-measles-15647091 (accessed 11.27.19).
12. Moss, W.J., Griffin, D.E., 2012. Measles. The Lancet 379, 153–164. https://doi.org/10.1016/S0140-6736(10)62352-5
13. NAO, 2019. Investigation into pre-school vaccinations 41.
14. PHE, 2019a. Measles in England – Public health matters [WWW Document]. URL https://publichealthmatters.blog.gov.uk/2019/08/19/measles-in-england/ (accessed 11.27.19).
15. PHE, 2019b. UK measles and rubella elimination indicators and status [WWW Document]. GOV.UK. URL https://www.gov.uk/government/publications/measles-and-rubella-elimination-uk/uk-measles-and-rubella-elimination (accessed 11.27.19).
16. PHE, 2018a. Public Health Profiles [WWW Document]. URL https://fingertips.phe.org.uk/search/measles#page/4/gid/1/pat/6/par/E12000005/ati/102/are/E08000025 (accessed 11.29.19).
17. PHE, 2018b. Making measles history together – a resource for local government 8.
18. PHE, 2013. Local MMR vaccination plans to be developed in response to increase in measles cases [WWW Document]. URL https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/740387/West_Midlands_PHE_Centre_-_MMR_press_release.pdf (accessed 11.29.19).
19. Sanondaf UK, 2019. The number of measles cases in Birmingham rising – how to protect your child. Sanondaf. URL http://www.sanondaf.co.uk/news/number-measles-cases-birmingham-rising-protect-child/ (accessed 11.24.19).
20. Smith, kristy, 2018. Preventing, identifying and managing measles outbreaks. Nurs. Times. URL https://www.nursingtimes.net/clinical-archive/infection-control/preventing-identifying-and-managing-measles-outbreaks-28-08-2018/ (accessed 11.23.19).
21. WHO, 2019. Measles [WWW Document]. URL https://www.who.int/news-room/fact-sheets/detail/measles (accessed 11.24.19).
22. WHO, 2017. WHO | Communicating science-based messages on vaccines [WWW Document]. WHO. https://doi.org/10.2471/BLT.17.021017

Introduction/Statement of the problem

Rubella (measles) is a multisystem, human-exclusive virus that has been determined eradicated in the United States since the 1960s. Measles is highly contagious, dealt with public health officials vaccinating nearly the entire population. However, the virus is prevalent in developing and developed regions alike today. Rubeola is an enveloped, single-stranded, negative-sense RNA virus (sense” describing polarity to other nucleic acids” negativity meaning that it must convert to positive-sense before translation). Measles uses the lytic cycle to reproduce” it destroys the host after producing as many copies possible. The preferred host cells of rubeola are the tissues lining the back of the throat, the nasal cavity and lungs, and then move onto immune cells. Rubeola is transmitted through mucus and other respiratory fluids, either aerially or contractually. However, it can survive up to two hours on an infected surface, enhancing its contagion risk. Statistically, 90% of people in proximity to a diseased person will become infected. Although there are countries that haven’t had an isolated case in decades, regions like central and west Africa and India endure fatalities from lack of disease control. Only the Northern, Central and Southern Americans have eradicated measles because vaccinations are mandatory before a child can enter school. However, outbreaks by the hundreds as recent as 2017 have been occuring in Europe, New Zealand and Australia, all of which include hospitalizations, fatalities, and new vaccination campaigns. Measles has been called the “7-day virus”, although it conventionally last 10-14 days. It’s really hard to verify if you have a virus on your person or in your body before you travel. You can’t see the virions, and if you are infected, you are sometimes capable of spreading the virus to others without showing any symptoms yourself.

Now, consider the number of people traipsing across countries and continents on any given day. Passenger airlines have made it incredibly easy for humans to quickly traverse the world in less time than it takes for us to realize we are carrying a virus with us. We are often in cramped airplanes with poor circulation, ideal for transmitting pathogens to other others. This is enough of a problem on its own, but you also have to consider the transfer of cargo. Countless tons of goods are shipped around the world on any given day, and they are also capable of carrying countless many pathogens. This risk increases further when you are transferring live cargo, such as poultry, fish, etc. This isn’t accounting for stowaways on boats and planes (mice, rats, etc.) that are also capable of transmitting disease. The thing about globalization is that people and goods can move around the world faster than ever before, but it also means that pathogens can spread across the world equally rapidly, oftentimes before we are aware of their presence. In the case of measles, the virus is easily spread through respiratory inhalation, and primary viremia occurs 2–3 days after exposure. You could be on the other side of the planet by then, and actively exposing other people (who may not be immune!) to a highly infectious and deadly virus.

