nhsManagers.net | Briefing | 10 March 2018

Medicine for Managers

Dr Paul Lambden BSc MB BS BDS FDSRCSEng MRCS LRCP DRCOG MHSM FRSM

For those of you who, like me, are more stricken in years, you will remember the childhood outbreaks of measles in school. We all had it, along with chicken pox and, in many cases, mumps. Then along came the measles vaccine and it promised to become an infection of the past.

However, in the last year, the number of cases of measles has risen considerably right across Europe with an overall three-fold increase.

The World Health Organisation has reported that there have been over 21,000 cases in Europe with thirty-five deaths. The increase was particularly dramatic in Germany, Italy and Romania. In England there have been outbreaks in the South, the Midlands and in the North.

Measles vaccine was introduced in the UK in 1968 and the single vaccine was replaced by the MMR (Measles, Mumps Rubella) vaccine in 1988.

Dr Andrew Wakefield, a gastro-enterologist at the Royal Free Hospital, published a paper in 1998 linking the measles vaccine with autism. It received huge publicity and

the take-up of measles in the UK and more widely fell for several years, between about 2002 and 2013.

The research was subsequently discredited but the consequences were considerable. There are still more measles cases in the UK than in the 1990s. The vaccine usage has steadily recovered until the recent decline.

Measles still results in the death of about one in every five thousand cases in the UK although the disease will cause about one in 100 to die in the poorest regions of the world. It has been reported that, in 2016, 90,000 people died across the globe from the disease.

Measles is spread by the dispersal of droplets of fluid coughed or sneezed by infected individuals.

It is highly infectious. If 99 non-vaccinated individuals come into contact with one person infected with measles, about 90 of them will catch the infection and six or seven will suffer complications. The importance oif the vaccine is therefore indisputable.

Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.

Measles Early in the 1970s, I attended my infectious disease course. Although a student at Guy’s, the whole group had to travel to Hither Green Hospital in South London where the wonderful Dr Brown would enthral us all with tales of measles, mumps, chicken pox, diphtheria, whooping cough and other terrible infections. Thanks to modern medicine, most common acute fevers are in retreat with immunisation and better social care. The course isn’t taught now and memories of classes decimated by measles outbreaks or polio scares have largely faded.

Measles itself usually starts with non-specific ‘viral’ symptoms such as a high temperature which may reach 39-40°C, sore throat, red eyes and photophobia and general cold- or flu-like symptoms such as runny nose, coughing and sneezing.

Some spots may appear in the mouth and throat and, as every medical student knows, these are called ‘Koplik’s spots (named after Henry Koplik, an American paediatrician who identified them in 1896). The symptoms are followed three or four days later, by the development of a rash which usually starts behind the ears and on the neck and spreads downwards. The rash is a dull red and is blotchy and is described as centrifugal, spreading outwards to the rest of the body.

For most people the acute symptoms start to subside once the rash has appeared and the disease settles after about seven to ten days, usually without any

complications.

Treatment and prevention of measles Effectively there is none, although there are actions to relieve the symptoms and to reduce the prospect of spread to other susceptible individuals.

As with many acute viral infections, general measures include rest, plenty of fluids, staying in a dark room if there is photophobia and taking antipyretic (temperature lowering) analgesics (pain killers) such as paracetamol or ibuprofen.

People with measles are infectious from when the symptoms first develop to about four or five days after the rash appears. Avoidance of

other people will reduce the risk of spread.

Of course the ultimate way to avoid measles is to protect against it with measles (and mumps and rubella [German

measles]) vaccination.

As part of the NHS childhood vaccination programme it is given as two doses, the first to a child when about thirteen months old and the second before the child starts school.

Complications of measles In the UK about one in 5,000 people who contract measles will die from it. For the substantial majority of people it is an unpleasant viral illness which lasts about ten days or so and then resolves without sequelae.

For six or seven people in 100, complications will occur. They are more common in the young, poorly nourished children and people whose immunity is compromised by treatment with steroids or anti-cancer drugs or because of illnesses such as HIV/AIDS.

Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.

Troublesome common complications include diarrhoea, chest infections, croup, ear infections and sometimes fits because of a high fever (febrile convulsions).

Less commonly a child will develop meningitis or encephalitis. Meningitis is an acute infection of the membranes covering the brain an spinal cord, known as the meninges.

A child developing measles will become more unwell and will develop headache and neck stiffness. Encephalitis is an inflammation of the brain itself.

Rarely, a child with measles may develop a complication, usually fatal, and called subacute sclerosing panencephalitis (SSPE). It may occur from months to several years after an episode of measles. It is a rare and chronic form of encephalitis (brain inflammation) with the measles virus or a mutation of it.

It usually affects children and young adults and is estimated to affect one in 10-15,000 patients who have had measles. No cure exists for the disease.

So, the moral of the story is to ensure your children have the measles vaccine. If the percentage of vaccinated children becomes sufficiently high, there will be insufficient unvaccinated children to spread the disease because of herd immunity (the high percentage of vaccinated children who stop spread).

Measles could easily become a dead disease. We are close to that and it can be achieved.

paulambden@compuserve.com

Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.