Features
Possible resurgence of childhood measles; last thing we need
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!
Features
Acid test emerges for US-EU ties
European Commission President Ursula von der Leyen addressing the World Economic Forum in Davos, Switzerland on Tuesday put forward the EU’s viewpoint on current questions in international politics with a clarity, coherence and eloquence that was noteworthy. Essentially, she aimed to leave no one in doubt that a ‘new form of European independence’ had emerged and that European solidarity was at a peak.
These comments emerge against the backdrop of speculation in some international quarters that the Post-World War Two global political and economic order is unraveling. For example, if there was a general tacit presumption that US- Western European ties in particular were more or less rock-solid, that proposition apparently could no longer be taken for granted.
For instance, while US President Donald Trump is on record that he would bring Greenland under US administrative control even by using force against any opposition, if necessary, the EU Commission President was forthright that the EU stood for Greenland’s continued sovereignty and independence.
In fact at the time of writing, small military contingents from France, Germany, Sweden, Norway and the Netherlands are reportedly already in Greenland’s capital of Nook for what are described as limited reconnaissance operations. Such moves acquire added importance in view of a further comment by von der Leyen to the effect that the EU would be acting ‘in full solidarity with Greenland and Denmark’; the latter being the current governing entity of Greenland.
It is also of note that the EU Commission President went on to say that the ‘EU has an unwavering commitment to UK’s independence.’ The immediate backdrop to this observation was a UK decision to hand over administrative control over the strategically important Indian Ocean island of Diego Garcia to Mauritius in the face of opposition by the Trump administration. That is, European unity in the face of present controversial moves by the US with regard to Greenland and other matters of contention is an unshakable ‘given’.
It is probably the fact that some prominent EU members, who also hold membership of NATO, are firmly behind the EU in its current stand-offs with the US that is prompting the view that the Post-World War Two order is beginning to unravel. This is, however, a matter for the future. It will be in the interests of the contending quarters concerned and probably the world to ensure that the present tensions do not degenerate into an armed confrontation which would have implications for world peace.
However, it is quite some time since the Post-World War Two order began to face challenges. Observers need to take their minds back to the Balkan crisis and the subsequent US invasions of Afghanistan and Iraq in the immediate Post-Cold War years, for example, to trace the basic historic contours of how the challenges emerged. In the above developments the seeds of global ‘disorder’ were sown.
Such ‘disorder’ was further aggravated by the Russian invasion of Ukraine four years ago. Now it may seem that the world is reaping the proverbial whirlwind. It is relevant to also note that the EU Commission President was on record as pledging to extend material and financial support to Ukraine in its travails.
Currently, the international law and order situation is such that sections of the world cannot be faulted for seeing the Post World War Two international order as relentlessly unraveling, as it were. It will be in the interests of all concerned for negotiated solutions to be found to these global tangles. In fact von der Leyen has committed the EU to finding diplomatic solutions to the issues at hand, including the US-inspired tariff-related squabbles.
Given the apparent helplessness of the UN system, a pre-World War Two situation seems to be unfolding, with those states wielding the most armed might trying to mould international power relations in their favour. In the lead-up to the Second World War, the Hitlerian regime in Germany invaded unopposed one Eastern European country after another as the League of Nations stood idly by. World War Two was the result of the Allied Powers finally jerking themselves out of their complacency and taking on Germany and its allies in a full-blown world war.
However, unlike in the late thirties of the last century, the seeming number one aggressor, which is the US this time around, is not going unchallenged. The EU which has within its fold the foremost of Western democracies has done well to indicate to the US that its power games in Europe are not going unmonitored and unchecked. If the US’ designs to take control of Greenland and Denmark, for instance, are not defeated the world could very well be having on its hands, sooner rather than later, a pre-World War Two type situation.
Ironically, it is the ‘World’s Mightiest Democracy’ which is today allowing itself to be seen as the prime aggressor in the present round of global tensions. In the current confrontations, democratic opinion the world over is obliged to back the EU, since it has emerged as the principal opponent of the US, which is allowing itself to be seen as a fascist power.
Hopefully sane counsel would prevail among the chief antagonists in the present standoff growing, once again, out of uncontainable territorial ambitions. The EU is obliged to lead from the front in resolving the current crisis by diplomatic means since a region-wide armed conflict, for instance, could lead to unbearable ill-consequences for the world.
