Coping with disability can be really hard, especially if the affected person was not born with it, and that is exactly what befell Peter Nyankiko and his wife, Venantie Mukanziza, residents of Bibare Cell, Kimironko Sector in Gasabo District when they became blind at the age of eight.
Their condition did not only saddle them, but also brought with it stigma as their community was not very accepting of a disability that had come in suddenly.
“I started experiencing blurred vision when I joined P1 at the age of eight. My parents took me to a health facility where the doctors confirmed that I would not be able to see again because I had been attacked by measles,” says Nyankiko.
Born in 1980, Nyankiko says his parents were not familiar with immunisation and its importance, adding that at the time, there was not much effort from the concerned authorities to promote immunisation.
At first, Nyankiko isolated himself from his friends as he went through a lot of suffering and depression, but he did not drop out of school. By the time he completed primary school, he was coping fairly well with his new condition, thanks to Gatagara school for children with disabilities in the Southern Province.
Dr Raymond Awazi, a pediatrician at La Croix du Sud Hospital in Kigali, says measles is one of the most highly contagious infections and spreads through droplet contamination via airborne transmission (sneezing and coughing) as well as direct contact with an affected person.
He explains that people who have not been immunised against it risk blindness, among other complications, later in life.
“It’s possible to develop measles after several years if one misses out on immunisation at nine months. The infection may even lead to death if not diagnosed early enough,” he says.
Awazi emphasises that babies, particularly, should be immunised against measles because they are more prone to the infection.
What is measles?
According to Dr Francis Kazungu, a general practitioner in Kigali, measles is a viral infection that causes fever, malaise followed by skin eruptions.
He says the disease can cause infection of the middle ear (otitis media), throat and sound box, the eyes, and cause diarrhea and vomiting. At times the infection can even spread to the brain, causing infection and inflammation of brain substance, such as encephalitis.
Dr Kazungu notes that measles’ vaccine is usually given at nine months, and it provides protection against three viral diseases, namely, measles, mumps and rubella.
According to Dr Kazungu, the statistics from the United Nations Children’s Fund (UNICEF) indicated that 2,700 measles cases were recorded in 2000 in Rwanda, but they dropped to only 80 in 2002, and continue to reduce drastically annually due to government interventions.
To determine if one is suffering from measles, Dr Kazungu says they exhibit various signs and symptoms, for instance, rashes, redness of the skin and eyes, discharge from the eyes, rushes in the mouth, fever and coughing.
“Within two days the characteristic measles rash emerges. This red, itchy rash starts at the hairline on the scalp and later covers the entire body, including the palms of the hands and soles of the feet. The illness runs for about 10 days after the rash begins,” he explains.
Dr Kazungu says if one experiences one of these symptoms, seeking medication is recommended so that if found out to be measles they are immunised against it immediately to save their lives.
Who is at risk?
“Children under the age of five are at risk of developing measles if they were not immunised. Below nine months, they are still protected by their mothers’ antibodies which they get from breast milk, which means that babies who are breastfed have passive immunity for longer. Their immunity becomes weaker as they grow, putting them at risk of contacting bacteria and viruses,” says Awazi.
The condition could be even worse for those who are pregnant as it causes congenital hearing loss in a newborn when exposed to measles in utero (in the womb).
“A measles attack during pregnancy puts the mother at risk of miscarriage and preterm delivery. If one plans to become pregnant and has come in contact with somebody suffering from measles, it is advisable to take one shot of measles normal immunoglobulin and plan pregnancy one month later,” cautions Awazi.
He explains that if a pregnant woman is exposed to any potential risk for infection, including measles, it can lead to damage to the cranial nerve of the infant that manages hearing, the measles infection causes hearing loss that is sensory in nature and often cannot be reversed after birth.
Awazi says that those who have never been immunised before are also at higher risk of developing measles even in their adulthood.
Preventions and treatment
Dr Kazungu says that diagnosis is clinical based on the characteristic nature of symptoms and history of exposure.
“The risk for complications from measles is high, primarily because the measles viruses use the immune system to distribute themselves, which compromises the immune response, lowering resistance to infection from other pathogens,” he says.
Dr Rachna Pande, a specialist in internal medicine, says prevention lies in immunisation, advising that if there is a case in the family the person with it should be isolated to minimise risk of spread of the infection.
“Anyone who has never been infected or immunised against measles is likely to develop the infection if he/she breathes in infected droplets or gets into physical contact with an infected person,” she says.
As there is no definite treatment for measles, Pande explains that drugs like paracetamol can be used to reduce fever.
“Rehydration, if one is dehydrated due to diarrhoea and vomiting, is recommended,” she says, noting that the disease subsides by itself in 2-3 weeks.
For the very basic prevention, she advises that covering the mouth and nose while coughing/sneezing is essential because the measles virus spreads through droplet infection and can easily spread to another person who may not have been immunised.
