Thinking Measles Unconventionally, SSPE - Why We Must Vaccinate

Measles-related neurological syndromes encompass primary measles encephalitis, acute post-measles encephalitis, measles inclusion-body encephalitis and subacute sclerosing panencephalitis (SSPE). SSPE is a catastrophic consequence of the defective wild-type measles virus with an estimated risk of 4?11/1,00,000 cases worldwide. Effective vaccination campaigns have eliminated measles from the developed countries but developing countries like India incidence rate is 21 cases/million population (1). In 1933 Dawson, for the first time, described a child with progressive mental deterioration and involuntary movements who, at necropsy, was found to have a dominant involvement of grey matter in which neuronal inclusion bodies were abundant [2] .The term SSPE was coined by Greenfield. It is characterized by progressive intellectual deterioration, focal and/or generalized seizures, myoclonus, ataxia, and visual disturbances[3]. Most of the patients die within 1-3 years from onset of symptoms, although spontaneous improvement or stabilization can occur in a small proportion of patients. Measles is primarily disease of childhood with age of onset before 2 years. After a latent period of 6-8 years, it is followed by the onset of progressive neurological symptoms suggestive of SSPE. As a result of subclinical measles infection before the age of 1 year, occasionally, it can be seen in vaccinated children. There is no evidence to suggest that attenuated vaccine virus is responsible for sporadic cases of SSPE. [4,5] Individuals with acquired immunodeficiency syndrome (AIDS) or children whose mothers have AIDS might be at higher risk of a fulminant course and earlier onset of SSPE. [6]