Measles is a viral disease characterized by a number of unpleasant consequences and complications and enters the body through the respiratory tract, mucous membranes of the nose and mouth. Measles was described as a separate disease in the 17th century, but there is still no etiotropic treatment aimed at eliminating its cause. The doctor prescribes individual treatment for each patient, which can only alleviate the symptoms. But one of the features of the course of this disease is a very high degree of transmission from a patient to a healthy person, almost 100%. At the same time, at the initial stage, measles can occur with mild symptoms, and the incubation period in an adult lasts up to a month. But most often children of preschool and primary school age get measles.
The only way to prevent health damage today is measles vaccination. The first vaccinations were tested 300 years ago, but researchers are still working on new vaccines, creating an increasingly effective and long-lasting drug. Nina Yandraykina, a pediatrician at the MEDSI children's clinic on Pirogovskaya, talks about the characteristics of measles in children and which measles vaccination for children would be optimal in modern conditions .
Federal News Agency / Photos courtesy of Nina Yandraykina
Measles is a truly dangerous disease, and above all because in most cases it occurs with pronounced symptoms, which in themselves are painful for the child: if it is a temperature, then it is very high, up to 39–40 degrees, if it is a cough, then it is sharp, irritable, if conjunctivitis, then with swelling of the eyes and photophobia. General symptoms are also clearly expressed - severe weakness, loss of appetite, headache, and sometimes vomiting, delirium, and convulsions can even occur.
“Measles is also dangerous because, even without complications, it sharply reduces immunity. Researchers have proven that the measles virus leads to T-immunodeficiency, that is, to a deficiency of cells that create immunity. This state of “anergy” lasts about a month after the illness itself and can cause the development of other diseases,” says Nina Yandraykina.
Complications from measles are also not simple - they are pneumonia, otitis media, laryngitis, stomatitis, and severe encephalitis. Laryngitis can occur with measles croup. The impressive list of complications continues with hepatitis, pancreatitis, thrombocytopenic purpura (ITP, primary immune thrombocytopenia, Werlhof's disease - an autoimmune blood disease), hemorrhagic syndrome - skin hemorrhage, bleeding of the mucous membranes, pericarditis, myocarditis (damage to the heart muscle) and keratitis, which leads to blindness . Subacute sclerosing panencephalitis is considered an extremely severe complication. The prefix “pan” means “solid”, that is, it is a continuous inflammation of brain tissue - a disease leading to loss of vital functions and early death. And it occurs in children with measles under two years of age. As studies have shown, it was vaccination that contributed to a sharp decrease in the incidence of panencephalitis.
It is also important to know that there is no single antiviral drug against measles. Treatment of measles is nonspecific, it is aimed at eliminating individual symptoms.
The danger of measles also lies in its high contagiousness and high susceptibility. The disease is transmitted by airborne droplets; one person can infect 18 others in contact with him. The measles susceptibility index is 0.96. People who have not previously had measles and have had direct, even short-term contact with a sick person, almost all become ill, regardless of age.
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Etiology of diseases
All three infections are viral in nature and affect the respiratory system and immune system. In severe cases and complications, internal organs, vision, the reproductive system (with mumps) and the nervous system can be damaged.
- Measles is characterized by a combination of eye and respiratory tract lesions and skin rashes. First manifestations:
- small white spots on the cheeks and gums (Koplik's sign);
- redness of the eyes;
- snot, nasal congestion;
- dry strong cough;
- heat;
- a pinpoint red rash that appears from the top of the head to the heels. Source: I.L. Solovyova, E.A. Alexandrova, E.M. Lezhen, O.V. Anosova, A.A. Solovyeva Vaccinal prevention of measles and mumps in children in modern conditions // Ulyanovsk Journal of Medical Biology, 2013, No. 4, pp. 47-53
Without treatment, measles is dangerous for the development of purulent otitis, bronchitis and pneumonia, as well as the formation of encephalitis.
- Mumps is a lesion of glandular tissue and respiratory organs. Typical for him are:
- runny nose;
- temperature increase;
- severe malaise with headache;
- muscle aches;
- pain in the masticatory muscles when swallowing;
- inflammation of the salivary glands with swelling behind the ears and along the edge of the lower jaw;
- dry mouth, decreased appetite, severe thirst.
With complications of mumps, inflammation of the appendages (in girls) and testicles (in boys) may develop, followed by infertility, as well as deafness, and the development of meningitis.
- Rubella is milder and is characterized :
- moderate temperature;
- redness of the eyes;
- the appearance of a rash on the skin;
- enlarged lymph nodes in the back of the head and neck;
- joint damage.
