Measles (Rubeola)

Notes
  • Measles virus is a single-stranded, negative-sense, enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae
  • Measles, a notifiable disease, is one of the leading cause of death in children globally.
  • The Global Measles and Rubella Strategic Plan 2012-2020 targets to eliminate measles globally by 2020.
  • Before 1963 (the discovery of measles vaccine) measles epidemic cycles could happen every 2-3 yrs and more than 90% of the population was infected by the age of 10 years.
  • One-dose measles vaccine efficacy is estimated at 85%–90% when done at 9 months of age while the 2-dose efficacy is more than 99% when the second dose is given at after 12 months of age or above.
  • Measles infection is specifically dangerous in malnourished children or in children who have other diseases such as TB or HIV/AIDS.
  • The disease is spread mostly by secretions from the nose, throat, and mouth.
  • For the first 6-12 months of life, the infant is usually protected by transplacentally transmitted measle antibodies from the previously immunized or exposed mother.
  • Statistics: Global mortality in 2014 – 114,900 down from 2.6 millions before the global widespread vaccination in 1980; measles vaccine coverage globally - 85%. Incubation period -7 to 10 days.
Symptoms
  • Fever
  • Cough
  • Coryza
  • Photophobia
  • Periorbital edema
  • Conjunctivitis
  • Enanthem (Koplik spots) on the oral mucosa
  • Maculopapular rash
  • Complications of measles infection
  • Prostration

_Persistent fever with the darkening of the rash also known as “Black measles)

_Pneumonia

_Encephalitis

_Opportunistic bacterial infections

_ Acute thrombocytopenic purpura

_Edema of hand or feet

_Transient hepatitis

_Clouding of the cornea

_Stomatitis and mouth ulcers

_Diarrhoea from measles attack or backerial infections.

_Malnutrition due to various factors such as stomatitis, diarrhea, fever and vomiting.

_Vitamin A deficiency due to the fact that measles increase Vitamin A consumption. This is manifested as kerotoconjuctivitis, xerophthalmia and blindness.

Diagnosis
  • Clinical evaluation
  • Immunoassay
  • Molecular diagnostics
  • Viral detection through culture
Prevention

Measles, Mumps, and Rubella (MMR) Vaccine

Management
  • Supportive treatment

_Antipyretics preferably paracetamol to control fever

_Treatment of candidiasis in case it becomes evident.

_Increase the frequency of feeding to encourage weight gain.

_Although routine administration of antibiotics is not advised they should be prescribed in suspected cases of bacterial infections including pneumonia and otitis media.

  • Vitamin A  supplementation

_2 doses are given (one at clinic and the other one the following day at home) at the doses below:

 

Age

Dose

Less than 6 months

(Below 8kg)

50,000IU

6-12months

100,000IU

12 months -5yrs

200,000IU

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