Measles in Developing Countries

Introduction

A developing country is one with a weak agricultural sector that is striving to achieve greater economic and social development. Developing countries often have similar traits, including widespread poverty, inadequate human resources, especially in the education and health sectors, and economic vulnerability. Despite significant efforts and increasing immunization coverage, developing countries still experience a significant number of measles-related deaths and disabilities.

What Is Measles?

Measles is an extremely contagious viral disease caused by the measles virus, which belongs to the paramyxovirus family. Measles is primarily transmitted through direct contact or inhalation of contaminated air. After infecting the respiratory system, the virus spreads to other parts of the body. Measles is exclusively a human disease and is not observed in animals.

What Are the Symptoms of Measles?

The symptoms of measles usually appear around ten to fourteen days after exposure to the virus and last for seven to ten days. The signs and symptoms associated with measles can be seen in two stages, as follows:

• Initial Symptoms- First few days after the infection.

  • High fever (as high as 104°F/ 40 °C).

  • Runny nose.

  • Red, watery eyes (conjunctivitis).

  • Cough.

  • Koplik's spots- After two or three days of fever, small white spots with bluish-white centers appear inside the mouth.

• Late Symptoms- After three or five days of initial symptoms.

  • A rash initially appears at the hairline area of the face and later spreads to the rest of the body (such as the neck, trunk, arms, legs, and feet). Rash has characteristic appearances such as:

    • Flat red or brownish-red spots.

    • Raised bumps.

    • Small, fluid-filled blisters.

    • It generally appears around fourteen days after being exposed to the virus, although the time frame can range from seven to eighteen days.

    • The measles rash usually lasts for five to six days before fading away.

  • Feeling unwell, tired, or irritable.

  • Loss of appetite.

  • Muscle aches.

  • Red, inflamed eyes (conjunctivitis).

  • Sensitivity to light.

  • Dry, hacking cough.

What Is the Treatment for Measles?

Currently, there is no antiviral medication specific for treating measles. As a result, treatment options focus on alleviating symptoms and preventing complications. A nutrition-rich diet and improved fluid intake can help with recovery for the individual. Infections affecting the lungs, ears, and eyes can be treated with appropriate antibiotics. Vitamin A supplements given in two doses, 24 hours apart, were seen as beneficial in preventing complications.

What Are the Complications of Measles?

Measles can get serious and cause complications if not treated with appropriate treatment measures at the earliest. While measles can be a serious illness for people of any age, children under the age of five, adults aged 20 years and above, individuals who are immunocompromised with diseases such as cancer or AIDS, and pregnant women are certain groups who are at a higher risk of experiencing complications from measles. The possible measles complications include:

• Ear Infection: This is a common complication of measles and can lead to hearing loss if left untreated.

• Diarrhea: Rarely can children get severe diarrhea following a measles infection, which causes malnutrition.

• Pneumonia: Pneumonia affects one out of twenty children infected with measles. Pneumonia is a severe lung infection that can potentially be life-threatening. One out of twenty children usually gets pneumonia.

• Encephalitis: Encephalitis is a rare but severe complication where the brain gets swollen when the measles virus infects the brain.

• Blindness: Although rare, measles can cause blindness in some cases, usually due to a condition called corneal ulceration. Each year, approximately one lakh children are reported to be blind following measles.

• Death: Measles can have fatal consequences, especially in individuals and young children with compromised immune systems, when the virus leads to complications in the functioning of the lungs and nervous system.

• Immunity Amnesia: After recovering from measles, a child's immune system can be weakened, leaving them more susceptible to other infections for an extended period.

• Pregnant Women: Pregnant women who are not vaccinated against measles are at risk of delivering their baby prematurely or giving birth to an infant with a low birth weight.

Why Is Measles More Prevalent in Developing Countries?

Research conducted in 2018 revealed that approximately nineteen million children did not receive even one dose of the measles vaccine through recommended routine vaccination, and roughly six million children were situated in three countries, namely Nigeria, Pakistan, and India.

• Some of the identified risk factors for the increased spread of measles in developing countries are as follows:

  • Low population immunity.

  • Presence of other epidemics.

  • Forced displacement due to flooding or drought.

  • A lack of access to healthcare.

  • Poor hygiene and sanitation access and practices.

  • Disruptions in childhood vaccinations.

• Confirmed cases of measles have increased significantly in Ethiopia, with 1953 cases reported in 2021 and 6933 cases reported as of May 1, 2023. From August 2021 until May 1, 2023, Ethiopia reported suspected cases of measles in different populations, leading to 182 deaths.

• Active measles outbreaks are not being adequately assessed due to a lack of reporting in Northern Ethiopia's (Tigray) crisis.

• Studies showed that only 36 percent of confirmed measles cases had received one dose or more of the measles-containing vaccine (MCV).

• The World Health Organization reported that India had the most significant measles outbreak in 2022, with 12,773 cases recorded as of November.

How to Prevent More Measles Outbreaks?

Vaccination campaigns around the globe were disrupted due to the recent COVID-19 pandemic. It is crucial to prioritize the strengthening of healthcare systems and ensure accessibility to the necessary routine immunizations for every child for optimal health.

An increase in the number of healthcare professionals who have undergone proper training, more vaccination facilities established in underprivileged areas, enhancement of health records, and effective communication regarding vaccines are some of the measures a country can implement to strengthen healthcare systems.

Prevention and control of measles are possible with an effective, safe, and inexpensive vaccine.

At nine months of age, the first dose of the measles-containing vaccine (MCV1) is given, and at fifteen months of age, the second dose of the measles-containing vaccine (MCV2) is given.

To prevent and control the spread of measles in a country, approximately 95 percent of the country’s population needs to receive MCV1 and MCV2 vaccination.

Conclusion

Measles remains a significant public health issue in many developing countries. Factors that contribute to the spread of measles include, additionally, malnutrition and other infections that weaken immune systems (especially in children), making one more susceptible to contracting measles. The high burden of measles in developing countries highlights the need for sustained efforts to improve vaccination coverage and strengthen healthcare systems.