High temperature, inflammation of the mucous membranes, intoxication and papular rash. This is measles - a dangerous viral disease, the outbreak of which is happening again in Ukraine. "And if only adults died during a previous outbreak in 2006, adults and children have become victims of the disease this year," said to 112.ua doctor of medical sciences, head of the Department of Infectious Diseases, a specialist in infections of the Ministry of Health of Ukraine Olha Holubovska. As of today, it is already known about the death of two adults and two children. In general, according to the latest data provided by the Ministry of Health on November 1, there were 70 times more cases of measles in the country than in the previous year - 2,381 people. "To date, we already have a figure that is approaching to 2.5 thousand sick people since the beginning of the year," said the associate professor of the National Medical Academy of Postgraduate Education, children infections' specialist Fedor Lapiy.
According to the doctor, more than half of the cases are related to children from one year to eight: "Although there are children under one-year-old - almost 30 patients."
The highest number of incidents is recorded in Odesa and Ivano-Frankivsk region, slightly lower is in Chernivtsi and Ternopil. "In these regions, we have the highest level of contraindications to vaccinations that are not logical, as well as the lowest level of vaccination coverage," says Lapiy.
Also, according to the doctor, there is still no reason to expect a decrease in the incidence. "The winter is only started, the school year will last until summer - measles will only progress," the doctor said. He recalled the unpleasant history, which recently occurred in Zaporizhya region. From one infected teacher almost 40 children got sick.
Measles is a very serious disease, for every thousand people one dies. "The virus affects the nervous system, causes severe immunosuppression, and the disease is known for its complications. It is possible to activate endogenous infections, including tuberculosis, damage the central or peripheral nervous system, cause pneumonia, and poliomyelitis," says Holubovska.
The doctor emphasizes that the illness for adults is much more complicated than for children.
Regarding children under five years old, measles can also cause inflammation of the middle ear (otitis), bronchitis, pneumonia, diarrhea, encephalitis, according to the information provided by the Ministry of Health.
Measles is characterized by a periodic certain cyclicity. Over the past 15 years, according to the Ministry of Health, there were 3 epidemic upsurge of the disease: in 2001, 2006 and 2012. During the epidemic rise in 2012, about 13 thousand cases of measles were registered.
The disease is characterized by high contagiousness (infectiousness). The index reaches 100%, notes Holubovska. According to her, almost everyone who is in contact with a sick person can get infected. The disease is contagious even after the appearance of the first clinical signs. Measles is being transmitted by coughing, sneezing or close contact with the patient.
The main reason for the current outbreak of measles is a low level of vaccination against the disease, experts say. In our country, a vaccine against measles is made by a combined vaccine (against measles, rubella, mumps). According to the Ministry of Health, in 2016, 45.5% of children were vaccinated against measles, only 30.2% were revaccinated. "Considering that the measles is transmitted quickly, vaccination coverage should be at least 95%," Lapiy said to 112.ua, noting that people who were vaccinated and who did not develop immunity are also ill. "If the child is vaccinated, he should not get sick at all, but there are cases when vaccinated children suffer too, because the vaccine is effective, but it protects 98% of the vaccinated, organisms of 2% cannot answer it - they do not have immunity and they can get sick, they need to be protected by other vaccines, but given the low vaccination coverage in the country, the virus feels much better. It circulates freely and therefore the risk of getting sick from those who have been vaccinated too," on the doctor explained.
"Children should be vaccinated by age, if adults do not remember, were they ill or not, they can do a blood test in the laboratory, it will show whether a person has immunity to the disease or not," adds Holubovska.
The doctor said that the current situation with vaccination was the result of disruptions with vaccines provision, uneven distribution of vaccines by region, which led to the failure of the vaccination schedule in some of them. Sometimes, instead of two vaccinations due to lack of vaccines, only one was done. "In general, the situation with vaccines is very worrying: Ukraine sent money to international organizations on time, but vaccines were not purchased, and when we started to investigate, it turned out that the Ministry of Health did not give an order on buying vaccines on time. Information is closed, everything is secret as usual, "she said.
