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MEASLESKristin Coleman

Jordan McCready
Reagan Rush
Samantha Wargo

Figure 1
History (Pre-Vaccine Era)

First recorded in 9th Century by Ibn Razi1 Figure 2


Francis Home 1757
Scottish Physician that discovered the illness was caused by an infectious agent in the blood 1
1912: Public Health made Measles a nationally notifiable disease
All diagnosed cases had to be reported1
6,000 measles related deaths reported annually after mandate1
Nearly every child contracted disease by their 15th birthday1
Time period between 1958-1962
432 measles related deaths annually2
503,282 measles cases reported annually2
History (Vaccine Development)
Research for a vaccine began in 19541
Figure 3
John F. Enders and Dr. Thomas C. Peebles
Collected blood samples from infected students in Massachusetts
Virus was isolated and vaccine created in 19631
John F. Enders and colleagues
Immediately licensed in the United States
Second vaccine was introduced in 19681
Maurice Hileman
More improved and safer than original
Edmonston-Enders strain: only vaccine used in the United States since 1968
Combined with Mumps and Rubella (MMR)1
Combined with Mumps, Rubella and Varicella (MMRV)1
History (Measles Elimination)
Figure 4

Measles deaths began to decline in 1965 and continued on 33 year downward trend
In 1978, the CDC set to eliminate Measles from the United States by 19821
Goal was never met, but vaccine greatly reduced reported cases
In 1981, reported measles cases were 80% fewer than previous year1
1989: second dose of vaccine became recommended1
1998: 89 reported measles cases were all associated with international importations1
The CDC deemed measles eliminated from the United States in 20001
Absence of transmission for 12 consecutive months
Measles is prevalent in developing countries and poses a risk to unvaccinated travelers3
Geography
Prevalent in Developing Countries3
Asia and Africa
10 million cases reported each year
Figure 5
75% of Measles related deaths occur in six countries3
Nigeria, India, Pakistan, Indonesia, Ethiopia and the DR of Congo
High mortality rate among children to to malnutrition and limited medical care
Uncommon in the United States3
Unvaccinated travelers put themselves at risk
Highly contagious disease
CDC Travelers Notice1
Measles and Rubella Initiative Figure 6

Launched in 2001 to help administer vaccines to children worldwide3


American Red Cross, CDC, WHO and United Nations Foundation
Prevented 20.6 million deaths between 2001-2016
Vaccinated 1.1 billion individuals since 2001
Website with current information/data on the program3
Measlesrubellainitiative.org
Launched Measles and Rubella Strategic Plan (2015-2020)3
Worked with domestic and international leaders to achieve elimination
goals
2015: reduce measles related deaths by 95% from 2000
2020: eliminate disease from 5 WHO regions
Post 2020: develop timeframe for global eradication of disease
Economical Impact
Figure 4
Outbreaks cost time, money and lives
Parents are required to miss work to take care of ill child
Could result in loss of hundreds of dollars
Measles Vaccine- $1 in developing countries4
Effectiveness of vaccine, low cost and impact, the rate of return is $58 for every
$1 spent.4
107 reported cases in 2011 with estimated public health cost of $2.7-$5.3 million5
In industrialized countries:
Average cost of MMR vaccine: $70.92 per dose (private sector)6
Political Impact
Fear of vaccination in industrialized nations
Alleged adverse health effects
Advisory groups promoting parents not to vaccinate their children.
However, 90% of children receive MMR on time6
However, 1 in 12 children are still at risk
In developing countries:
Must have renewed political commitment in these countries to ensure
adequate vaccination.4
Portal of Entry
Respiratory system
Conjunctiva
Lungs Lymph nodes Whole body 7
Entry into Cells
Binding of glycoprotein HA & F
Receptors CD150, nectin-4, CD46
Nectin-4 - adheren junctions of respiratory epithelium
CD150 - many immune cells
CD46- all nucleated human cells 8

Figure 7
Immune System Evasion
MDA5- crucial in innate immune defense
V protein interacts with PP1
Prevention of dephosphorylation of MDA5 9
Signs/Symptoms
Kopliks spots 10
High fever
Maculopapular rash Figure 8

