This document provides information on measles including:
- Measles is a highly infectious viral disease spread through airborne droplets from infected individuals. It primarily affects young children and can be fatal.
- Myanmar has set a goal to eliminate measles and control rubella by 2020 through high vaccination coverage and case-based surveillance starting in 2007. No indigenous measles transmission has been detected since 2013.
- Suspected measles cases are classified based on clinical presentation and laboratory testing to identify confirmed measles, rubella, or discarded cases for surveillance purposes. Performance indicators ensure the effectiveness of Myanmar's measles elimination efforts.
Measles is a highly contagious viral infection.
It is exanthematous disease with fewer, cough, coryza (rhinitis) and conjunctivitis.
Before the widespread use of measles vaccines, it was estimated that measles caused between 5 million and 8 million deaths worldwide each year.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
meningococcal meningitis is a very serious and fatal disease if not treated in time. the case fatality rate can go upto 50% in untreated cases .there are many strains which are responsible for its occurrence .it tend to occur both in endemic as well as in epidemic form. a qudrivalent vaccine is available for protection. recipient of this vaccine are to be given chemo prophylaxis .recently a vaccine against type b strain has been made avialable in canada for use in routine immunization
This ppt contains all information about epidemiology of Diptheria. It is useful for students of medical field learning preventive and social medicine, Swasthavritta (Ayurved), nursing and everyone who is interested in knowing about it.
Measles is a highly contagious viral infection.
It is exanthematous disease with fewer, cough, coryza (rhinitis) and conjunctivitis.
Before the widespread use of measles vaccines, it was estimated that measles caused between 5 million and 8 million deaths worldwide each year.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
meningococcal meningitis is a very serious and fatal disease if not treated in time. the case fatality rate can go upto 50% in untreated cases .there are many strains which are responsible for its occurrence .it tend to occur both in endemic as well as in epidemic form. a qudrivalent vaccine is available for protection. recipient of this vaccine are to be given chemo prophylaxis .recently a vaccine against type b strain has been made avialable in canada for use in routine immunization
This ppt contains all information about epidemiology of Diptheria. It is useful for students of medical field learning preventive and social medicine, Swasthavritta (Ayurved), nursing and everyone who is interested in knowing about it.
At the end of the session, the students should be able to:
a)
b) list the types and clinical features of Acute Respiratory Infections (ARI)
c) explain the epidemiological determinants of ARI
d) classify the illness based on signs during clinical assessment describe the elements of management of ARI
e) enumerate various preventive measures for control of ARI
Outbreak management ppt comprises the definition , history , investigations and the steps of management of outbreak. This was my seminar and UG class tpoic
Strep throat is the most common throat
infection caused by bacteria.
It is found most often in
children between the ages of 5 and 15, although it can occur in younger
children and adults. Children younger than 3 years old can get strep
infections, but these usually don’t affect the throat.
Strep throat infections usually occur in
the late fall, winter, and early spring.
At the end of the session, the students should be able to:
a)
b) list the types and clinical features of Acute Respiratory Infections (ARI)
c) explain the epidemiological determinants of ARI
d) classify the illness based on signs during clinical assessment describe the elements of management of ARI
e) enumerate various preventive measures for control of ARI
Outbreak management ppt comprises the definition , history , investigations and the steps of management of outbreak. This was my seminar and UG class tpoic
Strep throat is the most common throat
infection caused by bacteria.
It is found most often in
children between the ages of 5 and 15, although it can occur in younger
children and adults. Children younger than 3 years old can get strep
infections, but these usually don’t affect the throat.
Strep throat infections usually occur in
the late fall, winter, and early spring.
Presented by Dr. Seraj Ahmad Jahanfar; Emergency and Critical Care physician at French Medical Institute for Mother and Children in Kabul, Afghanistan.
Measles and its prevention - Slideset by professor EdwardsWAidid
In this study Professor Kathryn M. Edwards (Sarah H. Sell and Cornelius Vanderbilt Professor - Division of Pediatric Infectious Diseases - Vanderbilt University Medical Center) provides an update on measles and its prevention.
To learn more, please visit www.waidid.org!
Smallest known DNA viruses.
Structure
Non-enveloped
18-26 nm diameter
Single-stranded DNA, 5.6 kb
Icosahedral
Parvovirinae (vertebrates)
Parvovirus
Erythrovirus
Dependovirus (requires helper virus, such as an adenovirus)
Bocavirus
Amdovirus
Densovirinae (invertebrates)`
B19 virus most common.
Diseases
Erythema infectiosum (cutaneous rash)
Polyarthropathy syndrome (acute or chronic)
Transient aplastic crisis (severe acute anemia)
Pure red cell aplasia (chronic anemia)
Hydrops fetalis (fetal anemia)
Simplest animal viruses infecting humans, responsible for - childhood exanthema - erythema infectiosum (fifth disease).
Smallest viruses (18–26 nm size)
Non-enveloped with icosahedral symmetry
Only DNA viruses - possess single-stranded DNA
Depend upon the host cell enzymes for replication
Transmission - Respiratory route, followed by blood transfusion and transplacental route.
Infects precursors of RBCs: Parvovirus B19 has a special tropism for erythroid progenitor cells present in adult bone marrow and foetal liver as it binds to blood group P antigen as receptors; which are present on the RBC surface.
This results in red cell destruction and inhibition of erythropoiesis
Erythema infectiosum (or fifth disease)
Transient aplastic crisis
Pure red cell aplasia
Non-immune hydrops fetalis
Papular-purpuric gloves and socks syndrome
Known to cause foetal loss through hydrops fetalis; severe anaemia, congestive heart failure, generalized oedema and foetal death
No evidence of teratogenicity.
Risk of foetal death highest when infection occurs during the second trimester of pregnancy (12%).
Molecular methods:
PCR - detects viral DNA (e.g. genes coding for VP1 and VP2) from serum, tissue or respiratory secretions.
Real time PCR - used for quantification of viral load in blood, during acute infections
Antibody detection: ELISA – detecting antibodies against VP1 and VP2 antigens. IgM appears early - recent infection and remains elevated for 2–3 months
Antigen detection: Immunohistochemistry - detect viral antigens in fetal tissues and bone marrow.
No antiviral drug is available
Symptomatic treatment is given
Immunoglobulins containing neutralizing antibodies to human parvovirus are available commercially
No antiviral drug is available
Symptomatic treatment is given
Immunoglobulins containing neutralizing antibodies to human parvovirus are available commercially
Measles is an acute, highly contagious childhood disease characterized by fever & respiratory symptoms, followed by typical maculopapular rash.
Transmission
Droplets inhalation over short distances and, less commonly,
Small-particle aerosols - remain suspended especially in schools, hospitals, and enclosed public places in the air for longer period.
Spread-The virus multiplies locally in the respiratory tract; then spreads to the regional lymph nodes → enter into the bloodstream in infected monocytes (primary viremia)→further multiply in reticuloendothelial system → spills over into blo
a double-stranded DNA virus : human herpesvirus-3 subfamily Alphaherpersvirinae
only one serotype is known
humans are the only reservoir
VZV enters the host through the nasopharyngeal mucosa, and almost invariably produces clinical disease in susceptible individuals
Following varicella, the virus persists in sensory nerve ganglia, from where it may later be reactivated to cause herpes zoster (Shingles)
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. WHAT IS MEASLES?
Highly infectious viral disease
Genus Morbillivirus of the paramyxoviridae family
Exclusive human pathogen
Single stranded RNA
Eight classes (A, B, C, D, E, F, G and H)
23 genotypes
No animal reservoir or vector exits
3. Important cause of death among young children globally
More than 95% of measles death occur in low income countries with
weak infrastructure
Likely to occur in
• poorly nourished children esp. not received sufficient Vitamin A
• Live in crowded conditions
• Immune deficient patients ( HIV/AIDS or others)
4. MYANMAR SITUATION
Case based measles surveillance started in 2007 in Myanmar
In line with regional goal, Myanmar has set goal of measles
elimination and rubella and CRS control by 2020
Indigenous measles transmission was not found in the country
since 2013
Genotypes detected in 2016 – H1 and D8
5. TRANSMISSION
Contact with nose and throat secretions of infected people
Airborne droplets released when infected person sneezes or
cough
Can infect others for several days before and after onset of
symptoms
6. CLINICAL PRESENTATION
Average exposure to onset of rash is 14 days
Range 7-18 days
Infectious from 4 days before and after onset of rashes
7. SIGNS AND SYMPTOMS
High fever (peaking at 39-40˚C) (1st sign) 10-12 days after
exposure to measles virus and last several days
Runny nose
Cough
Red and watery eye
Small white spot (Koplik spots) in the oral mucosa, which are
pathognomonic of measles
8.
