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Possible resurgence of childhood measles; last thing we need

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Dr B.J.C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

The disease measles, also known as rubeola and morbilli, is an extremely contagious infective viral illness in children, characterised by fever and a skin rash, with the potential to cause diarrhoea, respiratory complications, like pneumonia, ear infections and inflammation of the brain. It has a very characteristic clinical picture, and the diagnosis is clinically quite obvious to those doctors who have seen it before. Currently, there are sophisticated antibody and viral isolation tests that could be used to confirm a definitive diagnosis of a measles infection.

Measles, though often recognised as a usual childhood illness and, perhaps, as just a part of growing up, was, however, well known to be a killer of some affected children, right up to about the middle of the 1980s. The younger the affected child, the more the likelihood of the occurrence of complications; infants under one year are the most vulnerable. Many children succumbed to the development of intractable respiratory infections and acute brain inflammation. This author, who saw loads of measles cases in his medical student days, early career and consultant stages, can vouch for what is documented here.

Of course, in many affected children, it was a rather mild disease. Yet for all that, in some, it caused very many problems. The crux of the matter was that it was not at all possible to predict which of those affected by the virus was likely to develop major complications. The acute involvement of the brain in the form of inflammatory encephalitis could kill or leave the child with permanent brain damage. There is no treatment or anti-viral drugs to treat this condition.

Even more importantly, measles was recognised in the late 1960s to be the cause of delayed onset brain damage known by the technical term Sub-acute Sclerosing Panencephalitis (SSPE). In that condition, known as a ‘slow-virus’ infection, the virus remains in the brain and slowly eats into the tissues of the brain over months and years. It is a slow but relentlessly progressive terrible complication of measles and is characterised by disturbances of motor functions with uncontrollable jerky movements of the head, trunk or limbs, overt convulsions or fits, progressive cognitive and higher brain function deterioration, changes in behaviour and even blindness.

In the advanced stages of the disease, individuals may lose the ability to walk as their muscles stiffen or spasm. There is progressive deterioration to a comatose state, and then to a persistent vegetative brain-dead state. Death is inevitable as there is no effective curative treatment. It kills and the diagnosis is a very definitive death certificate. Even if one child gets SSPE, it is one too many as there is no known treatment. It is a terrible complication of measles and doctors are entirely helpless in treating it.

This scenario completely changed, totally for the better, when Sri Lanka started an island-wide immunisation programme against measles in 1984. Later, we used the Measles-Rubella (MR) vaccine from 2001 and then we started using the Measles-Mumps-Rubella (MMR) vaccine from 2011. This author was the Consultant Paediatrician in Badulla when the measles vaccination was started and then he was transferred to the General Hospital, Ratnapura, in January 1985. In both these institutions, we saw a dramatic reduction in measles cases and later on in cases of SSPE.

From then onwards, over the years, there were a few catch-up campaigns of vaccination to vaccinate those who had missed. There was practically 100 percent coverage of all children through our Expanded Programme of Immunisation with fantastic results. The World Health Organisation (WHO) certified Sri Lanka as a measles-free country in 2016.

Having been put through the mill over the years, and through many a natural as well as man-made catastrophe in the not-too-distant past, we need a resurgence of measles, just like a hole in the head. We have got more than our fair share of problems to worry about without having to deal with the resurrection of an awfully contagious viral disease, like measles.

However, there are very loud alarm bells being sounded this year. Around the middle or so of May 2023, there was a diagnosed case of measles in a 23-year-old admitted to the National Hospital in Colombo. Then there were confirmed cases being reported from the Lady Ridgeway Hospital for Children and also from other areas of the country. Up to the time of writing this article, close to 50 cases have been reported, mostly from Colombo and the suburbs of Colombo, and some sporadic cases from several other areas of the country.

One thing was a common denominator for all these cases. THEY HAVE ALL NOT BEEN PROPERLY AND COMPLETELY VACCINATED AGAINST MEASLES. Eighty-seven percent were not given even one dose of the vaccine, and 17% had only one dose. None of those with measles had both doses of the vaccine. It was all due to vaccine hesitancy and vaccine refusal on the part of the parents. The vast majority of the patients were from one ethnic group.

