Measles
is a common vaccine preventable childhood disease in developing countries. It
is caused by the invasion of virus from Paramyxoviridae family. Interestingly, It is transmitted
via respiratory route. But, it can affect several other organs including
gastrointestinal system.
When
your mentor and professor say you know measles can cause diarrhea. It might
look doubtful and you are hesitant to accept this fact. You might think, “Come
on this is airborne infection, usually the sign and symptoms include runny nose, cough, fever, sneezing, conjunctivitis, skin rashes and Koplik's spot. how can it cause diarrhea? Where is the
pathophysiology, Man?”
Your
bafflement is genuine.
Diarrhea
is one of the commonest complications of measles infection, other being otitis
media, pneumonia and others listed below. Measles virus infects multiple organ systems and targets
epithelial (lining of the cavities, organs of the body), reticuloendothelial, and white blood cells, including monocytes,
macrophages, and T lymphocytes, which are vital components of our bodies
defense mechanism. Measles virus infection leads to a
decline in CD4 lymphocytes, starting just before the onset of rash and lasting for
up to 1 month. It is not exception that many of these
complications are caused by disruption
of epithelial surfaces and immunosuppression.
Usually
measles associated diarrhea occurs just prior to the appearance of rashes. Stools
of children with measles-associated diarrhea usually have the same bacteria as
those of children with diarrhea not associated with measles. This signifies the
possible secondary viral and bacterial infection due to immunosuppression and
disruption in epithelial surfaces. Measles-associated diarrhea typically begins
just before rash onset, suggesting that measles virus is responsible for most
of the diarrhea episodes but that secondary bacterial or viral infections may
contribute to the severity and duration of illness.
 |
| Complications Of Measles infections (From: The Clinical Significance of Measles: A Review) |
Lets
have some contextual information about measles in Nepal.
A little glimpse into measles status in
Nepal:
In 2013, Nepal, one of the 11 SEAR member states,
adopted a goal for national measles elimination by 2019 in line with
the 66th session of the Regional
Committee of the World Health Organization (WHO) South-East Asia Region (SEAR) in
2013, which established the goal
to eliminate measles and to control rubella and congenital rubella syndrome
(CRS)* in SEAR by 2020.
Reported suspected measles incidence declined by
13% during 2007–2014, from 54 to 47
cases per 1 million populations. In a study, Among the
4657 identified measles cases, 64 died within 30 days of rash onset meeting the
definition of a measles death. This yielded an overall case fatality rate (CFR) of 1.1% (95% CI: 0.5–2.3) in
Nepal.
Measles Vaccine Immunization update in
Nepal:
- In 1979, monovalent measles vaccine was introduced in three districts in Nepal for vaccination of infants at age 9 months.
- In 1989, the program was scaled up nationally.
- Nationwide supplementary immunization activities (SIA) conducted in 2012–2013.
- Measles-rubella (MR) vaccine was introduced into the national routine immunization schedule in 2013 and replaced monovalent measles vaccine administered at age 9 months.
- Second dose of MR vaccine, was introduced into the routine immunization program in September 2015 and is recommended for vaccination at age 15 months.
Sources:
1.
Progress Towards Measles Elimination-Nepal, 2007-2014. Weekly/March 4,
2016/65(8); 206-210. http://www.cdc.gov/mmwr/volumes/65/wr/mm6508a3.htm
2.
Measles deaths in Nepal: estimating the national case–fatality ratio Anand B
Joshi, Elizabeth T Luman, Robin Nandy, Bal K Subedi, Jayantha BL Liyanage &
Thomas F Wierzba. Bull World Health Organ 2009;87:456–465.
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