Measles (campak) is spread when an infected person talks, breathes, coughs or sneezes tiny particles containing infectious agents into the air. These are called small particle aerosols. Due to their tiny size, small particle aerosols can travel long distances on air currents and remain suspended in the air for minutes to hours. These small particle aerosols may be breathed in by another person. Measles (campak) is also spread by contact with hands, tissues and other articles soiled by nose and throat discharges. The virus is very infectious and droplets in the air may infect people entering a room up to 30 minutes after an infected person has left it.
Measles (campak): Signs and symptoms
Early in the infection, symptoms may include:
- sore throat
- runny nose
- sore eyes
- photophobia (discomfort when looking at light).
Image courtesy Prof. David Gordon, Flinders Medical Centre, Adelaide, South Australia.
These symptoms usually worsen over 3 to 5 days, then a blotchy rash (see image) begins on the head and over the next day or two spreads down the entire body.
The rash lasts 4 to 7 days. Measles illness usually lasts about 10 days. The cough may be the last symptom to disappear.
Measles (campak) is often a severe disease, frequently followed by middle ear infection (7% of cases) or bacterial pneumonia (lung infection or inflammation) in 6% of cases. In as many as 1 in every 1000 cases, brain infection occurs (encephalitis), often resulting in death or permanent brain damage. Sometimes brain damage may not appear until many years later.
Complications from measles are more common and more severe in the chronically ill and in very young children.
Image Courtesy, Public Health Image Library (PHIL), Department of Health and Human Services, Centers for Disease Control and Prevention (CDC-USA)
Clinical presentation provides suspicion for a diagnosis of measles (campak) and can be confirmed by a blood test, or detection of the virus in urine, throat or eye specimens.
(time between becoming infected and developing symptoms)
Usually 10 days to onset of fever (range 7 to 18 days) and about 14 days to onset of rash.
(time during which an infected person can infect others)
From 24 hours before the onset of symptoms to four days after the appearance of the rash.
There is no specific antiviral treatment for measles (campak), however, complications may require antibiotic treatment. Treatment for the symptoms includes plenty of fluids and paracetamol for the fever. Aspirin should not be given to children under 12 years of age unless specifically recommended by a doctor.
Exclude the person with measles from childcare, preschool, school and work for at least 4 days after the onset of the rash.
Exclusion periods for contacts*:
- In most circumstances, contacts who are not immune to measles (campak) should be excluded from childcare, preschool, school and work for 18 days after the last contact with an infectious person.
- Where the contact with an infectious person occurs in an early childhood education and care services or primary school setting, or if the contact is immune-suppressed, advice on the exclusion period should be sought from the Communicable Disease Control Branch of SA Health (1300 232 272).
*A contact is any person who has been close enough to an infected person. As a result, such person is at risk of having acquired the infection from that person.
Immunisation and immunoglobulin
Measles is best prevented by the measles, mumps and rubella (MMR) combination vaccine or the measles, mumps, rubella and varicella (MMRV) combination vaccine, or the recently launched Indonesian measles and rubella (MR) combination vaccine; vaksin MR.
Most noteworthy, 2 doses of a measles-containing vaccine will provide nearly 100% protection against measles.
If an un-immunised child aged 9 months of age or older or adult has contact with measles (campak), the infection may be prevented by immediate vaccination. Immediate vaccination should be done within 72 hours of first contact with an infectious person with a measles-containing vaccine (unless contraindicated). Subsequently, if it is more than 3 days (72 hours) and within 6 days (144 hours) since the first exposure, immunoglobulin (a solution containing human antibodies that is made from human blood products) may prevent infection.
If the infant is less than 9 months old and is in contact with measles, the risk of developing measles can be reduced by giving immunoglobulin within 6 days (144 hours) of first contact.. The MMR vaccine should then be given as close as possible to 12 months of age, but at least 5 to 6 months after giving immunoglobulin. The measles-mumps-rubella-varicella (MMRV) vaccine due at 18 months of age should still be given at that time.
Adults born during or since 1966 are very likely to be susceptible to measles. Unless they have had a medically confirmed infection with measles they should ensure that they have had 2 documented doses of a measles containing vaccine. Furthermore, this is especially important prior to travel out of Indonesia.
Measles Vaccine In Indonesia
Despite the scarcity of the MMR Vaccine and the still unavailable MMRV Vaccine in Indonesia over the past few years, Indonesia has launched a MR Vaccine (vaksin MR). Notably, this MR Vaccine (vaksin MR) protects against Mumps and Rubella only, without Measles and Varicella. In effort to eradicate Rubella in Indonesia, the Government of Indonesia launched a national measles-rubella immunisation campaign on 1st August 2017. This campaign targets all Indonesian children between the ages of nine months and 15 years. The campaign will aim to reach 95% immunisation coverage and thus eliminate measles and rubella in Indonesia by 2020.
Gavi – The Vaccine Alliance is supporting the Government of Indonesia by contributing 50% of the total cost of vaccines. WHO is assisting with the preparation of immunisation activities. This ensures all children to receive vaccinations, particularly in high-risk areas and among vulnerable populations.
This MR Vaccine is however, still only limited for the campaign use. It is available at the public health centres (PusKesMas) and public hospitals. The general public, – e.g. adults who want to acquire a booster MR Vaccination – are still unable to get access to the aforementioned vaccine, and might need to wait until further notice and increasing availability of the product.
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