THE national immunisation schedule includes a course of a combined vaccine against measles, mumps and rubella (MMR) for a year-old child, with a booster a month later.

Measles

Measles is a very infectious disease caused by the RNA virus Morbillivirus. As such, it tends to occur as epidemics. Measles is spread through airborne droplets released when infected persons sneeze or cough.

An infected person may have a high fever, running nose, cough as well as red and watery eyes, lasting several days. There are white spots inside the cheeks during this time. A slightly raised rash develops on the face and neck, then spreads to the trunk, hands and feet, and subsequently fades away after about three days.

Most persons recover from the infection without any after effects. Complications are more likely in unimmunised children below the age of five years, particularly infants. There may be diarrhoea, consequent dehydration, bleeding from the skin and mucosa, and infections of the middle ear and respiratory tract.

About five to 10% of children under five may get pneumonia, due to measles itself and/or secondary bacterial infection. Pneumonia is the most common cause of death. Encephalitis (inflammation of the brain) and blindness, may also occur. Complications are more likely in malnourished children or whose immunity is impaired by conditions like HIV/AIDS.

A natural infection results in life-long immunity. There is no specific treatment for measles. Vitamin A supplementation has been shown to reduce morbidity markedly and is prescribed when vitamin A deficiency is prevalent. Bacterial complications are treated with antibiotics.

Mumps

Mumps infection is caused by the mumps virus. It is spread by direct contact with infected persons and airborne droplets released when they sneeze or cough. About 30% of those infected have no symptoms or non-specific symptoms. The infection begins with non-specific symptoms like muscle ache, headache and a low-grade fever followed by the characteristic swelling of one or both of the parotid salivary glands. The fever and swollen glands disappear within a week, unless complications develop.

Deaths from mumps encephalitis are low but residual effects include paralysis, fits and hydrocephalus (fluid build-up in the brain). Mumps deafness is a leading cause of childhood deafness, affecting about five in 100,000 mumps cases.

Mumps infection in the first 12 weeks of pregnancy is associated with a 25% incidence of spontaneous abortions. In general, a natural infection confers life-long immunity but recurrent attacks have been reported. There is no specific treatment for mumps.

Rubella

Rubella infection is caused by the rubella virus. It is spread by airborne droplets released when an infected person sneezes or coughs. About 20 to 50% of those infected have no symptoms. The symptoms are mild and may include low grade fever, swollen neck glands, running nose, red eyes and a rash on the face which spreads to the feet.

Complications are more common in adults. About 70%, especially women, may have painful joints (arthralgia) in the fingers, wrists and knees or even arthritis itself. Encephalitis occurs in about one in 5,000 cases, mostly in women. Bleeding problems occur in about one in 3,000 cases, usually in children.

Rubella infection in the first eight to 10 weeks of pregnancy has a 90% risk of multiple malformations (congenital rubella syndrome or CRS), often resulting in miscarriage or stillbirth. If the baby with CRS survives, the child may face serious developmental disabilities, developmental delay and diabetes. In general, natural infection confers life-long immunity but re-infections have been reported. There is no specific treatment for rubella.

Immunisation

There are several live attenuated measles vaccines available, either by themselves or in combination with either rubella or mumps and rubella (MMR) vaccines. The MMR vaccine is given by intramuscular or deep subcutaneous injection to a child who is a year old.

The MMR vaccine leads to immunity of 96 to 100% for measles, 90 to 100% for mumps and 99 to 100% for rubella. The protection from a single dose given at the age of one year is life-long in the majority of those vaccinated. However, about five to 10% of those vaccinated may either have primary vaccine failure or lose protection over time. Those who receive two doses, with an interval of at least a month, after one year of age have life-long immunity to measles.

Adverse events are minimal. Uncommon but serious complications include bleeding due to low platelets, urticaria (hives), joint pains, febrile fits, and swelling of the parotid gland.

Children allergic to eggs can be given MMR vaccine as the rare and serious allergic reactions after MMR vaccination are believed to be due to other components of the vaccine and not eggs.

Special situations

HIV-infected persons who have no evidence of immuno-suppression can be given the MMR vaccine. The first dose should be administered at a year of age and the second dose, a month later. MMR or its component vaccines are not given to those whose immune system is suppressed or those who are on oral or topical steroids. It can be given a month after steroid therapy has been stopped. MMR vaccination is also delayed in those on high doses of immunoglobulin as it can inhibit the immune response to measles and rubella vaccine for three months or more.

The measles vaccine has reduced dramatically the morbidity and mortality from the extremely infective measles virus.

Rubella vaccination is mainly to prevent congenital rubella syndrome (CRS), a significant cause of mental retardation, blindness and deafness. The World Health Organisation estimates that there are about 100,000 CRS cases annually in developing countries. As with rubella, insufficient uptake of mumps vaccination can lead to a shift of mumps infection to older age groups, with the potential for more serious disease burden than before the introduction of immunisation.

In summary, the measles, mumps and rubella vaccine contribute significantly to protection from disabilities and premature death.

Dr Milton Lum is chairperson of the Commonwealth Medical Trust. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation he is associated with.

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