Title : Measles outbreak – Another post- Covid phenomenon: Lessons to be learnt
Abstract:
Introduction: Measles virus is an aerosol borne and one of the most Contagious Pathogens1. Almost every measles virus Infection becomes Clinically manifest, furthermore, it can cause fatal complications and has high morbidity and mortality. Measles virus infection is a vaccine preventable disease. This strategy is also used in developed countries as well because of naturally expected epidemic of measles after few years2. The first symptoms of Measles are fever, cough and coryza followed by maculopapular rash. Mortality in measles is due to complications and under 5 years of age, measles complications are higher.3 Measles cause serious complications among them Pneumonia, otitis media and diarrhea are in acute phase, furthermore, Tuberculosis activation, malnutrition after measles, T-Cell anergy here as well before SSPE (Subacute sclerosing panencephalitis) is a non-treatable and fatal neurological complication which leads to worsening of higher mental functions and eventually cause Death4. In Pakistan, mass immunization against measles in 2018 and Measles-Rubella IMMUNIZATION Campaign was done in 20215. More than 386,000 health professionals, including 76,000 vaccinators and more than 143,000 social mobilizers are mobilised for the two-week campaign supported by Gavi, the Vaccine Alliance, UNICEF, WHO and partners. The children aged between 9 months and 15 years, those aged up to five will also receive the oral polio vaccine, were targeted by the Campaign6.
In national Study, the number of cases of measles in 2012 was reported to be 14,000 with 210 patients dying of it. Unfortunately, due to a lack of proper surveillance infrastructure, the demographic statistics, including ages of the patients affected by measles in the current epidemic in Pakistan are unknown7. The Covid-19 Pandemic causes disruption in routine EPI services along-with inequality in access to Vaccines. Although WHO emphasize the importance of EPI Vaccinations, however, countries with resource limitation as in Pakistan current Epidemic COVID-19 vaccination was done by EPI Staff which affects routine EPI Vaccination Program8.
Materials and Method
Study Design: Cross-sectional study. It’s a multi-centric study and will be conducted in Mayo Hospital Lahore and Mother Children Complex Sheikhupura.
Sampling Technique: Non- Probability Convenience sampling.
Sample Size: All measles cases in both setup
Inclusion Criteria: All measles cases which are admitted in Mayo Hospital Lahore and Mother and Children Complex Sheikhupura.
Exclusion Criteria:
- Rash without fever
- Rash disappear within 72 hours
- Children admitted with measles in hospital 21 days prior measles infection. Medical record available
Data Collection Procedure: Measles patients admitted in Mayo Hospital Lahore and mother children complex Sheikhupura were admitted in this study. Patient’s gender, age and contact details were taken after their consent. Measles clinical spectrum, vaccination and malnutrition association will be assessed by predesigned Questionnaire performa by researchers.
Data Analysis: All the data will be entered and analysed by SPSS 22.
Objective: to assess the clinical spectrum of measles infection including its complications, association with malnutrition and positive Ig M results.
Operational definitions: Suspected Measles Case: A suspected case is one in which a patient with fever and maculopapular(non-vesicular) rash or in whom a healthcare worker suspects a measles.
Confirmed Case: A suspected case of Measles that has been confirmed positive by testing in a WHO accredited Laboratory and vaccine associated Illness has been ruled out.
Pneumonia: pneumonia is an acute respiratory infection that affects the lungs.
Meningo- Encephalitis: Meningo-encephalitis is a serious infection of the meninges (membranes covering the brain and spinal cord) and brain parenchyma.
Diarrhea: Diarrhea is defined as the passage of three or more loose stools or liquid stools per day.
Malnutrition: Malnutrition refers to deficiencies, excess or imbalance in a person’s intake of energy or nutrients. In our study, malnutrition refers to deficiency of nutrients which can be classified by using WHO classification. Z score along with anthropometric measures used to classify malnutrition as
- Mild -1.0 to 1.9
- Moderate -2.0 to 2.9
- Severe< -3.0
