Neetu Gupta

Roll No. 17
INTRODUCTION
Measles , aka RUBEOLA is an acute , highly contagious
exanthematous, respiratory, VIRAL ds. Of childhood.
Characterized by : Fever
Catarrhal respiratory symptoms ( cough, coryza)
Typical maculopapular rash
It is a cause of high childhood morbidity & mortality esp. in the
developing countries.
Measles occurs only in humans & there is no animal reservoir of
the infection.
PROBLEM STATEMENT
Measles is ENDEMIC to almost all parts of the world.
It occurs in epidemics when the proportion of susceptible children reaches about 40%.
Even though the ds. Is now rare in many developed countries , it still is a
common illness in the developing countries due to failure to deliver at least
one dose of measles vaccine to all infants.
-Weak immunization systems
- high infectious nature of the ds.
- refusal of immunization by some populations
- populations inaccessible due to conflict
-gap in the human & financial resources at the country, regional & global level
(Above mentioned are some challenges in measles elimination.)
In India, prior to the immunization programme, cyclical increase in the incidence
were recorded every third year. During 1987 about 2.47 million cases were
reported , however after UIP implementation no. of cases have come down t0
15,768 with 56 deaths in 2103.
 WHO STATISTICS & INITIATIVES
In 1980, before the widespread
use of measles vaccine , an
estimated 2.6 million measles
deaths occurred worldwide.
Accelerated immunization
activities have had a major
impact on reducing measles
deaths. During 2000-2015,
measles vaccination prevented an
estimated 20.3 million deaths.
Global measles deaths have
decreased by 79% from an
estimated 6,51,600 in 2000 to
1,34,200 in 2015.
 Strategy of delivering 2 doses of measles containing vaccine (MCV) to a children
through routine services & supplementary immunizing activities (SIA)
Improving disease surveillance.
In 2010, the World Health Assembly established 3 milestones towards the future eradication of
measles to be achieved by 2015:
increase routine coverage with the first dose of measles-containing vaccine (MCV1) by
more than 90% nationally and more than 80% in every district or equivalent administrative unit
for children aged 1 year;
reduce and maintain annual measles incidence to less than 5 cases per
million
reduce estimated measles mortality by more than 95% from the 2000 estimate

