This document provides information on measles and rubella. For measles, it describes the causative virus, signs and symptoms including the pathognomonic Koplik spots, complications such as pneumonia and encephalitis, and treatment including vitamin A supplementation. It also compares measles and chickenpox rashes. For rubella, it discusses the virus, transmission, clinical features including rash and lymphadenopathy, complications in adults and congenital rubella syndrome in infants, and prevention through vaccination of children.

1. Dr.Khagendra Shrestha
Medical Officer
Rangeli Hospital
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2. Measles(Rubeola)
PROGRAMME FOR IMMUNIZATION PREVENTABLE DISEASES

3. Etiology
 Measles virus, the cause of
measles,is an RNA virus of the
genus Morbillivirus in the family
Paramyxoviridae.
 Only one serotype is known

4. • Age distribution:
– greatest incidence in children < 5 years of
age
• Transmission:
– Humans are the only natural host.
– Transmitted through respiratory droplets
(coughing and sneezing).
– Airborne precautions should be taken for
all suspected cases of measles.
Epidemiology of Measles
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5. Clinical Manifestations
•Incubation period (exposure to
fever onset) : 10 - 11 days
(range: 7-18 days)
•Body temperature may increase
slightly 9-10 days from the date of
infection and then subside for 24 hr
or so.
5

6. Incubation period
•The patient may transmit the
virus by the 9th-10th day after
exposure and occasionally as early
as the 7th day, before the illness
can be diagnosed
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7. Prodromal stage
usually lasts 3-5 days and is characterized by:
* low-grade to moderate fever
* dry cough
* coryza
* conjunctivitis.
• These symptoms nearly always precede the
appearance of Koplik spots, the pathognomonic
sign of measles, by 2-3 days.
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8. Prodromal stage
•The conjunctival inflammation and
photophobia may suggest measles before
Koplik spots appear.
•In particular, a transverse line of conjunctival
inflammation, sharply demarcated along the
eyelid margin, may be of diagnostic assistance
in the prodromal stage. As the entire
conjunctiva becomes involved, the line
disappears.
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9. Koplik spots
Koplik spots are grayish white dots, usually as small
as grains of sand, that have slight, reddish areolae;
occasionally they are hemorrhagic.
Tend to occur opposite the lower molars but may
spread irregularly over the rest of the buccal
mucosa.
As they fade, a red, spotty discoloration of the
mucosa may remain.

10. Koplik Spots, if seen, are Pathognomonic for
Measles

11. Occasionally, the prodromal phase may be
severe, being ushered in by a sudden high fever,
sometimes with convulsions and even
pneumonia.
 Usually the coryza, fever, and cough are
increasingly severe up to the time the rash has
covered the body.
The temperature rises abruptly as the rash
appears and often reaches 40°C (104°F) or
higher.

12. In uncomplicated cases, as the rash
appears on the legs and feet, the symptoms
subside rapidly within about 2 days, usually
with an abrupt drop in temperature to
normal.
Patients up to this point may appear
desperately ill, but within 24 hr after the
temperature drops, they appear well.

13. Clinical Manifestations
•Rash
•2-4 days after prodromal stage.
•appears 14 days after exposure.
•Erythematous Maculopapular
eruption.
•Moves from face to trunk, then to
arms/legs.
•Persists 5-6 days.
•Fades in order of appearance.

14.  Typical rash on day 2–3 of measles

15.  Rash on day 5 of measles showing typical confluence and
density on head with scattered lesions on the trunk.

16. Complete absence of rash is rare except:
1)Patients who have received immunoglobulin
(Ig) during the incubation period.
2)In some patients with HIV infection.
3)occasionally in infants younger than 9
months of age who have appreciable levels
of maternal antibody.

17. Diagnosis:
The diagnosis is usually apparent from the
characteristic clinical picture; laboratory
confirmation is rarely needed.
Testing for measles IgM antibodies is
recommended in some situations.
Measles IgM is detectable for 1 mo after illness,
but sensitivity of IgM assays may be limited in the
first 72 hr of the rash illness.

18.  Cytopathic changes, visible in 5-10 days, consist
of multinucleated giant cells with intranuclear
inclusions.
The white blood cell count tends to be low with a
relative lymphocytosis
Cerebrospinal fluid in patients with measles
encephalitis usually shows an increase in protein
and a small increase in lymphocytes.
The glucose level is normal.

19. Encephalitis
Complications of Measles
Pneumonia & diarrhea
Corneal scarring
causing blindness
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20. MeaslesChickenpox
Rashes, difference between
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21. What does Chickenpox look like?
PROGRAMME FOR IMMUNIZATION PREVENTABLE DISEASES
Pleomorphic rashes (rashes on different stage): papules, vesicles,
pustules and scab formation are seen at the same time.