Current Policies

Common symptoms include: acute fever, runny nose, cough, general discomfort, koplik’s spots in the mouth, full-body rash. The full-body rash and koplik’s spots combined are conclusive for diagnosis. Visible symptoms, like the rash, begin 3 days after infection, while the virus has already begun infecting others. The rash begins at hairline and ends at the feet. The rash is a bright, red color and , as the infection ends, it changes to brown then faces. As opposed to other viral rashes, lesions from measles do not contain fluids but are only raised areas of skin. The symptoms of measles diagnosis aren’t life-threatening, However, measles is especially dangerous because of its many severe complications, including blindness, hemolysis, pneumonia and encephalitis (swelling of the brain). Miscarriage and premature birth can come from infection during pregnancy.

Measles onset before the age of 1 or during infancy sometimes results in mental retardation or an extremely rare degenerative disease (subacute sclerosing panencephalitis) later on. The MMR vaccine (measles, mumps and rubella) is a 2 part injection beginning at age 1. The second at ages 4-5 if immunity has not developed by adulthood, more vaccinations are administered. The vaccine is a mixture of live attenuated viruses (weakened beyond symptom activation) that the immune system develops against. In this case, during childhood. Because of its rigorous updates, it is not popular globally. There is no definite treatment of measles, but if uncomplicated, rest and pain/fever medication (except aspirin) can be used to let the virus pass more comfortably.

Possible solutions/ Alternatives

Avoiding contact. Measles is extremely infectious. It is spread by droplets from coughing and sneezing. These can be directly inhaled or possibly picked up from contaminated surfaces. The initial stages are similar to most viral illnesses so keep away from any possible infection. Wash hands, wear a mask, don’t eat or drink in public. This is impractical in many cases. Isolation. Infected persons are kept at home and not permitted to socialize especially with groups such as school church etc. Hopefully if the others at home are immunized they will be ok. This is necessary but very disruptive. Vaccination. Measles vaccine is very safe and very effective. The only way to stop the measles virus is to make sure that everyone is immunized. The people that deny their children from getting immunizations are risking their child’s lives because you cannot product which child will die from it. You also can easily spread measles from country to country by not immunizing your children, its happened a few times recently and put several children’s at very high risk. It is a very serious matter and everyone should be immunized.

Action Plan

Promote education concerning the need for routine immunization against measles. If the problem is getting worse over a period of time, then public health officials may have to declare mandatory vaccination of all children. Need better education system based around vaccinations. Illnesses such as this are a problem because of a growing anti-vaccination community. We require all students in public schools to be vaccinated. The measles virus is already disseminated worldwide. Countries which do not mandate immunizations or have multiple reasons to defer or object to immunization have higher rates of transmission. In the United States certain populations have higher numbers of anti-vax parents and have been the source of outbreaks; example is a community just outside Portland Oregon. Vaccines work — they are not the problem. The childhood diseases vaccines protect against are the problem — they kill and cripple Antri-Vaxers are a problem—-they continue to spread misinformation, falsehoods and rely on discredited pseudoscience to convince gullible parents to ignore real science and real evidence to not vaccinate their children Too many states have passed laws needlessly and foolishly giving credence to anti-vaxers by allowing almost unlimited right to “conscientious objections” to vaccines and continue to allow those kids to attend school.

The federal government should take the lead using policy and financial carrots and sticks to reverse this trend and require parents to vaccinate children in order to attend school, day care, sports activities, etc. Vaccinated children not only protect the individual but form a vaccinated herd that reduces the risk to those rare few who are medically unable to be administered one or more vaccines. We need to stop researching vaccine safety. We need to start researching risks and repercussions of childhood diseases such as Measles, Mumps, Rubella, and Polio. Any laws should make sure that doctors at least personally examine any children for whom they provide exemptions. Medical boards need to review exemption for signs of fraud and gaming, with a proper appeals process. The border patrols of any country should interview people coming from regions with measles cases (Ukraine, Madagascar, Texas) and check vaccination status and current health. When the swine flu was infecting people in the US, countries in South America did this. They didn’t keep you from entering unless you were sick. This isn’t a bad idea generally. I know that people are contagious during the prodrome, and may not fall ill until they have already entered a country, but this would catch some active cases of infectious disease. Social media should stop publishing anti-vax propaganda.

Conclusion

Measles uses the lytic cycle to reproduce it destroys the host after producing as many copies as possible. However, it can survive up to two hours on an infected surface, enhancing its contagion risk. Common symptoms include: acute fever, runny nose, cough, general discomfort, koplik’s spots in mouth, and full-body rash. The MMR vaccine (measles, mumps and rubella) is a 2 part injection beginning at age 1. These can be directly inhaled or possibly picked up from contaminated surfaces. The initial stages are similar to most viral illnesses so keep away from any possible infection. Medical boards need to review exemptions for signs of fraud and gaming, with a proper appeals process. When the swine flu was infecting people in the US, countries in South America did this.

