Coping with disability can be really hard, especially if the affected person was not born with it, and that is exactly what befell Peter Nyankiko and his wife, Venantie Mukanziza, residents of Bibare Cell, Kimironko Sector in Gasabo District when they became blind at the age of eight.

Their condition did not only saddle them, but also brought with it stigma as their community was not very accepting of a disability that had come in suddenly.

"I started experiencing blurred vision when I joined P1 at the age of eight. My parents took me to a health facility where the doctors confirmed that I would not be able to see again because I had been attacked by measles,” says Nyankiko.

Born in 1980, Nyankiko says his parents were not familiar with immunisation and its importance, adding that at the time, there was not much effort from the concerned authorities to promote immunisation.

At first, Nyankiko isolated himself from his friends as he went through a lot of suffering and depression, but he did not drop out of school. By the time he completed primary school, he was coping fairly well with his new condition, thanks to Gatagara school for children with disabilities in the Southern Province.

Dr Raymond Awazi, a pediatrician at La Croix du Sud Hospital in Kigali, says measles is one of the most highly contagious infections and spreads through droplet contamination via airborne transmission (sneezing and coughing) as well as direct contact with an affected person.

He explains that people who have not been immunised against it risk blindness, among other complications, later in life.

"It’s possible to develop measles after several years if one misses out on immunisation at nine months. The infection may even lead to death if not diagnosed early enough,” he says.

Awazi emphasises that babies, particularly, should be immunised against measles because they are more prone to the infection.

What is measles?

According to Dr Francis Kazungu, a general practitioner in Kigali, measles is a viral infection that causes fever, malaise followed by skin eruptions.

He says the disease can cause infection of the middle ear (otitis media), throat and sound box, the eyes, and cause diarrhea and vomiting. At times the infection can even spread to the brain, causing infection and inflammation of brain substance, such as encephalitis.

Dr Kazungu notes that measles’ vaccine is usually given at nine months, and it provides protection against three viral diseases, namely, measles, mumps and rubella.

According to Dr Kazungu, the statistics from the United Nations Children’s Fund (UNICEF) indicated that 2,700 measles cases were recorded in 2000 in Rwanda, but they dropped to only 80 in 2002, and continue to reduce drastically annually due to government interventions.

To determine if one is suffering from measles, Dr Kazungu says they exhibit various signs and symptoms, for instance, rashes, redness of the skin and eyes, discharge from the eyes, rushes in the mouth, fever and coughing.

"Within two days the characteristic measles rash emerges. This red, itchy rash starts at the hairline on the scalp and later covers the entire body, including the palms of the hands and soles of the feet. The illness runs for about 10 days after the rash begins,” he explains.

Dr Kazungu says if one experiences one of these symptoms, seeking medication is recommended so that if found out to be measles they are immunised against it immediately to save their lives.

Who is at risk?

"Children under the age of five are at risk of developing measles if they were not immunised. Below nine months, they are still protected by their mothers’ antibodies which they get from breast milk, which means that babies who are breastfed have passive immunity for longer. Their immunity becomes weaker as they grow, putting them at risk of contacting bacteria and viruses,” says Awazi.

The condition could be even worse for those who are pregnant as it causes congenital hearing loss in a newborn when exposed to measles in utero (in the womb).

"A measles attack during pregnancy puts the mother at risk of miscarriage and preterm delivery. If one plans to become pregnant and has come in contact with somebody suffering from measles, it is advisable to take one shot of measles normal immunoglobulin and plan pregnancy one month later,” cautions Awazi.

He explains that if a pregnant woman is exposed to any potential risk for infection, including measles, it can lead to damage to the cranial nerve of the infant that manages hearing, the measles infection causes hearing loss that is sensory in nature and often cannot be reversed after birth.

Awazi says that those who have never been immunised before are also at higher risk of developing measles even in their adulthood.

Preventions and treatment

Dr Kazungu says that diagnosis is clinical based on the characteristic nature of symptoms and history of exposure.

"The risk for complications from measles is high, primarily because the measles viruses use the immune system to distribute themselves, which compromises the immune response, lowering resistance to infection from other pathogens,” he says.

Dr Rachna Pande, a specialist in internal medicine, says prevention lies in immunisation, advising that if there is a case in the family the person with it should be isolated to minimise risk of spread of the infection.

"Anyone who has never been infected or immunised against measles is likely to develop the infection if he/she breathes in infected droplets or gets into physical contact with an infected person,” she says.

As there is no definite treatment for measles, Pande explains that drugs like paracetamol can be used to reduce fever.

"Rehydration, if one is dehydrated due to diarrhoea and vomiting, is recommended,” she says, noting that the disease subsides by itself in 2-3 weeks.

For the very basic prevention, she advises that covering the mouth and nose while coughing/sneezing is essential because the measles virus spreads through droplet infection and can easily spread to another person who may not have been immunised.

Pande also advises that immunisation against other killer diseases like polio, diphtheria, tetanus, tuberculosis, whooping cough, haemophilus influenza and hepatitis B is equally important, as well as adherence to vaccination timetables.

According to a report from the Ministry of Health, measles and rubella combined vaccine was introduced in routine immunisation in January 2014, which is administered at nine months, while measles vaccine stand-alone is given at 15 months as a booster dose.

The report indicates that immunisation coverage for measles and rubella combined vaccine is at 97 per cent nationwide.

editorial@newtimes.co.rw

*****

WHAT VACCINES DO ADULTS NEED?

Vaccines for adults are recommended based on your age, prior vaccinations, health, lifestyle, occupation and travel destinations.

The schedule is updated every year, and changes range from the addition of a new vaccine to tweaks of current recommendations.

What factors might affect my vaccine recommendations?

Several factors can affect whether you need certain vaccines. Be sure to tell your doctor if you: