Death may occur quickly (within three months) in a small subset of patients, but most individuals progress more slowly and die one to three years after diagnosis. Countries with strong immunization programs have seen declines in the incidence of SSPE of 90% or greater, but it is reported to persist at relatively high levels in Eastern Europe and India.
There is no cure for SSPE, but some trials suggest that antivirals and interferon can prolong life. Of significance to ophthalmologists is that the last ophthalmologist to win the Lasker Award (not counting the posthumous award presented to the widow of the surgical innovator Charles Kelman, MD) received the prize for work related to measles. Alfred Sommer, MD, MHS, was studying the potential of vitamin A supplementation to prevent xerophthalmia and corneal ulceration and melting in nutritionally deficient children. His work focuses on xerophthalmia and vitamin A deficiency.
If one of these children suffering from chronic malnutrition were to contract measles, the manifestations of the disease were often particularly severe, including corneal melting. Dr. Sommer, professor of ophthalmology, Johns Hopkins University, Baltimore, found that the vitamin did indeed reduce the likelihood of corneal perforation and blindness in children.
But even more striking was the dramatic reduction in mortality in these children, with a vitamin A capsule costing a few pennies proving to reduce mortality by about 50%. Measles, it turns out, “often blinds and kills by its acute, dramatic interference with vitamin A metabolism.” The World Bank has concluded that giving children periodic doses of vitamin A is one of the most cost-effective treatments in the history of medicine.
Peter J. McDonnell, MD
E: [email protected]
Dr. McDonnell is the director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.
1. Semba RD, Bloem MW. Measles blindness. Surv Ophthalmol 2003;12:5.