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MEASLES

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					Measles (Rubeola) (Morbilli)
 Highly Infectious childhood disease.  Leading cause of childhood mortality among all vaccine

preventable diseases.
 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 FACTORS
 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

after RASH

HOST FACTORS
 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

Contd….
 Season: Winter and early spring  Transmission: Droplet infection and droplet

nuclei.
 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)
 Fever

 Cough  Coryza (Sneezing and nasal discharge)  Redness in eye  Lacrimation  Photophobia
 KOPLIK’s Spots 1-2 days before RASH

[PATHOGNOMONIC of MEASLES]

ERUPTIVE PHASE
 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.

COMPLICATIONS
Most common are:
 Diarrhoea  Pneumonia  Otitis media Others:  Reactivation of latent TB  pyogenic infections & PEM  Subacute Sclerosing Pan-Encephalitis,  Febrile convulsions  Vitamin A deficiency

DIAGNOSIS
 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]

TREATMENT
 Rest, nursing and diet .

 Symptomatic therapy: fever and cough,  Treatment of complications  Vitamin A

Prevention
 Achieve immunization coverage >95%

 Ongoing vaccination of successive birth cohorts.

CONTROL
 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

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

VACCINE
 Single Dose: 0.5 ml, Subcutaneously
 Reaction:

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

MEASLES ELIMINATION
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

MEASLES ERADICATION
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.


				
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posted:7/24/2009
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