MEASLES

MEASLES - INTRODUCTION
y Also called as RUBEOLA/ RED SPOTS y Acute highly infectious disease of childhood y Caused by MYXOVIRUS y CLINICAL FEATURES:

fever catarrhal symptoms of URI (CORYZA,COUGH) typical rash

PROBLEM STATEMENT
y Endemic in all parts of world y Leading cause of death among vaccine

preventable diseases y Cyclical increase in incidence of measles for every 2-3yrs

EPIDEMOLOGICAL DETERMINANTS
AGENT

HOST

ENVIRONMENT

AGENT FACTORS
y AGENT: y Caused by PARAMYXOVIRUS

AGENT FACTORS
AGENT

RNA myxovirus
Case , subclinical measles

SOURCE OF INFECTION

INFECTIVE MATERIAL

Secretions of nose,throat,respiratory tract Prodromalstage,at the time of eruption( 4 days before & 5 days after rash)

COMMUNICABILITY

HOST FACTORS

ENVIRONMENTAL FACTORS
y Overcrowding

TRANSMISSION
y DROPLET infection

INCUBATION PERIOD
y 10 days from exposure to onset of fever

and 14 days to appearance of rash y When artificially induced, by-passing respiratory tract incubation period 7 days average

CLINICAL FEATURES
PRODROMAL
ERUPTIVE PHASE
POST-MEASLES

PRODROMAL STAGE
y BEGINS : 10 days after infection y LASTS

: until 14 days y CLINICAL FEATURES: fever coryza with sneezing,cough nasal discharge redness of eyes, lacrimation, photophobia vomitting&diarrhoea

KOPLIK S SPOTS
y Pathognomic of

measles y Table salt crystals appear on the buccal mucosa opposite to 1st& 2nd molar teeth y Small, bluish white spots on red base smaller than pin head size

ERUPTIVE PHASE
y CLINICAL FEATURES:
typical dusky-red macular papular rashes begins behind the ear spreads rapidly on face & neck next 2-3 days lower extremities KOPLIK SPOTS and TYPICAL RASH

POST-MEASLES STAGE
y Loss of weight & remain weak y Failure to recover y Growth retardation y Diarrhoea y Cancrumoris y Pyogenic infections y Candidosis y Reactivation of pulmonary TB

COMPLICATIONS
y Measles associated diarrhoea y Pneumonia y Otitis media y Febrile convulsions y Subacutesclerosingpanencephalitis paraly

sis , involuntary movements, muscle rigidity & coma

SSPE

PREVENTION
y Achieving an

immunisation rate of over 95% y On-going immunisation against measles through successive generation change

3 STAGES OF PREVENTION
y CONTROL:

reduction of incidence to an acceptable level y OUTBREAK PREVENTION: aggressive immunisation strategies y ELIMINATION: to reduction of incidence level zero y WHO defn/: absence of endemic measles for a period of more than or equal to 12 mon in the presence of adequate surveillance or y Incidence<1/100000 population

ELIMINATION
ySTRATEGIES: y CATCH UP: 1 time vaccination targeting age of 9 mon- 14 yrs y KEEP UP: routine services aimed at vaccinating more than 95% of each successive birth cohort y FOLLOW UP: subsequent nationwide vaccination campaign conducted every 2-4 yrs targeting usually all children born after the catch up campaign.

VACCINATION
y Measles is best prevented by active immunisation y Live attenuated vaccines are recommended y It is safe & effective

VACCINES
y All vaccines are TISSUE

CULTURE vaccines Chick embryo Human diploid cell y The vaccine is presented as freeze dried product. It is important to store the vaccine at recommended temp.

VACCINATION SCHEDULE
y WHO recommends immunisation at 9 months

of age . y Immunisation before the age of 9 mth rendered ineffective by natural antibodies through mothers y If there is measles outbreak this can be lowered to 6 mths if immunised between 6-9mon 2nd dose should be given on 9thmon provided 4wks after 1st dose y VIT-A dropsgiven along with the vaccine

ADMINISTRATION:
Single SC dose of 0.5ml Diluting fluid for reconstituting the vaccine must be kept cold at 4 to 80 C reconstituting vaccine should be kept on ice with in one hr

REACTIONS:
fever for 1 to 2 days rash for 1 to 3 days due to multiplication of attenuated virus IMMUNITY: LIFELONG

CONTRAINDICATIONS:
pregnancy deficient cell mediated immunity steroids

ADVERSE EFFECTS OF VACCINE

y Toxic shock syndrome occurs when

vaccine is contaminated used in more than one session on same day or next day

COMBINED VACCINE
y MMR y MMRV y MR

IMMUNOGLOBULIN:
WHO recommended dose is 0.25ml/kg It should be given within 3 to 4 days of exposure

CONTROL MEASURES
Isolation for 7days after onset of rash Immunisation of contacts within 2 days of exposure Prompt immunisation at the beginning of an epidemic