Uttar Pradesh: Post measles encephalitis threatens life of kids

[Ronan Kelly]

PME threatens life of kids
Naveen Kumar, TNN, Mar 2, 2011, 09.30pm IST

VARANASI: Is turning a blind eye to measles vaccination responsible for occurrence of post-measles encephalitis (PME), an infectious and life threatening disease affecting young children in the region? It would seem so if latest cases are taken into consideration. Though authorities concerned blame people, they are unable to answer how is skipping vaccine possible when it is a part of the routine immunisation programme.

While Japanese encephalitis (JE) is already known to create a havoc in some parts of east UP, particularly in the belts of Gorakhpur, Maharajganj and Deoria districts, the occurrence of PME in a number of children in the region, with some still undergoing medical treatment in city hospitals, has caused concern.

"The preliminary reports indicate PME conditions in a number of children from the region, out of which four children have even reached coma stage," informed secretary, Indian Academy of Paediatrics (IAP) UP Alok Bhardwaj. "Two of them have been discharged but the other are still kept under medical supervision. However, the concerning part of the exercise is the fact that the region has never reported such a large number of such cases," pointed out the senior paediatrician.

It may be mentioned here that out of four critical cases of PME, one each has been reported from Varanasi, Chandauli, Ballia and Buxar district of neighbouring Bihar state. Similarly, a number of PME cases have been also reported from Bhadohi, Mirzapur, Jaunpur and Ghazipur districts in the region.

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Read more: PME threatens life of kids - The Times of India http://timesofindia.indiatimes.com/...of-kids/articleshow/7612695.cms#ixzz1FXGwNRqr

 

[Ronan Kelly]

Re: Uttar Pradesh: Post measles encephalitis threatens life of kids

ProMED commentary on this article;

[Measles vaccine coverage (a mononvaalent vaccine at 9 months of age)
in India has been good, but measles incidence remains high in parts of
India. Measles even in previously healthy children can be a serious
illness requiring hospitalization. As many as one in 20 children with
measles develops pneumonia, and about one child in every 1000 who get
measles will develop encephalitis, which may leave a child deaf or
even mentally retarded. In developing countries, where malnutrition
and vitamin A deficiency are common, mortality from measles virus
infection can be considerable. Sub-acute sclerosing pan-encephalitis
(SSPE), a fatal degenerative disease of the central nervous system,
can be a very rare consequence of measles infection early in life.

The above account of encephalitis in the state of Uttar Pradesh
attributes many cases of encephalitis to measles virus infection as a
consequence of deficiencies in measles vaccine coverage. However a
recent publication by F.k. Beig et al. in the International Journal of
Infectious Disease (25 Jan 2010) describes an investigation of the
etiology of viral encephalitis (VE) in the children of western Uttar
Pradesh. Both cerebrospinal fluid and serum samples were collected
from pediatric patients suffering from encephalitis hospitalized at
Jawaharlal Nehru Medical College, Aligarh from July 2004 to November
2006. Viral isolation was done on RD cells, HEp-2 cells, and Vero
cells from the cerebrospinal fluid samples of children with suspected
VE. A microneutralization test was performed for enterovirus 71. An
enzyme immunoassay for IgM antibodies was performed for measles virus,
mumps virus, varicella zoster virus, herpes simplex virus 1, and
Japanese encephalitis virus. 87 patients were enrolled in the study.
The most common etiology of VE was enterovirus 71 (42.1 percent),
followed by measles (21.1 percent), varicella zoster virus (15.8
percent), herpes simplex virus (10.5 percent), and mumps (10.5
percent). Japanese encephalitis virus was not found in any case.
Enterovirus 71 infection caused significant morbidity in children;
mortality occurred in 50 percent. A preponderance of cases occurred in
December. In their study, generalized convulsions along with altered
sensorium were the significant findings in patients with VE. The
authors concluded that enterovirus 71, the major etiology of VE in the
study, was associated with significant mortality and morbidity.

It is likely, therefore, that improved measles vaccine coverage may
reduce the incidence of VE in Uttar Pradesh but will not eliminate
it.

The location of Uttar Pradesh can be found on the map of the states
of India at <http://www.fpaindia.org/FinalWeb/5/statesunder.htm>. -
Mod.CP]

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[Ronan Kelly]

Re: Uttar Pradesh: Post measles encephalitis threatens life of kids

A rare disease, always a killer but easily preventable
Posted: Mon Mar 07 2011, 23:39 hrs
- By BABYCHAN

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.

....

Dr Michel Phillipart, a California neurologist who has treated SSPE cases including Emmalee’s, 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.

...

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.

...

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

http://www.indianexpress.com/news/A-rare-disease--always-a-killer-but-easily-preventable/758701/