Thu, Apr 12, 2018 - Page 8 News List

Measles prevention can improve

By King Chwan-Chuen 金傳春

There have been four cases of measles in Taiwan since the middle of last month. The index case was a patient who visited Thailand between March 1 and March 4. After he returned from the trip, he started to experience symptoms, such as a high fever and coughing, on March 14, and went to see a doctor on the following two days.

On March 17, the patient flew to Okinawa. He developed a rash two days later and went to see a local doctor. The laboratory results confirmed that he had measles.

One of the patient’s colleagues, who lives in Taoyuan, was infected on March 16 and became the second measles case.

During this time, the index patient had been commuting by train between New Taipei City’s Sijhih District (汐止) and Taipei Railway Station, as well as to Taiwan Taoyuan International Airport for the trip to Okinawa.

A third and fourth measles case subsequently emerged; both were flight attendants living in Taipei.

As the measles virus is highly communicable and these cases cover three neighboring cities, it is important to closely monitor any possible cases that might emerge in other counties and cities.

Before measles vaccinations were implemented in Taiwan, measles epidemics usually occurred in spring, every two or three years. During this time, if the accumulated number of susceptible people — those who were not immune as they did not have the protective antibodies — increased, a measles epidemic would break out.

Person-to-person transmission among children going to the same doctor was frequent, and epidemics would spread from the two metropolitan areas of Taipei and Kaohsiung to other counties and cities, about one station further down the line along the train route each week.

Now that people in Taiwan often travel between cities by high-speed rail or airplanes, measles will spread even faster.

The four new confirmed measles cases are all in their 30s. This is something that the Centers for Disease Control and local public health agencies should pay attention to.

The government implemented a vaccination policy starting in 1978, administering one shot of measles vaccine to infants between nine and 15 months old. In 1988, this was changed to one shot for 12-month-old infants.

However, after a large-scale outbreak of measles in 1989, the policy changed again in 1992 and required that nine-month-old infants receive one shot of measles vaccine and then a measles, mumps and rubella (MMR) combination vaccine when they reach 15 months.

Starting from January 2006, the single shot measles vaccination was discontinued and was replaced by one dose of MMR vaccination administered to infants between 12 and 15 months old.

In 2009, the policy was changed again to administering one MMR vaccination to infants who were 12 months old, while a second shot was added in 2012 to every child upon enrolling in elementary school.

It is evident that the herd immunity to measles between 1978 and 1992 — i.e. for people between the ages of 26 and 40 — was not enough to protect people well.

This corresponds with the ages of the current four measles patients, who are all in their 30s.

Therefore, any person within this age range who suffers from “3C” syndrome — coughing, coryza and conjunctivitis — in combination with a fever, should wear a mask and immediately seek medical care. After that, they should stay home for voluntary health management to minimize transmission to others.

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