Measles is a highly contagious viral infection transmitted through airborne droplets. It was distinguished from smallpox in the 9th century but repeated epidemics were not recorded until the 11th-12th centuries. The virus spreads rapidly through the respiratory route and has an incubation period of 6-18 days. Typical measles is characterized by a prodromal phase including fever and Koplik's spots followed by a maculopapular rash that spreads from head to feet over 3-5 days. Complications can include pneumonia, encephalitis and death in rare cases. Two doses of the live attenuated MMR vaccine provide over 95% efficacy and lifelong immunity.

2. Measles is an acute high contagious viral
infection, mainly transmitted by an airborne
way, characterized by cyclic course, syndromes
of intoxication, catarrhal inflammation &
exanthema.

3. A bit of Measles history
Measles infection was distinguished from
smallpox as early as the 9th century by an Arab
physician by the name of Abu Becr Razi (the
Doctor of Baghdad).
However, there is no record of repeated
epidemics identified as measles until the 11th &
12th centuries.
Measles was first mentioned as a childhood
disease in 1224.
The Danish physician Peter Panum is generally
given credit for illuminating the basic principles
of measles infection and epidemiology during his
trip to the Faroe Islands in 1846 during a measles
epidemic.
Estimated to have killed about 200 million
worldwide in the last 150 years

4. Global Progress
Measles Mortality Reduction by 50% by 2005
(compared to 1999 : 875,000 deaths)
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
1999 2000 2001 2002 2003 2004 2005
Estimated Measles Mortality by Year

6. 2015 OUTBREAK IN 2015

7.  Paramyxovirus (RNA)
 One antigenic type
 Rapidly inactivated by
heat and light
MEASLES VIRUS

8. ETIOLOGY
Family Paramyxoviridae
Structure RNA, external lipoprotein shell
Labile Ultraviolet rays and light, At day time in droplets of
saliva it dies within 30 minutes
Isolation Blood, nasopharyngeal outwashings
Properties Complement fixation, Hem agglutination,Lytion
Tropism Epithelium of the URT & GI tract, CNS, leukocytes

9. AGENT
 RNA virus ( Paramyxovirus family, genus Morbillivirus)
 Source of infection - cases of measles, but not carriers.
 No animal reservoir
 Infective material - Nasal secretion ,Respiratory tract &
Throat
 Communicability - Highly infectious during prodromal
period and at the time of eruption.
 Secondary attack rate - > 80%

10. TRANSMISSION
The virus spreads by
the respiratory route
via aerosol droplets
and respiratory
secretions which can
remain infectious for
several hours.
The infection is
acquired through the
upper respiratory
tract or conjunctiva.

11. Temporal pattern :
Peak in late winter– spring
Communicability : 4 days before
to 4 days after rash onset.

12. CLINICAL TYPES

13. Incubation period - 6~18 days
10 days is the most common (3-4weeks)
Predromal phase - 3~4 days.
 Fever
 Catarrhal inflammation of URT
 Koplik’s spots
 Transient prodromal rashes.
TYPICAL TYPE

14. Koplik's spots, are
pathognomonic in
measles, appear on
the buccal and
lower labial
mucosa opposite
the lower molars as
White spots inside
the mouth

15. 2-4 days
after
prodro
me,
14 days
after
exposur
e
Maculop
apular,
becomes
confluen
t
Begins
on face
and
head
Persis
ts
5-6
days
Fades
in
order
of
appear
ance
Rash

16. DAY 1 DAY 2 DAY 3

17.  Eruption stage
 Time: 3~5 days after fever , but the 4th day is most
common;
 Shape: maculopapular
 Sequence: Behind the ear Along the hairline
Face Neck Chest Back Abdomen
Limbs Hand Feet ( palm , sole)
 The temperature rise continuously and companied with
the toxic symptoms exaggerate

18. Convalescent stage
 Brown staining.
 Fine branny desquamation.
 Course: 10-14 days

19.  Mild measles
 Severe measles (toxic & shock type measles)
 Hemorrhagic measles
 Variant measles
ATYPICAL TYPE
TETRAPLEGIA

20. COMPLICATIONS
I. Bronchopneumonia
II. Myocarditis
III. Laryngitis
IV.Neurologic
complications

21. Condition
Diarrhea
Otitis media
Pneumonia
Encephalitis
Hospitalization
Death
Percent reported
8
7
6
0.1
18
0.2
Based on 1985-1992 surveillance data
MEASLES COMPLICATION

22. Measles Complications by
Age Group
0
5
10
15
20
25
30
<5 5-19 20+
Age group (yrs)
Percent
Pneumonia Hospitalization

23. Measles Laboratory Diagnosis
 Isolation of measles virus from a
clinical specimen (e.g.,
nasopharynx, urine)
 Significant rise in measles IgG
by any standard serologic assay
(e.g., EIA, HA)
 Positive serologic test for
measles IgM antibody

24. Strategy for sustainable measles mortality
reduction
 Strong routine immunization > 90%
• Reaching Every District Strategy
 Surveillance
 Provide second opportunity for
measles immunization
• One time only “catch-up” campaign ( < 15 )
• “Follow-up” campaigns every 3-4 years ( < 5 )
• Routine scheduled second dose / opportunity
 Improved case management

25. Palestine
Bahrain
Measles Campaigns in EMRO through 2005
Preschool and school age (13)
School age (5)
Preschool age (1)
Not done (1)
Ongoing (2)

26. Composition Live virus
Efficacy 95% (range, 90%-98%)
Duration of
Immunity Lifelong
Schedule 2 doses
Should be administered with mumps and
rubella as MMR
The seroconversion rate is 95% and the
immunity lasts for at least 10 years or more,
possibly lifelong
VACCINE

27. MMRV (ProQuad)
 Combination measles, mumps, rubella and
varicella vaccine.
 Approved in children 12 months through 12
years of age (up to age 13 years)
 Titer of varicella vaccine virus in MMRV is
more than 7 times higher than standard
varicella vaccine

28. Measles (MMR) Vaccine Indications
 All infants >12 months of age
 Susceptible adolescents and adults without
documented evidence of immunity

29. MMR Vaccine
Contraindications and Precautions
 Severe allergic reaction
to vaccine component
or following prior dose
 Pregnancy
 Immunosuppression
 Moderate or severe
acute illness
 Recent blood product
• The use of live-
attenuated vaccine
for post-exposure
prophylaxis is
contraindicated.

30. MMR Vaccine and Autism
 Measles vaccine connection first suggested
by British gastroenterologist
 Diagnosis of autism often made in second
year of life
 Multiple studies have shown no association
“The evidence favors a rejection of a causal
relationship at the population level between MMR
vaccine and autism spectrum disorders (ASD).”
- Institute of Medicine, April 2001