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Can cause very serious complications: doctors talk about measles increase in Russia

Photo by Vladimir Fedotov on Unsplash

– Since the beginning of the year, about 700 people in Russia have already fallen ill with measles, such estimates are presented in the media. The day before, because of a case of measles a quarantine was imposed in Gubkin Russian State University of Oil and Gas. Can we talk about the beginning of the measles epidemic in the country?

– 700 persons fall ill, this is not yet an epidemic. Because an epidemic is still quite different numbers: just remember how many people were sick in one day COVID-19. But chickens are counted in the fall, so the statistics will show everything at the end of the year. Considering that previously we had almost no measles cases at all, 700 cases in three months is not insignificant.

– For which age groups measles is most dangerous?

– For children, especially the first two years of age and those who have comorbidities (and unvaccinated children usually have them), measles is dangerous. In general, children have more complications than adults. However, adults are now also slowly starting to get measles because the vaccination was a long time ago and many people’s immunity has already decreased. So for older people with chronic diseases, the risk of complications is also high.

– Does measles vaccination have an expiration date, or does it give lifelong immunity?

– In the Soviet Union, they began to vaccinate against measles in 1967, ten years later they realized that one shot was not enough and began to vaccinate again. According to the national vaccination calendar, children are vaccinated at the age of one and then at the age of six or seven before school. If everything is done perfectly, that is, the child was healthy at the time of vaccination and the vaccine was stored correctly, then this immunity is supposed to last a lifetime. In general, a third measles booster is not necessary.

However, since 2003, in the wake of measles outbreaks, adults, such as those who do not know whether they were vaccinated as a child, have also been revaccinated.

How does measles appear, what are its characteristic symptoms, and how quickly does the infection spread from person to person?

– The incubation period of measles lasts about 15-17 days, during which time the infected person has no symptoms, but he already infects those around him. The second period is catarrhal, the same as the flu and acute respiratory infections. At this time, the patient has a high fever, runny nose, severe cough, conjunctivitis, and photophobia. This condition lasts for three to four days and is similar to the flu or COVID-19. The doctor will know that it is still measles when he sees small white dots on the mucous membrane of the patient’s cheeks, as if they spilled semolina – this is the so-called Belsky-Filatov-Koplik syndrome, typical for measles.

Then comes the third period, when a rash appears on the skin – exanthema. In about three days, the rash spreads throughout the patient’s body. The first elements of the rash, pink-red spots, appear on the face, behind the ears, on the neck, and in the upper chest. On the second day, the rash descends to the torso, and on the third day to the lower legs and arms.

Then comes a period of pigmentation, which appears in place of the rash, it is similar to a tan. And during this period, complications often begin – bronchitis, pneumonia, otitis, etc. Rarely, but severe complications such as encephalitis and meningoencephalitis also occur.

– Is there a specific treatment for measles?

– You could say there isn’t. There are many antiviral drugs now that may be able to ease the course of the disease. But according to international recommendations, the only treatment for measles is fairly high doses of vitamin A. It is believed that vitamin A deficiency can lead to severe complications in measles. Otherwise, just bed rest, and mandatory hospitalization for severe forms and young children.

– Why has a previously almost forgotten disease returned?

– As far as I know, measles now comes from abroad, from Central Asia. The current outbreak was generally expected, because it was preceded by a break of several years, when there were almost no measles cases in Russia. And during that time, a layer of people with no immunity to measles has formed. Some are medically unvaccinated, but there are also many who simply refuse vaccination for no medical reason. But vaccination is the only option for protection against measles. Measles is a very serious infection, more severe than the flu.

– If measles is back, what other vaccine-preventable diseases can come back as vaccine denials go away? Are any more dangerous than measles?

– Let me start by saying that measles hasn’t been completely eradicated after all. For example, in 2019, before the pandemic, there was a rise in the incidence of measles in Russia. Then there was a period of lull, probably related to border closures due to the pandemic.

As for dangerous infections that will spread again as people refuse to be vaccinated, polio is one of the first to go. It is the most severe disease, if a child does not die from it, he is left with incurable paralysis. Diphtheria is an even more dangerous disease than measles, having hypertoxic forms with instant death and giving damage to the myocardium and nervous system.

– What is the epidemic situation for measles in Russia now?

– In the conditions of mass vaccination, which was carried out before anti-vaccinationists began to spread their ideas, we almost never encountered measles, there were only isolated cases. And those were always imported cases, so the spread of measles was quickly stopped. As for the current situation, such cases can be called a measles outbreak.

– Can a once-vaccinated person get measles?

– At first, it was thought that a double measles vaccination would really give lifelong immunity, like those who had been over vaccinated. But experience has shown that about ten years after vaccination, people lose immunity to measles and can get it, albeit in a milder form. But they will still be carriers of the infection. That’s why there is now an additional measles vaccination for adults. To decide if you need this vaccination, you can first determine your measles antibody titer, because everything is very individual, and some people may be immune for longer. If a person has ever had measles, they are immune for life.

– How dangerous is measles, what is its mortality rate?

Measles is an acute infectious viral disease with high contagiousness – out of 100 people who have had contact with the infection, 96 people become ill if they do not have immunity, that is, they are not vaccinated and have not had the disease before.

It’s hard to say what the mortality rate of measles is now, because it’s been a very long time since medics have had to deal with this infection. But in an era when there was no measles vaccine, the mortality rate was quite high. Measles can also cause very serious complications, such as measles pneumonia and measles encephalitis, as well as complications of the urinary system and the kidneys.

– What else are we threatened by the growth of anti-vaccination sentiment? What diseases will spread?

– In the 1990s, there was already a diphtheria outbreak in Russia, with fatalities among unvaccinated patients and those who had not been revaccinated in time. There were many cases of severe forms of the disease with complications – also in those who were not vaccinated.

Most likely, along with measles today diseases such as mumps and rubella may return. Rubella is mainly dangerous for pregnant women, and mumps is not as contagious as measles, but it can also lead to serious consequences. In addition, we cannot rule out out outbreaks of whooping cough among children due to refusals to vaccinate. Whooping cough is also a very serious infectious disease that used to be fatal.

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