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MEASLES Presentation

Measles is a highly contagious viral disease that can cause serious complications and death, especially in children under 5 years old. It is transmitted through the air via coughs or sneezes. While measles was once a major cause of childhood mortality, widespread vaccination programs have led to a large decrease in cases and deaths. However, outbreaks still occur where vaccination rates are low. The measles virus causes an initial fever and rash, which can lead to pneumonia, encephalitis or death if complications develop. Treatment focuses on supportive care and vitamin A supplementation. Vaccination within 3 days of exposure can prevent onset of the disease.

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Mobin Ur Rehman Khan
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256 views32 pages

MEASLES Presentation

Measles is a highly contagious viral disease that can cause serious complications and death, especially in children under 5 years old. It is transmitted through the air via coughs or sneezes. While measles was once a major cause of childhood mortality, widespread vaccination programs have led to a large decrease in cases and deaths. However, outbreaks still occur where vaccination rates are low. The measles virus causes an initial fever and rash, which can lead to pneumonia, encephalitis or death if complications develop. Treatment focuses on supportive care and vitamin A supplementation. Vaccination within 3 days of exposure can prevent onset of the disease.

Uploaded by

Mobin Ur Rehman Khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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MEASLES

DR Mobin
Department of Pediatrics

DEFINITION
Measles

is an acute highly contagious viral


disease caused by measles virus.

BASIC CHARACTERISTICS
Highly infectious vaccine preventable disease
One of the most important causes of childhood mortality world wide , responsible for 454

000 deaths in 2004


Derived from the German word Measles
Also called Rubeola (Red spots)
Causes by paramyxovirus :RNA , single stranded
No carriers
Peaks in winter and spring
Males and females both affected

EPIDEMIOLOGY
1995:

44 million cases( 1/3 of children born


world wide, 1.1 million deaths for children
<5yrs)
Currently 1-2 million cases reported
Most countries require reporting
WHO focussed on measles in 1990s
Current goal is the decrease cases <90% and
mortality by 95 %

PRE VACCINE
Large

epidemics
Every 1-2 years
Age 3-15 months
Urban > Rural

POST VACCINE
Small

epidemics
Every 5-10 years
Older children affected usually adolescents
Caused by accumulation of non vaccinated
population

WORLD WIDE
DISTRIBUTION
South

east Asia: In 2004, 454 000 deaths


world wide, 182,000 in south east asia
Europe: almost eliminated
Africa: poor control with many deaths

TRANSMISSION
Person

to person transmission
Human only reservoir
Droplet nuclei or aerosols
90% attack rate for close contacts
Contagious for 7-10 days ( including 2-4
days before the rash)

INCUBATION PERIOD
10

days from exposure to the onset of fever


14 days from exposure to onset of rash
Period of infectivity is 4 days before rash and
4 days afterwards

CASE DEFINATION
Generalized

rash lasting for > 3 days


Temperature > 101 F
Cough, coryza or conjunctivitis

SUSPECTED CASE
Febrile

illness acompanied by generlized


maculopapular rash

PROBABLE CASE
Case

definition with no or non contributory


serologic or virologic testing and not
epidemiologically linked to confirmed case

CONFIRMED CASE
Case

definition and epidemiologically linked


to confirmed or probable case or is laboratory
confirmed. A laboratory confirmed case does
not need to meet the clinical definition

CLINICAL
Prodromal
Eruptive
Post

measles

PRODROMAL
Begins

10 days after infection and lasts for 4


days till day 14
Characterized by Fever (>101 F) , lasts for a
week
Coryza
Conjunctivitis
Photophobia

PRODROMAL
Koplik

spots
Part of prodrome: day 1-3 days before rash
Raised papules on conjunctiva or buccal
mucosa
Adjacent to molars
Bluish white on red base
Gone by the time of rash

ERUPTIVE PHASE
Maculo

papular rash begins behind the ears


Travels downwards in 2-3 days
Desquamates at the end of illness
Rash in fever disappear in 3-4 weeks in the
absence of complication

POST MEASLES
Remains

weak with weight loss and


malnutrition
Pneumonia , tuberculosis and diarrhea
Complete recovery in 10-14 days

COMPLICATIONS
Secondary

bacterial infection: otitis media,


pneumonia, bronchitis, diarrhea
Measles pneumonia: causes 60% mortality in
measles, usually in immunocompromised
Measles encephalitis :2-6 days after rash, 15
% mortality

COMPLICATION ( CONT)
Sub

acute measles encephalitis:


immunocompromised, focal convulsions,
hemiplegia,coma and leads to death within
weeks
SSPE: 2-15 years post infection,15 % case
mortality, convulsion and myoclonic jerks

COMPLICATION
Myocarditis
Thrombocytopenic
Croup

purpura

DIAGNOSIS
Clinical:
Microscopy:

Multinucleate giant cells with

inclusions
Immunofluroscence: MV antigens
Viral isolation: throat or conjuntival washing
Serology :4 fold rise in acute and
convalescent phase

MORTALITY
Historically

1-5 %
Developed countries: 3/1000
Developing countries: 15-25%
Risk factors: immunodeficiency, Vitamin A
deficiency

MANAGMENT
Supportive:

rest , hydration, treat bacterial

infections
Vitamin A: < mortality by 40%, two doses 24
hrs apart immediately after diagnosis
Ribavirin: limited benefit , not practical for
developing countries
Vaccination : exposed persons within 72 hrs

PREVENTION(VACCINE)
Live

attenuated
Given at 9 months (developing countries)
Efficacy: life long,9 m (85%) >12 m (95%)
Contraindications: immunocompromised,
leukemia, lymphoma
Given in HIV

PREVENTION(IMMUNOGOL
UBIN)
Gamma

globulin ( 0.25 mg/kg)


Given within 3 days to persons in whom
vaccine contraindicated
Not for pakistan

MEASLES VACCINE
Freeze

dried product
Keep in freezer
Use within one hr after reconstitution
Sc , 0.5 ml
Reaction in 15-20%

MATERNAL ANTIBODIES
Protect

for 3-12 m, usually 6 m


Presence of Ab makes vaccine less effective

VITAMIN A
Every

3-6m in developing countries


Target > 6 m

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