Works cited

1. NHS Choices. Accessed February 22, 2019. https://www.nhs.uk/conditions/measles/treatment/#.
2. ‘Measles (Rubeola).’ Centers for Disease Control and Prevention. February 20, 2015. Accessed February 22, 2019. https://www.cdc.gov/measles/about/index.html.
3. Orenstein, Walter A., Perry, Robert T., Halsey, and Neal A. ‘Clinical Significance of Measles: A Review.’ OUP Academic. May 01, 2004. Accessed February 22, 2019. https://academic.oup.com/jid/article/189/Supplement_1/S4/823958.
4. Public Health Agency of Canada. ‘Measles.’ Canada.ca. February 05, 2019. Accessed February 22, 2019. https://www.canada.ca/en/public-health/services/diseases/measles.html.
5. ‘The Problem.’ Measles & Rubella Initiative. Accessed February 22, 2019. https://measlesrubellainitiative.org/learn/the-problem/.
6. Young, Leslie. ”This Is a Serious Disease’: Why We Should Worry That Measles Is Making a Comeback.’ Global News. February 17, 2019. Accessed February 22, 2019. https://globalnews.ca/news/4967561/measles-danger-deaths/.
7. ‘Measles Deaths in the 21st Century.’ VAXOPEDIA. January 27, 2019. Accessed March 17, 2019. https://vaxopedia.org/2017/04/22/measles-deaths-in-the-21st-century/.
8. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf
9. http://www.globalization101.org/uploads/File/Health/health.pdf

Morbilli, more commonly known as “measles,” is caused by Rubeola virus that results in a highly contagious disease that infects the respiratory system, immune system, and skin. Initial symptoms are a high fever, runny nose, bloodshot eyes, and white spots on the inside of the mouth. It then develops into a rash that spreads downwards (Naim, 2018). Logically, because this is such a contagious disease, anyone who comes into contact with someone who has measles will most likely contract the disease, and this is why the problem exists; additionally, in my opinion, the symptoms do not seem to be quite drastic until later, so the individual might not recognize that they have measles and continue to interact with others, resulting in a higher risk of infections. Measles happens when the virus is transmitted through either direct contact, airborne exposure, or droplet exposure; coughing, sneezing, or even just talking to someone with measles will increase exposure. Measles can occur anywhere, but an individual will mostly likely become more infected if they live in a place with low vaccine coverage. An example would be the Netherlands in 1999, where there was a study conducted in which they found out that elementary students who were vaccinated showed no symptoms of measles compared to those who were not (Van Den Hoff, et. al, 2001). Moreover, because of the disease’s contagious nature, places with high vaccine coverage can have outbreaks through international travel; this is how outbreaks can occur anywhere.

Thinking on social justice terms, measles causes problems in society because it can cause many people to develop diarrhea, pneumonia, or complications in pregnancy; people should have the right to good health if the disease is preventable. On a cost-benefit analysis level, I believe that measles is a problem in society because it can spread so easily that more people will have to be hospitalized at an exponential rate; there will be overcrowding in hospitals where the disease can spread to other people; additionally, the hospital would run out of resources to treat people.

According to the Centers for Disease Control and Prevention (2019), there have been the most cases of measles in the U.S. in 2019 since 1992; the CDC lists the main cause of the outbreaks as international travel. Although I do believe that this is a factor, I think that another main reason is that there is a lot of anti-vaccination movements in which people believe that vaccines can be harmful to the body; this creates misunderstanding and uncertainty in a preventative measure, which leads to higher risk of infection among the population. According to Azhar Hussain (2018), the measles vaccination (MMR) is one of the most controversial, and the anti-vaccination movement affects society because it is a regression in modern medicine, which is why it has recurred in the U.S, even though we believed it to be eliminated in 2000.

There are misconceptions that measles mostly occurs in children, but it can actually affect everybody; humans are also the only host capable of getting the Rubeola virus (White, et. al., 2019). I believe that its highly contagious nature allows for everybody, regardless of age, sex, and race, to be infected. However, people are more susceptible to measles when they come from places without routine immunizations, especially underdeveloped countries, which also spreads when they travel (White, et. al. 2019). According to John T. Watson (2007), from the World Health Organization, another etiological factor is natural disasters; for measles specifically, natural disasters can cause overcrowding in clinics, which spreads the disease; natural disasters can also interrupt immunization routines (Watson et. al., 2007).

