Measles a Tropical Disease?

As I practice medicine in Uganda, I find myself constantly flipping through my Oxford Tropical Medicine Handbook looking for clues on what a child has or best options for treatment of the disease. I have become decently versed in malaria, typhoid dysentery, helminths (worms) and several other infections known to be most common in the tropical world.

Today, however, I learned a new disease- measles. In my relatively short career in medicine, I have not come across a case of this once common infection. Near universal vaccinations have made measles all but disappear in the US. Vaccines ($19 lifetime cost) have reduced measles mortality by 75% since 2000. Additionally, Vitamin A supplementation in nutrition deficient areas is said to reduce mortality by an additional 50%. Vitamin A supplementation costs $1.25 and stays in the child's system for 6 months. Measles is both preventable and treatable.

However, 20 Million people a year still acquire the disease. 385 children die from measles a day. Most of these deaths occur in areas that are poor and the health system is broken or disjointed. In such places, vaccines are not given regularly and supportive care is not available to treat the complications of measles such as pneumonia to prevent death. Since most of these populations live near the equator, measles has become a tropical disease.

We went 8 months in our area about a year ago without any vaccines. Our refrigeration was not working, breaking the cold chain and causing us not to have vaccines for children. Two weeks ago, we had a child with a fever, congestion, facial rash and mucosal white spots in the mouth. Some pneumonic popped in my head from medical school days and I asked the nurse if it may be measles. She had seen many cases and concurred. So we isolated him, treated him, alerted the district and prayed there would be no other cases. Today I walked into the health center to find 7 cases of measles and diagnosed another.

Prayerfully, we have all of these children on adequate supportive care that will prevent death. This makes me thankful we are here. It also is a painful reminder of the massive discrepancy in healthcare between the western world and the majority world.

Location:Bundibugyo Uganda