This document discusses measles, its complications, and post-measles debility. It covers the epidemiology, pathophysiology, clinical features, investigations, complications, differential diagnoses, treatment, and prevention of measles. Measles is a highly contagious viral disease that is transmitted through the air or direct contact. It causes fever, rash, cough, runny nose, and red eyes. Complications can include pneumonia, encephalitis, or SSPE which is a rare neurological condition that develops years after measles. Treatment focuses on supportive care, vitamin A supplementation, and prevention through vaccination.

1. MEASLES,
COMPLICATIONS AND
POST DEBILITY
Presenter: Dr.Valentina Daniel
Supervising SR: Dr. Esuola
Supervising Consultant: Dr. Ekere

2. OUTLINE
• 1. Introduction
• 2. Epidemiology
• 3. Pathophysiology
• 4. Clinical Features
• 5. Investigations
• 6. Complications
• 7. Differential Diagnoses
• 8. Treatment
• 9. Post Measles Debility
• 10. Prevention
• 11. References

3. INTRODUCTION
• Measles is a highly contagious viral disease caused
by Morbillivirus, a member of the Paramyxovirus
family, which is transmitted to a susceptible
individual through aerosol or by direct contact.
• The virus infects the mucous membranes of an
exposed individual and then spreads to other parts
of the body.
• Measles is known to infect only humans with no
known animal reservoir.

4. • Measles has an incubation period of about 10
days (with a range of 7 to 18 days).
• It is characterized by prodromal fever,
conjunctivitis, coryza, cough and presence of
Koplik spots
• The mortality rate for measles infection in
children is usually 0.2%, but may be up to 10% in
malnourished children.
• In cases with complications, the mortality rate
may rise to 20-30%

5. EPIDEMIOLOGY
• Measles is an acute and extremely contagious
viral disease that has caused approximately 2.6
million deaths before the introduction of the
vaccine.
• Measles affects up to 20 million people a year
worldwide, most of these infections are seen in
the developing areas of Africa and Asia

6. Epidemiology
•Globally, measles mortality fell 60% from an
estimated 873,000 deaths in 1999 to 345,000
in 2005
•In Africa, measles remains a leading cause of
death and disability in most countries
•In 2015, theWorld HealthOrganization (WHO)
estimated that of the 134,200 measles deaths
recorded, majority were in sub-Saharan
Africa.

7. Epidemiology
• The United Nations Office for the Coordination
of Humanitarian Affairs (OCHA) reported
recently that from February to May 2023,
measles outbreaks attributed to the continuous
influx of unvaccinated children from hard-to-
reach and extremely hard-to-reach areas in
north-east Nigeria claimed the lives of more than
50 children.

8. Epidemiology
•Borno State was the most affected,
recording over 5,000 suspected cases, with
Jere LGA and Maiduguri Metropolitan
Council recording 1,644 and 1,627 cases,
respectively, by the end of May 2023.
•There were 917 suspected cases of measles
inYobe State, with 9 deaths from measles-
related complications, and 66 suspected
cases of measles reported in Adamawa
State

9. Pathophysiology
•Measles is a systemic infection.
•The primary site of infection is alveolar
macrophages or dendritic cells.
•Two to three days after replication in the
lung, measles virus spreads to regional
lymphoid tissues followed by a systemic
infection.

10. Pathophysiology
•Following further viral replication in regional
and distal reticuloendothelial sites, a second
viremia occurs 5 to 7 days after initial
infection.
•During this phase, infected lymphocytes and
dendritic cells migrate into the sub-epithelial
cell layer and transmit measles to epithelial
cells.
• Following amplification in the epithelia, the
virus is released into the respiratory tract

11. Clinical Features
•The clinical picture of measles can be
divided into three stages:
prodromal
eruptive
convalescent

12. KOPLIK SPOTS

13. Clinical features
•The primary or prodromal phase lasts 4-6
days and is characterized by the presence
of high fever, malaise, coryza,
conjunctivitis, palpebral edema, and dry
cough.
•Most cases show the characteristic Koplik
spots of the disease, located in the buccal
mucosa at the height of the second molar,
and appear two to three days before the
rash and disappear on the third day.