In my opinion, the risk of more measles outbreaks in the future could be increased if we do not try to have more urgent and preventative actions, which will be discussed in the next section.

Ways to solve the public health problem

According to the World Health Organization (2019), there is no specific treatment to combat the Rubeola virus. However, we can still try to prevent measles with two strategies: vaccinations and better enforcement of basic hygiene.

The CDC states that the measles vaccination, called the MMR vaccine, protects individuals from mumps, measles, and rubella. People are recommended to get two doses of the vaccine, one at 12-15 months and one at 4-6 years. It has been shown that one dose is 93% effective and two is 97% effective (Centers for Disease Control and Prevention, 2019). In my opinion, the MMR vaccine is probably one of the strongest ways that we can combat measles. As previously stated, we can simply see that it is statistically effective. Additionally, if many people are vaccinated, it would protect those who cannot be vaccinated, which is herd immunity. The fact that this is a possibility means that vaccinations are effective. We can also raise awareness of vaccinations through campaigns, such as the one in Uganda in October 2019, in which 18 million children were vaccinated, 43% of the population (Kampala, 2019). Because this is an underdeveloped country, many people did not have the vaccination and there was a higher risk of measles outbreaks. With a campaign, they can prevent many people from getting measles and also make people aware that there is something that can prevent measles.

An overlooked strategy to prevent measles would be having basic hygiene, such as washing your hands, not touching your face often, and sneezing into a tissue. I think that many people skip out or are relaxed about these strategies because it happens so often, so they automatically assume that nothing will happen, but because a means of transmission for measles is direct contact, we should be more cautious about hygiene. At the very least, though, we should be more hyper-active about hygiene when there is an outbreak occurring.

Another almost compounding factor that I would like to add is combating climate change. As previously stated, natural disasters can cause measles outbreaks, and climate change can make natural disasters worse. If we can work together to decrease our influence on climate change such as reducing waste and carbon emissions, then they would not be as severe and we could better handle an outbreak of measles if it ever occurred during a natural disaster. This would be primary prevention.

A historical example of taking preventative measures to reduce measles outbreaks is changing the vaccination from one dose to two doses. This was proposed by the Immunization Practices Advisory Committee (ACIP) in the 1980s.

A cultural example of preventative action is when the Measles-Rubella Initiative worked with the Philippines Red Cross (PRC) in February 2019. There was an outbreak of measles and more than 12,000 cases were reported. During this ordeal, the hospitals were overcrowded; similar to natural disasters, overcrowding can easily spread the disease because more people are in contact with each other; in this case, people had to share beds with one another. The PRC intervened by setting up Measles Care Units, in which they provided beds and emergency rooms for suspected peoples; the PRC also gave vaccinations and informed people on measles (Measles-Rubella Initiative, 2019). I think that this is important that we inform people of how one can contract measles, so that an outbreak like this does not happen again.

Public health in the future

Research suggests that the most effective method of measles prevention is the MMR vaccine. According to the Morbid and Mortality Weekly Report (1989), 400,000 cases were reported every year in the United States before the vaccine; afterwards, the numbers decreased. However, they decreased even further with the introduction of the recommendation to get two doses of the MMR vaccine, instead of one. As previously stated, one dose is 93% effective and two is 97% effective. Because we cannot directly combat the virus, the best we can do is to make sure the vaccines are potent. The FBR Administration suggests that we can ensure this by keeping them in optimal conditions: there are certain temperatures, lights, and places that we should store the vaccine in the refrigerator (FBR Admin, 2018).

I personally believe that we should push for world-wide vaccinations, except for those who cannot, such as people undergoing chemotherapy or newborn babies, but in that case, we will have herd immunity. However, I do acknowledge that it would be a hard and lengthy process to achieve this because of the vaccine’s controversial nature: there are many people who are anti-vaccine. These people are firm on their beliefs that vaccines are harmful, but the best we can do with them is to try to inform them with undeniable statistics or show them to actual people who have converted because they are more likely to believe someone similar; they might not believe plain statistics, but they will believe more local sources. We should also completely enforce mandatory immunization routines, such as the ones in place at UCI or to enter kindergarten. Ultimately, in order to completely eradicate measles, we would need a large intervention with vaccinations.

