MEASLES
Measles
• Highly contagious acute viral disease
marked by
• Prodromal fever, cough, coryza and conjuctivitis
• Pathognomonic enanthem – ‘koplik spot
• Erythenatous maculo – papular rash
• Causative agent – measles virus
• RNA virus
• Morbilli-virus genus
• Paramyxoviridae family
• Infection confers life-long immunity
Epidemiology
• ~30 million cases reported annually
• Causes one million deaths, and 15,000-
60,000 blindness per year
• Most cases in developing countries
• Mortality – most often due to
respiratory and neurologic
complications
Epidem…
• Risk factors for infection:
• Unimmunized children
• Immunodeficiency states (HIV/AIDS,
leukemia, steroid therapy, etc), regardless
of immunization status
• Loss of passive (maternal) antibodies prior
to age of routine vaccination
Epidem…
• Risk factors for severe measles and its
complication:
• Malnutrition
• Immunodeficiency states
• Pregnancy
• Vitamin A deficiency
• Age specific susceptibility –
• Higher in infants and school-age children
• Complications –
• Common in young children
Epidem…
• Eradication possible based on:
• Distinctive rash
• No animal reservoir
• No vector
• Seasonal occurrence with disease free intervals
• No transmissible latent virus
• One serotype and
• An effective vaccine
• Herd immunity achieve when > 90% of
infants are immunized
Transmission
• By respiratory route, via droplet spray
• Infected child infectious – 1 week before
and 5 days after onset of rash
• Infants protected by passive immunity
in the first 4 – 6 month
Pathogenesis
• Primary viremia to reticoloendotelial
system
• Secondary viremia to body surface
• Followed by viremia before appearance
of RASH
• Essential lesions found in:
• Skin, mucous membrane of naso-pharynx,
bronchi, intestinal tract and conjunctiva
Clinical manifestations
• Prodromal phase
• Follows an incubation period of 10-12 days
• Lasts 3-5 days
• Characterized by:
• Fever, cough, coryza, conjuctivitis
• Malaise, myalgia, photo-phobia and peri-
orbital edema
• With in 2-3 days koplik’s spots appear in buccal
mucosa (disappear with in 12 – 18 hrs)
Clinical…
• Exanthemataus phase
• Characterized by:
• High grade fever
• Rash – begins at the hair line posteriorly and
spreads caudally over the next 3 days with
resolution of prodromal symptoms
• Rash lasts 6 days and fades from head
downwards (desquamations may be present)
Clinical…
• Complete recovery – usually within 7-10 days from
the onset of rash
• Complications:
• Infectious
• Broncho-pneumonia
• Otitis media
• Laryngo-tracheo-bronchitis (croup)
• Diarrhea
• Reactivation of TB
• Others
• Blindness (corneal ulceration), hepatitis, encephalitis,
sub acute sclerosing pan encephalitis (SSPE),
myocarditis, peri carditis and thrombocytopenia
Laboratory investigation
• Unnecessary, given the classic
manifestations
Management
• Hydration
• Antipyretics
• Antibiotics (for secondary bacterial
infection)
• Vitamin A (therapeutic dose)
• Admission for those with severe
complications
Prevention
• Isolation – for infectious period
• Routine immunization
• National Immunization Days (NIDs)
• Mop-up Immunization campaigns