Rubella is especially dangerous for children and can lead to bronchitis and otitis media. For pregnant women, there is a risk of fetal defects. In rare cases, children may have bronchitis, otitis media or pneumonia.
How does measles occur in children and how do signs of the disease appear?
There are different degrees of the disease - mild, moderate and severe. However, in children, measles most often develops in moderate and severe forms, and is especially severe in children under two years of age. The mild form at the onset of the disease is quite dangerous, when the child has a slight fever, a slight cough, and can still attend kindergarten or school. If the disease is not tracked in time, such a child can infect all other unvaccinated children in the kindergarten or in the entire school (due to its high contagiousness).
The main symptoms of measles are fever, weakness, catarrh of the upper respiratory tract, inflammation of the eyes, and rash. The disease occurs cyclically. The first stage is catarrhal, when the main symptoms appear - cough, runny nose, fever, general weakness, conjunctivitis with photophobia and a “semolina”-type rash on the oral mucosa (the so-called Belsky-Filatov-Koplik spots), characteristic only of measles. Before the second stage begins, the temperature usually drops.
“After 3-4 days, the next stage begins - the period of rash. This is the peak of the disease, in which all the symptoms increase sharply, the temperature rises again and can reach 40 degrees or more, the cough intensifies, the lips and eyelids swell, the eyes water or fester, it hurts to look at the light, says Nina Yandraykina. “And a rash appears, starting from the area behind the ears and from the cheeks, then going down to the neck and chest, and the next day - to the entire torso, and on the third day also to the limbs. This stage lasts on average 3–4 days. Then comes the third stage - the period of pigmentation, when the rash gradually turns pale, disappears within 7-10 days, turning into light brown spots and accompanied by pityriasis-like peeling on the body, the temperature normalizes, and appetite appears.”
But, despite the improvement in the condition, the pigmentation phase is characterized by the presence of “anergy”, that is, a decrease in immunity. Therefore, those recovering from measles should be especially protected from contact with other infections and from physical and emotional stress.
pskovgorod.ru / City of Pskov
Vaccination schedule
Today, vaccination against measles, rubella, mumps, according to the National Vaccination Calendar, is given to all children who do not have contraindications to vaccination. In healthy children, the first vaccination is given at the age of one year, then before entering school, revaccination is performed at the age of 6-7 years.
If at the time of vaccination a child has a cold, an exacerbation of a chronic disease, or there are other contraindications determined by the doctor, immunization can be carried out according to an individual schedule, with preliminary preparation for vaccination and compliance with the timing between administration of the drug. Parents, due to various circumstances, can refuse vaccination or reschedule vaccination by writing a corresponding statement to the doctor.
Today, complex vaccines containing three components are used - one injection against three infections at once.
Impaired cholesterol metabolism due to measles vaccinations
Soon after measles vaccinations became widespread, the medical press began to fill with reports expressing concern about elevated cholesterol levels and abnormal high-density lipid ratios in young children.
Vicari et al. (1979, "Effect of measles and measles vaccine on serum cholesterol", Lancet
10:326) quote Drs Matthews and Phiri (1978) who
reported that immunization with influenza vaccine is likely accompanied by a subsequent increase in serum total cholesterol and a decrease in HDL levels. They suggested that immunization with viral antigens or natural viral infection may contribute to changes in lipid levels.
And further:
We measured total serum cholesterol levels in 97 children (mean age 2 years) before and 6 weeks after measles vaccination (Rimevax, RIT, Belgium) and in serial serum samples from 27 measles patients (mean age 4 years). The children received good nutrition. Antibody titers were analyzed by hemagglutination inhibition, and serum cholesterol was measured using the Leppilnen method. Samples taken from the same child were measured in the same series. Five children showed an exceptionally high relative increase (equal to 40% or higher) in serum cholesterol after vaccination, although the absolute values remained within the normal range. There was no significant correlation between initial cholesterol values or changes in cholesterol values and measles antibody responses. After 8 and 10 months, a relative increase in serum cholesterol was still observed in two children. Following natural measles infection, mean cholesterol levels were low in samples collected 1 to 7 days after symptom onset...
Vicari et al. (1979) concluded:
Our data show that natural measles in the acute phase of the disease reduces serum cholesterol levels. This is consistent with the observations of Lees et al., who showed that experimental mosquito virus infection reduced serum cholesterol levels for at least 10 days. Whether the same reduction in cholesterol levels occurs after vaccination against measles and, possibly, after vaccination with other viruses needs to be clarified. Our observations support the view expressed by Matthews and Phiri (1978) that natural viral infection or immunization with viral antigens causes changes in serum lipid levels in humans.