Doctor Collins rushes through a bustling pediatric office looking for her next patient. A child wails its mother’s arms as they wait their turn, and every seat is taken in the lobby. Busy would be an understatement, with the waiting room feeling like a Best Buy during a black friday sale rather than your typical doctor’s office. The measles outbreak plaguing the New York community has reached the suburb of Westchester, and riotous effects have followed. Measles is one of the most highly infectious diseases in existence, and for parents that haven’t vaccinated their children, one of the greatest threats to their child’s safety. The Measles virus, formerly thought to have been eliminated in 2000, is one of the top 10 global health threats, as stated by the World Health Organization. The disease’s rampant reemergence hasn’t been due to a new mutation of the virus, or a science experiment gone wrong. It’s been entirely caused by parents that have elected to forgo basic vaccines for their children. And, in a busy pediatric office in Mount Kisco, New York, the effects have become extremely prevalent.

The measles virus has caused a widespread global panic, and with five confirmed cases in Westchester County, Doctor Margaret Collins has her hands full. Dr. Collins is one of Westchester, New York’s best pediatric physicians. She graduated summa cum laude from the University of Pennsylvania with a major in Biological Basis of Behavior, then went to George Washington University Medical School and graduated first in her class. She completed her pediatric residency at North Shore University Hospital and was chief resident, then came back home to join the Mt. Kisco Medical Group, and has now been there for the last 26 years.

In these 26 years of practicing, she’s worked through the worst “epidemics”. However, the sheer panic tied into the Measles outbreaks have been enough to even shock her, but not enough to prevent her from saying “I told you so”. Doctor Collins has always been one of the strongest advocates for immunizations, and with the recent uptake in the amount of measles cases seen globally, she only wishes people had taken action sooner. “When I started practicing I got pretty fired up by anti-vaxxers”, says Collins. “I would come at them with all the science, all the studies of how safe it was, how bad those diseases could be, I could get into 20-30 minute conversations about that. They’d listen politely, nod their head, then they’d refuse all the vaccines”. When asked about how many of her patients remain unvaccinated today, she replied “about 25% of my patients. Despite all the studies, parents wholeheartedly believe that vaccines would harm their children more than these diseases could, and no matter how I try some of them just won’t listen”.

Measles now poses one of the greatest health threats in history due to its highly contagious nature. The extreme spread of the virus is largely due to the amount of travelers in and out of the United States acting as carriers of the disease, transmitting it to children unprotected against it. According to the CDC, the percentage of children who are unvaccinated has quadrupled since 2001, even though “the overall utilization of most vaccines remains high”.

As a result of “anti vaxxers” choosing not to vaccinate their children, massive outbreaks of Measles in both the United States and global have started to reemerge, and in 2014, one outbreak lead to more than 600 measles cases. As for 2019, the amount of measles cases has already surpassed the amount of outbreaks in the last 5 years, and by May 1st, 2019 there have already been over 700 cases. “Measles is a bad illness”, says Collins, ‘if you are exposed to someone with the measles and you aren’t vaccinated, you have a 90% chance of getting it. Most people don’t die from it but 2 out of 1000 do, which is scary if your child is sick”.

For residents of Westchester, New York, this threat isn’t just a global problem, its a problem close to home. Katy McKee of Chappaqua, New York expressed her sentiments on the disease while waiting for her son Max to be vaccinated. McKee was once a vaccine-hesitant parent, and refused immunizations for her son up until he was three years old. Now at four, Max is in the process of “catching up” on all of his vaccinations. “[My initial fear] wasn’t autism”, says McKee, “that was never my fear in that, I was more concerned about… you know you hear about brain swelling, really scary things”.

The greatest fear most parents have regarding vaccinations is the possible health threats tied to immunizations. One study conducted in 2002 linked the MMR (measles, mumps and rubella) vaccination to Autism, and since then has founded the idea in many parents’ minds that the vaccine can cause Autism. However, a decade-long study by the Annals of Internal Medicine published on March 5th, 2019 has now officially and unequivocally proven there is no link between the vaccination and Autism. Parents that were once opposed to vaccinations have now begun desperately looking for ways to protect their children against a disease that is running rampant across the country.

“I don’t think I changed my mind on the topic willingly’, says McKee. “Dr. Collins took a lot of time trying to convince me to change my mind, and I think the thing that really provoked it was seeing on the news just how contagious the Measles virus really is. I’m afraid of Max getting sick, and most importantly, I’m afraid of him getting my mother who isn’t in great health sick. I would hate for either of them to suffer because of me”. This fear has clearly been felt by the other parents in Westchester, based on the large attendance at the free MMR clinic held at Doctor Collins’ office on the day McKee and her son visited for his vaccines.

Pediatric Nurse Marissa Boyd provided further information regarding the Measles virus during the clinic hours, citing “young children under a year who haven’t been vaccinated yet, people who are immunocompromised; those who are on chemotherapy, who have had organ transplants, people with HIV, people who are on medications that may suppress their immune systems like arthritis medications”, as most susceptible to the measles virus. As for the length of time a person is contagious, the incubation period after you’re exposed is 7-21 days. “Measles is actually one of the most contagious infectious diseases that we know of”, says Boyd, “susceptible individuals will get measles if they’re exposed up to 90% of the time”.

