As in the Kaliningrad region in 2018 measles penetrated, but no one noticed it. Project "Doctors' affairs".
When in 2002, Russia joined the World Health Organization's program for the elimination of measles, that is, to eliminate it completely, it was planned to eliminate the disease in the country by 2010. However, by this time the situation with the incidence of measles began to worsen in Europe, the virus continued to penetrate into Russia and into adjacent territories. As a result, in our country, a complete victory over measles was postponed to 2015. It was planned that by this time, measles vaccination coverage would reach 95%. According to official figures, it happened. However, epidemiologists in a number of scientific articles raise the question of the reliability of these data: measles also made itself felt in the period of struggle with it, and after the “end” of the eradication of the disease.
If you open the website of the regional department of Rospotrebnadzor, then almost certainly one of the top, that is, the most recent and important messages, there will be information about the spread of measles among the population of Ukraine, Western and Eastern Europe. The Kaliningrad region itself, at least since 2013, is a territory free from this disease. However, the high mobility of the population and significant migration growth make the introduction of the virus onto the territory of the region very likely. At the beginning of 2018 in the Kaliningrad region – for the first time in years of calm – two cases of measles were detected.
The “Doctors' Affairs” project talked with the head of the health department of the regional ministry of health, Oksana Cherenkova, about the risks that people in the region are experiencing due to the tense situation with measles in Europe, about collective immunity and why additional measles vaccination in adulthood justifies itself.
Protection for state employees
In the City Clinic number 2 on the day before the start of the school year was not crowded. The morning flow of patients subsided, so a couple of people were waiting for their turn to the treatment room around noon. Among them is a young woman, a nurse. She had to be vaccinated against measles. Before the FIFA World Cup, all medical and some educational organizations in Kaliningrad were monitored for serological monitoring: they used a special analysis to determine whether antibodies to this infection were present in human blood. If the level of antibodies was below the protective threshold, such a medic or teacher was recommended to be vaccinated.
The same recommendations are received by all adults if they are engaged in work, the implementation of which is associated with a high risk of infectious diseases and requires mandatory preventive vaccinations. The list of such works was approved by a resolution of the government of the Russian Federation. It includes, among others, those who work in educational organizations whose activities are related to sewage, agriculture, and also potentially face contact with people who already have infectious diseases.
As Oksana Cherenkova says, the flu vaccine for adults and children comes to the Kaliningrad region at the expense of the federal budget. Protection against measles, like rubella, viral hepatitis B, diphtheria, tetanus and influenza, is provided to all residents of Russia as part of the national preventive vaccination calendar. Vaccines against these preventable infections usually enter the region in several stages. This means that at any time a person connected with one of the listed professions can apply to his clinic and receive a vaccine in the absence of contraindications.
“In any university and school, as well as in other organizations related to the work included in the government decree, the teacher must have a sanitary book. The functional duty to keep track of what is written there and how is assigned to the head of the institution. It is clear that he appoints the person in charge, but the full responsibility is on the manager. But if for some reason a person is not offered a vaccination, they are not interested in this issue, then you should come to the clinic at the place of attachment and find out what he has against this or that infection, in this case against measles. If there is information about double vaccination, then you can get a certificate of the availability of such vaccinations, ”says Oksana Cherenkova.
On the question of whether such a vaccine guarantees a real immunity, the head of the health department of the regional Ministry of Health specifies that in any case, it strongly recommends revaccination: “I recommended to get revaccination in case of a single measles vaccine.”
In 2018, people at risk from the region were tested for susceptibility to measles. The necessary anti-epidemic measures were carried out on the territory of the region. This was due to the fact that at the beginning of the year in one of the villages of the Guryev urban district, the disease was diagnosed in two children. The virus arrived along with the diseased from the regions of the North Caucasus. One child infected another. According to the regional Ministry of Health, both were not vaccinated.
“This was neither an epidemic nor an outbreak of the disease. I believe that thanks to the joint work of the ministry, the Rospotrebnadzor and the titanic work of the medical organization itself, on whose territory this case was registered, the incidence did not go further.
Earlier this year, in Guryevsk, measles was detected in two children. The virus arrived along with the diseased from the regions of the North Caucasus.
Vaccination in our time is the only way to prevent measles. In this case, the danger is that measles is a very contagious (contagious – Ed.) Disease, and if we get an outbreak, then measles doesn't matter if the child or adult is in front of it, and if these adults and children are not vaccinated then go snowball. An outbreak of measles, not necessarily this one, is any, due to the absence of fear, to the fact that people have a feeling that they live well, without epidemics, and they don’t need protection. After identifying two cases of measles, we went around the whole village in a circle and, according to the results, instilled a third of the residents – more than 300 people. People stood in line, even on cars, to get a vaccine: everyone understood the possible consequences, no one thought at that moment: whether I wanted or didn’t want to be vaccinated, ”Oksana Cherenkova recalls.
Words about titanic work can hardly be called exaggeration. From the point of view of society, its main result is the absence of an increase in the number of cases. For comparison: in 2016, two children who had contracted measles from an unknown source led to the spread of the disease among nearly 20 children and 40 adults in Yekaterinburg. An investigation into the causes of measles outbreaks led doctors to conclude that in some cases, doctors incorrectly determined the diagnosis of patients. As a result, the child with measles fell into the general hospital "with ARVI." And then the virus was transmitted by airborne droplets to other patients in the hospital and even to medical personnel. To stop the epidemic, specialists had to vaccinate more than 4.5 thousand people in Yekaterinburg.