9. SIGNS AND SYMPTOMS (CONT:)
Raised rash
Maculo-papular in nature
7-18 days after exposure
First appear on face and upper neck
then body, hand and feet
fading after bout 3 days
Patient normally improve by the third
day of rash
Fully recovered 7-10 days from the
onset of disease
10. COMPLICATIONS
Dehydration due to severe diarrhea
In developing countries, persistent diarrhea with protein-losing
enteropathy may ensure
Bleeding from skin and mucosa among children less than 5
years of age
Malnutrition
Inflammation of middle ear (5-15%)
11. COMPLICATIONS (CONT:)
Pneumonia (5-10%)
Encephalitis ( one in 1000 cases)
Major causes of blindness among children in Africa and other
endemic area
Death (5-15%)
12. SPECIMENS FOR SEROLOGY
While IgM ELISA tests for measles and rubella are more
sensitive between days 4 and 28 after the onset of rash
A single serum sample obtained at the first contact with the
health care system at any time within 28 days after onset is
considered adequate for surveillance purposes.
In outbreaks where 5-10 samples have been collected,
individual diagnosis is not critical
13. NASOPHARYNGEAL SPECIMENS FOR MEASLES VIRUS
ISOLATION
Nasopharyngeal/oropharyngeal swabs
obtained by firmly rubbing the
nasopharyngeal passage and back of the
throat with sterile cotton swabs to
dislodge epithelial cells. The swabs are
placed in sterile viral transport medium in
labeled screw-capped tubes
14. VIRAL ISOLATION (CONT:)
Samples
Nasopharyngeal swab
Urine simple
Virological culture should be collected within 5 days of rash
onset
This provide very important information about geographic
origin of measles virus importations and complements
information obtained from epidemiologic investigation
When vaccine related cases are investigated, sequencing of a
viral isolate allows discriminating between vaccine and wild
types strains
15. TREATMENT
No specific antiviral treatment
Antibiotics only for
Bacterial ear infection
Pneumonia
Nutritional support
Oral rehydration solution for dehydration
Encourage to eat and drink
Vitamin A two doses given 24 hours apart that help prevent
Eye damage
Blindness
Death reduction from measles by 50%
16. PREVENTION
Immunization
High coverage with a two doses schedule is needed to prevent
measles epidemic
9-12 months of age – first doses
Second doses at least 1 month after 1st dose
For infant at high risk – minimum age of 6 months
Dosage- 0.5 ml
AN thigh or upper arm
Subcutaneous
Storage 2-8˚C
Keep away from sunlight
18. MEASLES SURVEILLANCE IN MYANMAR
Measles Elimination goals
The absence of endemic measles transmission in a
geographic area (eg. Region or country) for more than 12
months in the presence of well performing surveillance
system
It also notes that verification of measles takes place after
36 months of interrupted endemic measles virus
transmission
19. Endemic measles virus transmission
The existence of continuous transmission indigenous or
imported measles virus that persists for more than 12
months in any defined geographic area
Endemic measles case
Laboratory or epidemiologically linked confirmed cases of
measles resulting from endemic transmission of measles
virus
20. CASE DEFINITION FOR MEASLES SURVEILLANCE
Suspected Measles
A patient in whom a health care worker suspects measles
infection or
A patient with fever and maculo-papular (non-vesicular)
rash
Laboratory confirmed Measles
A suspect case of Measles, that has been confirmed by a
proficient laboratory
21. CASE DEFINITION FOR MEASLES SURVEILLANCE
(CONT:)
Epidemiologically linked confirmed case of Measles
A suspected case of Measles, that has not been confirmed by
a laboratory but was geographically and temporally related,
with dates of rash onset occurring 7-21 days apart to a
laboratory confirmed case, or
In the event of a chain of transmission to another
epidemiologically confirmed measles case
22. CASE DEFINITION FOR MEASLES SURVEILLANCE
(CONT:)
Clinically compatible measles case
A case with fever and maculo-papaular (non-vesicular) rash
and one of
• Cough
• Coryza or
• Conjunctivitis
for which no adequate clinical specimen was taken and which