Boyd also made a striking comparison on just how contagious measles is, by comparing it to the contagion rate of chickenpox. “If you have 10 people who are susceptible to chickenpox and they’re exposed, only 7 will get sick. 9 out of those 10 will get sick if they’re exposed to Measles. Carriers of the disease going around not realizing they’re sick yet are so concerning because they’re going to public places with lots of people and there’s bound to be susceptible people that have been exposed”. The risk caused by vaccine-hesitant parents has outweighed the “potential threats” caused by vaccines, and now that Autism has been ruled out, there is very little evidence supporting anti-vaxxers rationale on not vaccinating their children. The greatest challenge now is encouraging parents to change their minds on vaccinations.

When asked about her success on changing parents’ minds, Collins said that it was hard, but not impossible. “Parents get information in both directions from their social groups. I always tell the parents I’m not going to force them to do anything. We’ll talk about it in two months, in four months, and I gradually see patients become more comfortable with vaccines over those first few months. I currently have patients I’m seeing today that are in the process of catching up with their vaccines they didn’t receive beforehand”.

With a contagion rate of 90 percent, it comes at no shock just how incredibly fast Measles has spread across the country. States all across the country are currently experiencing widespread outbreaks, and it is entirely due to the amount of children and adults that have declined vaccinations. Measles is a disease that is 99% preventable through vaccinations, but because of anti-vaxxers, the disease thought to have been completely eliminated in 2000 has made a rampant reemergence in the United States. Currently, New York City is facing one of the worst measles outbreaks in decades, with 423 of the 704 reported cases taking place within the city. Rockland county, a northern suburb in New York has also recorded 200 cases.

According to the New York Times, public health emergencies have now been declared in both these locations, and schools in these locations have been closed to prevent further infection. These areas are heavily populated by Orthodox Jewish communities who have declined vaccinations for their children, and the main culprit for their reluctance has been handbooks and hotlines that have misinformed parents on vaccine dangers. Anti-Vaxxer propaganda has run rampant through the Orthodox communities, and many parents fear that vaccines could be the reason their children are becoming sick in the first place. As a response, the city has issued summonses to those not following vaccination requirements, and has closed some ultra-Orthodox Jewish schools where unvaccinated students were attending class.

These communities are very reluctant to change, and with their Rabbis and other religious officials preaching vaccine danger, it is going to be difficult to change their minds. Governor Mario Cuomo has made steps in trying to take legal action against the ability to opt-out, but New York lawmakers have been reluctant to step in. Cuomo wants to make it illegal to opt out of vaccinations for religious or philosophical reasons during this “public health crisis”. However, according to one New York Times reporter named Jesse McKinley, ‘the lawmakers’ reluctance seems to stem from concern about angering ultra-Orthodox and other religious constituents who have often wielded political influence”. This could make it even more difficult to stop the continuous spread of Measles in New York City, and for now the best roadblock officials can put up is closing public schools in the orthodox areas of the city and limiting travel.

For Westchester County however, the threat is made much worse by the confirmed cases, because it proves the Measles virus has finally escaped the New York City bubble. Five confirmed cases has put local communities into a “state of emergency”, and with vaccine clinics being run out of local doctors offices, many parents are scared for the safety of their children. McKee was only one of the many parents that attended the free vaccination session, but her emotions reflected the entire group. “I first heard about the outbreaks when my sister called me to tell me that she received an email from the school district that there were some few confirmed cases in the area. My reaction was simply, ‘oh sh*t.’ This whole outbreak terrifies me, but the fact it’s now so close to home makes it feel so much more real. I’m here to get Max vaccinated today because I’m genuinely afraid.” One school district in Chappaqua, New York sent out a Measles PSA email to all members of the school district once the cases were announced, listing frequently asked questions about the MMR vaccination, and the dates and locations for the free vaccination clinics. The email additionally encouraged parents to, “please call your doctor if you have any specific questions about yourself or your family. For more information, call the NYS Measles Hotline at 1-888-364-4837”.

​The realization that this disease isn’t simply another news story has presented a great shock to many parents, and for many anti-vaxxers, it could be the push they need to change their stance on vaccinations. Vaccine clinics have been opened all across New York State, and members of the CDC and New York Department of Public Health have begun progress on properly informing Orthodox communities on the benefits of vaccinations. Since the surge in Measles reporting in New York City, there has also been an immense uptake in MMR vaccinations among children in the city, according to data from New York City’s health department, with many of them coming from within the Orthodox community.

