DON'T BE COMPLACEMENT ABOUT MEASLES
AS THE VIRAL INFECTION SPREADS AROUND THE WORLD, THAILAND RESIDENTS NEED TO KNOW IF THEY SHOULD RECEIVE THE VACCINE
Thailand at first didn’t seem to be much affected by the unprecedented outbreaks of measles reported earlier this year to have wrecked havoc in several European countries, especially Romania and Italy.
But after the recent headline news of the rising measles cases in Japan’s southern island of Okinawa as well as in Taiwan, following a 30-yearold man being infected in Thailand before spreading the virus to two more flight attendants on an Okinawa-bound flight, many here are starting to wonder if the infectious disease is now hitting closer to home.
Dr Lapakorn Chatapat of the Thai Travel Clinic, Hospital for Tropical Diseases, Mahidol University’s Faculty of Tropical Medicine, said there are reasons to believe measles is a worrying issue in the country.
“Measles is one of the most easily contagious infectious diseases. The virus is transmitted through the air we breathe. It is even more easily transmittable than the flu,” said Dr Lapakorn.
The measles outbreak currently hitting many countries actually began back in 2014, when the spread of the disease started to be found in a number of countries, both developed and developing, cold and tropical. According to the specialist, travel is an important factor in the international spread of measles.
“When the disease attacks big cities like Los Angeles, London and New York, where there are a huge number of people travelling through, it gets spread to many other locations in the world more easily.”
More than 21,000 cases of measles were reported in Europe last year, with 35 deaths, a fourfold increase in cases compared to the previous year. Data from the European Centre for Disease Prevention and Control (ECDC) showed that from March 2017 to February this year, almost 15,000 measles cases were reported through the European surveillance system.
Globally, measles-related deaths plunged from 550,100 in 2000 to just under 90,000 in 2016, according to figures from the World Health Organization (WHO).
In Thailand, the Bureau of Epidemiology under the Department of Disease Control saw 994 measles cases in 2015, equivalent to 1.52 cases per 100,000 Thais. No deaths were reported. The Bureau attributed better vaccination programmes to such low measles figures.
Measles is a viral infection characterised by fever, red eyes and head-to-toe rashes. The incubation period is four to seven days after being exposed to the virus. If left unattended, the infection could lead to encephalitis (acute inflammation of the brain), as well as the inflammation of the ears and lungs. Measles can be fatal but rarely is.
Thailand has actually implemented quite a successful vaccination programme to cope with measles, said Dr Lapakorn, citing statistics from the WHO seeing 80% of Thai children being vaccinated against the virus back in 1990. Fast-forward to 2016, when the percentage of Thai kids receiving the measles vaccine rose to 99%.
Such encouraging statistical data makes it sound like Thais could all be safe from measles. That might not be the case, considering that the measles vaccine — given in two shots, at nine months and then three years old — only reached Thai shores around 1982.
“What about those born before 1982, when the vaccine didn’t even exist?” added Dr Lapakorn, also a preventive medicine specialist. “Without a vaccine, they are still susceptible to being infected.”
The MMR vaccine — a single shot for measles, mumps and rubella — was introduced in Thailand later, in 1997, adding to more accessibility and affordability among Thais, thanks to the vaccine’s low price and especially the fact that the shot was part of the country’s national immunisation programme. The Department of Public Health also expects to wipe out measles from the country by 2020, curbing the ratio of infection to only one per million members of the population.
Dr Lapakorn also pointed out that the efficacy of the vaccine, in some cases, can reduce as people age, even though the measles shot is expected to render lifelong protection. Also, while scientists believe one’s immunity against measles can be naturally boosted once exposed to the virus in their current environment, such a scenario does not necessarily happen, especially these days, with the vaccine so widespread.
“That’s why we still see people infected with measles despite the high vaccination rate,” she said. “Also, with people travelling to Thailand, the virus can be transmitted via them to Thais who have zero or low measles immunity.
“The risks are there, but that does not mean we [medical practitioners] would approach people on the street and ask them to be vaccinated. The number of measles cases is not that high. Otherwise the government will have to do something like give free measles shots.”
The measles-only shot, said Dr Lapakorn, is no longer available in Thailand. So those with possible risks of infection — including medical personnel, people travelling to measles-affected areas or people living with measles patients — are recommended to receive an MMR shot, to take effect 72 hours after injection.
If measles occurs during pregnancy, it is likely to pose a higher risk of premature labour and miscarriage. So women who plan to have a baby are advised to receive the shot three months before becoming pregnant. A booster shot is also recommended for those who had the vaccine but are at a high risk of infection.
However, the measles vaccine is a don’t for those with immune-deficiency circumstances such as HIV, those on immunosuppressants and those allergic to antibiotic neomycin.
“Measles shots contain living viruses,” explained Dr Lapakorn. “People with low immunity could end up getting infected by the virus in the vaccine themselves. So HIV patients should be given the shot only when their CD4 [a type of white blood cell that destroys germs] count exceeds 499. The vaccine will not be given to pregnant and breastfeeding women, as well as babies aged below nine months.”
Notwithstanding these restrictions, Dr Lapakorn said a vaccine is the best prevention against measles.
“These days, several diseases that heavily spread in the past return as current endemics. This means the future is unpredictable. So if you do not qualify for any of the vaccine’s restrictions, it does you no harm.”
MEASLES IS EVEN MORE EASILY TRANSMITTABLE THAN THE FLU