Cough
Red, watery eyes
Runny nose
Loss of appetite
Fatigue
Conjunctivitis 3,7
Infection Period
Incubation period- 10-14 days
Prodromal phase
Begins with fever
3-5 days later is rash
Total duration
17-21 days after fever onset (not including complications)
Infectious 4 days before rash to 4 days after 8
Immunosuppression
Measles virus induced immunosuppression
Can occur up to 2-3 years afterwards
Suppression of delayed-typed hypersensitivity responses
Secondary bacterial infections, pneumonia, gastrointestinal infections 8
Severe Complications
Acute disseminated encephalomyelitis (ADEM)
Measles inclusion body encephalitis (MIBE)
Subacute sclerosing panencephalitis (SSPE) 11
Treatment
No specific antiviral treatment
Supportive care12
Rehydration
Fever reducers
Antibiotics for post-disease infections Figure 10

Vitamin A3
Other Medical Options
Vaccination of non-immunized person within 72 hours of exposure
Can prevent a patient getting measles
Milder case of disease if contracted
Immune serum globulin
Immunocompromised patients, pregnant women, infants
Can help prevent measles if given within 6 days after exposure12
Prevention
Vaccine preventable
Used for over 50 years
Usually combined with mumps or rubella vaccinations (MMR)
Two doses recommended
Mass-vaccination campaigns3
One dose: 93% effective
Two doses: 97% effective13
Cost:
One U.S. dollar3
Epidemiology
Pre-Vaccine
Outbreaks
winter months in temperate climates
dry season in tropical climates
Correlates with differing population densities
Commonly affects young children
Post-Vaccine
All age groups had reduced incidence
Higher susceptibility
Older age groups - may not have gotten vaccine
Infants under one- not received the vaccine8
Epidemiology
Herd immunity: 95%
Very high
When vaccination rates go down, measles commonly seen
Global incidence:
Current: 36/ 1 million cases
2000: 146/ million cases8

Figure 11
Recent Epidemic
Minnesota, 2017
April 8th- 25 month old unvaccinated child was brought to hospital
April 11th - 35 month old admitted with same symptoms
Sibling experiencing similar symptoms
Confirmed cases of measles
By May 31st, 65 confirmed cases
20 of these cases required hospitalization
85% of reported children has been U.S. born Somali children
Fear of link between MMR and autism13
Issues, attitudes, and relevance for life on our
planet now and in the future
Vaccines
Odebiyi & Ekong study14
Attitudes towards measles vaccine
WHO and African Region15

