how does measles present, approach, signs and symptoms, treatment in the developing countries like nepal and vaccination program, its scenario after earthquake

1. Common Childhood exanthematous illness :
Measles
Presentation By : Hari Sedai
Roll No. : 1626
MBBS 3rd Year
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2. Measles
• Common and serious viral exanthematous illness
• Aka morbilli, red measles, English measles, hard measles, rubeola,
fourth day disease, first fever/disease, dadura, khasra, sitala rog
• Historical disease
• Currently 3,50,000 children death annually in developing countries
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4. Causative organism : Measles virus (Paramyxovirus)
MOT :
Droplet spread, usually 4 days before to 5 days after the rash
Highly contagious
Portal of entry :
Respiratory tract where the virus multiplies in the respiratory epithelium
Reservoir : Human
Incubation Period : 10 days
Most common in preschool children ( 3 – 6 ) years
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5. Pathogenesis
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Entry of pathogen
Primary viraemia : Infection of the Reticuloendothelial system
Secondary Viraemia : Systemic symptoms

6. Clinical features
Prodromal (Catarrhal) phase :
• Fever ( more than 104 F ), rhinorrhea (coryza), conjunctival
congestion, dry hacking cough, photophobia
• Koplik spots
Pathognomonic
Appear opposite the lower 2nd molar teeth on the buccal mucosa on
the 2nd or 3rd day of the illness
Gray or white lesions resembling grains of sand with surrounding
erythema
• Stimson line : characteristic transverse line of inflammation along the
eyelid margin in conjunctiva
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9. Fig : Stimson line
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10. Exanthematous ( rash ) phase :
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Faint reddish macular rash appear behind the ears, along the hairline
and posterior aspects of the cheeks with fever on the 4th day
Becomes maculopapular and spread to the face, neck, chest, arms,
trunk, thigh and legs in that order over next 3 days
Starts fading in the same order that it appeared with branny
desquamation and brownish discoloration which fade over 10 days

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Fig : Rash confined to face on the 4th day of illness

12. Fig : Typical measles rash of 6th day of illness
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13. One case, various faces
Modified measles :
• In partially immune individuals
• Milder and shorter illness
Hemorrhagic/Black measles :
• Purpuric rash and bleeding from nose, mouth or bowel
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Fig : Hemorrhagic measles

15. Complications
• More frequent in very young, malnourished and
immunocompromised
• Causes widespread mucosal damage and significant
immunosuppression
• Bacterial bronchopneumonia, otitis media, laryngitis, tracheitis,
bronchitis, flaring up of latent M.tuberculosis infection, giant cell
pneumonia
• Diarrhea, appendicitis, hepatitis, ileocolitis
• Precipitate malnutrition and noma or gangrene of cheeks
• CNS : Acute encephalitis during the illness, brain abscess, post
measles encephalitis, fatal Subacute Sclerosing Panencephalitis
(SSPE), deafness, blindness
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17. Diagnosis
• Clinical
• Estimating the level of IgM antibodies that is present 3 days after the
rash and persists for one month
• PCR
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18. Differential features of other childhood exanthematous illnesses
• Rubella, enterovirus and adenoviral infections : mild rash and less
prominent fever
• Roseola infantum : Rash appears once fever disappears (unlike
measles where fever increases with rash )
• Rickettsia infections : Face is spared
• Meningococcemia : Absence of upper respiratory symptoms and rash
rapidly becomes petechial
• Kawasaki disease : glossitis, cervical lymphadenopathy, fissuring of
lips, edema of hands, scaling
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19. Management
• Symptomatic
• Vitamin A supplementation ( a single oral dose of 1,00,000 units
below 1 year and 2,00,000 units over the age of 1 year
recommended by WHO )
Rationale ?
• Management of complications
• Measles immune serum globin for passive protection
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20. Prevention
• Isolation ( droplet isolation ) until 4 days after the rash appears
• MR (9 and 15 months, 2*0.5ml , subcutaneous ), a live attenuated
vaccine
• Vaccination coverage rate for measles in Nepal is almost 90%
• Contraindication of MR : pregnancy, neoplasms, AIDS, antimetabolites
and steroids intake ( vaccine with inactivated virus can be used )
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21. • In April 2015 a major earthquake struck Nepal. A year later people in
one village of Dolakha district recall their struggles, in its aftermath,
to keep their children safe through immunization ( WHO )
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22. Late John Enders
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23. Bibliography
• OP Ghai Essentials of paediatrics
• Nelson Essentials of Paediatrics
• Davidson’s principle and practice of medicine
• Tabers encyclopedia
• ilner, Danny A. (2015). Diagnostic Pathology: Infectious Diseases E-
Book. Elsevier Health Sciences. p. 24. ISBN 9780323400374
• Caserta, MT, ed. (September 2013). "Measles". Merck Manual
Professional. Merck Sharp & Dohme Corp.
• Measles (Rubeola) Signs and Symptoms". cdc.gov
• http://www.who.int/features/2016/nepal-immunization/en/
THANK YOU!!! 23