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The increase in the number of cases of measles in Israel began in March, but it seemed that the figures were just a bit higher than usual. One of the most serious infections in the world is one of the world's most infectious diseases – one that led to the death of an 18-month-old child last week.
The local situation is related to a competitor, but it is important to take a closer look at the incidence of measles in Europe.
What is measles?
Measles is caused by a virus from the morbillivirus family, and it affects only humans and animals, unlike many other infectious diseases. Although it is effective against the background of the 1960s, measles is still common and it is one of the most contagious diseases of all, with a 90-percent risk of infection among unvaccinated people. The virus is highly infectious because it can survive long time in the air: When someone with the disease coughs, sneezes or talks, infected droplets are sprayed into the air, which are then inhaled by other people. After infection, the virus attacks the immune system; it usually incubates for a period of between eight to twelve days before symptoms occur.
What are the symptoms?
Signs and symptoms include high fever, runny nose, coughing, red eyes and sensitivity to light. Four days after the appearance of these symptoms, a dark red rash appears on the skin. It starts on the neck and spreads to the face, the body and the extremities.
The rash begins as individual spots, but these often converge into a rash that covers large areas of the body. On the third day after it appears, the rash starts to fade and begins to look like the small, dense flowers of the squill plant – hatzav in Hebrew, which is why the disease is Hebrew name is hatzevet. At this point the patient will have a better understanding of the disease.
What are the complications and risks?
Aside from being extremely contagious, measles is dangerous because there is no remedy for it. The illness can damage the respiratory and nervous systems. One-third of patients will develop middle-ear infections, diarrhea or cornea inflammation. A rare complication, which can emerge up to 10 years after infection, is a degenerative brain condition that causes severe and irreversible damage to the central nervous system, including mental deterioration and seizures. One in 1,000 cases of measles is fatal.
Why is there an outbreak now?
Measles is pbaded on only among human beings and there is an effective vaccine to prevent it, the outbreak is only man-made. If the immunization rate in a population drops, however, the collective immunity provided by the vaccinated people – known as "herd immunity" – is undermined. Larger parts of the population are then exposed to the disease and the risk of a flare-up increases.
The source of the current outbreak in Israel has been attributed to European countries which have also seen a drop in inoculation rates – countries that Israelis often visit, like Italy, England, Ukraine and Romania. Since then the number of Europeans has dropped to 40,000, and more than 40 people have died.
But the situation did not arise because of some unvaccinated person. The overall measles-inoculation rate in Israel surpbades 95 percent – but there are a few densely populated communities and neighborhoods with much lower vaccination rates. According to the Ministry of Health, in some Jerusalem neighborhoods, for instance, the vaccination rate is only 55 percent. As a result, there is an uptick in the number of cases of measles in the country as a whole: from 40 cases in all of 2017 to 1,334 cases so far this year.
Is this the first time Israel is facing such a surge in cases of measles?
In the 1950s, there was a vaccine, there were thousands of cases annually. Since 1967, when the inoculation became part of the Health Ministry's protocol, there has been a decline in the number of cases to a few dozen a year. Still, there have been other outbreaks. In 2003, for example, 60 Israeli youngsters contracted measles within two weeks, and one of them died. The last large flare-up was in 2008, when there were 1,452 cases reported among unvaccinated people, most of them in the Jerusalem area.
How effective is the measles vaccine?
Like other vaccines, the measles vaccine has been used to protect the population, and to prevent the spread of the disease and protect people at risk who can not be vaccinated for medical reasons. The two doses of the vaccine that are part of the protocol offer 97 percent protection from the disease. The shot is administered at the age of one year and again at age 6, as part of a quadruple vaccine that covers rubella (German measles), mumps and chicken pox.
What does the Health Ministry do when the measles case is discovered?
In the case of infection, whether the patient is discovered on a flight, in a hospital, at school or elsewhere. Once the symptoms appear and a case of the disease is suspected, a sample of the patient's blood is sent to a laboratory to determine if measles is indeed present; at the same time, medical teams that are likely to be in contact with one another and who have been vaccinated and In many cases, Health Ministry or Hospital Doctors Summon Those Exposed for Preventive Treatment, i.e., to be inoculated.
The race to identify each case has become more intense as the disease spreads. Doctors in Jerusalem, where so many instances of measles have been recorded, are finding it difficult to keep pace with the identification and treatment of patients. The Health Ministry is focusing its efforts on raising immunization rates in ultra-orthodox neighborhoods by extending Tipat Halav well-baby clinics. A caregiver has also made the rounds to allow easier access to vaccinations.
What other steps are being taken?
The Health Ministry has banned unvaccinated people from hospital departments that are considered particularly sensitive, such as neonatal units, intensive care, oncology, hemato-oncology, and so on. In addition, the ministry is considering banning unvaccinated children from schools, and is in the process of being informed that it can be routinely administered at 9 months.
If someone is exposed to measles, can anything be done to their intensity?
Yes, but one must act immediately. One of the most important vaccines in the life of the virus is to vaccinate the patient within 72 hours of exposure, but someone who can not get the vaccine can get a positive result.
When should one be vaccinated or update his vaccinations?
The Health Ministry is calling on adults who have never had measles and have had two shots of the vaccine to get vaccinated. The vaccine must be given in two doses of at least four weeks apart. This recommendation does not apply to those born before 1956.
The ministry is also advising parents to approach the second dose until they reach school age, but to have the child inoculated immediately, as long as the first dose. The ministry is also advising that they should not be immune to immunity, but they should take full advantage of the vaccine. If they are traveling with a baby between 6 and 11 months of age, the child should receive the first shot before leaving.
People born in Israel between 1957 and 1977 are considered to be unvaccinated or only partially vaccinated, since those who have been vaccinated have been vaccinated. Such people are advised to get inoculated now.
Who should not be vaccinated?
The Health Ministry says the following people should not be vaccinated: Pregnant women; a person with a high fever; a person who has had an allergic reaction to a previous vaccine; who has a sensitivity to one of the components of the vaccine; and people whose immune systems are seriously compromised.
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