14. •The second phase, the eruptive stage, is
characterized by the appearance of a
maculo-papular rash, initially fine that
subsequently becomes confluent.
•The rash begins behind the auricle and
along the hair implantation line, and
extends downward to the face, trunk, and
extremities.

15. • The third phase or convalescence occurs after
three to four days when the rash begins to
disappear, in the same order in which it
appeared, leaving brown spots and producing a
thin peeling of the skin.The fever disappears two
to three days after the rash begins, as does the
general malaise.

16. • In atypical measles, the onset is acute, with high
fever, headache, abdominal pain, and myalgia.
• The rash may be minimal in children with
measles modified by the vaccine.
• In addition, they may not have one or more of the
classic triad - cough, coryza, or conjunctivitis.
Unusual manifestations of measles include
pneumonia, otitis media, myocarditis,
pericarditis, and encephalitis.

17. Investigations
•Serological tests with specific
immunoglobulin G (IgG) and
immunoglobulin M (IgM) measurements,
molecular biologic techniques with reverse
transcription-polymerase chain reaction
application, and viral isolation are available
for diagnostic confirmation.
•The measles specific IgM antibody in
primary infection, which is confirmatory of
disease, are detected from the third day of
the rash and remain positive for 30 to 60
days.

18. Investigations
•For the evaluation of IgG, there is more than
a four-fold increase in antibodies between
the acute and convalescence phases of the
disease.
•Measles RNA can be detected by a
polymerase chain reaction from pharyngeal
or nasopharyngeal swabs or urine samples.
•This test confirms the disease and allows the
genotyping of the agent.

19. Complications
•Bacterial super-infection, including
pneumonia
•Acute thrombocytopenic purpura
•Encephalitis
•Transient hepatitis
•Subacute sclerosing panencephalitis

20. Differential diagnoses
rubella,
scarlet fever,
drug rash,
serum sickness ,
roseola infantum,
infectious mononucleosis,
erythema infectiosum,
Kawasaki disease

21. Differential diagnoses
• Rubella causes a rash similar to measles with
head to caudal distribution, mild respiratory
symptoms, the absence of conjunctivitis. Still, it
is accompanied by the presence of adenopathies
- which is characteristic of this disease.
• Roseola is characterized by an illness beginning
with a high fever, which subsides after a few
days, accompanied by the appearance of a rash
in the central part of the body, without the
presence of Koplik's points.

22. Differential diagnoses
• Mononucleosis is a febrile viral disease, a
characteristic course with few symptoms during
childhood, contrary to what happens in more
advanced ages. Mononucleosis manifests itself
by pharyngeal compromise, polyadenopathy,
and hepatosplenomegaly, and the rash can have
different forms of presentation.
• In Kawasaki disease, there is an ocular
compromise with the presence of conjunctivitis
without exudate, and the respiratory
compromise is not part of this pathology.

23. Differential diagnoses
• Group A Streptococcus (particularly Scarlet
fever) may present with a similar rash (a
coarse, sandpaper-like, blanching,
erythematous) to measles in association with
pharyngitis.
• Drug rash: A rash caused by drug
hypersensitivity often resembles the measles
rash, but a prodrome is absent, there is no
cephalocaudal progression or cough, and
there is usually a history of recent drug
exposure.

24. TREATMENT
•There is no specific treatment of measles
except supportive care to relieve common
symptoms associated with this condition.
•Supportive measures include antipyretics
for fevers, hydration, and adequate
nutritional support, including the
encouragement of breastfeeding.

25. •TheWorld Health Organization
recommends the administration of vitamin
A for all children with measles, but
particularly for children who reside in areas
where the case fatality rate is more than
1%, areas with known vitaminA deficiency,
and in severe cases of complicated
measles.

26. • For infants less than 6 months of age, the doses
are 50,000 IU
• for children between 6 and 12 months, 100,000 IU;
• for children aged 12 months and older, 200,000 IU.
• The measles virus is susceptible to the medication
ribavirin in vitro, but due to a lack of clinical data,
its routine use is not recommended.
• It may be considered for use in certain high-risk
groups.

27. POST MEASLES DEBILITY
• Subacute sclerosing panencephalitis (SSPE) is a
very rare, but fatal disease of the central nervous
system that results from a measles virus infection
acquired earlier in life.
• SSPE generally develops 7 to 10 years after a
person has measles, even though the person
seems to have fully recovered from the illness.
• The risk of developing SSPE may be higher for a
person who gets measles before they are 2 years
of age.