has not been linked epidemiologically to a laboratory
confirmed case of measles or laboratory confirmed
communicable diseases
24. Measles Surveillance – Summary of Case Classification
Clinically suspect
measles case
Adequate Blood
Specimen*
IgM Positive for
Rubella
Equivocal
IgM negative for
Measles & Rubella
Repeat blood test with
fresh sample and
classify as above
Lab confirmed measles
Still equivocal
Clinically
confirmed measles
Lab confirmed rubella
Discard
Clinically confirmed
measles
Epidemiologically
confirmed measles
Epidemiologically
confirmed rubella
No Adequate
Blood specimen
AND
*A single serum sample obtained at the first contact with the health care system within 28 days after onset is considered adequate for measles surveillance
Epidemiologic Link to lab
confirmed measles case or
outbreak
Epidemiologic Link to lab
confirmed Rubella case or
outbreak
No Epidemiologic link to
lab confirmed case or
outbreak
IgM Positive for
measles
26. Age Group Distribution of Reported Fever with Rash cases
2017
306, 18%
399, 24%
186, 11%
74, 5%
695, 42%
0-11 months
1-4 Years
5-9 years
10-14 years
≥ 15 years
Data as of 16.1.2018
27. Immunization status of reported fever with rash cases
2017
993
162
106
9
6
320
0 200 400 600 800 1000 1200
0 dose
1 dose
2 doses
3 doses
4 doses
unknown
Data as of 16.1.2018
28. Reported Fever with Rash cases 2017 by State and Region
(n=1660) as of 16.1.2018
AYEYARWADY 156
Bago 124
Chin 3
Kachin 9
Kayah 7
Kayin 14
Magway 49
Mandalay 68
Mon State 82
Naypyitaw 30
Rakhine 99
Sagaing 7
Shan (North) 56
Shan (South) 14
Tanintharyi 61
Yangon 850
Kokant 31
29. Classification of cases with IgM positive result and
recent history of measles vaccination
Final classification Vaccination history Epidemiological findings
Discarded History of measles
vaccination within six
weeks before onset of rash
Active case search in
community does not reveal
evident of measles
infection
Confirmed History of measles
vaccination within six
weeks before onset of rash
Active case search in
community reveal other
laboratory confirmed
measles infection
30. Measles vaccine associated illness
A suspect measles case can be classified as discarded and diagnosed as
vaccine related if it meets all 5 of the following criteria
1. The patient had a rash illness, with or without fever, but did not
have cough or other respiratory symptoms related to the rash
2. The rash began 7-14 days after vaccination with a measles
containing vaccine
3. The blood specimen, which was positive for measles IgM, was
collected 8-56 days after vaccination
4. Thorough field investigation did not identified any secondary
cases
5. Field and laboratory investigations failed to identified other
causes
– Alternatively, a suspected case from which virus was isolated
and found on genotyping to be a vaccine strain will be
diagnosed as vaccine related measles
31. Measles Surveillance Performance Indicators
No Indicator Target
1 Disease incidence
Annual incidence of confirmed measles cases
Absence of indigenous
measles transmission
2 Adequacy of investigation
Proportion of all suspected measles and rubella
cases that have had an adequate investigation
initiated within 48 hours of notification
>80%
3 Outbreak investigation
Percentage of suspected measles outbreak fully
investigated
>80%
Percentage of suspected measles outbreak tested
for virus detection
>80%
32. Measles Surveillance Performance Indicators (Cont:)
No Indicator Target
4 Immunization coverage
MCV1 & MCV2 coverage nationally and by district
administrative
95% national
95% district
5 • Timeliness of reporting
• Proportion of surveillance units reporting to
the national level on time
• >80%
• >80%
6 Reporting rate of discarded non-measles, non-
rubella per 100,000 population
2
7 Representative of reporting
Proportion of sub-national administrative units
reporting at least 2 discarded non measles/
rubella cases per 100,000 population
>80%
33. Measles Surveillance Performance Indicators (Cont:)
No Indicator Target
8 Proportion of suspected cases with adequate
specimen for measles and rubella infection and
