[bpsdb] Please give a warm welcome to guest blogger "DeeTee", a British doctor with experience working in Africa.

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We are used to hearing from antivaccine lobbyists that diseases like measles are trivial conditions, notable only because they used to give kids the chance of a few days bunking off school. Sure, most of us old enough to have been children in the prevaccine era will probably think "what is the fuss all about?" But memory plays us false, and the reality can be quite different.

I spent my formative medical years working in Africa. Even though there was an effective vaccine available, the problem was getting it to those who needed it in the face of a dodgy health infrastructure and poor transport links. Needing to preserve the cold chain didn't help either, so the result was that while doing paediatrics in one of the major hospitals, I would admit at least half a dozen unvaccinated children with measles each day. These were not simple, "uncomplicated" cases or even those with minor problems like otitis media, these all needed to be in hospital; Encephalitis, severe tracheo-bronchitis, pneumonia, and severe gastroenteritis were commonplace. Some kids got complications like cancrum oris, a nasty necrotising septic infection that ate away the face. Others were tipped into florid malnutrition (kwashiorkor or marasmus) by the assault of measles on the infant gut and the immune system, and many died despite all the medical help we could offer. Once or twice a week I had to break the news to a distraught mother that her child had died; something I never got used to doing, despite all the practice.

In the UK, although I was doing training in infectious diseases and paediatrics, I seldom saw cases of measles, and had hoped it was a disease that had been consigned to history, at least as far as the UK was concerned. But last year all that changed. Where I work we saw dozens of cases of measles over the summer. It was odd having to dredge my memory banks to remember details of this "lost" disease, but at least with measles once one has seen cases and one knows the symptoms and signs these are not easily forgotten. It was also quite satisfying to confidently conjure up a diagnosis of measles and see the bewildered looks on the face of the trainees who reacted as though I had just diagnosed some exotica such as green monkey disease.

Fortunately all (kids and some adults too) did well, but there were still a few close calls from complications like pneumonia. The disease is a different beast in "healthy", first world children, but can be still very debilitating and cause real misery, and I wonder if any of the cases I saw might still suffer future problems like subacute sclerosing panencephalitis, a devastating slowly progressive and fatal complication that afflicts one in every 10 thousand cases of measles. Fortunately, thanks largely to a lot of publicity and efforts to give unvaccinated/partially vaccinated kids MMR, we seem to have seen the epidemic off (at least for now, but with MMR vaccination rates still some way short of what they should be, the next epidemic may be just around the corner).

But recently 2 cases I saw reminded me of measles' potentially devastating legacy. The first was a patient who had lost one of her 2 children in infancy. "Measles", she said, matter-of-factly, when I asked her why. The other case was a patient in her fifties who came in for an unrelated problem, but had a lifelong severe disability because of a paralysed left side, and who had poorly-controlled epilepsy. I imagined these were the result of a congenital problem such as cerebral palsy. "No", explained her carer. "It was encephalitis from measles".

Much of my time is spent battling illnesses that are largely unavoidable, but from time to time I see things that are totally preventable, like the measles cases last summer, and it rankles, big time. Knowing that there are those who actively campaign against vaccines makes me unspeakably angry.