Pande also advises that immunisation against other killer diseases like polio, diphtheria, tetanus, tuberculosis, whooping cough, haemophilus influenza and hepatitis B is equally important, as well as adherence to vaccination timetables.
According to a report from the Ministry of Health, measles and rubella combined vaccine was introduced in routine immunisation in January 2014, which is administered at nine months, while measles vaccine stand-alone is given at 15 months as a booster dose.
The report indicates that immunisation coverage for measles and rubella combined vaccine is at 97 per cent nationwide.
WHAT VACCINES DO ADULTS NEED?
Vaccines for adults are recommended based on your age, prior vaccinations, health, lifestyle, occupation and travel destinations.
The schedule is updated every year, and changes range from the addition of a new vaccine to tweaks of current recommendations.
What factors might affect my vaccine recommendations?
Several factors can affect whether you need certain vaccines. Be sure to tell your doctor if you:
- Are planning to travel abroad
- Have had your spleen removed
- Work in certain occupations where exposures could occur
- Are or might be pregnant
- Are breast-feeding
- Are moderately or severely ill or have a chronic illness
- Have any severe allergies, including a serious allergic reaction to a previous dose of a vaccine
- Have had a disorder in which your body’s immune system attacks your nerves, such as Guillain-Barre syndrome
- Have a weakened immune system or are being treated with an immunosuppressant
- Have recently had another vaccine
- Have recently had a transfusion or received other blood products
- Have a personal or family history of seizures
Your doctor might also recommend certain vaccines based on your sexual activity. Vaccinations can protect you from hepatitis A and hepatitis B, serious liver infections that can spread through sexual contact. The HPV vaccine is recommended for men up to age 21 and women up to age 26.
Why are some vaccines particularly important for adults?
Adults of any age can benefit from vaccines. However, certain diseases, such as the flu, can be particularly serious for older adults or those living with certain chronic illnesses.
How can I keep track of my vaccines?
To gather information about your vaccination status, talk to your parents or other caregivers. Check with your doctor’s office, as well as any previous doctors’ offices, schools and employers. Some states also have registries that include adult immunisations.
If you can’t find your records, talk to your doctor. He or she might be able to do blood tests to see if you are immune to certain diseases that can be prevented by vaccines. You might need to get some vaccines again.
To stay on top of your vaccines, ask your doctor for an immunization record form. Bring the form with you to all of your doctor visits and ask your provider to sign and date the form for each vaccine you receive.
COMMON QUESTIONS ON VACCINATION
Childhood vaccines protect children from a variety of serious or potentially fatal diseases, including diphtheria, measles, polio and whooping cough (pertussis). If these diseases seem uncommon – or even unheard of – it’s usually because these vaccines are doing their job.
Still, you might wonder about the benefits and risks of childhood vaccines. Here are straight answers to common questions about childhood vaccines.
Is natural immunity better than vaccination?
A natural infection might provide better immunity than vaccination – but there are serious risks. For example, a natural chickenpox (varicella) infection could lead to pneumonia. A natural polio infection could cause permanent paralysis. A natural mumps infection could lead to deafness. A natural Haemophilus influenzae type b (Hib) infection could result in permanent brain damage. Vaccination can help prevent these diseases and their potentially serious complications.
Do vaccines cause autism?
Vaccines do not cause autism. Despite much controversy on the topic, researchers haven’t found a connection between autism and childhood vaccines. In fact, the original study that ignited the debate years ago has been retracted.
Are vaccine side effects dangerous?
Any vaccine can cause side effects. Usually, these side effects are minor – e.g low-grade fever, fussiness and soreness at the injection site. Some vaccines cause a temporary headache, fatigue or loss of appetite. Rarely, a child might experience a severe allergic reaction or a neurological side effect, such as a seizure.
Although these rare side effects are a concern, the risk of a vaccine causing serious harm or death is extremely small. The benefits of getting a vaccine are much greater than the possible side effects for almost all children.
Of course, vaccines aren’t given to children who have known allergies to specific vaccine components. Likewise, if your child develops a life-threatening reaction to a particular vaccine, further doses of that vaccine won’t be given.
Why are vaccines given so early?
The diseases that childhood vaccines are meant to prevent are most likely to occur when a child is very young and the risk of complications is greatest. That makes early vaccination – sometimes beginning shortly after birth – essential. If you postpone vaccines until a child is older, it might be too late.
Is it OK to pick and choose vaccines?
In general, skipping vaccines isn’t a good idea. This can leave your child vulnerable to potentially serious diseases that could otherwise be avoided. And consider this: For some children – including those who can’t receive certain vaccines for medical reasons – the only protection from vaccine-preventable diseases is the immunity of the people around them. If immunsation rates drop, vaccine-preventable diseases might once again become common threats.
If you have reservations about particular vaccines, discuss your concerns with your child’s doctor. If your child falls behind the standard vaccines schedule, ask the doctor about catch-up immunisations.