tested in a proficient laboratory
≥80%
9 Timeliness of specimen transport
Proportion of specimen received at the
Laboratory within 5 days of collection
≥80%
10 Proportion of results reported by the laboratory
within 4 days of receiving specimen
≥80%
11 Viral detection Proportion of laboratory-
confirmed chains of transmission with sample
adequate for detection measles and rubella
virus collected and tested in an accredited
laboratory
≥80%
34. Indicators of Implementation of activities for Measles
Elimination
Major Indicator Sub Indicator Target
A. Diseases Incidence
A1. Annual Incidence of confirmed
measles cases 0
A2. Annual Incidence of confirmed
rubella cases 0
B. Adequacy of
Investigation
B1. Proportion of all suspected measles
and rubella cases that was investigated
adequately within 24 hours of notification >80%
35. Indicators of Implementation of activities for Measles
Elimination (Cont:)
Major Indicator Sub Indicator Target by 2020
C. Outbreak
Investigation
C1. Proportion of suspected
measles outbreak fully
investigated
>80%
C2. Proportion of suspected
measles outbreak tested
for virus detection
>80%
36. Indicators of Implementation of activities for Measles
Elimination(Cont:)
Major Indicator Sub Indicator Target by
2020
D. Immunization coverage
D1. MCV1 coverage >95%
D2. MCV2 coverage >95%
E. Quality of reporting
E1. Timeliness of reporting (on time) >80%
E2. Reporting rate of discarded non-
measles, non-rubella per 100,000
population
2
E3. Representativeness of administrative
units reporting E2 above
>80%
37. Indicators of Implementation of activities for Measles
Elimination(Cont:)
Major Indicator Sub Indicator Target by
2020
F. Laboratory Investigation
F1. Proportion of suspected cases
with adequate specimen for measles
and rubella tested
>80%
F2. Timeliness of specimen
transport (received within 5 days at
accredited Laboratory)
>80%
F3. Timeliness of reporting results
(within 4 days of receiving specimen)
>80%
F4. Viral detection ratio (measles
and rubella)
>80%
39. Measles outbreak Definition
Any single case of confirmed measles or rubella is considered as an
outbreak in elimination setting
Identifying a Measles outbreak
For operational purposes, presence of suspected measles
outbreak should be verified if two more clinically confirmed
cases of measles are identified in a village or urban, ward in a
week or one or more deaths due to clinically diagnosed measles
occurs in the same geographical area
Active searches at the reporting sights by RSO/SDCU team
leader can provide information on the occurrence of measles in
the field
Conversation with local health workers, traditional healers and
community leaders may also be a source of information about
an unusual increase in the occurrence of measles
40. Steps of Measles outbreak investigation
1. Identifying the measles outbreaks and assigning an outbreak
number
2. Mobilization of Rapid Response Team (RRT)
3. Orientation & planning meeting at the local level
4. Conducting Measles case search including appropriate
management of cases
5. Collection and shipment of specimens to the laboratory
6. Serological confirmation of the outbreak
7. Data analysis
8. Conversion of data to information for action
9. Outbreak Notification
10. Giving feedback
11. Initiating actions-Immunization
12. Report writing
41. An Adequately investigated measles outbreak
Initial visit to the case within 48 hours
house to house search of cases within one week
Information collected on all core epidemiological data variables
Sample collected and sent to NHL
Urine/Nasopharyngeal samples collected from at least 5 suspected
cases
42. Managing cases and contacts to limit spread
• Limiting contact to only immediate family members who have been
vaccinated or have prior history of measles
• Avoid contact with infants or young unimmunized children in the
household
• Suspected cases should not be hospitalized unless they have
complications or another condition that require hospitalization
because of intra hospital transmission
• Patients with measles who require hospitalization, if possible, be
