Virusphere. Frank Ryan

from measles. There is an incubation period of one to 12 days after exposure to the virus, during which it is passing through the target cells in the respiratory tract, through the lymph glands and entering the bloodstream. At this stage the illness becomes obvious, with fever, cough, runny nose and inflamed eyes. Two or three days later, the Koplik’s spots appear on the inner lining of the cheeks and the rash appears on the face and spreads over a day or two to be confluent over the skin. Ironically the striking symptoms and signs, including the fever and the rash, are actually produced by the attack of the immune system on the virus. Through the actions of that same immune system, the majority of children go on to make a full recovery – after which the immune system retains its memory of the antigens on the surface of the virus. In most cases, this will ensure that the sufferer is resistant to any future infection with measles. But further complications bedevil the recovery in a tragic minority of infected children, which include diarrhoea, pneumonia, blindness and, most serious of all, the inflammation of the brain called encephalitis.

      Readers may be astonished to read that before the introduction of the measles vaccine, in 1963, major epidemics of measles swept through the global population every two to three years, causing some 2.6 million deaths. Even today, measles is still one of the leading causes of death in young children, despite the fact that a safe and cost-effective vaccine is available to prevent the infection. Between the years 2000 to 2016, the World Health Organization estimated that measles vaccination had prevented some 20.4 million deaths; but, tragically, in 2016 some 90,000 people still died needlessly from this preventable infection.

      Unlike my generation, in which measles infection was commonplace, most parents in developed countries these days will have little or no experience of dealing with measles in the family. This, thankfully, is through the benefit of the MMR vaccination programmes which are now governmental policy in many countries. MMR vaccines protect children against three different viral illnesses: measles, mumps and rubella. But as a result of so-called ‘MMR misinformation scares’, the triple vaccine has been the subject of controversy in different countries, with some misguided parents withdrawing their children from the vaccination programmes.

      I shall return to this important topic later in this chapter, but first I would like to examine the other two viruses involved in the vaccine.

      The infection we call ‘the mumps’ probably derives its name from an old word meaning ‘to mope’ – an apt description of the afflicted child, struck down by malaise and fever and, a day after the onset, the painful swelling of one or both parotid glands within the cheeks, a condition known clinically as ‘parotitis’. The causative virus, the mumps virus, is another paramyxovirus, which is also global in distribution. Unlike measles, mumps was familiar to Hippocrates, some two and a half millennia ago. Mumps is also specific to and dependent on the human host, which, in symbiological parlance, is its co-evolving partner, and sole natural reservoir. Once more, the mumps virus is usually spread by the respiratory route, but it can also be spread through contamination with virus-infected saliva.

      Fortunately, in most cases the illness is quickly dealt with by the immune system, with the symptoms settling within a few days, so that recovery is usually uneventful. In some cases the illness is so slight that the sufferer doesn’t even realise he or she has encountered the virus. But in 20 per cent of males who contract mumps after the age of puberty, the virus causes inflammation of the testes, clinically known as ‘orchitis’. This manifests as local pain, which can be severe, accompanied by the swelling of one or both testes some four or five days after the onset of the parotitis. Though some testicular atrophy may result, thankfully the orchitis doesn’t usually cause subsequent sterility. Though uncommon, mumps can occasionally cause inflammation in the ovaries in females, and equally rarely cause pancreatitis in either sex. Mumps may also cause a viral, or ‘aseptic’, meningitis and, like measles, it may also cause encephalitis. Meningitis and encephalitis are serious medical complications, which will usually result in hospitalisation and, in some cases, mortality.

      Rubella, or the so-called ‘German measles’, is not a German contagion at all but rather a globally distributed infection. The illness just happened to be first described by two German doctors back in the eighteenth century. No more does it have anything to do with measles. The causative virus is in fact a ‘togavirus’, and an interesting example of this family of viruses since it is the only togavirus that isn’t spread by biting insects. Rubella is a contagious, generally mild, viral infection that mostly afflicts children and young adults. But if the virus infects women in early pregnancy, at a key time when major embryological development is taking place in the foetus, it can cause foetal death or a range of severe congenital defects known as ‘congenital rubella syndrome’ (CRS). These include hearing impairment, eye and heart defects, autism, diabetes mellitus and thyroid malfunction.

      The key fact here is that rubella, like measles and mumps, is exclusive to humans. It means that we are the only reservoir or host of all three viruses – in the symbiological lexicon, we are the exclusive partner. That means that if the reservoir were to be closed down, for example through vaccination, the diseases would disappear.

      The risk of all three of these viruses – measles, mumps and rubella – has been greatly reduced in developed countries by preventive vaccination, which, in the UK, the US and many other countries, is achieved using the combined MMR vaccine. It is important, given various misinformation scares, that we grasp the purpose of such a vaccine, and indeed the way in which vaccination works.

      Vaccines use either a live, but harmless, variant of a live virus, or a killed virus – or even antigens extracted from parts of a virus – to protect children from the suffering and potential complications of virus infection. The MMR triple vaccine, which employs all three live attenuated viruses – measles, mumps and rubella – has greatly reduced the prevalence of all three viral diseases in the countries where it has been introduced. Unfortunately, a scientifically disproven claim that the MMR vaccine increases the risk of autism has persuaded some parents to forgo vaccinating their children.

      People really do need to sit up and take notice of the advice of doctors and health authorities and ignore the misinformation coming from unreliable sources. Not doing so has the potential for unpleasant consequences. In a recent case involving the Somali-American community in the state of Minnesota, the local population, being misguided into believing that the vaccine had increased the frequency of autism in their children, stopped vaccinating their children with MMR. The real truth was exposed by a joint study by the University of Minnesota, the Centers for Disease Control in Atlanta, and the US National Institutes of Health, which showed that the incidence of autism in the Somali-Americans was no different from the vaccinated city’s white population. Alas, in May 2017 Minnesota saw the biggest outbreak of measles in the state for 27 years. State officials recommended that the Somali children be protected as soon as possible with vaccination booster shots.

      America is far from alone in the resurgence of this dangerous and highly infectious disease of childhood. In May 2018, the British newspaper, the Daily Telegraph, reported a resurgence of measles throughout the continent of Europe, with the disease increasing in Belgium, Portugal, France and Germany. Once again, the efficacy of MMR vaccination was being undermined by the same baseless linking of the measles vaccine to autism, which had resulted in a rise from a record low incidence of measles Europe-wide, with 300 per cent rise in cases from 2017 to an estimated 21,000 cases in 2018, and some 35 reported deaths. In the UK, following years of similar misinformation about a link between the MMR and autism, many people of late teenage years to early twenties had not been vaccinated in their childhood years, making them now susceptible to this unpleasant and potentially dangerous viral infection. In July 2018 The Times reported a national alert being sounded out to family doctors throughout the UK, warning them to be on the alert for the disease in families returning from holidays in Italy. In England alone some 729 cases had already been reported in the first half of the year, when compared to 274 in the whole of the previous year.

      Parents with any due concerns should seek the advice of their knowledgeable family doctors.

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