Strange infectious disease that shows importance of vaccinations

WHAT does measles have in common with electronica?

By measles, of course, I mean the viral illness characterised by fever, conjunctivitis, cough and runny nose followed by a characteristic red rash that starts behind the ears and spreads downwards across the trunk towards the hands and feet.

By electronica, I mean a particular form of dance music.

It so happens that electronica has been found to be one of the most infectious genres of music.

From the covid pandemic, you may already have heard of the R naught value (a measure of a disease’s ability to spread assuming the population has no immunity). Believe it or not, a team of mathematicians looking at music download patterns used it to rank how contagious different genres of music are, with electronica coming out on top with an R value of 3,430.

If there were a disease with an R value that high, spending time analysing download patterns to ascertain the infectivity of different music genres would be the last thing on anyone’s minds. Bear in mind, covid at its peak had an estimated R value of between two and five.

Among diseases, you don’t get many more infectious than measles. Estimates put its R value at around 12 to 18.

The virus itself (a morbillivirus of the paramyxovirus family, if you’re interested) is spread via the airborne route or by direct contact with respiratory secretions.

It is said that if someone with measles has been in a room, it can hang around airborne for a couple of hours. No wonder then that it can spread so easily.

You will be aware that the number of measles cases has been on the up recently. There have been outbreaks around the West Midlands and reported cases across the country have risen steadily over the last three years from around 360 in 2021 to 735 in 2022 and 1,603 in 2023 across England and Wales.

Considering the announcement that the UK had achieved elimination status (an absence of endemic cases) in 2016 and 2017, these numbers might seem high.

However, before vaccination began in 1968 measles was everywhere. There were between 160,000 and 800,000 reported cases each year with a peak every two years or so and around 100 deaths a year.

In fact, it was so common that the Persian physician who first described it believed it to be a natural stage of childhood that must be endured.

While some populations gradually developed an inherent immunity that tempered the impact, as those populations spread across the globe measles went with them, wreaking havoc on civilisations with as yet no contact with the virus.

The Spanish conquistador colonisation of the Incans and Aztecs, for example, brought untold misery with them in the form of smallpox and measles to which the native populations had had no exposure, resulting in huge numbers of casualties without even the swing of a sword.

Measles is a strange disease as most of the time it results in a relatively mild illness. Most sufferers make a full recovery after about seven days by simply managing the symptoms.

However, a word of caution. Between 2018 and 2020, the Democratic Republic of Congo suffered an ebola outbreak that killed 2,299 people. Over the same period, 7,800 people there died as a result of measles.

Its danger lies in the potential complications, which include diarrhoea leading to dehydration, secondary pneumonia, irritation and inflammation of the lungs (pneumonitis), convulsions and encephalitis. Encephalitis is an inflammation and infection of the brain and even if not fatal can cause severe long-term effects.

While adults are more likely to develop complications, measles is very much a disease of childhood and the most vulnerable are the very young.

The initial symptoms of measles could be any one of a hundred other viruses. Cold-like symptoms precede the more characteristic features, that of the rash and also spots known as Koplik’s spots.

These spots appear on the mucosa inside the mouth. Children tend to be infectious around four days before the rash appears and this continues for four days afterwards. During this period, they should be isolated to avoid any spread.

There is no specific treatment other than rest, plenty of fluids and paracetamol or ibuprofen for any symptomatic relief they may need. However, if there is a concern that they may be struggling to breathe, they have a persistently high temperature, or if they seem at all confused, they must be checked by a doctor.

If measles is suspected, it is usually a clinical diagnosis but doctors are obliged to notify the health authority and if this happens a testing kit (most likely a cheek swab) will be sent through via the post.

Despite the furore involved, the vast majority of cases of measles resolve on their own.

While annual deaths in England and Wales over the last decade have remained in single figures, there is a trend upwards and every single one of those people who have died since 2000 have been unvaccinated.

Hopefully, this highlights the importance of vaccination. The MMR vaccine (Measles Mumps and Rubella) was introduced in 1988 and a clear subsequent drop in cases has been demonstrated.

It is estimated that between 2000 and 2020 the MMR vaccine programme has saved 31.7 million lives worldwide. This notwithstanding, there were still around 140,000 global deaths in 2018, most in children under the age of five.

I have already mentioned how infectious measles is. One person in a room is likely to spread it to almost every single other person in the same room if they have not been vaccinated.

While the MMR has been a huge success, there have been setbacks, including the high-profile case of fraudulent research linking the MMR to autism. Though completely discredited (its author being banned from practising medicine), its reach created vaccine hesitancy that caused real harm.

More recently, similar types of systemic misinformation continue to hamper the vaccination process, something that crept back in to a degree during the covid vaccination process.

This, along with supply limits and sometimes just oversight, means that a small proportion of children are still not receiving the MMR jabs.

Infants should get their first jab at one year old and a further booster when they are aged three. If they have missed one or both, it is never too late to get them done so contact your GP surgery if these are still outstanding.

To prevent epidemics of measles, a high level of immunity throughout the population (95 per cent) is required due to its infectivity.

The MMR vaccine is the best way of achieving this. As yet, however, there is no vaccine for electronica but who knows what the future might bring?