Bell et al. (2012) wrote:
In a large population-based sample of Australian schoolchildren, we found a higher incidence of abnormal lipid profiles compared with American data. In addition, many children have levels outside the normal range for healthy Australian children. Research is needed to follow the lipid profile of Australian children into adulthood to understand the association of these levels with future cardiovascular risk.
In her 72-page doctoral dissertation, Louise Strandberg (2009) took an exhaustive, in-depth look at the relationships between diet, obesity and the immune system.
It is important to note that she writes the following:
In the 1950s, it was first recognized that dietary fat may contribute to cardiovascular disease in the Western world. However, the Greenland Eskimos are known to eat large amounts of fat, but they still have a very low incidence of cardiovascular disease. In the 1970s, Bang and Dyerberg found that Eskimos had low levels of cholesterol and lipoproteins other than high-density lipoprotein, which [sic] is now known as "good cholesterol" ... the quality of dietary fat, not the quantity, is important for the development of heart disease. vascular diseases.
This was a generation of unvaccinated Eskimos.
Based on medical research, it is logical to conclude that an important underlying cause of observed abnormal cholesterol and triglyceride levels in children may be invasive medical intervention in the form of vaccinations.
LITERATURE
Rauh LW, and Schmidt R. 1965. Measles immunization with killed virus vaccine. Am J Dis Child
109:232–237.
Fulginiti VA, Eller JJ, Downie AW, and Kempe CH. 1967. Altered reactivity to meats virus. Atypical measles in children previously inoculated with killed-virus vaccines. JAMA
202(12):1075–1080.
Scott TF, and Bonanno DE 1967. Reactions to live-measles-virus vaccine in children previously inoculated with killed-virus vaccine. NEJM
277(5):248–251.
Barratta RO, Ginter MC, Price MA, Walker JW, Skinner RG. et al. 1970. Measles (Rubeola) in previously immunized children. Pediatrics
46(3):397–402.
Conrad JL, Wallace R, and Witte JJ. 1971. The epidemiologic rationale for the failure to eradicate measles in the United States. Am J Publ Health
61(11):2304–2310.
Linnemann CC, Hegg ME Rotte TC et al. 1973. Measles MgE response during re-infection of previously vaccinated children. J Pediatrics
82:798–801.
Gustafson TL, Lievens AW, Brunell PA, Moellenberg RG, Christopher BS et al. 1987. Measles outbreak in a fully immunized secondary-school population. NEJM
316(13):771–774.
Black EI, Berman LL, Reichelt CA, de Pinheiro P et al. 1984. Inadequate immunity to meats in children vaccinated at an early age: effect of revacination. BULL WHO
62(92):315–319.
Robertson SE, Markowitz LE, Dini EF, and Orenstein WA. 1992. A million dollar outbreak: epidemiology, risk factors, and selective revaccination strategy. Publ Health Reports
197(1):24–31.
Sutter RW, Markowitz LE, Bennetch JM, Morris W, Zell ER and Preblud WSR. 1991. Measles among the Amish: a comparative study of meats severity in primary and secondary cases in households. J Infect Dis
163:12–16.
Hedrich AW. 1933. Monthly estimates of the child population “susceptible” to meats, 1900–1931, Baltimore, MD. Am J Hygiene
613–635.
Lennon and Black 1986. Maternally derived meats immunity in the era of vaccine-protected mothers. J Pediatr
108(1):671–676.
Matthews and Feery 1978, Lancet
ii: 1212–1213.
Bell et al. (2012). Lipids in Australian children: cause for concern? 2005—2007 Busselton Health Study. J Paediatr & Child Health
Oct 2012: 863–953.
Contraindications for carrying out
Contraindications to vaccination are determined by the doctor. They can be temporary - these are acute diseases (ARVI, influenza, intestinal infections, fever of unknown origin), exacerbation of chronic pathology, allergic reactions. Vaccination may be delayed if the child has just returned from a trip to another country, has had contact with sick people, and infection is possible.
Constant contraindications include allergies to vaccine components, tumor processes, congenital or acquired immunodeficiencies, severe blood diseases. If there was a strong reaction to the first vaccination, subsequent doses are prohibited.
Preparation for MMR vaccination, carrying out
At the time of vaccination, the child must be absolutely healthy, without signs of acute respiratory viral infections, intestinal disorders, or allergies. If a child has had ARVI or another infection, at least 4 weeks must pass after recovery. 3 days before vaccination, you should avoid visiting crowded places and avoid contact with sick people. Source: N.V. Yuminova, E.O. Kontarova, N.V. Balaev, S.V. Artyushenko, N.A. Kontarov, N.V. Rossoshanskaya, E.S. Sidorenko, R.R. Gafarov, V.V. Zverev Vaccinal prevention of measles, mumps and rubella: objectives, problems and realities // Epidemiology and Vaccinal Prevention, 2011, No. 4(59), pp. 40-44
Before the vaccination is administered, an examination is carried out by a pediatrician. If in doubt, blood and urine tests may be ordered.
