1. Measles

2. Measles is one of the most contagious infectious diseases
Caused by the measles virus, which is RNA virus, a member of the family paramyxoviridae, genus Morbillivirus.

3. Epidemiology
Approximately 17 million measles cases and deaths worldwide in
Over 80% reported cases are from southeast Asia and Africa.
Over 85% in children aged <5 years.
In temperate climates, it occurs in late winter and late spring.
In tropical climates, it occurs primarily in dry season

4. Epidemiology Race: Measles affects people of all races. Sex:
Excess mortality following acute measles has been observed among females at all ages, but it is most marked in adolescents and young adults.

5. Epidemiology
Age:
affect everyone in infancy or childhood between 6m-3 years in developing countries and children > 5years in developed countries .
Following the use of measles vaccine ,the disease now seen in older age groups

6. Epidemiology Prior to widespread immunization
It was a common childhood disease.
There were an estimated 100 million cases and 6 million death each year.
It was endemic in large communities attained epidemic proportion every 2 or 3 years.
In small communities epidemics tended to be more widely spaced and more severe.

7. Epidemiology Effect of routine vaccination on the
epidemiology of measles
Reduction of the incidence by 99% in many developed countries.
Reduction of the CFR.
Cases appeared among young unimmunized children or older children, adolescents or young adults who received one dose.

8. Risk factors for infection
Children with immunodeficiency due to HIV or AIDS, leukemia, alkylating agents, or corticosteroid therapy, regardless of immunization status.
Travelers to areas where measles is endemic or contact with travelers to endemic areas.
Infants who lose passive antibody prior to the age of routine immunization

9. Risk factors for severe measles
Malnutrition
Underlying immunodeficiency
Pregnancy
Vitamin A deficiency (clinical and sub clinical)
Infants and adults

10. Chain of events Reservoir Human Mode of transmission Direct droplet
Air borne
Direct contact with nasal or throat discharge.
Articles soiled with nose & throat secretion (less common).

11. Chain of events
The incubation period
ranges from 8-12 days

12. Chain of events Period of communicability
signs and symptoms
one day before prodreomal period days after rash

13. Chain of events Susceptibility & resistance
Acquired immunity after illness is permanent.
Immunization at months induced immunity in 94-98% of recipients.
There is maternal immunity (6-9 months) depending on:
Amount of residual maternal antibodies at the time of pregnancy .
Rate of antibody degradation

14. Chain of events Susceptibility & resistance
Maternal antibodies interfere with the response to vaccination
Re immunization increases immunity level to about 99%.

15. Clinical features Incubation period ranges from 8-12 days
Prodromal stage: (last 3-5 days)
fever, malaise ,rhinorrhea, conjunctivitis, Koplik spots (small grey irregular lesions surrounded by erythematous base appears on buccal and pharyngeal mucosa).

16. Clinical features Rash (last 5 days)
Macculopapular rash started behind ears, face, and neck and then progress to involve the whole body ,arms and legs in spreading manner.
Rash usually associated with high fever (temp C)
Rash usually disappear in the same manner (this usually last 7-10 days)

17. Clinical features

18. Clinical Characteristics Complications
Otitis media
Interstitial pneumonitis,
Bronchopneumonia and croup
Dehydration and diarrhoea
Blindness
Sever skin infection.
Approximately 1 of every 1,000 patients develops acute encephalitis

19. Clinical Characteristics Complications
Rare complication include hemorrhagic measles, and protein losing enteropathy.
Sub acute sclerosing pan encephalitis (SSPE) (1/ cases) developed several years after infection.
Exacerbation of tuberculosis.
Encephalomyelitis.

20. Diagnosis
Diagnosis is usually on classic clinical picture and on epidemiological grounds.
Serological tests (IgM, IgG)
Isolation of measles virus from nasopharyngeal mucosa or blood

21. Prevention Public education Immunization
Live attenuated vaccine indicated to all persons not immune to measles ,unless otherwise contra-indicated.
Single injection of measles vaccine (MMR) which can be administrated concurrently with other inactivated vaccines or toxoid induces active immunity in 94-98% of susceptible (life long)
2 nd dose increases the immunity level to as high as 99%.

22. Prevention Side effects
5-15 % fever ,malaise within 5-12 days after immunization, lasts 1-2 days.
Occasionally rash, coryza, Koplik spots.
Infrequently febrile seizures .
1:10 6 dose Encephalitis & encephalopathy

23. Prevention In developed countries
To reduce the no. of vaccination failure :
1st dose at months.
2nd dose at 4-6 years Or
It must be given after one month after the first dose where the risk of exposed is high.
Both doses are generally given as MMR

24. Optimal age of vaccination
WHO recommend immunization at 9 months of age
Immunization before the age of 9 months run the risk the vaccine being rendered ineffective by natural antibodies through mother.
Age of vaccination can be lowered to 6 months if there is measles outbreak.
For infants immunized between 6-9 months, second dose should be gives as soon as possible after the child reach age of 9 months.

25. Contra-indication of vaccination
PT with primary immune deficiency disease affecting T-cell functions, or acquired immunodeficiency except HIV.
Sever illness with or without fever, Delay the dose until recovery.
minor illnesses such as diarrhea , upper respiratory infections are not a contra-indication..
Anaphylactic hypersensitivity to previous measles vaccine, gelatin or neomycin and egg hypersensitivity
Pregnancy

26. Control
Reporting
Obligatory early reporting means better control of the outbreak.
Isolation
At community level is impractical .
Children should be kept out of school for 4 days after appearance of rash.
Respiratory isolation for hospital cases

27. Control
Contacts
Live attenuated vaccine is effective if it given within 72 hrs of exposure.
IG should be used within 6 days of exposure for susceptible contacts or other contacts with high risk of complications.
For whom?????

28. Contacts Control Risk of complication is high <1 year of age
Pregnant women
Immunocompromised
If measles vaccine is contra indicated

29. 4- Specific treatment (essential steps)
Relieve common symptoms
Provide nutritional support
Promote breast feeding
Giving vit A

30. Control Specific treatment (essential steps)
Vit A At the time of diagnosis
Significantly reduces fatality
Prevent blindness due to corneal ulceration and keratomalacia

31. Control
4- Specific treatment (essential steps)
It is the recommended for children with measles in the following situations :
Areas where measles CFR>1%.
Areas of known vit A deficiency.
In all cases of sever complicated measles.

32. Vit A
1st dose immediately on the Dx
2nd dose in the next day
If the child has any eye signs indicating vitamin A deficiency, then a third dose must be given 2-4 weeks later
Doses
Infant<6 months IU
Infant 6-11 months IU
Infant 12 months IU

33. Epidemic measures Rapid (within 24 h) reporting of suspected cases.
Comprehensive immunization program.
In institutional outbreaks new admission should receive Ig.
In many developing countries rapid immunization campaign is essential. If the vaccine supply is limited priority should be given to young children for whom the risk is greater.

34. Thanks