4.2.4 Treatment, prevention and control of measles
Cases of severe measles with pneumonia or clouding of the cornea should be referred immediately to the nearest health facility.
It is very important to encourage children with measles to eat and drink. Advise the parents to help their child as much as possible with nutrition and intake of fluids; treat any dehydration with oral rehydration salts (ORS) as necessary. Antibiotics should only be prescribed for ear infections and pneumonia caused by bacteria, which are able to develop in the person weakened by measles. Remember that antibiotics only attack bacteria – they have no activity against any viruses, including the measles virus.
Vitamin A supplementation
As lack of vitamin A is such a problem associated with measles, all children in developing countries who are diagnosed with measles should receive two doses of vitamin A supplements given 24 hours apart, at a dosage appropriate to their age (see Table 4.2). For instance, a 7 month-old infant with measles should receive one dose of vitamin A, which contains 100,000 International Units (IU) on the day of diagnosis (day 1) and also on the next day (day 2). Giving Vitamin A can help prevent eye damage and blindness and reduce the number of deaths from measles by 50%, so this is a very important and effective part of the treatment.
IU stands for International Unit; this is the internationally agreed measurement of vitamin dosages
Table 4.2 Dosage of vitamin A for children with measles.
|Age||Immediately on diagnosis||Next day||Follow-up|
|Infants less than 6 months old||50,000 IU||50,000 IU||Third dose 2–4 weeks later if there are signs of eye problems|
|Infants aged 6–11 months||100,000 IU||100,000 IU|
|Children aged 12 months and over||200,000 IU||200,000 IU|
How to administer the measles vaccine to children is described in the Immunization Module.
Measles is prevented by vaccination with measles vaccine. By the year 2008, successful vaccination campaigns all over the world had succeeded in reducing measles deaths by around 75% — a huge drop from the 750,000 deaths in the year 2000. The World Health Organization (WHO) estimated that in 2008 around 83% of the world’s children were receiving one dose of measles vaccine by their first birthday.
All infants at nine months of age or shortly thereafter should be vaccinated through routine immunization services. This is the foundation of the sustainable measles death-reduction strategy. It is also possible to reduce infections with measles by giving vaccination to vulnerable children. For example, to reduce the risk of measles infection in hospitals, all children between the ages of six and nine months, who have not received measles vaccine and who are admitted to a hospital, should be vaccinated against measles. If the children’s parents do not remember or know whether they have received measles vaccine, the child should still be vaccinated. If a hospitalised child has received measles vaccine before nine months of age, a second dose should be administered at nine months, or as soon as possible after nine months.
All children should be provided with a second opportunity for measles vaccination. This is to make sure that children who did not receive a previous dose of measles vaccine, or children who were vaccinated earlier but did not develop immunity, have another chance to develop immunity. The second opportunity may be delivered either through routine immunization services or through periodic mass campaigns of vaccination.
Measles surveillance (looking for cases of measles in the community) should be strengthened at community level, so that there is early warning of any possible epidemics. Try to persuade parents that a child with measles should be kept isolated from other children who have not previously had measles or been vaccinated, to avoid the disease from spreading. As a health worker, you should report any cases of measles in your community to the District Health Office. As well as this, of course, you have the important task of vaccinating all children who are around nine months old against measles.
Next, we would like you to read Case Study 4.1 and then answer the questions that follow it.
Case Study 4.1 Alemu’s parents want to cure his rash by prayer
During a house-to-house visit in a remote village, you see a one year-old boy called Alemu, who has a high fever, a cough and small rashes (the spots look like teff) on his forehead and neck. Alemu’s parents call this illness ‘ankelis’ or ‘wotetie’ in the local language. The treatment they believe will cure their son is to prepare a coffee ceremony to the gods who they believe to have spiritual power. They informed you that their two older children were cured by the same treatment and they will continue acting the same way for Alemu.
What should you advise Alemu’s parents? What actions should you take to help the child? And what else should you do?
Advise the parents that the child may have a disease called measles, which is caused by a virus. Measles is prevented by vaccination, and children who recover from measles naturally will never get it again (they develop lifelong immunity). If the disease is severe, children may die. Inform the parents that for a very sick child like Alemu, complications such as pneumonia and death can be prevented by giving vitamin A and fluids such as oral rehydration salts. Give vitamin A (200,000 IU) on the first and second day to Alemu. After convincing the parents, refer the child to the health centre and report the case to the District Health Office. Search for other similar cases in the village.