The document discusses measles, including: 1. Measles is a highly infectious disease caused by a virus that affects virtually all children in developing countries where environmental conditions are poor. 2. While most cases are not serious, measles can cause complications like pneumonia, encephalitis, and death. It can also weaken the immune system and cause malnutrition. 3. Measles can be eliminated through high vaccination coverage with effective measles vaccines via routine immunization programs and supplemental immunization activities like catch-up campaigns for children. Maintaining high coverage is important to prevent outbreaks.

2. Why measles is serious?
Measles affects virtually everyone in
infancy/childhood in developing countries
where environmental conditions are poor.
• For most children who get measles, the illness
is not serious.
– 8% People with measles get diarrhea
– 5-15% get a middle ear infection (mainly young
children)
– 20-80 % get pneumonia

3. • About 1 in 3 lakh people with measles get
encephalitis (SSPE) - serious brain infection.
• Measles can turn a healthy child to
malnourished.
• Measles in pregnancy - early labor,
miscarriage, and low birth weight infants.
• Measles in people with AIDS or weak immune
systems can be very severe.

4. • When measles introduced to a virgin community
> 90% infected
• Epidemic of Measles - When susceptible children
>40%
• Secondary attack rate - 80%

7. Measles
• Caused by a RNA virus
• Paramyxo virus
• Only one antigenic type
• Reservoir/ source – human
• Transmission – respiratory route

8. Contd….
• Temporal pattern – peak in late winter
• and spring
• Communicability – 4days before and 4
days after rash onset
• Incubation period – 10-12 days
(7-18 d range)

9. Clinical features
• Prodromal stage
• Eruptive stage
• Post-measles stage

12. KOPLIK SPOT
Source:
http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lo
res.jpg

14. Complication
• Diarrhea,
• Pneumonia
• Otitis media
• Convulsions,
• SSPE (sub acute sclerosing panencephalitis)

15. SEPIO Meet, 18-20 May 2011 Bose, WHO 15
Measles complications
Corneal scarring
causing blindness
Vitamin A deficiency
(Common)
Encephalitis
Older children, adults
≈ 0.1% of cases
Chronic disability
Pneumonia &
Diarrhea
(Common)
Diarrhea common in developing countries
Pneumonia ~ 5-10% of cases, usually bacterial
desquamation

16. Can Measles be eliminated/eradicated
YES.
Highly effective measles vaccine.
Strong vaccination program that achieves high
vaccine coverage in children
Strong public health system for detecting and
responding to measles cases and outbreaks
Measles affects only humans
Only one serotype of measles virus

17. What should be done if someone is
exposed to measles?
• Notification of the exposure should be
communicated to a doctor.
• If the person has not been vaccinated,
measles vaccine may prevent disease if given
within 72 hours of exposure.
• Immune globulin (a blood product containing
antibodies to the measles virus) may prevent
or lessen the severity of measles if given
within 3-4 days of exposure.

18. What is the role of vit A in measles
 People with low levels of vitamin A are
more likely to have a more severe case of
measles.
 Vitamin A megadoses on each day for two
days lessens severity of Measles.
 Two doses of vitamin A not too expensive,
not likely to produce adverse effects.

19. How many doses of Measles vaccine in
National immunisation schdule?

20. When a second dose of measles vaccine be
added to the routine schedule?
• When a country achieves 80% immunsation
coverage with single dose in Routine
Immunisation,can add 2nd dose in RI
• States with <80% evaluated coverage of
1st dose of Measles vaccine in RI
Supplementary immunization activity (SIA) for
measles through catch up immunization
campaigns and or follow up immunization
campaigns

21. SIA: MCV1 <80%
RI: MCV1 > 80%
2nd Dose of Measles vaccine:
State specific delivery strategies
MCV1: Coverage of Measles containing vaccine
per DLHS-3; CES-06 for Nagaland

22. What are the AEFI following measles
vaccination?
• Fever
• Rashes
• Anaphylaxis 0-1 hr
• Febrile seizures(6-12 days)
• Thrombocytopenia - 60days
• Toxic shock Syndrome

23. How can Toxic shock syndrome
following Measles be vaccine reduced?
TSS - staphylococcal contamination of vaccine
• Fever ,vomiting ,diarrhoea ,shock
• Reconstituted measles vaccine should not be
used after 4 hrs.
• Use Sterile syringes,needles

25. Measles vaccine
Type Live attenuated
Dose 0.5 ml
Route Subcutaneous
Site Right Upperarm

27. Who should not receive the MMR
vaccination?
Pregnant women
Anyone with a weakened immune system
(cancer patients receiving treatment)
Who has had an anaphylactic reaction to
gelatin, or the antibiotic neomycin

28. Why measles vaccine given at 9 mon in
India and >1 Year in US?
• As the envirnmental conditions of country
improve,where incidence of measles declined
the age of MCV can be taken later(after 1
year)
• Till 1 year maternal antibody gives passive
protection
• WHO recommends 9 mon for India
• Age can be lowerd to 6 mon – in measles
outbreak

29. What is the epidemiologic shift seen
in measles
With the use of measles vaccination in
children measles now seen in old age.severity
of illness more in oldage

30. Growth on global vaccination of
Measles containing vaccine 1989-2012

31. WHO targets for 2015
• Raise RI coverage with MCV 1 > 90%
nationally/ >80% every distric
• Reduce and maintain annual measles
incidence <5/million
• Reduce measles mortality by >95% of year
2000

32. What are the challenges in measles
elimination in India ?
• Highly infectious nature of disease
• Changing epidemiology of measles
• Need to provide catch-up vaccination to >130
million children in India
• Population that are inaccessible due to conflict
• Refusal of immunisation by some community
• Weak immunisation programme
• Gaps in human and financial recourses of the
country.

33. How to achieve high level of
vaccination coverage
• Through RI(Routine immunisation) &
SIA(supplimentary immunisation activity

34. What are the SIA s?-
Catchup and Follow up
Catch Up- Onetime nationwide vaccination of
all children 9 mon to 14 years regardless of
vaccination /disease status
Keep Up- Routine vaccination for vaccinating >
95% successive birth cohort
Follow Up- successive nationwide campaign
every 2-3 years born after catchup campaign

35. What is atypical Measles?
• Occures in individuals who were previously
vaccinated with killed measles vaccine b/w
1963- 1967 who have incomplete immunity
• Fever, headache, abd pain ,rashes prominent
in body creases.

36. Measles vaccination started at what
year india
• Measles vaccination started at what year india
– 1985,when EPI UPI
Measles 2nd dose started in 2010 in 14 states.

37. If a child has received the Measles vaccine
before 9months of age, is it necessary to
repeat the vaccine later?
Yes, 2 nd dose as soon as the child reaches 9
mon.It can be given till 5 years of age

38. Further read about – Global Measles and
rubella initiative 2012-2020