A rare disease,always a killer but easily preventable

Complication follows some years after measles,can be blocked with double dose of vaccine.

Measles can be followed by a complication that,though rare,nearly always kills. Vaccination can prevent measles and therefore the fatal complication,called sub-acute sclerosing pan encephalitis SSPE and affecting the nervous system,but it is necessary to give children two doses.

Emmalee Madeline Snehal Parker,adopted from a Pune orphanage in 2005,died in the US this year after several months of suffering from SSPE. She had been vaccinated against measles in Pune but that had been before India introduced a second dose. In fact,even now,Maharashtra has not introduced a free second dose at government-run hospitals and centres.

Brian and Erica Parker,who had adopted Emmalee at age two,noticed in July that she was struggling to walk. She was diagnosed a month later with SSPE. There was no chance of recovery, Erica Parker said from the US.

In the last few months,Emmalee developed a kind of seizure that caused her limbs to jerk and her body to lurch,sometimes to the point of falling to the ground. Despite treatment,she slipped into coma within months.

Dr Sudha Kessler,a neurologist who treated Emmalee at a childrens hospital,said SSPE affects only 1 in 100,000 people who have had measles.

Dr Michel Phillipart,a California neurologist who has treated SSPE cases including Emmalees,said at highest risk are those not vaccinated as infants. There is typically a latent period of many years before a child infected with measles develops SSPE. This is almost always fatal; very few people survive more than five years longer and even then neurological disability is universal.

Though Emmalee had been vaccinated,it is possible that she had been infected with measles before a year of age,or that she had an incomplete response to the vaccine and was exposed to measles infection after that,says Dr Jayant Navrange,a paediatrician who is in charge of the Pune unit of the Indian Medical Associations medico legal cell.

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Vaccine coverage in India is only 66 per cent and even below 50 per cent in many states. Till 2009,India was the only country that had not introduced the second dose.

Now,some states have begun giving the second dose free at government centres. In Maharashtra,we want to start giving the second booster dose but are still waiting for a written order from the Centre,said Dr V M Kulkarni,in charge of the states immunisation section.

The first dose against measles is to be given at the age of 9 months,the second at 12-15 months.

MULTIPLE RISK
Measles can cause:
Ear infection: 1 in 10 children have it after measles
Brain damage: 1 in 1,000 get encephalitis. Measles can also cause permanent brain damage. A few suffer a fatal complication called SSPE
Death: 1 in 20 children catch pneumonia,which sometimes kills. So does diarrhoea,1 or 2 in 1,000 children who catch measles die of it
What killed Emmalee
SSPM: Sub-acute sclerosing pan encephalitis is a rare complication hat affects the nervous system; when it occurs,it almost always kills
Risk: 1 in 100,000 people who have had measles get SSPM. Follows measles after a latent period of some years
Prevention: Vaccination against measles,double dose