However, Lapiy asserts that the situation with vaccines in Ukraine is not so pessimistic. "Stocks of vaccines for measles prevention are sufficient, those vaccines that we have in the public sector are the same as in the private sector, and they are available free of charge. Just a week ago, Ukraine had 600,000 doses of the vaccine - this is more than the half-yearly need of the country. The vaccine is from a European manufacturer, which is produced in Belgium and is used in the EU. It’s wrong to say that we have low quantities of it in Ukraine," he said.
According to Lapiy, the level of vaccination coverage is low, because some of the parents officially refuse it, and a part of the refusal is not written, but the child is not vaccinated either. "There are many cases when a child is vaccinated only on paper, it is like people who instead of wearing a seat belt, just buy a stub to stop a safety sound," says Lapiy. He notes that when people hear about death cases, they start coming themselves and asking to give them a shot: "They agreed earlier when buying a fake certificate."
In general, according to the level of vaccination against infectious diseases of one-year-old children in 2016, Ukraine entered to the top eight countries with the lowest level of vaccination coverage. Almost 50% of children in the first year of life were not vaccinated in the country.
Parents refuse to vaccinate children because there is no trust to medicine in Ukraine in general. This is due to a large number of low-quality vaccines, Holubovska is sure. "The state has to defend the interests of our citizens and ensure that vaccines are delivered in time without interruptions and in the best quality. All the talk is about the fact that there are few quality vaccines in the world and there is a queue. But the government has to make sure that we are buying the needed one, but not the substandard vaccines, which nobody uses after all, "she said.
The combined measles vaccine that is currently used in Ukraine is qualitative and very well tolerated, Lapiy protests: "It can give a response because it contains alive, albeit weakened, virus, so a reaction is possible, but not earlier than on the fourth day. The reaction usually reveals in a form of a rash, which takes a week to show up."
According to the doctor, regarding complications from vaccines, "there are more myths about this than a real threat. Speaking about the connection between vaccination and autism, this is the most common myth, and it is disproved. In the United States, for example, there is a "vaccine court "that decides on the payment of monetary compensation. It stopped responded to complaints about the vaccine a few years ago, stopped accepting applications for compensation on the grounds that there is already enough scientifically substantiated and proven evidence that the vaccine is not the cause of autism, "said Lapiy to 112.ua.
A child infections disease specialist told that a story about the alleged link between autism and measles vaccine arose after the British Andrew Wakefield in 1998 published a study on 12 children in the Lancer magazine. An investigation was conducted.
Wakefield was convicted of falsification. "There was a medical court in Britain, it turned out that he had a conflict of interest, and it was found out during the investigation that the parents he was referring to did not provide him with the data he was appealing to." Wakefield 's fault was proved: this is a fairly well-known story and it is very unfortunate that despite this, we still have many doctors who continue to support this myth and spread it around, "Lapiy said.
Holubovska noted that, partly, the current outbreak of measles is also associated with a problematic health care system in our country. "Outbreaks of infectious diseases always accompany cataclysms that occur in society, for example, in Yemen, where the war is going on, outbreaks of diphtheria are reported. In Ukraine, people are in a state of chronic stress - food diet is unbalanced, and this also affects all diseases, especially infectious diseases", she says.
At the same time, according to Lapiy, the nutrition does not have much influence on the course of the disease. "It is well known that a more severe course of measles is promoted by a significant vitamin A deficiency. We have enough foods that contains vitamin A. This is both carrot and pumpkin. It is incorrect to say that we have a significant vitamin A deficiency, as compare with African countries, where they are facing the issue of hunger", the doctor said.
Experts stressed that the only way to protect both children and adults against measles is vaccination. "As a rule, there are no repeated measles cases. If a person has recovered, then he/she will not get sick again. However, it's better not to take risks and get vaccinated," Holubovska stressed.
Vaccination does not protect against the virus 100%, but significantly reduces the possibility of catching it, in addition, it softens the course of the disease.
She recalled that there is no specific treatment for measles: "It is very important to establish a diagnosis for a disease so that there are no mistakes and no extra treatment is applied, which is dangerous for this disease." The doctor noted that in the early days, measles can be asymptomatic and, as a rule, the diagnosis is being voiced when a rash appears.
Lapiy said that vaccination against measles has already proved to be effective in many countries: "There are many cases when countries, with its help, managed to eliminate measles – creating a situation in which circulation of the pathogen was stopped. For example, in North and South America and many EU countries."