Department of Paediatrics, King Fah'd Specialist Hospital, Buraidah, Kingdom of
Saudi Arabia.
The incidence of measles is on the decline but it still claims the lives of one
million children annually worldwide. The devastating effects of the disease on the health and nutrition of
children in developing countries and its high mortality are well documented.
The rapid decay of maternal antibodies in infants in developing countries
results in early susceptibility to the disease and hence the general
recommendation to vaccinate at the age of 9 months. Sustained international
efforts have raised global vaccination coverage rates to around 80% at which
level it has remained static. Many countries in the western hemisphere have
eliminated the disease by adopting aggressive strategies, which include one-off
'catch-up' mass campaigns to vaccinate all children aged 1-14 years, 'mop-up'
campaigns targeting children who were missed during the 'catch-up' campaign,
efficient routine vaccination services capable of reaching 90% of infants,
strong surveillance activities, prompt outbreak response, and 'follow-up'
campaigns every 2-4 years which target 1-4-year-old children. This success
story coupled with the fact that measles has many biological features favouring
eradication, and considering that it is a severe and lethal disease still
prevailing in many areas, calls for immediate international adoption of
eradication goals within a specified period of time.
[Micronutrients and tropical viral infections: one aspect
of pathogenic complexity in tropical medicine]
[Article in French]
Malvy D.
Centre Rene Labusquiere/INSERM 330, Universite Victor Segalen Bordeaux 2,
France. [email protected]
In tropical zones, uncertain living
conditions, inadequate food intake, and poor medical facilities enhance
unnecessary morbidity and mortality especially involving infants and young
children. In addition to protein-caloric malnutrition, deficiencies
in essential micronutrients have a specific health impact. Such deficiencies
can be the direct cause of disease such as vitamin A deficiency and
blindness or have a promoting effect by compromising immune status and
increasing susceptibility to and severity of infectious diseases especially
of viral origin. The promoting effect of micronutrient deficiency plays a
significant role in measles, rotavirus-related diarrhea, and, to a certain
extent, progression of HIV infection. Several examples are described to
illustrate the relationship between tropical viral infection and
micronutrients including vitamin A, selenium, and various other
antioxidants. These examples highlight the effect of infectious disease on
micronutritional status (vitamin A and measles) and the need to develop
reliable, practical tools to evaluate the relevance and effectiveness of
dietary supplementation. In any case, improving living conditions and health
programs such as the Expanded Vaccination Program are required and
illustrate a transverse approach for prevention of infectious and
non-infectious tropical disease. The relationship between micronutrients and
infection is only one aspect of the multifactorial reality that must be
dealt with in tropical medicine.
Nearly every measles infection results in well-recognized clinical disease. In
nonimmunized populations almost every child will get measles early in life. The
universality of the disease in nonimmunized communities, particularly those in
the developing world, has led to a more or less passive acceptance of measles
as an unavoidable risk of early life. The clinical spectrum of measles ranges
from a mild, self-limiting illness to a fatal disease. Conditions encountered
mainly in the developing world, e.g., unfavorable nutrition, high risk of
concurrent infection, and inadequate case management -- particularly at home --
favor the development of complications and adverse outcome. Conversely, good
clinical management of an otherwise healthy child, a situation seen mostly in
the developed world, greatly influences the course of the disease. Hence many
in the medical profession believe that measles is a mild disease except among
populations living under particularly unfavorable conditions. Measles vaccine
is effective in preventing disease in the individual and in controlling it in
the community if it is given at the critical age when maternal antibodies wane
and the risk of natural infection increases sharply and if a high immunization
rate is maintained in the target population. The experience with immunization,
particularly in sub-saharan Africa, is rewarding: mothers who had previously
accepted measles as an unavoidable risk clamour for immunization of their
children once its effectiveness has been demonstrated. No reason exists for
measles to claim its present toll of morbidity and mortality. With extension of
the Expanded Programme on Immunization of the World Health Organization, the
impact of measles should progressively decline.
Selective primary health care: strategies for control of
disease in the developing world. IV. Measles.
Walsh JA.
Measles, a highly contagious viral disease, kills several hundred thousand
infants and young children yearly. Essentially all children will become
infected; at least 1% of those living in developing countries will die
unless protected by immunization. In urban areas, peak incidence occurs in
those younger than three years. The
youngest and most undernourished children suffer the most severe
complications and the highest risk of death. Diarrhea, malnutrition,
pneumonia, and blindness associated with vitamin A deficiency are the worst
complications. The infection is preventable by the timely administration of
a potent vaccine. This endeavor requires a well-managed technical and
administrative network that remains difficult to organize in many areas of
the world. The vaccine is efficacious and has few adverse effects but must
be provided to children during the short interval between loss of
transplacentally acquired antibodies and the acquisition of natural
infection. The improvements in heat stability of the vaccine increase the
likelihood of providing potent vaccine, but a well-managed cold chain
remains a prerequisite for any successful immunization program. Health
education, improved management skills, publicity, and community support are
all important factors for ultimately preventing the morbidity and mortality
from this disease.
PMID: 6844806 [PubMed - indexed for MEDLINE]
Date:
February 1, 2002
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