28. •Subacute sclerosing panencephalitis is
characterized by progressive cognitive
decline.
•Symptoms typically present about 8 to 11
years of post-measles infection.
•Initially, personality or behavior changes
are present, in addition to poor school
performance and intellectual deterioration.

29. •There is a steady decline in motor function
with myoclonus in most cases, autonomic
dysfunction, and focal paralysis.
•Some patients have seizures, either focal
or generalized, and about one-third of
patients with SSPE develop epilepsy.
Patients eventually fall into a vegetative
state or akinetic mutism, which is shortly
followed by death

30. •The course of SSPE has been divided into
stages, each of which describes a certain
phase of the disease.
•Stage I includes many personality or
behavioral changes, such as irritability,
dementia, lethargy, social withdrawal, or
speech regression.
•Stage II is made up of the progressive
decline in motor function, including
myoclonus, dyskinesia, and dystonia.

31. •Stage III consists of patients who have
progressed to extrapyramidal symptoms,
posturing, and spasticity.
•Stage IV occurs when patients develop
akinetic mutism, autonomic failure, or
enter a vegetative state.

32. DIAGNOSIS OF SSPE
•Serologic testing
•Electroencephalography (EEG)
•Neuroimaging (CT or MRI)
SSPE is suspected in young patients with
dementia and neuromuscular irritability.
EEG shows periodic complexes with high-
voltage diphasic waves occurring
synchronously throughout the recording.

33. •CT or MRI may show cortical atrophy or
white matter lesions.
•CSF examination usually reveals normal
pressure, cell count, and total protein
content; however, CSF globulin is almost
always elevated, constituting up to 20 to
60% of CSF protein.
•Serum and CSF contain elevated levels of
measles virus antibodies.

34. •Anti-measles IgG appears to increase as
the disease progresses.
•If test results are inconclusive, brain biopsy
may be needed.

35. Treatment of SSPE
•Supportive care
•Anticonvulsants and other supportive
measures are the only accepted treatments.
•Isoprinosine, interferon alfa, and
lamivudine are controversial, and antiviral
medications have generally not proved helpful

36. Prognosis for SSPE
•The disease is almost invariably fatal within
1 to 3 years (often pneumonia is the
terminal event), although some patients
have a more protracted course.

37. Prevention
Vaccine
• Vaccination against measles is the most effective and
safe prevention strategy
• Measles vaccine is available as a combined vaccine with
measles-mumps-rubella vaccine
Post-exposure Prophylaxis
• Susceptible individuals exposed tomeasles may be
protected from infection by either vaccine administration
or with Ig
• The vaccine is effective in prevention or modification of
measles if given within 72 hr of exposure
• Ig may be given up to 6 days after exposure to prevent or
modify infection

38. Prevention strategies
•Primary –
Vaccination. Measles can be prevented
with measles-containing vaccine, which is
primarily administered as the combination
measles-mumps-rubella (MMR) vaccine.
•Secondary :- Secondary prevention
includes steps to isolate cases and treat or
immunize contacts so as to prevent further
cases of meningitis or measles, for
example, in outbreaks.

39. Tertiary Prevention:
•It is implemented in symptomatic patients
and aims to reduce the severity of the
disease as well as of any associated sequelae.
While secondary prevention seeks to prevent
the onset of illness, tertiary prevention aims
to reduce the effects of the disease once
established in an individual.

40. Quaternary prevention
• Public health interventions to reduce the
secondary spread of measles are:-
vaccination of susceptible contacts;
human immunoglobulin (Ig) for susceptible
contacts;
quarantine of susceptible contacts;
isolation of active measles cases; and
special vaccination clinics or activities during
outbreaks to increase population immunization
coverage

41. Conclusion
• Measles is a highly contagious viral infection
spread by air/droplet transmission
• There are several symptoms but it is
characterized by a distinctive rash.
• Measles can be prevented by vaccination, either
singly or in addition to mumps and rubella, all of
which can also have serious complications.
• High vaccination coverage provides a ‘herd
immunity’ effect which also protects those who
are unable to be vaccinated

42. Thank you for listening

43. references