Outbreaks of measles are not exclusive to Brazil. In Europe, more than 41,000 people were infected with the virus in the first six months of this year, according to a warning from the World Health Organization on Monday.
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At least seven European countries already register more than a thousand cases the measles
in children and adults this year, as reported by the WHO. Among them are France, Georgia, Greece, Italy, Russia, Serbia and Ukraine.
In total, the number is larger, given the entire continent, than the balance recorded in the last years of this decade in 12 months. By that time, the largest number of cases had been established between 2010 and 2017 last year, when 23,927 infections were counted. The data also show that at least 37 people died this year as a result of the disease.
In Ukraine alone, more than 23,000 people were affected by the disease, accounting for more than half of all cases identified on the continent. Measles-related deaths were reported in all seven countries, with Serbia accounting for the highest number: 14 to date.
"We are seeing a dramatic increase in infections and long-term outbreaks," said WHO Regional Director for Europe Zsuzsanna Jakab. "We urge all countries to immediately implement comprehensive and context-sensitive measures to prevent further spread of this disease," he said, accepting the importance of measles immunization programs & # 39; s.
The organization has emphasized that the measles virus is exceptionally contagious and spreads easily among susceptible people. Guidelines for preventing outbreaks are to treat the vaccine at least 95% each year with two doses of the vaccine, with special efforts to identify children, adolescents and adults who have not been immunized in the past.
Status of measles in Brazil
Currently the country stands for two outbreaks of measles
, in Roraima and Amazonas, according to information from the Ministry of Health Until August 14, the date of the latest epidemiological bulletin, 910 cases of the disease were confirmed in Amazonas, of which 5.630 are still being investigated. In Roraima there were 296 registered cases and 101 are suspected.
The outbreaks are related to imports, since the genotype of the virus (D8) circulating in the country is the same as in Venezuela, which has been confronted with an outbreak of the disease since 2017.
Individual cases concerning imports were also identified in São Paulo (1), Rio de Janeiro (14); Rio Grande do Sul (13); Rondônia (1) and Pará (2). Vaccine blocking measures, even in suspicious cases, are carried out in all states.
To date, six deaths from measles have been confirmed, four in Roraima (three abroad and one in Brazilian) and two in Amazonas (Brazilians).
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Why did the measles return?
The condition, once a major cause of infant mortality and severe neurological consequences, is very contagious, because the transmission takes place directly from person to person by coughing, sneezing, speaking or breathing.
However, it is not fair to attribute all blame for the return of the disease to immigration, as indicated by Juarez Cunha, the second secretary of the Brazilian Immunity Company (SICM). The outbreak could have been fought with vaccine
, available for free on the public network.
"In addition to the situation in Venezuela, measles have had eruptions in Europe since 2016. With the drop in vaccine coverage and with diseases that have already been eliminated in the vicinity of Brazil, the risk of outbreaks is much greater," he said.
According to the ministry, the target of vaccination against measles, 95% of the target population, was not reached in the last years of the campaign. Preliminary data from last year indicate that coverage in Brazil was 85.21% in the first dose (triple viral) and 69.95% in the second dose (viral titer).
Part of the National Immunization Program of the Ministry of Health, two vaccines form protection against infections. The most common is the Viral Triple, which still protects against rubella and mumps. But the Unified Health System also offers Tetra Viral, which provides extra protection against chickenpox.
Renato Kfouri, chairman of the immunization department of the Brazilian Society of Pediatrics (SBP), although there is no accurate study indicating the cause of the return of the disease cases this year, the false sense of calm that population has had a strong cooperation since the elimination of virus circulation in order to reduce compliance with the protection.
"The disappearance of diseases discourages the demand for vaccines, which is determined by the number of reported cases of the disease.We know that people only seek prevention if they feel in danger.When this happens, the vaccines are successful, the disease eliminated and the perception of the risk ends, both for the general population and for health professionals ", Kfouri analyzes.
Other factors that may also have contributed to the low demand for immunization are the difficulty of having access to the doses. In addition to the lack of supply at many health clinics, the unit programs & # 39; s are not flexible. "For example, they do not serve working mothers, access is hampered, especially as the posts do not open on Saturdays," said the SBP specialist.
Cunha adds another view to the problem: the spread of false news, especially on social networks. "Any report of wrong news or an isolated case of adverse reactions to the vaccine, for example, puts the credibility of immunization at risk: people can not distinguish between the risks of the natural disease and the risk of the vaccine. So the whole positive side of immunization is threatened, "he says.
The orientation of the Ministry of Health, SBP and SBIm to combat the disease is to have the population vaccinated. Throughout the country, the National Vaccination Campaign against Measles and Poliomyelitis, which lasts until 31 August, will vaccinate all children between 1 and under 5 years of age, even those who have already received the doses.
Consult the list below for questions about which vaccine to take and who should receive the protection.
Yes, according to the Pan American Health Organization (PAHO), Brazil is experiencing an outbreak of the disease, concentrated in Roraima and Amazonas, but two cases have been confirmed in Rio de Janeiro, seven in Rio Grande do Sul, two in Mato Grosso and one in São Paulo. Paulo.