2012-2020 Global Measles and Rubella Strategic Plan

By the end of 2015 the plan aims:
to reduce global measles deaths by at least 95% compared with 2000 levels;
to achieve regional measles and rubella/congenital rubella syndrome (CRS) elimination goals.
By the end of 2020 the plan aims:
to achieve measles and rubella elimination in at least 5 WHO regions.
 EPIDEMIOLOGICAL DETERMINANTS
AGENT FACTORS
Caused by RNA Paramyxovirus
Source of infection: Cases
Infective materials : Secretions from
nose, throat & respiratory tract of a
case
Communicability: highly infectious
during prodromal phase and at time of
eruption of rash.
Period of communicability 4 days
before and 4 days after the
appearance of the rash.
Secondary attack rate Infection confers
lifelong immunity Picture of the measles virus studded with
THERE IS ONLY ONE ANTIGENIC TYPE OF glycoprotein on its surface.
MEASLES.
 HOST FACTORS
AGE- Affects almost everyone in infancy or childhood b/w 6
months & 3 years of age in developing countries.
Older children usually 5 yrs. in developed countries.
Gender- No gender predisposition
IMMUNITY- No age is immune if no previous immunity. One attack
confers lifelong immunity.
NURITION : Malnourished children are 400 times more prone to
developing serious complications due to the ds. It maybe due to
poor cell mediated immunity.
INCUBATION PERIOD
Usually 10 days from exposure to onset of fever & 14 days to
appearance of rash
 ENVIRONMENTAL FACTORS:
It can spread in any season
In tropics - Most cases during DRY SEASON
In temperate WINTERS mainly, maybe due to crowding indoors.
In India Epidemics common during winter and early spring ( JAN- APR)
Population density & movement affects epidemicity.
Poor Socio-economic conditions = lower the avg. age at which children are
attacked.
TRANSMISSION :
Person to person transmission
via Droplet infection & droplet nuclei from 4 days before onset of rash
until 4 days thereafter.
Portal of entry Respiratory tract, Conjunctiva
Recipients of measles vaccine are not contagious to others.
There are 3 stages-
1. PRODROMAL OR PRE-ERUPTIVE STAGE
2. ERUPTIVE STAGES
3. POST-MEASLES STAGE
1. PRODROMAL STAGE - Begins 10 days after contacting infection
Lasts till the 14th day thereafter
Characterized by FEVER
RESP. SYMP Coryza, sneezing, nasal
discharge, cough .
OCULAR SYMP. - Redness of eye,
lacrimation & often photophobia
GI SYMP. Diarrhea or vomiting.
KOPLIKS SPOTS appear a day or two
before appearance of the rash.
Kopliks spots- Table
salt like crystals appear on
the buccal mucosa opposite
the 1st & 2nd molars.
These are small, bluish-white
spots on the red base ,
smaller than head of pin
These are PATHOGNOMIC OF
MEASLES.
2. ERUPTIVE STAGE :
A typical , dusky red, macular or
maculopapular rash appears.
First behind ears & spreads within
a few hrs. over the face & neck.
Then extends down the body ,
involves the trunk &within 2-3
days reaches lower extremities.
Rash may remain discrete or
become confluent & blotchy as
shown in picture.
The lesions & fever may
disappear in another 3-4 days &
ds ends.
 The rash fades in same as order as
appearance leaving a brownish
discoloration which may persist for 2
months or more.
 During Prodromal phase (of about 4 days) and first 2-4 days after
rash appears- VIRUS IS PRESENT IN THE Tears, Nasa & throat
secretions, Urine & Blood.
As rash appears, circulating antibodies in body become
detectable.
Rash develops as result interaction of T cells with virus infected
cells in small blood vessels.
In pts. With defective cell mediated immunity, RASH DOES NOT
DEVELOP.
. POST MEASLES STAGE:
3

Child has weight loss

Remains weak for a no. of days
Ds. May progress to chronic
illness- due to increased
susceptibility to bacterial & other
viral infections, nutritional &
metabolic effects.
Other Clinical features maybe-
Growth retardation, diarrhea,
cancrum oris, pyogenic infections,
candidiasis, reactivation of
Pulmonary TB.
 COMPLICATIONS OF MEASLES
1. Pneumonia is most common.
(Pulmonary infections account for more than 90% measles
related deaths.)
2. Otitis Media- occurs in about 5-15% cases.
3. Neurological complications Febrile convulsions, encephalitis
(1:1000 cases), SSPE (1:300,0000 cases)
(Subacute sclerosing pan encephalitis- progressive mental
deterioration, muscle rigidity & coma)
Even though SSPE is a rare comp. It is fatal within 1-3 years of
onset.
4.In pregnant woman, it may cause Spontaneous abortion, premature
delivery. Infants born to measles infected mothers must be passively
immunized with Immunoglobulins soon after birth.

5. Acute Vitamin A deficiency can lead to Keratomalacia & blindness from

corneal scarring.
6. DIARRHEA

Measles & chicken pox may sometimes occur together & first infection may
diminish the severity of rash of the other infection.
 PREVENTION
Two main GUIDELINES IN
COMBATING MEASLES-
1. Achieving an
immunization rate of 95%
2. On going immunization
against measles through successive
generation of children.
Two ways to prevent-
1. Active immunization
2. Passive Immunization
1. MEASLES VACCINATION

