Measles is an acute respiratory viral infection, contagious in nature. It may lead to epidemic if susceptible population is more than 40%. But with very effective vaccine, it can be eliminated

1. Identify the Disease

4. Measles
(Rubeola)
Dr . Anuradha Davey
Associate Professor
Community Medicine

5. Introduction
• Measles means- Red Spots
• It is Acute Viral exanthematous fever and
leading cause of VPD
• Most contagious disease known
– And if ds is introduced in a virgin community- 90%
of population will be affected
– Immunity level needed to interrupt transmission is
94% or higher

6. • Prior to vaccination- epidemic after every 2-3
yrs
• After vaccination- Interval increased to 5 years
and peak of intensity decreased
• Epidemic occur when susceptible population
reached around 40%

7. Clinical features
3 stages
• Prodromal
• Eruptive phase
• Post Eruptive phase

8. Prodromal phase

9. Prodromal:
begins at 10 days after exposure and last for 4 days
– Fever
– Coryza
– Sneezing
– Nasal discharge
– Cough
– Redness of eyes
– Lacrimation
– Photophobia
– May be vomiting or diarrhoea

10. • KOPLIK SPOT: 1-2 day before or after
appearance of rash: small bluish-white spot on
red base, smaller than head of a pin, against
first and second lower molar tooth.
“Pathognomic”

11. Koplik Spot

12. Eruptive phase:
Rash appearance: after 4days of fever or 14 days
of exposure
– Dusky red, Maculo-papular rash ( pathognomic)
– Discrete, confluent, blotchy
– Begin behind the ear, in few hrs face and neck, down body
in 2-3 days
– Disappear in another 3-4 days in same order
– Patient normally improves by 3rd day of rash and
uncomplicated case recover within 7-10 days of onset of
disease
– Brownish discoloration lasting for 2 months or so
During this phase, virus excrete from tear, nasal & throat
secretion, urine, blood

13. Measles Rash-3rd day

14. Brownish discoloration of rash

15.  Rash are because of circulating antibodies ,
result from interaction of T cells with virus
infected cells in small blood vessels
 Patient with defective CMI- no rash

16. Post eruptive phase
• Decreased immunity: chances of secondary
infection
• Loss of weight
• Growth retardation
• Diarrhoea
• Cancrum oris
• Pyogenic infection
• Candidiasis
• Reactivation of pulmonary TB

17. Complications
• Measles associated diarrhoea
• Pneumonia (most common cause of death)
• Respiratory tract infection
• Otitis media

18. Complications…Measles
• Encephalitis (4-7 d after onset of rash) : 1: 1000 → 15%
die
• Sub acute sclerosing pan encephalitis: rare(1: 3,00,000)
• develop many yrs after measles infection.
• Diagnosis by CF AB in CSF. Fatal →
severe personality changes, myoclonic seizures, motor
impairment,coma and death over course of several
months to years

19. EPIDEMIOLOGY
Agent
Transmission
Host
Environment

20. Agent
Category: Viral Disease-RNA paramyxovirus
 Only one serotype- so life long immunity
• Easily destroyed by sunlight, acids and drying
• BUT At sub zero temp: virus retain infectivity,

21. Agent…..
• Source of Infection: Case or subclinical case
No carrier stage
Infective material: secretion from nose, throat,
respiratory tract

22. • Direct- Person to person: droplet infection (the virus
can survive for atlest two hours in fine droplets)
• Indirect: droplet nuclei, articles freshly soiled with
discharges
Entry point : respiratory tract
• Conjunctiva
Transmission
Communicability: prodromal phase and eruption of
rashes.
4 days before and 4 days after the appearance of rash.