Figure 13

Figure 12
Catholic Social Teaching
Themes
Right and Responsibilities

Option for the Poor and


Vulnerable16

Care for Gods Creation


Figure 14 Figure 15
References
1. Centers for Disease Control and Prevention. (2017, March 3). Measles History. Retrieved from https://www.cdc.gov/measles/about/history.html
2. Centers for Disease Control and Prevention. (1999, April 2). MMWR; Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children.
Retreived from https://www.cdc.gov/mmwr/preview/mmwrhtml/00056803.htm
3. World Health Organization. (2017, October). Measles. Retrieved from http://www.who.int/mediacentre/factsheets/fs286/en/
4. Centers for Disease Control and Prevention. (2017). Measles and Rubella Initiative. Retrieved from https://www.cdc.gov/globalhealth/measles/pdf/measles-rubella-fact-
sheet.pdf
5. Centers for Disease Control and Prevention. (2016, April 27). Measles Data and Statistics. Retrieved from
https://www.cdc.gov/measles/downloads/measlesdataandstatsslideset.pdf
6. Centers for Disease Control and Prevention. (2017, September 1). CDC Vaccine Price List. Retrieved from https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-
management/price-list/index.html
7. Foster, J., Aliabadi, Z., & Slonczewski, J. (2016). Microbiology: The human experience. New York, New York. W.W. Norton & Company, Inc.
8. Coughlin, M.M., Beck, A.S., Bankamp, B., & Rota, P.A. (2017). Perspective on Global Measles Epidemiology and Control and the Role of Novel Vaccination Strategies. Virus
9(1), 11. Retrieved from http://www.mdpi.com/1999-4915/9/1/11/htm
9. Davis, M.E., Wang, M.K., Rennick, L.J., Full F., Gableske, S., Mesman, A.W., Gringhuis, S.I., Geijtenbeek, T.B.H., Duprex, P., & Gack, M.U. (2014). Antagonism of the
Phosphatase PP1 by the Measles Virus V Protein Is Required for Innate Immune Escape of MDA5. Cell Host & Microbe, 16(1). Retrieved from http://www.cell.com/cell-host-
microbe/fulltext/S1931-3128(14)00223-6
10. Xavier, S. & Forgie, S.E.D. (2015). Koplik spots revisited. CMAJ: Canadian Association Journal, 187(8), 600. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435874/
11. Yu, X. & Ghildyal, R. (2012). Measles Virus Infection: Mechanisms of Immune Suppression, Immunosuppression - Role in Health and Diseases, Dr. Suman Kapur (Ed.),
InTech. Retrieved from https://pdfs.semanticscholar.org/b11f/43f0a5b90e0a06a2f04b7baa171abfe5a37d.pdf
12. Mayo Clinic Staff. 2017. Measles: Treatments and drugs. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/measles/basics/treatment/con-
20019675
13. Hall V, Banerjee E, Kenyon C, et al. (2017). Measles Outbreak. Morbidity and Mortality Weekly Report, 66(27); 713-717. Retrieved from
https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a1.htm#suggestedcitation
14. Odebiyi, A. & Ekong, S. (1982). Mothers' concept of measles and attitudes towards the measles vaccine in Ife-Ife, Nigeria. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1052213/?page=3
15. Arevshatian, L., Clements, C., Lwanga, S., Misore, A., Ndumbe, P., Seward, J., & Taylor, P. (2007). An evaluation of infant immunization in Africa: is a transformation in
progress? Retrieved from http://www.who.int/bulletin/volumes/85/6/06-031526.pdf
16. Goodson, J., Masresha, B., Wannemuehler, K., Uzicanin, A., & Cochi, S. (2011). Changing Epidemiology of Measles in Africa. Retrieved from
https://academic.oup.com/jid/article/204/suppl_1/S205/2194363
Image References
1. Kullabs: Note on Measles. (2017). [Image]. Retrieved from https://kullabs.com/classes/subjects/units/lessons/notes/note-detail/4993
2. Measles Outbreaks are Concerning, Even to the Vaccinated. (2014). [Image]. Retrieved from
https://shotofprevention.com/2014/03/11/measles-outbreaks-are-concerning-even-to-the-vaccinated/
3. The First Measles Vaccine. (2011). [Image]. Retrieved from http://pediatrics.aappublications.org/content/128/3/435
4. Epidemiology and Prevention of Vaccine-Preventable Diseases. (2016). [Image]. Retrieved from
https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html
5. This is What Measles Actually Looks Like. (2015). [Image] Retrieved from https://www.buzzfeed.com/virginiahughes/what-measles-outbreak-
actually-looks-like?utm_term=.ooyXKEzN3#.lbqdLOo2n
6. Measles and Rubella Initiative. (2017). [Image]. Retrieved from https://measlesrubellainitiative.org/research-innovation/
7. Measles (Rubeola). (2017). [Image]. Retrieved from https://www.cdc.gov/measles/about/photos.html
8. Public Health Image Library. (2017). [Image]. Retrieved from https://phil.cdc.gov/details.aspx?pid=3187
9. https://digital.wwnorton.com/4058/r/goto/cfi/318!/4
10. Public Health Image Library. (2017). [Image]. Retrieved from https://phil.cdc.gov/details.aspx?pid=132
11. Morbidity and Weekly Report. (2017). [Image]. Retrieved from https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a1.htm#suggestedcitation
12. Ife-Ife, Nigeria. (2017). [Image]. Retrieved from http://www.geastudy.org/ileife/
13. Measles. (2017). [Image]. Retrieved from https://www.nigeriagalleria.com/Community-Health/Measles.html
14. Meningitis Vaccine Developed With Gates Foundation Drives Africa Cases to Lowest In Decade. (2013). [Image]. Retrieved from
https://www.huffingtonpost.com/2013/06/06/meningitis-vaccine-bill-gates_n_3398557.html
15. Millions of children to receive measles vaccine in north-eastern Nigeria. (2017). [Image]. Retrieved from
http://www.who.int/features/2017/measles-vaccination-nigeria/en/