Many things worry all of us in situations like this. From experience, this could just be the start of an epidemic as we know to our cost that this is how such things start. This is particularly so because we have an extremely vulnerable cohort of 6- to 9-month-old babies who have not been vaccinated and who do not have natural immunity transferred from the mother. Originally, it was decided to give the first dose of the vaccine at nine months of age because the immunity in the mothers as a result of acquiring the natural disease during their childhood, had sufficient antibodies to be transferred to the babies which lasted up to around nine months of age.

However, once the disease was wiped out, the current set of mothers have immunity against measles only through two doses of the vaccine that they have had during their childhood rather than through natural measles infection. Research work done internationally and in Sri Lanka has very clearly shown that the babies of those mothers have very little, if any, antibodies against measles from six months of age. They belong to the lot of an extremely susceptible and defenceless group in whom the disease could spread like wildfire. By their age, they are also a group of children in whom the propensity to develop all complications of the disease is sky high.

The Epidemiology Unit and the Family Health Bureau of the Ministry of Health have responded ever so promptly to the current situation by instituting certain measures. To their eternal credit, no stone has remained unmoved in a dedicated quest towards thwarting the development of an epidemic of measles.

However, there is a limit to what they could do. The success of it all depends on public cooperation and reinvigorating a sense of public-spiritedness and intense responsibility on the part of all Sri Lankan parents. All these vaccine-avoider parents may have their reasons for taking such a course of action and on closer scrutiny, all of them are based on myths. None of those reasons stand up to scientific scrutiny and as I said before, any death from measles, EITHER IN THE ACUTE PHASE OR YEARS LATER DUE TO SSPE, IS A DEATH THAT IS ONE DEATH TOO MANY.

All parents in our country, irrespective of age, caste, creed, religion, or ethnicity, simply owe it to our nation to put their collective shoulder to the wheel to prevent a dismal and disastrous calamity of a measles epidemic in our country. This writer has fought many valiant battles in the past to protect our children from infectious diseases. He has even crossed swords with the Health authorities for the sake of the children of our Motherland. All he is asking now is unstinted cooperation from the parents. If you have the slightest regard for what I say, PLEASE, PLEASE, VACCINATE ALL CHILDREN. Let none of them be left behind.

I have said this before, even very recently at that, and I will say it again, even ad nauseam…, even to ad infinitum…., VACCINATION SAVES LIVES!



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Fractious West facing a more solidified Eastern opposition

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An Iranian attack on a neighbouring Gulf state. Image courtesy BBC.

Going forward, it is hoped that a reported ceasefire agreement between the US and Iran would provide a basis for a degree of stability in the Middle East and pave the way for substantive peace talks between the powers concerned. The world is compelled to fall back on hope because there is never knowing when President Donald Trump would change his mind and plans on matters of the first importance. So erratic has he been.

Yet, confusion abounds on who has agreed to what. The US President is on record that a number of conditions put forward by him to Iran to deescalate tensions have been accepted by the latter, whereas Iran is yet to state unambiguously that this is so. For instance, the US side claims that Iran has come clear on the point that it would not work towards acquiring a nuclear weapons capability, but there is no official confirmation by Iran that this is so. The same goes for the rest of the conditions.

Accordingly, the peace process between the US and Iran, if such a thing solidly exists, could be said to be mired in uncertainty. Nevertheless, the wider publics of the world are bound to welcome the prospects of some sort of ceasing of hostilities because it would have the effect of improving their economic and material well being which is today under a cloud.

However, questions of the first magnitude would continue to bedevil international politics and provide the breeding ground for continued tensions between East and West. Iran-US hostilities helped highlight some of these divisive issues and a deescalation of these tensions would not inevitably translate into even a temporary resolution of these questions. The world community would have no choice but to take them up and work towards comprehending them better and managing them more effectively.

For example, there are thorny questions arising from the Treaty on the Non-Proliferation of Nuclear Weapons (NPT). Essentially, this treaty bans the processing and use of nuclear weapons by states but some of the foremost powers are not signatories to it.

Moreover, the NPT does not provide for the destroying of nuclear arsenals by those signatory states which are already in possession of these WMDs. Consequently, there would be a glaring power imbalance between the latter nuclear-armed states and others which possess only conventional weapons.

Such a situation has grave implications for Iran’s security, for instance. The latter could argue, in view of the NPT restrictions, that the US poses a security threat to it but that it is debarred by the Treaty from developing a nuclear arms capability of its own to enable it to match the nuclear capability of the US. Moreover, its regional rival Israel is believed to possess a nuclear weapons capability.