Investigation of this situation led epidemiologists to the conclusion that during the years of “quiet life” even doctors lost their suspicion about measles. This was expressed in the fact that the disease was not immediately recognized "by sight", and by the fact that children often began to be given unjustified medical withdrawals from vaccination for a sufficiently long period.
During the years of “quiet life,” even doctors lost their suspicion for measles.
On the other hand, the rapid spread of the disease in one group is explained by the concentration of children, in principle, not vaccinated against measles. Indeed, among the sick children without vaccinations was the majority. But among adults there were those who received one vaccine, and those who had already undergone revaccination. The largest gap between the last vaccine and the disease in the Urals was 28 years.
“People in Europe and in our country began to refuse vaccination, because it seems to them that there is no infection around, so they began to forget about this problem. We can say that now we have begun to re-discover what measles is, ”says Oksana Cherenkova.
In the presence of the head of the health department, I raise the question of several stories that have become known to me from third parties. All concern vaccination against measles and how adult workers from the public sector try to avoid it, fearing above all “terrible side effects”. But the doctor always first of all asks if these people are thinking about the fact that they can get sick and infect their loved ones.
“People often confuse a vaccination reaction with a post-vaccination complication and take the reaction for a complication. Vaccine reactions can be both local and general. Local – this is some kind of redness, compaction at the injection site, but not affecting the general well-being of a person. The overall reaction can be expressed through an increase in temperature, manifested by discomfort.
“People often confuse vaccination reactions with post-vaccination complications. Over the past 2 years, adults with such diagnoses have not been admitted to hospitals in the region. ”
This is a normal, non-pathological reaction to the vaccine. This suggests that the body produces antibodies.
Severe post-vaccination complications are another. Over the past 2 years, adults with such complications have not been admitted to hospitals in the Kaliningrad region. To say that the patient’s condition is caused by a post-vaccination complication, it is necessary to have evidence of a causal relationship. Even a strong reaction is not a complication, although an emergency notification will be filed to its Rospotrebnadzor. If, for example, there are several reports of strong reactions to a specific series or a specific vaccine, then this batch is withdrawn.
Oksana Cherenkova recalls that the worst thing for an adult and a child is complications of measles itself: pneumonia, meningitis, meningoencephalitis, which can lead to the most serious consequences, even death.
In the most primitive form, the interaction of a person with the measles virus can be described as follows (based on the materials of the popular video channel Kurzgesagt). The measles virus is quite tenacious, but it can not exist by itself. To share and reproduce itself, it requires a human host cell. Infection occurs only from another patient, and airborne, that is, through the nose, mouth or eyes. Moreover, with the personal contact of a sick person with an unvaccinated person, infection is almost inevitable.
The virus begins its destructive work in the lungs, where measles easily penetrates the body's first line of defense. They reprogram the protective macrophage cells attacking them and turn them into centers for the manufacture of the virus. When a cell is filled with viruses, they leave it and re-start the cycle.
At this stage, they are attacked by killer cells, which by their own rules quite effectively deal with cells infected with the infection.
It is necessary to come to the clinic at the place of attachment and find out what you generally have against this or that infection.
This struggle can last long enough for a person for 10 days not to notice signs of indisposition. However, the virus then penetrates dendritic cells, which have special mechanisms for recognizing enemy cells and can “train” other cells of the body to resist them. However, if such a cell is infected with a virus, its recognition program does not work, and it brings the virus to other immune cells.
When even more cells are infected, which should resist the disease, the process develops much faster. The lymphatic system spreads the virus everywhere and it enters the bloodstream. The virus infects the intestines, liver, spleen and lungs. Symptoms include nausea, very high fever, headaches and, of course, a rash. At this point, the person begins to cough up millions of measles viruses. And his own lungs, left completely without protection, can become an easy target for other viruses and bacteria that can cause new infectious diseases, such as pneumonia, the most common cause of death in measles. In some cases, the measles virus can make its way into the brain, and then the risk of death increases to 20–40%.
The immune system allows you to resist the disease for a long time, and due to the surviving dendritic cells, the body can trigger the biochemical control mechanism that finally defeats measles and develops immunity with one hundred percent reliability.
However, for more than a hundred years, mankind has been using exactly the vaccine to prevent this disease, which causes more than 100 thousand people to die each year. For a number of people it is unavailable for many reasons, including due to oncological diseases or individual intolerance to the components of the vaccine. They have nothing to rely on to protect against measles, except for collective immunity. Contributing to its creation are those who protect themselves first and foremost – with the help of preventive vaccinations.
Text: Maria Pustovaya
Photo: Julia Vlasova
The following literature and sources were used in the preparation of the article: 1. Semenenko, T. A., et al. Features of the manifestation of the measles epidemic process in Moscow in 1992–2014. 2. Scriabin SV and others. Outbreak of measles in the Sverdlovsk region in 2016. 3. Materials of the Kurzgesagt video project.