The most effective way to preserve the immune population is vaccination. Therefore, the goal of the Ministry of Health is to immunize 95% of the population from 12 months to 49 years.
Other measures that can be taken to prevent contamination are: • Always clean your hands before touching your eyes, mouth and nose before eating and avoid sneezing and coughing in your hands.
The circulation of the virus is usually greater in closed environments and clusters, which should be avoided by those who have not received the protection.
Is there more than one vaccine that protects against the disease? Are the two available on the public network?
Yes, if the routine of the national vaccination program is followed, children aged 12 months and younger than 5 years will receive one dose of the triple virus at 12 months and then another at 15 months of age of the viral tetanus. Both are available free of charge in health clinics.
Children aged 5 years to 9 years who missed the vaccination course will eventually receive two doses of the triple viral vaccine, with an interval of one to two months.
For those who have been vaccinated, the second SBIm secretary warns: "Until the year 2000, the vaccine was given to children aged 9 months, but the ideal is that the child is immunized after 12 months, that is, who before 1 year The old was protected, the vaccine should search in the public network because it is not considered properly immune.
Adults who do not remember or are not sure whether they have had measles must be vaccinated?
Even though they are aimed at children, adults and adolescents who have not received the vaccine can seek free protection in health clinics. "If the person has lost evidence of the vaccine and is not sure if he has taken it, it is ideal to seek immunization, and it is no problem to take more doses if the administration has already been performed," said Juarez.
For adolescents and adults up to 49 years old there are two recommendations, according to the Ministry of Health: people aged 10-29 years old should receive two doses of the triple virus, while people from 30 to 49 years old should receive only one dose of the triple virus. receive.
Who is older than 50 years can use the vaccine?
According to the Ministry of Health, it is not necessary to call for protection, even if someone older than 50 does not know for sure whether or not he has used vaccination.
"It is clear that in the childhood of these people, because they had no vaccine, they are likely to have the disease, so you do not have to receive the dose, but the SBIm recommends immunization because it is not possible to to be sure whether the individual had the condition or not, "says Cunha.
Who has already been vaccinated, should be strengthened?
No. According to the Ministry of Health, the person who proves vaccination against measles as recommended for his age group does not have to receive the vaccine again.
Not too. Persons with a history of measles, mumps and rubella are considered to have been immunized against disease, but the diagnosis is correct. When in doubt, it is better to vaccinate.
"It's simply not going to take the vaccine if you're sure that you've been vaccinated or have had the disease, and that certainty is proven by the voucher in the vaccination report or by tests that prove the measles, and if the person does not have it, you can better to be immunized, just the story that you had the disease or received the vaccine is not worth it, "said the SBI specialist.
Are babies & # 39; s risk of the disease?
Babies from mothers who have been vaccinated have already been born with the antibodies needed to protect against measles, so the vaccine is not needed. In exceptional cases of outbreaks, however, there is an indication for the immunization of infants aged six months. At the moment this measure is not necessary.
Can pregnant women be vaccinated?
No. The recommendation of the Ministry of Health is that pregnant women must wait to be vaccinated after delivery.
For those who are planning to become pregnant, it is ideal to ensure that they are protected. In these cases a blood test can show whether the person is already immune to the disease. If not, the vaccine can be taken one month before the pregnancy.
Are there any contraindications for the vaccine?
"Because it is a weakened vaccine with a weakened life, immunodepressant viruses should not receive the doses", Cunha advises.
Immunocompromised persons with impaired immunity means disease or medication, such as people with cancer who receive chemotherapy or who live with the HIV virus.
What precautions should I take after vaccination?
According to SBIm, any serious or unexpected symptom should be reported to the department administering the dose after immunization. In case of fever, protection should be postponed until the improvement of the individual occurs.
"Cold compresses relieve the reaction at the site of use.The symptoms of severe or persistent side effects, which last more than 24 to 72 hours (depending on the symptom), have to be investigated for other causes," he adds.
What is measles?
Measles is a contagious, viral, serious, transmissible and extremely contagious infectious disease. Infectious complications contribute to the severity of the condition, especially in malnourished children and younger than 1 year.
Symptoms are high fever above 38.5 ° C; skin rash; cough; running nose; conjunctivitis; and white spots that appear on the oral mucosa, known as Koplik signs, and which date one day before the start of the rash.
Transmission of the virus takes place four to six days before and up to four days after the start of the rash. The period of greatest transferability occurs two days before and two days after the start of the result.
There is no specific treatment for who gets the infection. The guideline is that the person receives the vitamin A administration to reduce the occurrence of serious and fatal cases. Prophylactic antibiotic treatment is contraindicated, according to the Ministry of Health.
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For the uncomplicated cases, the goal is to maintain hydration, nutritional support and reduce hyperthermia. Many children need four to eight weeks to regain their nutritional status the measles
. Complications such as diarrhea, pneumonia and otitis media must be treated according to the standards and procedures established by the pulp.