Accordingly, a case could be made that the NPT is inherently unfair. The US would need to help resolve this vexatious matter going forward. But if it remains, US-Iran tensions would not prove easy to resolve. The same goes for Iran-Israeli tensions. Consequently, the Middle East would remain the proverbial ‘powder keg’.

Besides the above issues, the world has ample evidence that it could no longer speak in terms of a united NATO or West. Apparently, there could be no guarantee that US-NATO relations would remain untroubled in future, even if the current Iran-US standoff is peacefully resolved. US-NATO ties almost reached breaking point in the current crisis when the US President called on its NATO partners, particularly Britain, to help keep open the Hormuz Straits for easy navigation by commercial vessels, militarily, on seeing that such help was not forthcoming. Such questions are bound to remain sore points in intra-Western ties.

In other words, it would be imperative for the US’ NATO partners to help pull the US’ ‘chestnuts out of the fire’ going ahead. The question is, would NATO be willing to thus toe the US line even at the cost of its best interests.

For the West, these fractious issues are coming to the fore at a most unpropitious moment. The reality that could faze the West at present is the strong opposition shown to its efforts to bolster its power and influence by China and Russia. Right through the present crisis, the latter have stood by Iran, materially and morally. For instance, the most recent Security Council resolution spearheaded by the US which was strongly critical of Iran, was vetoed by China and Russia.

Accordingly, we have in the latter developments some marked polarities in international politics that could stand in the way of the West advancing its interests unchallenged. They point to progressively intensifying East-West tensions in international relations in the absence of consensuality.

It is only to be expected that given the substance of international politics that the West would be opposed by the East, read China and Russia, in any of the former’s efforts to advance its self interests unilaterally in ways that could be seen as illegitimate, but what is sorely needed at present is consensuality among the foremost powers if the world is to be ‘a less dangerous place to live in.’ Minus a focus on the latter, it would be a ‘no-win’ situation for all concerned.

It would be central to world stability for International Law to be upheld by all states and international actors. Military intervention by major powers in the internal affairs of other countries remains a principal cause of international mayhem. Both East and West are obliged to abide scrupulously with this principle.

From the latter viewpoint, not only did the West err in recent times, but the East did so as well. Iran, for instance, acted in gross violation of International Law when it attacked neighbouring Gulf states which are seen as US allies. Neither Iran nor the US-Israel combine have helped in advancing international law and order by thus taking the law into their own hands.

Unfortunately, the UN has been a passive spectator to these disruptive developments. It needs to play a more robust role in promoting world peace and in furthering consensual understanding among the principal powers in particular. The need is also urgent to advance UN reform and render the UN a vital instrument in furthering world peace. The East and West need to think alike and quickly on this urgent undertaking.

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Science-driven health policies key to tackling emerging challenges — UNFPA

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Dr. Dayanath Ranatunga

Marking World Health Day on April 7, health experts have called for a stronger commitment to science-based decision-making to address increasingly complex and evolving health challenges in Sri Lanka and beyond.

Dr. Dayanath Ranatunga, Assistant Representative of the United Nations Population Fund, stressed that health is no longer confined to hospitals or traditional medical systems, but is shaped by a broad spectrum of social, environmental, and technological factors.

“This year’s theme, ‘Together for Health. Stand with Science,’ reminds us that science is not only for laboratories or policymakers. It is a way of thinking and a tool that shapes everyday decisions,” he said.

Dr. Ranatunga noted that modern health challenges are increasingly interconnected, ranging from infectious diseases such as COVID-19 to climate-related risks, demographic shifts, and emerging forms of online violence.

He warned that maternal and newborn health continues to demand urgent attention despite progress. Globally, an estimated 260,000 women died from pregnancy and childbirth-related causes in 2023 alone—many of them preventable through timely, science-based interventions.

“In countries like Sri Lanka, where fertility rates are declining and survival rates improving, every pregnancy carries greater significance—not just for families, but for the future of communities and economies,” he said.

The UNFPA official also highlighted the growing threat of Technology Facilitated Gender-Based Violence (TFGBV), including cyber harassment and online abuse, noting that these forms of violence can have deep psychological consequences despite lacking visible physical harm.

