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MEASLES

DR Mobin
Department of Pediatrics

Measles is an acute highly contagious viral
disease caused by measles virus.
BASIC CHARACTERISTICS
Highly infectious vaccine preventable disease
One of the most important causes of childhood mortality world wide , responsible for 454
000 deaths in 2004
Derived from the German word Measles
Also called Rubeola (Red spots)
Causes by paramyxovirus :RNA , single stranded
No carriers
Peaks in winter and spring
Males and females both affected


EPIDEMIOLOGY
1995: 44 million cases( 1/3 of children born
world wide, 1.1 million deaths for children
<5yrs)
Currently 1-2 million cases reported
Most countries require reporting
WHO focussed on measles in 1990s
Current goal is the decrease cases <90% and
mortality by 95 %
PRE VACCINE
Large epidemics
Every 1-2 years
Age 3-15 months
Urban > Rural
POST VACCINE
Small epidemics
Every 5-10 years
Older children affected usually adolescents
Caused by accumulation of non vaccinated
population


WORLD WIDE DISTRIBUTION
South east Asia: In 2004, 454 000 deaths
world wide, 182,000 in south east asia
Europe: almost eliminated
Africa: poor control with many deaths

TRANSMISSION
Person to person transmission
Human only reservoir
Droplet nuclei or aerosols
90% attack rate for close contacts
Contagious for 7-10 days ( including 2-4
days before the rash)


INCUBATION PERIOD
10 days from exposure to the onset of fever
14 days from exposure to onset of rash
Period of infectivity is 4 days before rash and
4 days afterwards
CASE DEFINATION
Generalized rash lasting for > 3 days
Temperature > 101 F
Cough, coryza or conjunctivitis

SUSPECTED CASE
Febrile illness acompanied by generlized
maculopapular rash
PROBABLE CASE
Case definition with no or non contributory
serologic or virologic testing and not
epidemiologically linked to confirmed case
CONFIRMED CASE
Case definition and epidemiologically linked
to confirmed or probable case or is laboratory
confirmed. A laboratory confirmed case does
not need to meet the clinical definition
CLINICAL
Prodromal
Eruptive
Post measles
PRODROMAL
Begins 10 days after infection and lasts for 4
days till day 14
Characterized by Fever (>101 F) , lasts for a
week
Coryza
Conjunctivitis
Photophobia

ERUPTIVE PHASE
Maculo papular rash begins behind the ears
Travels downwards in 2-3 days
Desquamates at the end of illness
Rash in fever disappear in 3-4 weeks in the
absence of complication

POST MEASLES
Remains weak with weight loss and
malnutrition
Pneumonia , tuberculosis and diarrhea
Complete recovery in 10-14 days
COMPLICATIONS
Secondary bacterial infection: otitis media,
pneumonia, bronchitis, diarrhea
Measles pneumonia: causes 60% mortality in
measles, usually in immunocompromised
Measles encephalitis :2-6 days after rash, 15
% mortality
COMPLICATION ( CONT)
Sub acute measles encephalitis:
immunocompromised, focal convulsions,
hemiplegia,coma and leads to death within
weeks
SSPE: 2-15 years post infection,15 % case
mortality, convulsion and myoclonic jerks
COMPLICATION
Myocarditis
Thrombocytopenic purpura
Croup


DIAGNOSIS
Clinical:
Microscopy: Multinucleate giant cells with
inclusions
Immunofluroscence: MV antigens
Viral isolation: throat or conjuntival washing
Serology :4 fold rise in acute and
convalescent phase
MORTALITY
Historically 1-5 %
Developed countries: 3/1000
Developing countries: 15-25%
Risk factors: immunodeficiency, Vitamin A
deficiency
MANAGMENT
Supportive: rest , hydration, treat bacterial
infections
Vitamin A: < mortality by 40%, two doses 24
hrs apart immediately after diagnosis
Ribavirin: limited benefit , not practical for
developing countries
Vaccination : exposed persons within 72 hrs
PREVENTION(VACCINE)
Live attenuated
Given at 9 months (developing countries)
Efficacy: life long,9 m (85%) >12 m (95%)
Contraindications: immunocompromised,
leukemia, lymphoma
Given in HIV
PREVENTION(IMMUNOGOLUBIN)
Gamma globulin ( 0.25 mg/kg)
Given within 3 days to persons in whom
vaccine contraindicated
Not for pakistan

MATERNAL ANTIBODIES
Protect for 3-12 m, usually 6 m
Presence of Ab makes vaccine less effective

VITAMIN A
Every 3-6m in developing countries
Target > 6 m

MEASLES VACCINE
Freeze dried product
Keep in freezer
Use within one hr after reconstitution
Sc , 0.5 ml
Reaction in 15-20%
PRODROMAL
Koplik spots
Part of prodrome: day 1-3 days before rash
Raised papules on conjunctiva or buccal
mucosa
Adjacent to molars
Bluish white on red base
Gone by the time of rash