isolated from onset of prodromal symptoms until 5 days after onset
of rash
43. Managing cases and contacts to limit spread (Cont:)
• Contacts should be limited to out patient departments (eg. Waiting
rooms)
• Officials would identify the persons who have had contact with a
confirmed measles case and take the following action to minimize
spread
Contact (children between 6 months 5 years ) without evident
of measles vaccination should be vaccinated immediately and
the symptoms of measles should be clarified to them
During 2nd week after exposure, at 1st sign of possible measles
(fever, runny nose, cough or red eyes) the contact should be
instructed to stay at home (eg. prevent them from attending
school, work, large gatherings)
44. Contact Management
• Contact persons with case should be identified and followed up
Four days before and after rash onset ( for rubella)
Seven days before and five days after rash onset (for measles)
• Contacts at high risk for severe measles disease
Children aged ˂5 years and adults
Person living in crowded environments
Persons with immunosuppression
Persons with malnutrition
Persons with vitamin A deficiency
Should be evaluate and receive appropriate preventive measures
45. Contact Management (Cont:)
• Susceptible contacts who are aged-eligible and have no
contraindications to measles and rubella containing vaccine should
be vaccinated as soon as possible
• Even if contact is already infected, vaccination within two days of
exposure may help modify the clinical course of disease or may
even prevent symptoms
• If indicated, 2nd dose should be given at least 28 days after the
receipt of first dose of the vaccine
• There is no upper age limit for immunization with measles and
rubella containing vaccines
• All close contact of a suspected measles case should be identified
and monitored closely for four weeks from the day the patient
under investigation developed rash
46. Immunization response
• Epidemiological information collected during the outbreak
investigation should be analyzed and an appropriate immunization
response should be initiated
• Vaccination within 72 hours of exposure may help to prevent the
disease and mitigate severity
• Vaccination of previously unvaccinated persons should start
immediately
• If outbreak is large and may cases are occurring in infants less than
9 months, vaccination should be decrease to 6 months
These infants should be revaccinated when they reach 9 months
of age (at least one month interval between the doses)
47. Immunization response (Cont:)
• All health workers must be vaccinated
• Children hospitalized or attending outpatient clinic and who cannot
provide written proof of MR vaccination should be vaccinated, if not
contraindicated
• Gathering points such as school, institutes and health post may be
chosen as mass vaccination sites
48. Immunization response (Cont:)
• In addition vaccination of adolescent and young adults residing or
working in institution such as
Military bases
High school
Colleges’ dormitories
Hospitals
Religious centers
Factories
Should be considered based on risk assessment
49. Accessing the risk of a large outbreak with high
morbidity and mortality
As soon as outbreak is suspected, the risk of a large outbreak with
high morbidity and mortality must be accessed
This assessment is needed to determine what type of immunization
response is most appropriate to control the outbreak
Evaluate the susceptibility of the population and potential for
spread
Approximately 15% of children vaccinated at 9 months of age and
5-10% of those vaccinated at 12 months of age fail to seroconvert
50. Evaluation the susceptibility of the population and
potential for spread
Example
District - X
Population - 500,000
Births per year - 12,500
Measles vaccination coverage (routine) - 80%
Measles vaccine effectiveness - 85%
Population protected against measles - 12,500 × 0.8 × 0.85
= 8500 (68%)
Measles susceptible children - 4000 (32%)
51. As a general guide, an outbreak is likely to occur when the pool of
susceptible children reach the size of one birth cohort
Year Cumulative No.