He emphasised the need for multidisciplinary, science-informed approaches that integrate mental health, digital safety, and survivor-centered care.

Turning to demographic trends, Dr. Ranatunga pointed out that increasing life expectancy is bringing new challenges, particularly the rise of non-communicable diseases such as diabetes, cardiovascular illnesses, and cancers.

In Sri Lanka, nearly 13.9% of mothers develop diabetes during pregnancy, a trend attributed to obesity and unhealthy lifestyles, underscoring the urgent need for preventive healthcare strategies.

“Are we investing enough in prevention?” he asked, noting that early intervention and healthier lifestyles could significantly reduce long-term healthcare costs, especially in a country with a free public healthcare system.

He underscored the importance of data-driven policymaking, stating that scientific research and analytics enable governments to identify gaps, anticipate future needs, and allocate resources more effectively.

The UNFPA, he said, is already leveraging tools such as Geographic Information Systems (GIS) to improve access to maternal healthcare, including mapping travel times for pregnant women to reach health facilities.

Digital innovation is also transforming healthcare delivery, from telemedicine to real-time data systems, improving efficiency and ensuring continuity of care even during emergencies.

In Sri Lanka, partnerships between the government and development agencies are helping to modernise training institutions, including facilities in Batticaloa, equipping healthcare workers with both clinical and digital skills.

However, Dr. Ranatunga cautioned that technology alone is not a solution.

“It must be guided by evidence and grounded in equity,” he said, pointing out that women’s health remains significantly underfunded, with only about 7% of global healthcare research focusing on conditions specific to women.

He also drew attention to the growing health impacts of climate change, including extreme weather, food insecurity, and displacement, describing it as an emerging public health crisis.

“Health does not begin in hospitals. It is shaped by the environments we live in, the choices we make, and the systems we build,” he said.

Calling for renewed commitment, Dr. Ranatunga urged stakeholders to invest in prevention, embrace innovation, and ensure that science remains central to policy and practice.

“Science is not just about knowledge—it is about ensuring that everyone has the opportunity to live healthy, dignified lives, and that no one is left behind,” he added.

 

By Ifham Nizam

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Sharing the festive joy with ‘Awurudu Kaale’

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The visually impaired who make up Bright Light Band in Awurudu attire

Melantha Perera is well known as a very versatile musician.

He was involved with the band Mirage, as their keyboardist/vocalist, and was also seen in action with other outfits, as well, before embarking on a trip to Australia, as a solo artiste.

I now hear that he has plans to operate as a trio.

However, what has got many talking about Melantha, these days, is his awesome work with the visually impaired Bright Light Band.

They have worked out a special song for the Sinhala and Tamil New Year, aptly titled ‘Awurudu Kaale.

Says Melantha: “This song has been created to celebrate the spirit of the Sinhala and Tamil New Year and to share the joy of the Awurudu season with all Sri Lankans”.

Yes, of course, Melantha composed the song, with the lyrics written collaboratively by Melantha, Badra, and the parents of the talented performers, whose creative input brought the song to life during moments of inspiration.

Melantha Perera: Awesome work with Bright Light Band

This meaningful collaboration reflects the strong community behind the Bright Light Band.

According to Melantha, accompaning the song is a vibrant video production that also features the involvement of the parents, highlighting unity, joy, and togetherness.

Beyond showcasing their musical talents, the visually impaired members of Bright Light Band deliver a powerful message, through this project, that their abilities extend beyond singing, as they also express themselves through movement and dance.

Melantha expressed his satisfaction with the outcome of the project and looks forward to sharing it with audiences across the country during this festive season.

He went on to say that Bright Light Band extends its sincere gratitude to Bcert Australia for their generous Mian sponsorship, the CEO of the company, Samath Fernando, for his continuous support in making such initiatives possible, and Rukshan Perera for his personal support and encouragement in bringing this project to completion.

The band also acknowledges Udara Fernando for his invaluable contribution, generously providing studio space and accommodating extended recording sessions to suit the children’s availability.

Appreciation is warmly extended to the parents, whose unwavering commitment from ensuring attendance at rehearsals to supporting the video production has been instrumental in the success of this project.

Through ‘Awurudu Kaale’, Bright Light Band hopes to spread festive cheer and inspire audiences, proving that passion and talent know no boundaries.

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