Measles

• Rubeola
• Acute highly infectious disease of childhood by a
virus of the group myxoviruses.
• Measles is characterized by a prodrome of fever
and malaise, cough, coryza, and conjunctivitis,
followed by a maculopapular rash.
• Agent –RNA Paramyxovirus, only one serotype so far
• Source of infection-a case of infection
• Infective material-secretions of nose , throat and
respiratory tract
• Communicability-prodromal period ;at the time of
eruption
• Host- infants or child b/w 6 months to 3 years in
developing countries 5years in developed countries.
• Sex –equal
• Immunity-No age is immune, if there was no previous
immunity.
• Nutrition –severe in malnourished child;400 times
higher mortality.
• Environment
• Spread any season in India winter and early
spring(Jan to April)
• Transmission-direct contact by droplet
• Incubation period-10 days from exposure to
onset of fever, and 14 days to appearance of
rash
• The most important clinical predictors are included in
the clinical case definition for measles which is an
illness characterised by all the following features:
• generalised maculopapular rash, usually lasting
three or more days
• fever (at least 38°C if measured) present at the time
of rash onset
• cough, coryza, conjunctivitis and Koplik’s spots
• The characteristic red, blotchy rash appears on the
third to seventh day. It begins on the face before
becoming generalised and generally lasts four to
seven days.
• Measles infection (confirmed virologically) may
rarely occur without a rash.
 Clinical features
1. Prodromal stage
• Begins 10 days after infection and last until 14
days
• Fever , coryza with sneezing and nasal
discharge,cough redness of the eyes,lacrimation
and often photophobia,may be vomiting or
diarrhoea
2. Eruptive stage
• Dusky red maculo papular rash begins behind the
ears and rapidly spread to face, neck and extends
down to the body with in 2- 3 days- Koplik’s spot
3. Post measles stage
• Loss of wt
• Growth retardation and diarrhoea
• Rashes – fade in the same manner as they
appeared, from the face downwards, leaving a
dirty brown pigmentation and finely granular
which maybe noted for several days.
• DIAGNOSIS
• Clinical diagnosis of measles requires a history
of fever of at least three days, with at least one
of the three C's (cough, coryza, conjunctivitis).
Observation of Koplik's spots is also diagnostic
of measles.
• Alternatively, laboratory diagnosis of measles can be
done with confirmation of positive measles IgM
antibodies or isolation of measles virus RNA from
respiratory specimens.
• In patients where phlebotomy is not possible, saliva
can be collected for salivary measles-specific IgA
testing. Positive contact with other patients known to
have measles adds strong epidemiological evidence to
the diagnosis. The contact with any infected person in
any way, including semen through sex, saliva, or
mucus, can cause infection.
• There is no specific treatment for measles. Rest and
supportive mgt
• Patient should be monitored for the development of
bacterial infections which should be treated with
appropriate antibiotics on the basis of clinical and
bacteriological finding
• The patient may also take over-the-counter medications
such as acetaminophen (Tylenol, others) or non-steroidal
anti-inflammatory drugs (NSAIDs) to help relieve the fever
that accompanies measles.
• Don’t give aspirin to children because of the risk of
Reye’s syndrome — a rare but potentially fatal disease.
• Maintain bedrest and provide quiet activities for
the child. If there is sensitivity to light, keep room
darkly lit. Remove eye secretions with warm saline
or water.
• Encourage the patient not to rub the eyes.
Administer antipyretic medication and tepid sponge
baths as ordered.
• A cool mist vaporizer can be used to relieve cough.
• Apply antipruritic medication to prevent itching.
Isolate child until fifth day of rash.
• Prevention of Measles
• Avoid exposing children to any person with fever or with
acute catarrhal symptoms
• Isolation of cases from diagnosis until about 5-7 days after
onset of rash
• Disinfection of all articles soiled with secretion of nose and
throat
• Encourage by health department and by private physician of
administration of measles immune globulin to susceptible
infants and children under 3 years of age in families or
institutions where measles occurs.
• Live attenuated and inactivated measles virus vaccines have
been tested and are available for use in children with no
history of measles, at 9 months of age or soon thereafter
• Live attenuated measles vaccine is
recommended for all persons unless specific
contra-indications to live vaccines exist.
• It is recommended that this vaccine be given as
measles-mumps-rubella (MMR) vaccine at 9 to 12
months of age and a second dose at four years of
age (prior to school entry).
GUIDE ON MEASLES IMMUNIZATION- Route
Subcutaneous Site Outer part of upper left arm
Number of Dose 1 dose Age at First Dose 9 months
Dosage 0.5mL
• Storage Temperature -15 to -25 °C