Letters to the Editor

Indian Pediatrics 2002; 39:210-211  

Measles without Rash and Encephalopathy: More Information is the Need of the Hour

It is a matter of utmost concern that epidemics of unexplained encephalopathy that is rapidly fatal is likely to be due to measles virus(1). The Siliguri epidemic which killed more than 20 people in the year 2001 including doctors and nurses also is being attributed to a mutant strain of measles virus with a predilection for affecting brain and kidneys without producing rash(2).

Few observations made in the study need to be viewed seriously. Some of the affected children did not have IgG antibodies in the serum suggesting either lack of immunization or no previous infection. Could it be also due to waning off of the protective antibodies over time making these children partially immune with a varied clinical presentation after reinfection? Epidemics in adults observed at Siliguri also could be due to reduced levels of protective antibodies. It is obvious however that this virus causing encephalopathy is definitely affecting those who are not seroprotected. It is then justified to administer pulse measles vaccination to children once the cases are reported during an epidemic. Testing of CSF for IgM antimeasles antibodies should be a routine in evaluation of any patient with sudden onset encephalopathy and if found positive such cases should be immediately notified to the local health authorities. This is vital considering very rapid deterioration and fatality within few days.

There were no clustering of cases and no definite contacts were traced during the epidemics. This prompts us to also attribute another common factor that might be responsible for precipitating the encephalo-pathy in a measles infected individual (like Reye’s Syndrome). Could that common factor be a drug like antipyretic? I feel, studies to identify epidemiological linkage to any drug intake merit a trial.

Follow up studies should be carried out in survivors of this illness for determining persistence of measles antibody in CSF and for the appearance of protective IgG antibodies. It may then be possible to direct efforts towards identification of the mutant strain and its characteristics and to prepare a vaccine. It is obvious that more than 50% mortality observed in these epidemics is definitely alarming and all possible measures should be taken to prevent this illness in future. Regular discussions and periodic updates should be promptly made available to readers.

K.M. Adhikari,
Department of Pediatrics,
INHS Jeevanti,
Vasco-Da-Gama,
Goa 403 802, India,
E-mail: [email protected]

 

1. Wairagkar NS, Shaikh NK, Ratho RK, Ghosh D, Mahajan RC, Singhi S, et al. Isolation of measles virus from cerebrospinal fluid from children with acute encephalopathy without rash. Indian Pediatr 2001; 38: 589-595.

2. Mudur G. Indian scientists warn of "mutant measles" virus. Selection from BMJ (South Asia Edition) 2001; 17: 306.