Samoa is currently experiencing a tragic measles outbreak. Thousands of people have been affected and at least 70 have died, mostly children under the age of 5. With medical science providing us with the option not to get measles by vaccinating our children why are outbreaks like this still happening? The answer? People are choosing NOT to vaccinate.

Indonesia has its own set of specific problems. Vaccination rates for measles have dipped across Southeast Asia, falling below the 95 per cent mark, which experts say is needed to fully protect a community from the infectious   disease. At the same time, cases of measles have spiked in Indonesia, Malaysia and the Philippines in recent years – part of a worldwide 50 per cent increase in measles cases seen last year, according to the World Health Organization (WHO).

For the past two years, the Philippines and Indonesia have had the world’s second- and third-highest rates of measles, behind India. In Indonesia, cases doubled from 2015 to a high of 11,300 in 2017, and 5,500 in 2018.

The disease mainly affects children and is highly infectious. According to the WHO, roughly 2.6 million people died annually from measles before the advent of mass vaccinations in the 1980s. Anti-vaccine sentiment has been on the rise worldwide in the past two decades, particularly in the United States and in Europe – which saw 83,000 cases last year.

A 1998 study – discredited but still cited in anti-vaccine communities online – linked the measles, mumps, and rubella (MMR) vaccine with autism, and coincided with growing public mistrust of medical experts and              pharmaceutical companies. As elsewhere, anti-vaccine sentiment in Southeast Asia stems from public mistrust in the safety and efficacy of vaccines.

Government mismanagement has made matters worse, with cases of mislabeling and faulty vaccines being spread widely on social media. Religious and ethical concerns within Muslim communities in Indonesia and Malaysia    have also had an effect. A massive drive by Indonesia to vaccinate 70 million children last year was derailed when the country’s influential Islamic Council issued a fatwa against the measles vaccine because it contained pig    components.

Although the council clarified the vaccine could be used given no available alternatives, vaccination rates plummeted across Southeast Asia’s most populous nation to an average of 65 per cent – and as low as 6 per cent in Sumatra’s Aceh province.

What is measles?

Measles is highly contagious. An un-immunized child (or older person) is very likely to catch it if exposed to a person who has measles. So what’s the big deal? Our Mothers used to take us to “measles parties”. When one child had measles all the Moms used to get together so their child would also catch it, get over it and auto-immunize themselves. Trouble is 1:1000 of those children will end up with serious affects from the disease. Measles can be a serious childhood infection. Measles is not just one of the things that children catch and get over. Children often get very sick with measles; they can have serious health problems and even die. Young children in groups such as child care and playgroups are particularly at risk of measles if they have not been immunized.

•  Measles is a serious illness caused by a virus  (the Rubeola viris, not to be confused with the Rubella virus) and it is easily spread to other people.

•  It is usually spread by droplets (through coughing, sneezing, runny nose, or runny eyes).

•  The first signs come about 10 to 12 days after being in contact with measles. These include a fever, cough and sore, red eyes (conjunctivitis).

•  After 2 to 3 days the measles rash appears. This is the time when the person is most unwell.

•  Fever tends to improve after 2 to 3 days and the person usually quickly recovers unless there are other problems caused by the measles, such as ear infections, bronchitis and pneumonia.

Health problems from measles

Other health problems happen often and include ear infections, pneumonia, bronchitis and diarrhea. Measles may also cause permanent hearing and visual problems (blindness).

Encephalitis (inflammation of the brain) happens in around 1 in every 1000 cases, and about 15% of these children die. A further 15 to 40% are left with permanent brain damage. There are also other uncommon serious health problems from measles, such as encephalitis (subacute sclerosing panencephalitis, SSPE) that occurs several years after the measles illness and causes progressive brain damage and death. This occurs in about 1 in 25,000 cases.

Measles tends to be worse in older children and adults, and is a common cause of death when children are malnourished or have other serious health problems and are un-immunized.

Protecting children from measles

•  Measles vaccination in the form of MMR (Measles, Mumps, Rubella) is recommended for children when they are 12 months old and when they are 4 years old (immediately after their 4th birthday is suggested or before starting school).

•  Anyone who might have been in contact with measles should see his or her doctor for immunization as soon as possible (within 72 hours), unless there is good evidence that the child or adult has had 2 doses of measles

    vaccine or has already had measles.

•  If you are uncertain whether you or your child has had 2 doses of vaccine (or had the illness) get another dose of measles vaccine. There are no health risks in giving a dose of the vaccine to someone who is already immune.

•  Immunization is likely to prevent the development of measles, because the immunization builds up the body’s defenses more quickly after immunization (4 to 6 days) than the virus infection develops (10 to 14 days).

Keeping children away from school or child care

Keep the child away from other children and anyone who has not been immunized for at least four days after the start of the rash. (This may not prevent others getting measles, since measles is also very infectious before the rash comes).

If un-immunized people are immunized within 72 hours of their contact with measles they can return to school, child-care or work.

What you can do

Children with measles should be seen by a doctor for treatment and to watch for any other health problems. Since measles spreads so easily, a home visit by a doctor should be arranged, or an appointment at the doctor’s rooms can be arranged that does not put other people at risk.

Children with measles need rest and extra drinks, and paracetamol can be used for high fever. Eyes will be  sensitive to light, and usually the child will feel better in lower light. Light will not harm the eyes, but it can hurt them.

Do not take you child out to places where other people  may be exposed to your child’s infection. In countries or communities where a child’s diet may be deficient in Vitamin A, extra Vitamin A can help recovery from measles (care is needed to select the correct dose).

Kim Patra is a qualified Midwife  &  Nurse  Practioner who has been living and working in  Bali for over 30 years. She now runs her own Private Practice  & Mothers & Babies center at her Community Health Care office in  Sanur.

Kim is happy to discuss any health concerns that you have and may be contacted via email at balikim2000@gmail.com, or office phone 085105-775666 or https://www.facebook.com/CHCBali

Copyright © 2020 Kim Patra

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