It does not follow that the UN has no role to play currently. Given the existing power realities within the UN Security Council, the UN cannot be faulted for coming to be seen as helpless in the face of the present tensions. However, it will need to continue with and build on its worldwide development activities since the global South in particular needs them very badly.
The UN needs to strive in the latter directions more than ever before since multi-billionaires are now in the seats of power in the principle state of the global North, the US. As the charity Oxfam has pointed out, such financially all-powerful persons and allied institutions are multiplying virtually incalculably. It follows from these realities that the poor of the world would suffer continuous neglect. The UN would need to redouble its efforts to help these needy sections before widespread poverty leads to hemispheric discontent.
Features
Brighten up your skin …
Hi! This week I’ve come up with tips to brighten up your skin.
* Turmeric and Yoghurt Face Pack:
You will need 01 teaspoon of turmeric powder and 02 tablespoons of fresh yoghurt.
Mix the turmeric and yoghurt into a smooth paste and apply evenly on clean skin. Leave it for 15–20 minutes and then rinse with lukewarm water
Benefits:
Reduces pigmentation, brightens dull skin and fights acne-causing bacteria.
* Lemon and Honey Glow Pack:
Mix 01teaspoon lemon juice and 01 tablespoon honey and apply it gently to the face. Leave for 10–15 minutes and then wash off with cool water.
Benefits:
Lightens dark spots, improves skin tone and deeply moisturises. By the way, use only 01–02 times a week and avoid sun exposure after use.
* Aloe Vera Gel Treatment:
All you need is fresh aloe vera gel which you can extract from an aloe leaf. Apply a thin layer, before bedtime, leave it overnight, and then wash face in the morning.
Benefits:
Repairs damaged skin, lightens pigmentation and adds natural glow.
* Rice Flour and Milk Scrub:
You will need 01 tablespoon rice flour and 02 tablespoons fresh milk.
Mix the rice flour and milk into a thick paste and then massage gently in circular motions. Leave for 10 minutes and then rinse with water.
Benefits:
Removes dead skin cells, improves complexion, and smoothens skin.
* Tomato Pulp Mask:
Apply the tomato pulp directly, leave for 15 minutes, and then rinse with cool water
Benefits:
Controls excess oil, reduces tan, and brightens skin naturally.
Features
Shooting for the stars …
That’s precisely what 25-year-old Hansana Balasuriya has in mind – shooting for the stars – when she was selected to represent Sri Lanka on the international stage at Miss Intercontinental 2025, in Sahl Hasheesh, Egypt.
The grand finale is next Thursday, 29th January, and Hansana is all geared up to make her presence felt in a big way.
Her journey is a testament to her fearless spirit and multifaceted talents … yes, her life is a whirlwind of passion, purpose, and pageantry.
Raised in a family of water babies (Director of The Deep End and Glory Swim Shop), Hansana’s love affair with swimming began in childhood and then she branched out to master the “art of 8 limbs” as a Muay Thai fighter, nailed Karate and Kickboxing (3-time black belt holder), and even threw herself into athletics (literally!), especially throwing events, and netball, as well.
A proud Bishop’s College alumna, Hansana’s leadership skills also shone bright as Senior Choir Leader.
She earned a BA (Hons) in Business Administration from Esoft Metropolitan University, and then the world became her playground.
Before long, modelling and pageantry also came into her scene.
She says she took to part-time modelling, as a hobby, and that led to pageants, grabbing 2nd Runner-up titles at Miss Nature Queen and Miss World Sri Lanka 2025.
When she’s not ruling the stage, or pool, Hansana’s belting tunes with Soul Sounds, Sri Lanka’s largest female ensemble.
What’s more, her artistry extends to drawing, and she loves hitting the open road for long drives, she says.
This water warrior is also on a mission – as Founder of Wave of Safety,
Hansana happens to be the youngest Executive Committee Member of the Sri Lanka Aquatic Sports Union (SLASU) and, as founder of Wave of Safety, she’s spreading water safety awareness and saving lives.
Today is Hansana’s ninth day in Egypt and the itinerary for today, says National Director for Sri Lanka, Brian Kerkoven, is ‘Jeep Safari and Sunset at the Desert.’
And … the all-important day at Miss Intercontinental 2025 is next Thursday, 29th January.
Well, good luck to Hansana.
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