MEASLES IN CHILDREN AND MANAGEMENT IN HOSPITAL SETTING

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2. Background
An acute highly infectious viral disease.
First described in 7th century
Near universal infection of childhood in pre-
vaccination era
Common and often fatal in developing countries
Vaccine preventable
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Hemaglutinin and Fusion proteins important surface antigen
One antigenic type

4. Measles - epidemiology
Occurrence
Throughout the world
Reservoir
Human
Transmission
Respiratory - airborne
Communicability
4 days before to 4 days after rash onset
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5. Two reasons stand out for the severity of infection in the developing
world.
1) Overcrowding: measles is a very contagious virus up to 90% of non-
immune people who come into contact with a case will be infected.
Transmission rates are therefore high in areas of overcrowding.
2) Malnutrition: cellular immunity is important for the host's response to
the measles virus.
Since this is impaired on the severely malnourished child, poverty and
malnutrition may predispose to severe and persistent infections.
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6. Measles pathogenesis
Respiratory transmission of virus
Replication in nasopharynx and regional lymph nodes
Primary viremia 2-3 days post exposure
Secondary viremia 5-7 days after exposure with spread to
tissues
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7. Pathology
The virus infects and lyses epithelial cells of the respiratory and GI tracts
leading to secondary bacterial pneumonia and enteropathy that
produces further malnutrition.
It also attacks and depresses the immune system itself, encouraging both
the secondary infections and reactivation of dormant pathogens such as
TB.
 Death mostly occurs from respiratory and CNS complications.
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8. Measles - clinical presentation
•4 stages: incubation, prodromal, Exanthem and recovery
Incubation period 10-12 days
Prodromal phase 2-4 days
• Stepwise increase in fever up to 40⁰C
• Cough, coryza, and conjunctivitis
• Koplik’s spots (rash on mucous membranes)
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9. Measles - clinical presentation
•4 stages: incubation, prodrome, and recovery
 Exanthem 5-6 days
2-4 days after prodrome, 14 days post exposure
Begins on face and upper neck
Maculopapular , becomes confluent
Fades in order of appearance.
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11. Typical measles rash & Koplik’s spots
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12. Clinical features…

13. Clinical features…

14. Clinical features…

15. Clinical features…

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17. Measles - diagnosis
• This is almost always based on clinical and epidemiologic
findings.
• Laboratory confirmation
• Isolation of virus from urine, nasopharynx (multinucleated giant
cells), blood, and throat
• Significant rise in measles IgG by any standard serologic assay (e.g.,
EIA, HI)
• Positive serologic test for IgM antibody
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19. Management
Essentially supportive
Hospitalization (complications)
Antibiotics (secondary bacterial infections)
Occasional IV rehydration
Standard antipyretics (fever)
Antiviral therapy (Ribavirin)
Vitamin A supplementation
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25. Condition
•Diarrhea 8%
•Otitis media 7%
•Pneumonia 6%
•Encephalitis 0.1%
•Acute
•Subacute
•SSPE
•Hospitalization 18%
•Death 0.2%
Measles Complications
Based on 1985-1992 surveillance data
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 Active immunization with one dose of attenuated measles virus
vaccine at 8-9 months of age.

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