Yet, despite this progress, the amount of people that still remain unvaccinated presents enough of a challenge that the Measles outbreak doesn’t seem likely to be resolved in the near future. The only known cure is prevention, and for those concerned, Doctor Collins provided advice on the best way to avoid exposure. “Two doses of the Measles vaccine provides over 90% protection against the measles. It’s the best, and only way we have to keep kids and adults safe”. For parents like McKee, the only hope now is that the virus passes their children unharmed, or that they can be vaccinated in time.

Measles virus, a paramyxovirus is one of the main causes of death in children in developing countries and responsible for some deaths in industrialized nations. Infection resorts to immunosuppression, making the host more susceptible to secondary infections with a range of viral and bacterial pathogens and causing most measles associated (Carter et al, 2007). Measles is an acute highly viral infectious disease. Before vaccines, infection was nearly universal during childhood. It has no known animal reservoir and no asymptomatic carrier state has been recorded (Roy P et al, 2015). Measles is still a common and fatal disease especially in developing countries. It is primarily transmitted through large respiratory droplets. It is highly infectious, with greater than 90% secondary attack rates among susceptible persons (CDC, 2015). It infects nearly 30 million children per year worldwide. Complications related to pneumonia, diarrhea and malnutrition usually cause death (Orenstein et al, 2004). WHO estimates that of the approximately two- thirds of the global burden of death due to measles, almost 1,36,000 (range: 98,000 to 1,80,000) occurred in the South East Asian Region in 2007, with most of in India. India had 47% of estimated global measles mortality in 2010 (Simon et al, 2012).

Infection is very contagious and usually through aerosol route. Initially, the Virus replicates in the respiratory tract, then spreads to lymphoid tissues. Viremia and spread to a variety of epithelial sites follows. About 1-2 weeks after infection disease symptoms develop.

Diagnosis includes: 1) clinical picture (history of exposure and upper respiratory tract symptoms, Koplik’s spots and rash); 2) confirmatory tests. Disease is confirmed with RT-PCR serodiagnosis, isolation. Serology diagnosis by IgG is simpler than isolation but two samples are needed (one 10-21 days post rash) so it takes longer. An IgM test is now available.

Almost all individuals infected are symptomatic. Only one serotype exists. A single natural infection gives life-long protection. Inhalation is the main route of infection. It is highly contagious – the maximum period of contagiousness is 2-3 days before the onset of rash (Hunt M, 2009).

Problems associated with measles infection

A high fever is usually the first sign of infection with measles, which begins after incubation period which is about 10 to 12 days after exposure to the virus, and lasts for about 4 to 7 days. A runny nose with cough, conjunctivitis, and koplik can develop in the initial stage. After several days, a rash apears, often on the face and upper neck, averagely, the rash occurs 14 days after infection (in a range of 7 to 18 days). Over about 3 days, the rash spreads, it eventually gets to the hands and feet. It lasts for 5 to 6 days, and then fades (Roy P et al, 2015).

Most measles-related deaths are as a resort of associated complications. Complications are more common in children under the age of 5, or adults over the age of 20. The severe complications are blindness, severe diarrhea and resulting dehydration, ear infections, and severe respiratory infections such as pneumonia. Measles could be severe among poorly nourished young children, especially those with insufficient vitamin A, or the immune-compromised (WHO measles factsheet, 2015).

In a very small proportion, the virus establishes in the brain and, after a long period of incubation, causes a degenerative pattern of changes in brain function, this includes loss of higher brain activity, death is inevitable. Two related but different diseases result from neural infection, Measles Inclusion Body Encephalitis (MIBE) and Sub-acute Sclerosing Pan Encephalitis (SSPE).

MIBE occurs in approximately 1 in 2000 cases of infection, a chronic progressive encephalitis which occurs in young adults and children and is associated with a persistent measles virus infection. MIBE can be fatal with the survival time after diagnosis being an average of 3 years. It is usually a seen in immunocompromised patients and is associated with early primary infection usually before two years of age.

SSPE a slowly progressive neurological degenerative disease, occurs in approximately 1 in 100,000 cases. It is associated with a long term persistent measles virus infection that leads to death many years after the first infection (Dimmock et al, 2015).