of live births
Cumulative No. of
children against measles
Cumulative No. of children
susceptible to measles
1 12500 8500 4000
2 25000 17000 8000
3 37500 25500 12000
4 50000 34000 16000
In this example, an outbreak is likely to occur in district X after 3-4
years
52. Data Analysis
During an outbreak, data collection should be limited to obtaining
basic information from each case
Age
Sex
Immunization status
Date of last vaccination
Symptoms
Date of rash onset
Outcome
Collected into an outbreak line list
53. Data Analysis (Cont:)
Case fatality ratio (CFR)
CFR =
No. of cases who died of measles
Total no. of measles cases × 100
Attack rate (AR)
AR =
𝑁𝑜.𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 𝑖𝑛 𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛 𝑎𝑔𝑒 0 𝑡𝑜 11 𝑚𝑜𝑛𝑡ℎ𝑠
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜.𝑜𝑓 𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛 𝑎𝑔𝑒 0 𝑡𝑜 11 𝑚𝑜𝑛𝑡ℎ
Vaccine efficacy (VE)
VE = (𝐴𝑅𝑈 − 𝐴𝑅𝑉) 𝐴𝑅𝑈
54. Using data for action
Failure to get vaccine
• Failure to administer at least 1 dose of measles vaccine to all the
infants continues to be the main cause of morbidity and
mortality
• Age specific AR can help to identify reasons for a failure to
vaccination
• High risk area and groups can be identified with spot maps
Vaccine failure
• Decrease vaccine efficacy
• Cold chain failure
• Vaccine potency problems
55. Provide adequate Feedback
• Local level (RHC?MCH or UHC in the ward) including community
leaders
• Township Public Health Officer/ District Public Health Officer
• State/ Regional Health Authority
• Central Epidemiology Unit
56. Evaluate the risk of further transmission,
morbidity and mortality
• Population characteristics such as size, density, movement and
setting
• Under 5 mortality rate
• Nutrition and Vitamin A status
• HIV prevalence in the population
• Period of the year and plans for any festivals or other social event
• Number of cases reported and comparison with data from previous
years
• Access to health services
57. Conducting appropriate vaccination activities
When the outbreak is suspected
Selective vaccination activities
Enhance social mobilization activities
Inform community of suspected outbreak and provide
instructions
Vaccinate all children (6 months to 5 years) presenting to health
facilities and immunization posts 6 months to 5 year without a
history of measles vaccination
Revaccinate children receiving measles vaccine before 9 months
Ensure sufficient supplies are available
58. Conducting appropriate vaccination activities (Cont:)
Reinforce EPI
Rapidly identify priority areas within the affected district
Joint work on strengthening the available district immunization
work plan
Locate health centers needing additional staff or vaccine
supplies
Correct programme weaknesses eg. Adding extra sections
59. Conducting appropriate vaccination activities
When the outbreak is confirmed
Continue selective vaccination activities and re-enforcing EPI
Evaluate the susceptibility of the population and potential for
spread
Evaluate the risk of further transmission, morbidity and mortality
If the risk assessment indicate, there is a high risk for large measles
outbreak with potential high complications and mortality
Evaluate the availability of sufficient capacity (Staff, Vaccine &
supply, finance & other resources) to carry out a safe and a timely
campaign
If there is sufficient capacity, conduct Non-Selective vaccination
activities (mass campaign) targeting the population and
geographical area based on local epidemiological data and risk
assessment
60. Conducting appropriate vaccination activities (Cont:)
Timing of intervention and target population
Once the decision to intervene has been made, it is critical to
act quickly to minimize the number of severe measles cases and
deaths
Target coverage
Should be 100%
Measles immunization in emergency situations
Eg. Floods, earth quakes, cyclones
Prompt measles vaccination and Vitamin A supplementation of
all children between 6 months to 5 years irrespective of their
immunization status is recommended
61. Conducting appropriate vaccination activities (Cont:)
Ensuring effective community involvement and public awareness
Existence of an outbreak and the benefits of measles
vaccination
Signs and symptoms of the disease
Encourage parents whose children have had a recent rash and
fever illness to consult a health care facility
Instruct parents to bring their children to health care facility/
vaccine post for vaccination
Inform locations and timings of health facility/ vaccine post
62. Report writing
Report should be written systematically including
Introduction and background information about the area affected
Review of measles and routine immunization
Short review of measles outbreaks in the past
Measles reporting and surveillance system
Confirmation of outbreak by serology
Data collection methodology
63. Report writing (Cont:)
Data analysis
• Time, place and person analysis of case
• Mapping of cases
• Age distribution and vaccination status analysis
• Attack rate analysis
• Analysis of case fatality rate
• Vaccine efficacy analysis
• Proportion of vaccine preventable cases
64.
65. Report writing (Cont:)
Probable reasons of outbreak
Population at risk
Case management and Vitamin A
Response to outbreak
Conclusion and recommendation
the report should also include
• Relevant charts, Maps and graphs
• Key rates and indicators
Report should be sent to township, district, province and CEU
66. In January 2017, five cases of fever with rash who were living in
Hlaingtharyar were admitted to Yangon Children Hospital.
YCH MS reported to CEU, what would you do?