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Letters to the Editor

Indian Pediatrics 2003; 40:374-375

In the Wake of Mutant Virus of Measles and Immunization Strategy  


Apropos Dr. Parthasarathy’s apt reply(1) to the points raised by Dr. Havaldar and Dr. Chorghade about measles immunization, I would like to add a new dimension to the discussion under two areas: (a) why measles virus behaves the way it did in the years 1997-2001, and (b) what lesson(s) we should learn from this mutant virus of measles.

The central point of discussion was the changed behavior of measles virus over the Indian scenario effectively brought out by Wairagkar et al(2). Curiously, certain missing links and factors were difficult to explain in this series: nonclustering of cases, absence of rash, no detectable exposure to measles and the incidence in the non-season of measles(2). For this, we shall have to take resort to the knowledge of changing environment – global in general and Indian in particular – since EI Nino tropical even subtropical catastrophic phenomenon affecting biological life in general is a recent decade old experience. This implies global warming, ultraviolet radiation, global water and its changing physical-chemical properties influencing its biological characteristics. My recent article(3) dwells on these aspects in detail. This also opens up further the emerging environmental science of morphogenesis or ‘the robotics of life’ implying certain changes in the phenotype and genotype of microbes in general - bacteria and viruses in particular - under the environ-mental degradation affecting biological life as a whole.

Timely described in the British Medical Journal(4), mutant virus is the buzz word. Such viruses are known for bizarre manifestations and behavior, not only clinical and epidemiological but also in terms of breaking the known geographic and seasonal boundaries, affliction of new host species and the changing host - pathogen relationship like renal affliction in measles(2). All this lies outside the domain of immunization success or failure whatever have you. We have numerous global examples: H5N1 avian flu HK, Ebola and Hanta viruses, the Hendra virus of pigs (Malaysia), even rabies following mongoose bite(5).

Dr. Parthasarathy(1) has rightly quoted from the Red Book 2000 of American Academy of Pediatrics, since updated in 2001, that developing countries should apply their own immunization strategy based on needs and circumstances; hence IAP’s recom-mendation of monovalent measles vaccine at 9 months of age followed by MMR first dose at age 12-15 months. Presuming that our immunization cover is uniform and drop out rates are not ‘worrisome’, what should be our strategy in view of the mutant virus of measles? This is additional burden on vaccine era. But immunologists, virologists and pediatricians have to rise to the occasion despite the cost. The debatable vital issue is whether this mutant virus has the possibility of natural death given the fact of non clustering(2) of cases.

Analogy between polio outbreaks and measles mutant virus cannot be stretched beyond a point since polio is an example of photoreactivation(6) under favourable circumstances for polio virus while measles mutation is under adverse environment. But both are according to the Darwinian principle of struggle for survival hence the analogy.

K.B. Kulkarni,
Sanjivani Nursing Home for Children,
Swami Vivekanand Marg,
Gwalior 474 001, M.P.,
India.
E-mail: kkulkarni8@hotmail.com

References

1. Parthasarathy A. Measles and MMR immunization: Reply. Indian Pediatr 2002; 39: 108-111.

2. Wairagkar SN, Shaikh NJ, Ratho RK, Ghosh D, Mahajan RC, Singhi S, et al. Isolation of measles virus from CSF of children with acute encephalopathy without rash. Indian Pediatr, 2001; 38: 589-595.

3. Kulkarni KB: Global water, EI Nino phenomenon and survival of microorganisms. Indian J Pract Pediatr 2001; 3: 99-100.

4. Havaldar PV. Emerging issues in Immunization. Indian Pediatrics 2001; 38: 106-107.

5. Kulkarni KB: Rabies following mongoose bite. Indian J Pract Pediatr 2001; 3: 103.

6. Pyatkin KD, Krivoshein YS: Influence of environmental factors on microbes. In: Microbiology with Virology & Immunology, 2nd edn. Ed. Pyatkin KD, Moscow, Mir Publishers 1980; pp 133-139.

 

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