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    A6. MSL Case Management

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    Pradeep Verma
    This document discusses measles, its complications, and vitamin A supplementation. Measles is highly contagious viral infection that increases susceptibility to other infections. It commonly causes pneumonia, diarrhea, and croup, especially in malnourished children. Vitamin A deficiency exacerbates measles and increases mortality. The document recommends giving two doses of vitamin A to children with measles to reduce complications and deaths by 48-81%. It also provides treatment guidelines for complicated and uncomplicated measles.

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    A6. MSL Case Management

    Uploaded by

    Pradeep Verma
    21 views14 pages
    This document discusses measles, its complications, and vitamin A supplementation. Measles is highly contagious viral infection that increases susceptibility to other infections. It commonly causes pneumonia, diarrhea, and croup, especially in malnourished children. Vitamin A deficiency exacerbates measles and increases mortality. The document recommends giving two doses of vitamin A to children with measles to reduce complications and deaths by 48-81%. It also provides treatment guidelines for complicated and uncomplicated measles.

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    This document discusses measles, its complications, and vitamin A supplementation. Measles is highly contagious viral infection that increases susceptibility to other infections. It commonly causes pneumonia, diarrhea, and croup, especially in malnourished children. Vitamin A deficiency exacerbates measles and increases mortality. The document recommends giving two doses of vitamin A to children with measles to reduce complications and deaths by 48-81%. It also provides treatment guidelines for complicated and uncomplicated measles.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    21 views14 pages

    A6. MSL Case Management

    Uploaded by

    Pradeep Verma
    This document discusses measles, its complications, and vitamin A supplementation. Measles is highly contagious viral infection that increases susceptibility to other infections. It commonly causes pneumonia, diarrhea, and croup, especially in malnourished children. Vitamin A deficiency exacerbates measles and increases mortality. The document recommends giving two doses of vitamin A to children with measles to reduce complications and deaths by 48-81%. It also provides treatment guidelines for complicated and uncomplicated measles.

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    Measles

    Case Management and Vit A supplementation

    Measles Surveillance
    District Workshop

    WHO/NPSP
    Basic facts… 1

    • Measles is a highly communicable viral


    infection
    • Measles can increase susceptibility to
    other infections such as pneumococcus
    and Gram-negative bacteria.
    • It can lead to or exacerbate vitamin A
    deficiency
    Introduction to Measles
    Basic facts … 2
    Basic facts

    • Factors increasing risk of complications/deaths


    – Infants
    – Malnutrition
    – Vit-A deficiency – clinical/sub-clinical
    • Deaths -- mostly the result of complications
    • Pneumonia,
    • Croup
    • Diarrhea
    • frequently associated with Malnutrition.
    Clinical features

    • Measles is highly infectious from the start of the


    prodromal period until approximately 4–5 days
    after the rash appears.

    • Case–fatality rates are estimated to be 3–5% in


    developing countries but may reach as much as
    10–30% in displaced populations. Recent Bihar
    outbreak had a CFR of 6%.
    Clinical features contd..
    • Characteristic
    erythematous (red)
    maculopapular
    (blotchy) rash appears
    on the third to seventh
    day, starting behind
    the ears and on the
    hairline and then
    spreading to rest of
    thebody.
    Complications
    Complications develop in 5–10% of cases.
    Complications occurring in the first week of illness,
    such as croup, diarrhoea and pneumonia, are
    usually due to effects of the measles virus and
    are rarely life-threatening.
    Later complications are usually due to secondary
    viral or bacterial infections – post measles
    pneumonia, diarrhoea and croup are the most
    common life-threatening complications.
    Complications of Measles
    Corneal scarring
    causing blindness

    Encephalitis

    Pneumonia &
    diarrhea
    Measles and vitamin A
    • Low vitamin A levels: ~ higher rates of complications &
    deaths
    • Synergy of measles & vitamin A deficiency have
    additive pathological effect on epithelia and immune
    system
    • This synergy causes ~ 1 million deaths

    • Measles itself may lead to severe acute depletion of


    vitamin A
    • Precipitates keratomalacia & blindness

    • Role of Vitamin A in measles:


    – 2 doses of Vitamin–A reduce mortality by 48-81%
    Uncomplicated measles
    • Administer Vitamin A
    < 6 months: 50,000 IU on 2 consecutive days
    6 to 11 months: 100,000 IU on 2 consecutive days
    >12 months: 200,000 IU on 2 consecutive days

    Education of mothers
    – Continue breast feeding, weaning foods, fluids
    - ORS if signs of dehydration
    - Control fever
    - Recognize symptoms and signs of complications
    GoI recommended Vitamin A
    schedule for treatment of measles
    Immediately on
    Age Next day
    diagnosis

    < 6 months 50,000 IU 50,000 IU

    6 – 11 months 1,00,000 IU 1,00,000 IU

    > 12 months 2,00,000 IU 2,00,000 IU

    2 dose schedule is more effective than single dose schedule


    Complicated measles
    • 2 doses of Vitamin A as for uncomplicated measles
    • Treat complications
    – Eye lesions: clean, 1% tetracycline ointment X 7 days, (if
    corneal lesions: cover with patch and give 3rd dose of
    Vitamin A at least after 2 weeks)
    – Ear discharge: clean and give antibiotics
    – Pneumonia: give antibiotics
    – Diarrhea and malnutrition: fluids and high quality diet
    – Encephalitis: refer to hospital

    Early and effective treatment of complications can


    reduce morbidity and mortality
    Summary: Basic Principles of
    management
    • Anticipate complications
    • Encourage breast feeding
    • Provide nutritional support to all children
    • Administer vitamin A
    • Give paracetamol if temperature exceeds 39°C
    • Give ORS for diarrhoea
    • Treat eyes promptly to prevent blindness
    • Use antibiotics if indicated
    • Admit severely ill children
    • Monitor growth regularly

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