Measles

An Introduction

Ron Waldman, MD, MPH

Professor of Global Health
Milken Institute School of Public Health
George Washington University
National Press Foundation
February 23, 2015

Panums Observations

7,782 inhabitants
No cases for 65 years
6,000 cases
incubation period 10-14 days
in affected villages, 19/20 fell ill
older people spared (0/98)
death: 23/1,000

Panums Observations
Of the 6,000 cases, [t]here was not a
single one in which it was justifiable to
attribute the affection to a miasmatic
origin, while at the same time it was
everywhere clear that the disease had
spread from man to man

Symptoms
10-14 days after exposure:
fever
cough
runny nose
sore throat
conjunctivitis
(Kopliks spots)
generalized rash large, red blotchy
spots

Stages of Measles

incubation period, after infection

non-specific illness (prodrome)
acute illness and rash phase
recovery and convalescence

Complications of Measles
Common
ear infection (1 in 10)
diarrhea (1 in 10)

Severe
pneumonia (1 in 20)
encephalitis (1 in 1000) convulsions, deafness
Blindness (was leading cause in children in
2004)
death (1 in 1000)

Long-term Complications of Measles

Sub-acute Sclerosing Panencephalitis
(SSPE)
-- fatal
-- develops 7-10 years following full
recovery
-- 4-11 cases/100,000 cases of
measles

Measles -- Treatment
Non-specific
hydration
food
analgesic, e.g., acetaminophen

Vitamin A supplementation if
indicated

Routes of Transmission of
Communicable Diseases

Airborne (no direct contact required)

Droplet
Sexual
Animal or insect
Food/water
Health care settings

"Sneeze" by James Gathany - CDC Public Health Image library ID

Herd Immunity (1)

Herd Immunity (2)

Major Causes of Death

in Refugee Populations
Somalia: Gedo Region, 7
Camps January, 1980

Sudan: Wad Kowli Camp

February, 1985

Measles
ARI
Malaria
Diarrhea
Other
Source: Centers for Disease Control and Prevention, FamineAffected, Refugee, and Displaced Populations: Recommendations
for Public Health Issues. MMWR, 1992;41(No. RR-13):8.

Measles in the World, 2013

Measles is one of the leading causes of death among young children even
though a safe and cost-effective vaccine is available.
In 2013, there were 145 700 measles deaths globally about 400 deaths
every day or 16 deaths every hour, but down from 2.6 million in 1980.
Measles vaccination resulted in a 75% drop in measles deaths between
2000 and 2013 worldwide.
In 2013, about 84% of the world's children received one dose of measles
vaccine by their first birthday through routine health services up from
73% in 2000.
During 2000-2013, measles vaccination prevented an estimated 15.6
million deaths making measles vaccine one of the best buys in public
health.

Coverage with 1st dose of Measles-containing vaccine (line)

and Measles case reports (bars), WHO Africa Region, 1980-2013

Pertussis: Global Trends and Vaccine Uptake

Berger S. Pertussis: Global Status 2013.

www.gideononline.com/ebooks/disease

"Runderpest in Nederland 18e eeuw" by Jacobus Eussen - Henk Pove

in:Tien eeuwen tussen Lek en IJssel, 2004 ISBN 90 6868 378 0. Licensed