23. Host factor
• Age: 6 mths to 3 year in developing countries
and around 5 years in developed
• Sex: equal in both sex but mortality following acute
measles in greater in females at all age
Immunity: If no previous immunity: all ages are
susceptible
•One attack gives life long immunity
•Second attack is 90%
•Immunity after vaccination is life lasting
•Maternal ab persists from 6-9 mths after birth

24. Host continued…….
• Increased risk of developing severe or fatal measles
in the following cases:
– Malnutrition (measles can precipitate kwashiorkor
in borderline cases)
– Vit A Deficiency
– Severe immunological disorder such as advanced
HIV Infection-

25. Environment
• Tropical zone: dry season
• Temperate zone: winter
Overcrowding favours transmission
Incubation period:
From exposure to onset of fever: 10 days and
From exposure to appearence of rash: 14 days
•Overcrowding favours transmission
Mini measles by passing the RT (through vaccination) : 7
days

26. • Measles infection during pregnancy→
spontaneous abortion, LBW, premature
delivery
• Atypical Measles Syndrome: high fever,
pneumonia, pleural effusion, edema of hands
& feet, hepatic abn, unusual rash
↓
seen in persons who received killed measles
vaccine in the past & who were subsequently
exposed to measles virus

27. Prevention and Control
• Active Immunization- Primary method of
prevention
• Passive immunization- Administration of
Immunoglobins
• General measures

28. Diagnosis
• History of contact with a case
• C/F: maculopapular rash & koplik spots are
pathognomic
• Lab:
A four fold rise in in measles antibody titre in
acute or convalescent serum
IgG antibodies appear shortly after rash,peak
in 2 to 4 weeks and last for lifetime
Viral particles can be demonstrated using RT-
PCR

29. Active Immunization
• Type of vaccine: Live attenuated vaccine- as freeze
dried product (Chick embro or Human Diploid Cell line(
Edmonston Zagreb strain vaccine)
• Reconstitution: by cooled sterile diluents, must not
be frozen
• Sensitive to light : so kept in covered glass vials and
reconstituted vaccine must be used in 6 hours

30. Continued….
• Dose: 0.5 ml,
• Route: S/c or IM
• Age: 9 months
– THREE situation where vaccine can be given at 6
months if measles outbreak in India
Malnourished child
HIV (Asymptomatic ) infection
and repeat dose at 6-9 mth with 4 weeks interval
Contraindications: Pregnancy
immunocompromised
anaphylactic reaction to neomycin, gelatin
or other components of vaccine

31.  Immune response: humoral and cellular response with
lower Ab titer
 Reaction: Mini measles illness 5-10 days after
immunisation (15-20% of the vaccinees)
Fever lasts for 1-2 days and rashes last for 3-4 days
Immunity: develops after 11-12 days
99% protection when given at 12 month and 90%
protection when given at 9 month because of slow
sero conversion

32. Passive immunization
• Normal human Immunoglobins
• Dose: 0.25ml/kgbw
• Within 6 days
• Indication: vulnerable susceptible households
contacts like immunocompromised children

33. General measures
• Isolation : for one week from appearance of
rash
• Articles soiled with secretions or fluids from
vesicles s/b incinerated or treated with
disinfectants
• Reporting of outbreaks to local health
authorities

34. Treatment
• No specific treatment
• Supportive therapy-
– Fever(antipyretics)
– Dehydration (ORS)
– Gen. Nutritional support
– Antibiotic-for secondary bacterial infection
– Vit A supplementation
Dose: 2 doses 24 hours apart
supplementaty doses: 6mth- 1 year: one lakh IU
above 1 year: 2 lakh IU every 6 mthly

35. Definition of Elimination of Measles
by WHO
Absence of endemic measles for more than 12
months in the presence of adequate
surveillance
Indicator of measles Elimination:
• Sustained measles incidence <1/100,000
population

36. Why Measles can be eliminated…
• One sero type
• Life long immunity
• No chronic carrier state
• No animal reservoir
• Virus is easily destroyed

37. WHO Strategy for elimination
Catch up
Keep up
Follow up
• 1. Catch up: one time nation wide
vaccination campaign targeting usually all
children from 9mths to 14 yrs regardless
of previous h/o vaccination or ds
.

38. Continued….
2. Keep up: Routine services aimed at vaccinating
more than 95% of each successive birth cohort
3. Follow up: Subsequent nation wide vaccination
campaign after every 2-4 years targeting all children
born after catch up campaign
First two are the supplementary vaccination
campaign

39. Measles vaccination with HIV infection
• Asymptomatic HIV infection: Measles is not a
contraindication.
– It is given at 6 months and additional dose at 9
months
• Severely immuno-compromised: Measles
contraindicated

40. •Thank you