22. Clinical Case Management
Vitamin A supplementation: Two
doses to all suspected measles cases on
day 1 and 2.
Respiratory isolation of hospitalized
cases.
Supportive treatment (antipyretics,
antibiotics, fluids, nutrition).
Treatment of complications as
needed.

23. Measles Treatment with Vitamin A
AGE Immediately on
Diagnosis
Next
Day
0-6 months 50,000 IU 50,000 IU
6-11 months 100,000 IU 100,000 IU
> 12 months 200,000 IU 200,000 IU
* For ocular manifestations, give a 3rd dose 2-4 weeks after the 2nd dose
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24. Rubella
(German Measles)

25. PROGRAMME FOR IMMUNIZATION
PREVENTABLE DISEASES
Background: Rubella
•From Latin meaning "little red"
•Discovered in 18th century - thought to be variant of
measles
•Congenital rubella syndrome (CRS) described by Gregg in
1941

26. Rubella Epidemiology
Reservoir Human
Transmission Respiratory droplets
Temporal pattern Peak in late winter and spring
Communicability 7 days before to 5-7 days
after rash onset
Infants with CRS may shed virus for a year or more

27. Rubella Virus
• Togavirus
• RNA virus
• Rapidly inactivated by chemical agents, ultraviolet light, low pH, and
heat

28. Mode of Transmission
Person to person- via respiratory route:-
Droplet from nose & throat
Droplet nuclei (aerosols)
 Maintain in human population by chain transmission.
Acquired during pregnancy- vertical transmission:-
 Virus can enter via the Placenta & infect the foetus in
utero (Congenital Rubella Syndrome).

29. Rubella Clinical Features
• Incubation period: 14 days
(range 12-23 days)
• Prodrome of low-grade fever
• Maculopapular rash: 14-17 days
after exposure
• Lymphadenopathy in second
week

30. Sign and Symptoms:
RASH:
After an incubation period of 14-21 days, the primary
symptom of rubella virus infection is
the appearance of a rash (exanthema) on the face, Which
spreads to the trunk and limbs.
Usually fades after three days with no staining or peeling of
skin.
The skin manifestations are called “blueberry muffins
lesions”.

31. Lymphadenopathy
Tender
lymphadenopathy
(particularly posterior
auricular and suboccipital
ymph nodes)
persist for up to a week.

32. Temperature
•Fever rarely rises above 38 C (100.4 o F)

33. Pathognomonic sign
•Forchheimer’s Spot
•Fleeting exanthema Pinpoint or larger petechiae
that usually occur on the soft palate in 20% of
patients Similar spots can be seen in measles
and scarlet fever.

35. Rubella Complications
• Arthralgia or Arthritis
• Adult female upto 70%
• Children rare
• Thrombocytopenic purpura1/3,000 cases
• Encephalitis 1/6,000 cases
• Neuritis rare
• Orchitis rare

36. Congenital Rubella Syndrome (CRS)
• Infection may affect all organs
• May lead to fetal death or premature delivery
• Severity of damage to fetus depends on gestational age
• Up to 85% of infants affected if infected during first trimester

37. Congenital Rubella Syndrome
•Rash at birth
•Deafness
•Cataracts
•Heart defects
•Microcephaly
•Mental retardation
•Liver and spleen damage

38. Treatment
• Rubella is a mild self limiting illness.
• No specific treatment or Antiviral treatment is indicated.
• Isolation and quarantine.
• Increase fluid intake.
• Encourage the patient to rest.
• Good ventilation.
• Encourage the patient to drink either lemon or orange juice
• Provide health teaching about Rubella (cause,
immunizations).

39. Treatment for acute maternal
rubella infection:
Acetaminophen for symptomatic relief.
IgG-Role is controversial, CDC recommends limiting use of
immunoglobulin to women with known rubella exposure
who decline pregnancy termination.
Glucocorticoids, platelet transfusion, and other supportive
measures for complications.
Counseled about maternal-fetal transmission and offered
pregnancy termination, especially prior to 16 weeks
gestation.

40. Prevention: Vaccination
Recommended Measles-rubella (MR) Vaccine
1st Dose:
0.5 ml of reconstituted vaccine to children at 9
months of age
2nd Dose:
0.5 ml of reconstituted vaccine to children at 15 months
of age

41. • Vaccine is given as a subcutaneous injection.
• Live attenuated vaccine.
• Freeze dried (lyophilized) and used with diluents.
• Store vaccine at 2°- 8° C (but can be frozen).
• Protect from light at all times. Discard the vaccine
after 6 hours of reconstitution.

42. Treatment, Prevention, Control
in childbearing age women
•No specific treatment is available
 CRS can be prevented by effective
Immunization of the young children and teenage
girls, remain the best option to prevent
Congenital Rubella Syndrome.