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The United Nations Children’s Fund, UNICEF, and the World Health Organisation (WHO) have warned of a “perfect storm” of conditions for measles outbreaks, as measles cases increased by 79 per cent in the first two months of 2022, compared to the same period in 2021.
But amid the current resurgence of measles, many people may still believe it’s a harmless, transient disease. They think of measles as just a little rash and fever that clears up in a few days. Also, they don’t see the need for children takes booster doses of the measles vaccine to further boost their immunity against the viral infection when exposed.
The measles vaccine is frequently given as part of a combined vaccine against measles, mumps and rubella – known as MMR.
Measles is a highly contagious, vaccine-preventable disease caused by the measles virus and it is a disease of public health importance, especially in children younger than 5 years of age. The virus can spread through coughing and sneezing from close personal contact or direct contact with infected persons.
But experts warn that even before the telltale skin rash appears, the infection typically shows up in the eyes and there is no way to tell in advance the severity of the symptoms a child will experience. In rare cases, measles can trigger long-term vision problems and even blindness, especially in children younger than 5 years of age.
Severe complications from measles can include brain swelling that – along with irritation or clouding of the eye’s cornea – can rob children of their sight.
It also weakens the immune system and makes many children more vulnerable to other infectious diseases like pneumonia and diarrhoea, including for months after the measles infection itself among those who survive.
Dr Jonathan Song, an associate professor of ophthalmology at the Keck School of Medicine at the University of Southern California, in Los Angeles stated “Almost all people who get measles will get the red eyes called conjunctivitis. Once they get red eyes … they can develop inflammation of the cornea, which can break down the cornea and lead to scarring and even blindness.”
The cornea is the clear tissue serving as the “window” into the eye.
Dr Song added, “the earlier a child is infected with measles, the more likely any resulting eye damage will be lifelong. In a normal child, the visual system develops within the first four months of life, when babies are forming connections from the brain to the eye. So if anything is blocking the front of the eye that can be permanent.”
Sometimes, measles infection damages or destroys cells in the retina. The retina lines the back of the eye, sensing light and sending signals to the brain. According to the academy of ophthalmology, in rare cases, the virus even damages the optic nerve, causing potentially irreversible blindness.
Howbeit, experts say that the high prevalence of measles-induced hearing loss in Ekiti State is worrisome despite the availability of the measles vaccine and so recommended routine hearing assessment for children with febrile conditions to detect any hearing loss promptly.
In the study, the researchers found that measles takes up the largest ‘chunk’ of the cases of hearing loss in both ears with a prevalence of 45.8%. Twenty-eight (32.2%) were from febrile illnesses that were treated with ototoxic (ear poisoning) antibiotics.
The researchers looked at the medical records of 142 children with profound hearing loss in both ears at the otolaryngological and paediatric clinics of Ekiti State University Teaching Hospital, Ado Ekiti and Federal Teaching Hospital, IdoEkiti, between January 2009 and December 2018. It was in the Pan African Medical Journal.
The children were aged 6 to 15 years. Causes of hearing loss in these children include measles, meningitis, malaria, mumps, sickle cell disease (SCD), birth asphyxia (lack of oxygen and blood flow to the brain) and neonatal jaundice. Immunisation was received by 13 (20%) of those with measles-induced hearing loss.
They, however, said that 20% of the children with measles-induced profound hearing loss in both ears in this study had previously been immunised against measles although it could not be ascertained if this was due to measles vaccine failure.
According to them, “Of great concern, however, was the occurrence of profound bilateral hearing loss unknown causes. One reason that might be advanced for the recurring ‘decimal’ is the inability of pregnant women to recognise the characteristic features of some intrauterine causes of profound bilateral hearing loss. A typical example is the occurrence of maternal rubella(measles), the features of which may appear as a red herring.
“Also, ear discharge is believed by mothers to be a normal feature of teething and hence innocuous. This myth might prevent early uptake of treatment for ear discharge among children. Thus, there is a need to sensitise mothers on prompt treatment of ear discharge among children. This may reduce the incidence of profound bilateral hearing loss.”
Profound bilateral hearing loss is largely irreversible and without rehabilitation, the victim risks being deaf and dumb. It is caused by damage to the inner ear or the nerve from the ear to the brain. In children and infants, causes include congenital abnormalities or infections.
Mothers need to ensure their children receive all recommended vaccine doses to enjoy the full benefits of vaccination. By age nine months, most children would have taken doses of different vaccines. But delaying vaccination for whatever reason is dangerous for children.
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