Available control measures

A live attenuated virus vaccine (grown in chicken embryo fibroblast culture) is currently recommended to be given to children at twelve to fifteen months, Younger children do not show a strong immune response to the vaccine. A Second dose is given at about four to six years of age. Thus, reducing the number of persons who are susceptible due to failure of primary vaccine. Vaccination gives long term immunity and the vaccinee does not spread the virus. Immune serum globulin can be used for at risk patients (less than 1 year old, or with impaired cellular immunity) during an outbreak (Hunt M, 2009). Measles virus has not changed over its known history of about fifty years, the same level of protection is still reached by the original vaccines. The polio and measles viruses are stable when compared with HIV-1 and the influenza virus (Dimmock et al, 2007). Although the vaccine can cause fatal giant cell pneumonia in those with severely compromised cell-mediated immunity (Hunt M., 2009).

Challenges faced with global ambition of completely eliminating measles

The feasibility of measles eradication has been proven by the Region of the Americas, where elimination of measles and interruption of transmission has been achieved and sustained since 2002 (WHO Global Eradication of Measles, 2015). Despite the success in global measles control, the progress in reduction of the numbers of measles cases and deaths became stagnant between 2008 and 2010. This is was mostly due to prolonged measles outbreaks in Africa and Europe and the high burden of the disease in India. The number of measles cases in western European countries, rose from 7,499 in 2009 to over 30,000 in 2010 and 2011, this contributed to an increase the number of reported cases globally. During the same period, twenty-eight countries in sub-Saharan Africa were affected in a widespread resurgence (CDC, Eliminating measles, Rubella and CRS worldwide, 2015).

The eradication of measles is faced with so many challenges, some of the key challenges include:

1. Maternal antibody fast rate of waning. A large number of children are left unprotected before the first dose because of the fast rate of waning of these maternal antibodies (Adu, 2008).
2. Injectable nature of vaccine. There are problems with vaccine administration. Unlike the polio vaccine, the measles vaccine is administered with the injection, so it is not easy to administer. A large number of workforce are to be trained for vaccine administration. A very good solution to this problem would be the may be use of aerosol technique which, this can also be used by field workers. The acceptability of the vaccine may be improved through this method, since it would not require the use of injections (Roy P et al, 2015).
3. Adverse reaction and reversion to virulent strain. The chances of adverse reactions to the live vaccine need to be addressed. Maintaining proper cold chain during storage and transportation of vaccine should also be considered (Roy P et al, 2015).
4. Other competing priorities. The availability of qualified staff and funds are affected by competition from other health programs.There are competing priorities like streamlining of newer vaccines, polio eradication and other health initiatives (Roy P et al, 2015).
5. Population displacement and migration. Population displacement and migration are challenges a measles eradication initiative would also face. Presently, there are large displaced populations in urban areas. Current eradication programs may face greater challenges than earlier programs as a result of exponential increase in trans- migration (United Nations Population Fund, 2015).
6. Political instability. In several countries particularly Somalia and Afganistan, Sierra Leone, part of Parkistan, Congo, Sudan, Ethiopa and Liberia political instability and armed conflicts cause vaccination to be logistically unpredictable and difficult. In addition, Nigerian internal politics in the boycott of the 2003 immunization, were ramifications from the arena of international politics (Okonko et al, 2009).
7. Terrorism and War. The main measles- endemic countries are at war, and the world spends more on arms than ever before. Both real and perceived terrorism, makes the situation more complex. As a resort, reaching high rates of vaccination coverage in areas affected by conflict will be very dangerous and difficult (Roy P et al, 2015).
8. Low vaccination rates and surveillance. It is essential to maintain excellent vaccination coverage with high quality surveillance. Overcoming this, will be critical in dealing with importations of measles virus, so long as the measles virus is still endemic in other parts of the world (Andrus, 2011).
9. Poor maintenance of high population immunity. Maintaining a high population immunity with excellent coverage and laboratory networking that is efficient for high- quality surveillance would deal with the problem of the importation of measles virus into countries where it has been eliminated (Ministry of Health and Family Welfare, 2004).
10. The changing epidemiology of measles. The increased transmission of measles among adolescents and adults as a result of the changing epidemiology of measles should also be considered (Roy P et al, 2015).

Conclusion

To eradicate measles, research has shown the need to have homogeneous population immunity of ≥93% (WHO Global Immunization Vision and Strategy, 2005). Elimination of measles requires immunization coverage of at least 96% of children aged less than one year and also the prevention of accumulation in the immunity gap (Roy P et al, 2015). Three criteria are biologically important for the feasibility of the eradication of a disease, measles meets all: 1) humans are the only reservoir; 2) existence of accurate diagnostic tests; 3) an practical and effective intervention is available at an affordable cost. It can be concluded, that measles eradication is a very challenging but feasible target. Exponential increase in commitment and resources is an essential requirements, if the measles eradication initiative should be pursued. To achieve measles eradication, all the regions and countries of the world will have to work together.