The doctor will tell you where the vaccination is given: before three years of age it is an intramuscular injection in the buttock, after three years - in the shoulder area.
What not to do after vaccination
Healthy children do not need to take any medications (antihistamines, antipyretics) after vaccination. On the day of the injection, it is not recommended to bathe the child; the next day you can wash without rubbing the injection site. In the first 2-3 days, you should not visit crowded places with your child (circus, cinema, shopping centers). It is important not to overheat or overcool the baby, and to dress according to the weather when walking.
In the next 2-3 days after the injection, there is no need to introduce new foods to rule out allergies; it is important not to overfeed the child and give plenty of fluids.
How many times are adults vaccinated against measles?
Since the world is currently experiencing a difficult epidemiological situation, doctors strongly recommend that adults also get vaccinated. In addition, sometimes you need a certificate of vaccination to travel.
Adults are usually vaccinated against measles twice. Between them should pass from one to three months. Research shows that these vaccinations are sufficient to obtain complete immunity from this infectious disease.
After vaccination, it is advisable not to drink alcohol for at least several days, because the immune system is already weakened. You should also avoid swimming in bodies of water with unreliable water. You can shower without risk to your health.
Possible reactions and complications
The doctor will tell you in detail how the vaccine is tolerated, what kind of reaction to the vaccine is acceptable and when you should worry. After the injection, redness at the injection site and mild cold-like conditions are possible; in the period from 5 to 12 days, mild rashes are possible after vaccination. This is not dangerous; such a child’s reaction to the KKP vaccination is due to the fact that the injected viruses are live, weakened, and they imitate the infectious process in the body, stimulating the production of protective antibodies.
Possible side reactions and effects include allergic reactions, fever in the first 6-12 days. It is extremely rare that there may be more serious consequences and complications (thrombocytopenia, post-vaccination encephalitis), but all of them are likely in cases where contraindications are not taken into account.
Side effects of the measles vaccine in adulthood
It is important to understand that vaccination is a small infection. Therefore, unpleasant side effects are possible. These include:
Skin redness and slight rash;
- Swelling and pain at the puncture site;
- Symptoms of ARVI (runny nose, sore throat, slight increase in temperature, general weakness). Such symptoms can even be considered a good sign. They mean that immunity to this disease has already developed;
- The skin at the puncture site (usually the left shoulder) may be feverish;
- Joint pain.
These are harmless symptoms that go away within a few days. However, there are more dangerous reactions that you need to be aware of. They occur extremely rarely (less than 0.01% of cases).
Dangerous reactions are considered:
- Anaphylactic shock;
- Negative reactions of the central nervous system;
- Inflammation of the brain (encephalitis);
- Intoxication;
- Problems with the cardiovascular system, myocarditis;
- Pneumonia
These symptoms require immediate medical attention. However, by choosing the right preventive serum, the risk will be minimized.
Preparations for vaccination
In our country, imported (Priorix, MMR-II) and domestic trivaccines are used. They contain laboratory-cultivated, live and weakened viruses from three infections. According to indications, a divaccine (against two infections) or vaccinations against only one disease can be administered. Drugs can be imported or domestic.
Sources:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605874/ Hervé Haas, Patrick Richard, Cécile Eymin, Anne Fiquet, Barbara Kuter and Benoit Soubeyrand. Immunogenicity and safety of intramuscular versus subcutaneous administration of a combined measles, mumps, rubella, and varicella vaccine to children 12 to 18 months of age // Hum Vaccin Immunother. 2019; 15(4): 778–785.
- I.L. Solovyova, E.A. Alexandrova, E.M. Lezhen, O.V. Anosova, A.A. Solovyova. Vaccinal prevention of measles and mumps in children in modern conditions // Ulyanovsk Journal of Medical Biology, 2013, No. 4, pp. 47-53.
- N.V. Yuminova, E.O. Kontarova, N.V. Balaev, S.V. Artyushenko, N.A. Kontarov, N.V. Rossoshanskaya, E.S. Sidorenko, R.R. Gafarov, V.V. Zverev. Vaccinal prevention of measles, mumps and rubella: objectives, problems and realities // Epidemiology and Vaccinal Prevention, 2011, No. 4(59), pp. 40-44.
