Measles

Measles is one of the leading causes of death in children, even though it is easily prevented by vaccines.

Despite being easily prevented, measles is still common, and affects many thousands of children, especially in parts of Africa and Asia. Without vaccinations, children and adults living anywhere in the world can get measles.

The impact of measles on global health

The World Health Organization says that 140,000 people died from measles in 2018. Most of these were children under the age of five years;
Measles vaccinations resulted in an 73 per cent drop in deaths worldwide between 2000-2018;
23.2 million deaths were prevented by measles vaccination from 2000-2018;
The World Health Organization estimates 7 million people were affected by measles in 2016.

Measles Facts

What is measles?

Measles is a highly contagious viral disease characterised by a rash, and mainly affects young children.

What causes measles?

Measles is caused by a virus which is easily spread from person to person.

How does measles spread?

As one of the world’s most contagious diseases, measles spreads very easily from one person to the next.

It is transmitted through the air by droplets from the nose, mouth or throat of an infected person when they cough, sneeze or breathe out. It can also spread by direct contact, for example touching or kissing, as well as from sharing cups or utensils or touching a contaminated surface.

What is an outbreak?

When illness spreads through a whole community or region, it’s termed an ‘outbreak’.

During the late 2010s, measles outbreaks have been fuelled by:

The interruption of routine immunisation programs by conflict;
High numbers of displaced people living in close quarters such as refugee camps;
A number of people in a specific area choosing not to vaccinate their children.

Because it is so contagious, in a setting like a refugee camp, an outbreak is declared when a single case of measles is confirmed.

What does measles look like?

Measles symptoms appear between 10 and 14 days after exposure to the virus. The first sign of measles is often a high fever.

Other symptoms can include: a runny nose; a cough; red, watery eyes; or eye infection. A few days after symptoms appear, tiny white spots may appear inside the cheeks and mouth.

A few days after the start of symptoms, a red rash appears. The rash usually begins as flat, red spots on the face, before spreading down the body to the chest and arms. The rash may last five or six days.

Can you die from measles?

Sometimes, measles can cause serious and even fatal complications, such as diarrhoea and related dehydration, ear infections, pneumonia, blindness and encephalitis (an infection that causes swelling of the brain).

Severe measles and complications are more likely to affect malnourished children under the age of five (especially when they are deficient in vitamin A), and people whose immune systems are compromised, such as people living with HIV.

How do you prevent measles?

Routine measles vaccinations delivered through mass immunisation campaigns are very effective in reducing global measles deaths.

The measles vaccine has been used for more than 50 years. It is a safe, effective, and inexpensive public health intervention.

The measles vaccination is often combined with the mumps and rubella vaccines (known as the measles, mumps and rubella or MMR vaccine). It is equally safe and effective when given in both formulations (single or combination dose).

How Medecins Sans Frontieres responds to measles

Vaccination is the best protection against measles. Médecins Sans Frontières responds to the threat of measles epidemics by undertaking mass vaccination campaigns in vulnerable communities.

Routine measles immunisations

Médecins Sans Frontières provides routine measles vaccinations as part of paediatric care, both in emergency settings and in areas where government immunisation programs are not operational.

During measles outbreaks, Médecins Sans Frontières also provides support and care for infected children, to prevent complications from becoming fatal.

Preventative action against measles

Launching a campaign before the first case of measles is identified in an area dramatically reduces the chances of an epidemic. For this reason, part of Médecins Sans Frontières’ measles response is to conduct mass vaccination campaigns in areas where measles vaccine coverage is low, and chances of an outbreak are high.

The other area of concern is conflict settings, where war has destroyed disrupted the health system. The lack of routine immunisation programs means vaccine coverage rates drop, making the population vulnerable to outbreaks.

Children should be fully vaccinated against measles by the time they're one year old, but this often doesn’t happen in these situations. This makes ‘catch-up’ vaccination important – to try to raise the levels of vaccine coverage and protect the population.

Measles outbreak response

In a setting like a refugee camp, where there are many people living close to each other, an outbreak is declared when a single case of measles is confirmed. Once an outbreak is declared, Médecins Sans Frontières teams respond fast, preparing a vaccination campaign. Even after the disease has started to spread, immunising people at risk can still reduce the number of infections and deaths.

Advocacy

Médecins Sans Frontières is advocating for new measles vaccines that are easier to use in complex humanitarian contexts. Developing a heat-stable vaccine that doesn’t require refrigeration or cold chain management, or one which doesn’t require injection, will be hugely useful in expanding immunisation coverage and protecting more children from measles.

In 2018, Médecins Sans Frontières vaccinated 1,479,787 people in response to measles outbreaks

Challenges of the measles vaccine cold chain

Vaccines arrive at the Lunyeka health centre, Democratic Republic of Congo, a day before the kickoff of a vaccination campaign. ©Pablo Garrigos/MSF

One of the challenges of mass vaccination campaigns in areas where there are few or no healthcare facilities, is the ‘cold chain’.

Measles vaccines must be kept cold – between two and eight degrees Celsius throughout the transport and storage chain. If exposed to higher temperature or light, the potency of the vaccines is affected, and they could become contaminated.

It takes a great team effort to prepare for a vaccination campaign. Logistics workers fill coolers with ice packs to keep the day’s vaccines cold. Supplies are loaded onto trucks or other transport.

Some rural villages are hard to reach and require health workers to travel great distances on foot, motorbike or by horse. Community health workers spread the word to local leaders and people. Nurses set up vaccination stations under trees or near schools.

Children who already show signs of measles are isolated for support treatment or referred to a hospital if necessary.

In the last decade, Médecins Sans Frontières has done more than 30 vaccination campaigns, many of these in Democratic Republic of Congo, Central African Republic, Sudan, Niger, Chad, and Nigeria—many of them among populations displaced by conflict.

‘It was a race against the clock to try and get the activity running as quickly as possible’

Australian nurse Jai Defranciscis joined Médecins Sans Frontières’ team in Marawi, Philippines to urgently stem a measles outbreak that had already proven fatal for several children in the community.

“In Marawi, there had been a number of measles cases detected and even a few deaths which resulted in an outbreak being declared by the Ministry of Health. Médecins Sans Frontières' role was to support the outbreak response. I've unfortunately seen many children suffer with vaccine preventable diseases, and measles is one of the worst. It was a race against the clock to try and get the activity running as quickly as possible to prevent the further spread of this exceptionally contagious disease. So from the day I landed in the country, the planning and preparation work commenced.

In Marawi, vaccination coverage had been complicated by the long siege, displacement, and the disruption and destruction of necessary health services. Displaced due to the conflict, many families have been living together in very poor and dirty conditions, or in evacuation centres.

Our teams mobilised to provide educational information sessions about the benefits and safety of vaccination, and the side-effects and complications of measles. Our target age group was children under five years old, as they are the most at risk. Their immune system isn't developed enough to fight off infection.

Due to our speedy response, we were able to stem the outbreak from getting out of control and wreaking havoc on an already weak and susceptible population.”