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The increase in the number of measles cases in Israel began in March, but three months ago it seemed that the numbers were a little higher than usual. The local health facility is of the opinion that the country is currently experiencing a serious epidemic of one of the most infectious diseases in the world, which resulted in the death of an 18-month-old child last week.
The local situation is linked to a sharp simultaneous increase in the incidence of measles in Europe, but in this case, the disease can spread into "pockets" of unvaccinated people in some cities and neighborhoods.
What is measles?
Measles is caused by a virus of the morbillivirus family, and it only affects humans and not animals, unlike many other infectious diseases. Even though an effective vaccine has existed since the 1960s, measles is still common and is one of the most contagious diseases, with a risk of infection of 90% in unvaccinated people. The virus is very contagious because it can survive long in the open air: when a person with the disease coughs, sneezes or speaks, infected droplets are sprayed in the air, then inhaled by other people. After infection, the virus attacks the immune system. The incubation usually lasts between eight and 12 days before the onset of symptoms.
What are the symptoms?
Signs and symptoms include high fever, runny nose, cough, red eyes and sensitivity to light. Four to five days after the onset of these symptoms (which are common to many ailments), a dark red rash appears on the skin. It usually begins with the neck and spreads to the face, body and extremities.
The rashes begin as individual spots, but these often converge to a rash that covers large areas of the body. The third day after its appearance, the rash begins to fade and to look like small dense flowers of the scille. Hatzav in Hebrew, why the Hebrew name for the disease is Hatzevet. At this point, the patient will generally start to feel better, although the course of the disease varies in some cases.
What are the complications and risks?
In addition to being extremely contagious, measles is dangerous because it has no cure. The disease can damage the respiratory and nervous systems. A third of those affected will develop a middle ear infection, diarrhea or inflammation of the cornea. A rare complication, which can occur up to 10 years after infection, is a degenerative brain disease that causes serious and irreversible damage to the central nervous system, including a deterioration of mental status and seizures. . One in 1,000 cases of measles is fatal.
Why is there an epidemic now?
Measles is transmitted only by humans and, as there is an effective vaccine to prevent it, the epidemic is due to humans. However, if the vaccination rate of a population decreases, the collective immunity offered to all persons vaccinated by unvaccinated persons – called "collective immunity" – is undermined. Larger fractions of the population are then exposed to the disease and the risk of outbreak increases.
The source of the current epidemic in Israel is attributed to last year's epidemics in various European countries that have also seen a decline in inoculation rates – countries frequently frequented by Israelis, such as Italy, England, Ukraine and Romania. Since then, the number of European cases has reached 40,000, and more than 40 people have died.
But the situation did not happen here because an unvaccinated person was infected abroad and brought the disease home. The overall rate of measles inoculation in Israel exceeds 95% – but there are some densely populated communities and neighborhoods with much lower vaccination rates. According to the Ministry of Health, in some areas of Jerusalem, for example, the vaccination rate is only 55%. As a result, the number of measles cases nationwide has increased: from 40 cases in 2017 to 1,334 cases so far this year.
Is this the first time that Israel is facing such a resurgence of measles cases?
In the 1950s, before the introduction of a vaccine, thousands of cases were reported each year. Since 1967, when inoculation became an integral part of the Ministry of Health protocol, the number of cases has steadily dropped to a few dozen per year. Yet there have been other outbreaks. In 2003, for example, 60 young Israelis caught measles in less than two weeks and one of them died. The last big outbreak occurred in 2008: in a few months, 1,452 cases were reported among unvaccinated people, most of them in the Jerusalem area.
What is the effectiveness of the measles vaccine?
Like other vaccines, the measles vaccine has two goals: to protect the person against infection, to prevent the spread of the disease and to protect at-risk populations that can not be vaccinated for medical reasons. Both vaccine doses included in the protocol provide 97% protection against the disease. The bite is administered at the age of one year and again at the age of 6 years, as part of a quadruple vaccine that covers rubella (German measles), mumps and chickenpox .
What does the Ministry of Health do when a case of measles is discovered?
In recent months, the health facility has monitored all cases of infection, whether the patient was discovered during a robbery, in a hospital, at school or elsewhere. Once 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 actually present. At the same time, medical teams are trying to locate all who have come in contact with the person and determine if he has been vaccinated and what is the state of his immune system. In many cases, doctors from the Ministry of Health or the hospital will summon those exposed to preventive treatment, that is to say they will be vaccinated.
The race to identify each case has become more intense as the disease spreads. The doctors in Jerusalem, where so many cases of measles have been recorded, are struggling to keep up with the pace of patient identification and treatment. The Ministry of Health is focusing its efforts on increasing the vaccination rate in ultra-Orthodox neighborhoods by extending reception hours in Tipat Halav baby clinics. A car belonging to Natali's health service also went around to facilitate access to the vaccines.
What other measures are taken?
The Ministry of Health has banned unvaccinated persons from hospital departments considered particularly sensitive, such as neonatal units, intensive care units, oncology, hemato-oncology, and so on. In addition, the Ministry plans to ban unvaccinated children schools and checks inoculation now given to children at one year can be routinely administered at 9 months.
If an unvaccinated person is exposed to measles, can anything be done to reduce the intensity?
Yes, but we must act immediately. Preventive primary care involves the administration of live virus vaccine within 72 hours of exposure, but a person who can not get the active vaccine can get a passive vaccine that will produce antibodies against the disease within six days.
When should you vaccinate or update your vaccinations?
The Ministry of Health uses adults who have never had measles and have never been vaccinated twice. The vaccine should be administered in two separate doses of at least four weeks. This recommendation does not apply to persons born before 1956.
The ministry also recommends parents who have received their first shot not to wait for the second dose until they reach school age, but to vaccinate the child immediately, until four weeks after the first dose. The ministry also advises people traveling abroad who have doubts about their immunity to be vaccinated before leaving Israel, even if it takes two weeks for the vaccine to take effect. If they travel with a baby aged 6 to 11 months, the child should receive the first shot before leaving.
People born in Israel between 1957 and 1977 are considered unvaccinated or only partly vaccinated, since during these years only one vaccine was administered and not everyone received it. These people are advised to get vaccinated now.
Who should not be vaccinated?
The Ministry of Health has stated that 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; someone who has a sensitivity to one of the components of the vaccine; and people whose immune systems are seriously compromised.
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