measles 12-12-2019

Measle
: COMMUNITY MEDICINE SPECIALIST

DR MOHAMMED AL-HAKAMY
;COMMUNITY MEDICINE DEPARTMENT
FACULTY OF MEDICINE ; IBB UNIVERSITY
2019 -12- 12
Headlines
Definition of measles 
History of measles disease 
Problem statement 
Epidemiological determinants 
Clinical features 
Complication 
Prevention 
Measles
Measles: An acute highly infectious disease of childhood caused 

.by a specific virus
History: The earliest description of M. was given by the noted 
Arab physician Abu Bacr (865-925)
M virus was isolated by Enders in USA – 1954 
M vaccine was first used in a clinical triad – 1958 
live M vaccine was licenced for use – 1963 

Problem statement
M endemic in all parts of the world 
M tends to occur in epidemics when the proportion of susceptible 

children reaches about 40%
The case fatality rate range from 2-15(in developing countries) 
.compared to less 0.2 per 10000 notified cases in developed countries
Before the vaccine became M killed 7-8 million children a year and 
.caused an estimated 135 million cases a year worldwide
Today it still kills about 1million children among 30 million cases 
The M is still a leading killer among vaccine-preventable dis. Of 

.children mainly among malnourished children
In 2004 it was estimated 454000 M deaths globally (1200 deaths 
.every day or 50 deaths every hour
Epidemiological
determinants
:Agent factors 
A- Agent – M. caused by an RNA paramyxvirus one serotype, 

cannot survive outside the human body but retains infectivity
.when stored at sub-zero temperature
.B- Source of infection – the only source a case of M 
C- Infective materials- secretion of the nose, throat and RT. 

.During prodromal period and early stage rash
Communicability- M. is highly during prodromal and eruption(4 
days before and 5 days after rash)and declines rapidly after the
.appearance of rash
.E- Secondary attack rate – infection confers life long immunity 
:Host factor 
A- Age – infancy or 6months to 3 years of in developing 

.countries
.And over 5 years in developed countries 
B- Sex- incidence equal 
C- Immunity- no age is immune if there was no previous 

.immunity, one attack of M. confers life long immunity
.Infant are protected by maternal antibodies up 6 months of age 
D- Nutration - M. tends to be very sever in malnourished child, 

.mortality 400 times higher than in well-nourished children
:Transmission 
Directly from person to person by droplet infection and droplet 

.nuclei from 4 days before onset of rash until 5 days therafter
:Incubation period 
days from exposure to onset of disease 10 

Clinical features
:Three stages in the natural history 
Prodromal stage- it begins 10 days after infection and lasts -1 

until day 14 ( fever, sneeze, nasal discharge, cough, redness of
the eyes, may be vomiting, diarrhea. A day before the rash
.Koplik’s spots appeare on the buccal mucosa
Eruptive phase- typical dusky-red, macular or maculo-popular -2 
rash which begins behind the ears and spread rapidly in a few
hours over the face and neck and extend down the body taking
.2-3 days to progress the lower extremities
Diagnosis based on the typical rash and Koplik’s spots 
Post-measles stage- lost weight, remain weak for days and -3 

become susceptible to other infection
complications
The most common are diarrhea, pneumonia and otitis media 
The rare complications are neurological which include – fibrile 

convulsion, encephalitis and sub-acute sclerosing pan-
encephalitis(SSPE) –mental deterioration leading to paralysis .
The diagnosis by demonstration of high levels of M. complement
fixing anti-bodys in CSF and serum. the frequency of SSPE is
7cases in one million cases
Deficiency of vitamin A leading to keratomalacia and night 
blindness
Prevention
Achieving an immunization -1

rate of over 95%
On-going immunization -2
against M. through successive
generation of childhood
Measles vaccine
A live attenuated vaccine 
WHO Expanded Program on Immunization(EPI) 

recommended immunization at 9 month of age, this age
can be lowed to 6 months in outbreak situation. The
.second dose at 18 months of age
Administration – subcutaneous of 0.5ml (fever for 1-2-1 
days after adm. And rash for 1-3 days after adm. Are
normal reaction )
Immunity – developed after 11-12 days of vaccination, -2 
.one dose can give 95% protection for life long period
contacts – susceptible contact over 9-12 months may -3 
be protected with M. vaccine provide within 3 days of
.exposure
Adverse effects of
vaccination
toxic shock syndrome TSS occurs when M, vaccine 
contaminated or the same vial is used for more than one
session on the same day or next day(the vacc. Should not
be used after 4 hours of opening the vial )
TSS – include sever watery diarrhea, vomiting high fever 
.may reported within few hours of vaccination
The vaccines Measles, Rubella, and Mumps can be 
combined together.(MMRvaccine)
Immunoglobulin – M. may be protected by adm. I.g early 
in the incubation period, the recommended dose is 0.25ml
per k.g body weight should be given within 3-4 days of
exposure followed by given M. vaccine through 8- 12
.weeks late
Control measures
isolation for 7 days after -1

.onset of rash
immunization of contacts -2
within 2 days of exposure
prompt immunization at the -3
beginning of an epidemics is
.essential to limit the spread
WHO’s M elimination
strategy
WHO – comprises a three part vaccination
strategy
Catch-up, keep-up and follow-up
catch-up - is defined as a one time nationwide -1
vaccination campaign targeting all children aged
9month – 14years regardless of history of M
.disease or vaccination
keep-up – is defined as routine services aimed -2
at vaccinating more than 95% successive birth
.cohort
follow-up – is defined as subsequent nationwide -3
The priorities of countries pursuing M. control 
:include
improve routine vacc. Coverage level to at -1 
least 95%
Active coverage of more than 90% in catch-up -2 
.and follow-up or with routine second dose
Establish case-based surveillance with -3 
laboratory confirmation of suspected cases and
virus isolation from all chains of transmission
conduct supplementary vaccination campaign -4 
.together with vitamin A

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Measle

: COMMUNITY MEDICINE SPECIALIST

History of measles disease 

Measles: An acute highly infectious disease of childhood caused 

M vaccine was first used in a clinical triad – 1958 

live M vaccine was licenced for use – 1963 

M endemic in all parts of the world 

M tends to occur in epidemics when the proportion of susceptible 

The M is still a leading killer among vaccine-preventable dis. Of 

A- Agent – M. caused by an RNA paramyxvirus one serotype, 

C- Infective materials- secretion of the nose, throat and RT. 

A- Age – infancy or 6months to 3 years of in developing 

B- Sex- incidence equal 

C- Immunity- no age is immune if there was no previous 

D- Nutration - M. tends to be very sever in malnourished child, 

Directly from person to person by droplet infection and droplet 

days from exposure to onset of disease 10 

:Three stages in the natural history 

Prodromal stage- it begins 10 days after infection and lasts -1 

Post-measles stage- lost weight, remain weak for days and -3 

The most common are diarrhea, pneumonia and otitis media 

The rare complications are neurological which include – fibrile 

Achieving an immunization -1

A live attenuated vaccine 

WHO Expanded Program on Immunization(EPI) 

isolation for 7 days after -1

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