Measles best prevented by ACTIVE IMMUNIZATION

VACCINE- Its LIVE ATTENUATED VACCINE . Each dose of 0.5 ml contains
>1000 viral infective units of vaccine strain.
Before use, lyophilized vaccine is reconstituted with sterile diluent. It contains-
sorbitol, hydrolyzed gelatin as stabilizers , neomycin. It is sensitive to sunight,
so kept in colored vials. Also, it must be stored in refrigerated conditions.
Measles immunization requires proper timing of administration
AGE- If given before 9 months , maybe rendered ineffective due action of
antibodies acquired from mother at birth.
If given after 9 months, some proportion of children may contact
measles in this interval.
SO, MOST EFFECTIVE COMPROMISE IS IMMUNIZATION AS CLOSE TO 9 MONTHS
OF AGE AS POSSIBLE.
 As WHO recommendations, one dose of vaccine be given at 9 Months of age or
6 months if there is any outbreak in the community.
Second dose be given 4 weeks later.
In countries where measles has declined, age is raised to 12 months.
ADMINISTRATION Subcutaneous inj. Or IM
IMMUNE RESPONSE TO VACCINE- Vaccine induces both humoral & Cellular
immunity .
IMMUNITY- Vaccine provides immunity to even severly malnourished children.
It develops 11-12 days after vaccination and remain for a lifetime
CONTACTS- Susceptible contacts of age 9-12 months can be protected against
measles by the vaccine if given within 3 days of exposure.
 CONTRAINDIACTIONS
1. High fever or any other signs of serious ds.
2. Pregnancy
3. People with h/o anaphylactic rxn. to NEOMYCIN, GELATIN or
other components of the vaccine.
4. Immunocompromised persons-
severe HIV infection, advanced leukemia or lymphoma, serious
malignancies, t/t with high doses of steroids, alkylating agents or
antimetabolites or those on immunosuppressive radiotherapy
 ADRs
1. TSS (Toxic Shock Syndrome ) may occur if vaccine is
contaminated or same vial has been used for more than one
session on same day or next day or if vial is used after 4 hours of
opening vial.
Symptoms- Watery diarrhea, vomiting, high fever within a
few hours of vaccination. Death may occur within 48 hours.

MEASLES & HIV

Measles vaccine can still be given in HIV symptomatic adults & children only if
they are not severely immunocompromised.
In areas of high incidence of HIV & MEASLES, 2 additional doses are
recommended. First dose must be given at 6 month.
 COMBINED VACCINES.
1. MMR
2. MMRV
3. MR
The measles vaccine has been in use since the
1960s. It is safe, effective and inexpensive. WHO
recommends immunization for all susceptible
children and adults for whom measles vaccination is
not contraindicated. Reaching all children with 2
doses of measles vaccine, either alone, or in a
measles-rubella (MR), measles-mumps-rubella
(MMR), or measles-mumps-rubella-varicella (MMRV)
combination, should be the standard for all national
immunization programmes.
 PASSIVE IMMUNIZATION
Immunization with Immunoglobulins
This form of immunization mainly helps prevent the ds in
the early IP
DOSE 0.25 ml per kg bd. Wt. Given within 3-4 days of
exposure
Personpassively immunized must be give Live attenuated vaccine aso
8-12 weeks later.
OUTBREAK CONTROL OF
MEASLES
FOLLOWING MEASURES ARE RECOMMENDED:

Isolation for 7 days after onset of ras

Immunization of contacts within 2 days of
exposure (if vaccine c/I Igs be given within 3-4
days of exposure.)
Prompt immunization at beginning of an
epidemic is essential to limit the spread.
 Summary
Measles is a highly contagious viral disease, which affects mostly children.
It is transmitted via droplets from the nose, mouth or throat of infected persons.
Initial symptoms, which usually appear 1012 days after infection, include high
fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth.
Several days later, a rash develops, starting on the face and upper neck and gradually
spreading downwards.
There is no specific treatment for measles and most people recover within 23
weeks.
However, particularly in malnourished children and people with reduced immunity,
measles can cause serious complications, including blindness, encephalitis, severe
diarrhoea, ear infection and pneumonia.

Measles can be prevented by immunization!

 BIBLIOGRAPHY
Parks Textbook of PREVENTIVE AND SOCIAL MEDICINE
www.cdc.gov
http://www.who.int/mediacentre/factsheets/fs286/en