Measles (Rubeola) (Morbilli)
Highly Infectious childhood disease. Leading cause of childhood mortality among all vaccine
Fever and catarrhal symptoms, Typical Rash
High morbidity and mortality in developing countries. CFR : 2 – 15 % in developing countries Endemic all over world Epidemics when susceptibles reach 40%
STAGING OF COUNTRIES – 3 CATEGOTRIES
Based on the implementation of a combination of immunization and surveillance strategies: CONTROL: Objective : Achieve high routine coverage with 1 dose of vaccine among infants, reduce the incidence rate to an acceptable level thus reducing morbidity and mortality . OUTBREAK PREVENTION: Aggressive immunization strategies to prevent outbreak. ELIMINATION: Reduction of incidence to zero by continuous control measures
Agent: RNA paramyxovirus, One serotype
Source of infection: Only CASES
No carriers and subclinical infections Infective material: Secretions of nose, throat Communicability: 4 days before and 5 days
Age: 6 months - 3 years
Sex: both equally susceptible.
Immunity: One attack gives life long immunity
Nutrition: Disease severe in malnourished
Measles leads to malnutrition
Season: Winter and early spring Transmission: Droplet infection and droplet
Portal of entry: respiratory tract . Incubation period: 10 days
CLINICAL FEATURES 3 STAGES IN THE NATURAL HISTORY:
PRODROMAL STAGE (4 days) ERUPTIVE STAGE (3-4 days)
CONVALESCENCE STAGE (1-2 weeks)
weight loss and weakness
Prodromal stage (pre-eruptive)
Cough Coryza (Sneezing and nasal discharge) Redness in eye Lacrimation Photophobia
KOPLIK’s Spots 1-2 days before RASH
[PATHOGNOMONIC of MEASLES]
Rash appears on 4 th day Dusky red Maculopapular, discrete/ confluent/ blotchy Sequence: behind the
ear→face→neck→chest→abdomen→limbs Progress in 2-3 days RASH fades in the same order 3-4 days Brownish discoloration of skin.
Most common are:
Diarrhoea Pneumonia Otitis media Others: Reactivation of latent TB pyogenic infections & PEM Subacute Sclerosing Pan-Encephalitis, Febrile convulsions Vitamin A deficiency
Typical RASH KOPLIK’s Spots
Clinical Case Definition:
Generalized rash lasting >3 days, and Temperature 101°F (>38.3°C), and Cough or Coryza & conjunctivitis [ red eye]
Rest, nursing and diet .
Symptomatic therapy: fever and cough, Treatment of complications Vitamin A
Achieve immunization coverage >95%
Ongoing vaccination of successive birth cohorts.
Isolation of a case for 7 days after onset of RASH Immunize contacts within 2 days of exposure.
Immunization of all at beginning of epidemic.
Chick embryo or Human diploid cell cultured
vaccine Live attenuated vaccine Freeze dried form Heat stable, Potent for 2 years at 2- 8 deg. C Age: 9 months 6 - 8 months during epidemics and for malnourished children. Then 2nd dose at 9th month. HDC Edmonston-Zagreb strain suitable for 4 -6 month olds
Single Dose: 0.5 ml, Subcutaneously
Mild measles like illness Immunity: After 11-12 days for life long Contraindications: Pregnancy and immunodeficiency Adverse effect: Toxic Shock Syndrome (TSS) Combined vaccine: MMR, given at 15 months
Stages of countries (COPE) 1. CONTROL: Reduction of measles incidence to an acceptable level 2. OUTBREAK PREVENTION: Prevention of measles outbreak 3. ELIMINATION: Zero incidence of Measles
WHO Measles Elimination Strategies Nationwide “Catch up” campaigns “Keep up” high routine coverage Case based “Surveillance”
Nationwide “Follow up” campaigns
Measles Elimination Strategies
CATCH-UP: one-time nationwide immunization campaign covering all children 9 months-14 years irrespective of measles or vaccination status. KEEP UP: Routine immunization aimed to vaccinate > 95% of each successive birth cohort FOLLOW-UP: Subsequent nationwide vaccination campaign every 2-4 years targeting children born after catch-up campaign
Priorities for control
1. Improve routine coverage to at least 90% 2. Active coverage of > 90% in catch-up and
follow-up campaigns 3. Case-based surveillance with LAB confirmation of suspected cases and virus isolation 4. In high risk areas conduct supplementary immunization + vitamin-A administration
Possible because : Virus can not survive outside human body, No known carrier state. A potent heat stable vaccine is available, A single dose is necessary Immunization coverage of > 95% is necessary.