MEASLES,PSM,COMMUNITY MEDICINE,MBBS,BPH,MD,MPH,DR NARENDRA KUMAR YADAV

1. MEASLES
(RUBEOLA)
DR NARENDRA KUMAR YADAV
MBBS, MD Community Medicine & Tropical Diseases

2. Case-Scenario:
Q. A 3 years male child was brought in OPD with fever, cough, sneezing,
running nose, and redness of eyes. The mother told that her child
developed a fever 4 days back. On examination: Some small, bluish-white
spots on a red base were seen on the buccal mucosa opposite the first
and second lower molars. The immunization status of the child was not
known. (1+1+1+2+2.5)
a. What is your probable diagnosis? (1)
b. Describe the epidemiology of given disease.(1)
c. What is the Pathognomonic clinical feature of the upper mentioned
disease? (1)
d. Explain the clinical stages in the natural history of this disease. (2)
e. Discuss the prevention and control measures of the given disease in
community? (2.5)

3. Measles:
An acute highly infectious disease of childhood caused by an RNA
paramyxovirus.
 Only one strain causes infection.
 Infection confers lifelong immunity.
 Second attacks are rare.

4. The challenges for measles elimination include:
1. Weak immunization systems
2. High infectious nature of measles.
3. The increasing refusal of immunization by some populations.
4. Populations that are inaccessible due to conflict.
5. The changing epidemiology of measles which has led to increased
transmission among adolescents and adults.
 SAR=Number of new cases among contacts/Total number of susceptible con
tacts​×100%

5. Epidemiology of measles:
Measles is endemic in all parts of the world.
Measles can affect anyone but is most common in Children (6 months -5
years).
Measles occurs predominantly in area with low vaccination rate,
particularly resource-limited setting.
WHO: Despite the availability of a safe and cost vaccine, 128000 people
died from measles in 2021 (World).

6. Nepal:
Measles is endemic in Nepal and is reported every year.
On January 2023, an outbreak of measles was confirmed in Nepalgunj by
NPHL following a cluster of cases of fever and rash.
Between 24th Nov 2022 and 10th march 2023, 690 measles cases, including
1 associated death (Case fatality ratio: 0.14%) have been reported from 7
districts of western Nepal and 3 districts in eastern Nepal.
The majority of the cases (n=591; 86%) have been reported in children aged
less than 15 years.

7. In area with low vaccine coverage, epidemics typically occurs every 2-
3 years and usually last between 2-3 months.

8. Epidemiological determinants of measles:
Agent factors Host factors Environmental factors
RNA Paramyxovirus
SOURCE OF
INFECTION: Cases
Children (6 momths-5 years)
Poorly nourished children
(Malnutrition)
Vitamin A deficiency
HIV/AIDS
Sex: Incidence is equal
Any season but more
common in WINTER.

9. Measles:
 Incubation period of measles: 10-14 days (10 days)
Mode of transmission of measles: Respiratory disease, transmitted
mainly by Air droplets .
Period of communicability: 4 days-Rash-5 days
SAR: > 90%
 SAR=Number of new cases among contacts/Total number of susceptible con
tacts​×100%

10. Clinical features of measles:
There are three stages in the natural history of measles:
(Fever starts on 10th day of infection).
 Rashes appear on
14th day of
infection.
After 3-4 days both fever and
rashes disappear. This is the
end of measles.

11. .
.
Measles is highly infectious during the prodromal period and at the
time of eruption.

12. KOPLIK SPOT:
Q. Pathognomonic clinical feature of Measles: KOPLIK SPOT
 KOPLIK SPOT: Small, bluish-white spots on a red base (Table salt crystal appearance)
were seen on the buccal mucosa opposite the first and second lower molars.

13. MEASLES RASH:
 RETROAURICULAR origin
 Macular or Maculopapular rash
Rashes appear 1-2 days after Koplik spot.

14. Papule and Macule:

15. Diagnosis:
 Diagnosis of measles is based on Typical rash and KOPLIK SPOT
seen in the oral mucosa.
 IgM-antibodies

16. Complications of measles:
1. OTITIS MEDIA (M/C Complication)
2. Diarrhoea
3. RTI (Pneumonia)
4. Rare/Least common/Late complication: SSPE (Sub-acute sclerosing
pan-encephalitis): Seen after 7-10 years and 7/million

17. Prevention of measles:
1. Active immunization: Live attenuated MR vaccine
2. Passive immunization: Immunoglobulin (0.25 ml/kg)
3. P/o Vitamin A
4. Proper nutrition
5. Isolation: Cases should be isolated
6. Contacts should be kept under surveillance.
7. Health Education, Information and Communication

18. MMR vaccine (Active immunization):
Types: Live attenuated
Strain: EDMONSTON ZAGREB S
Age of administration: 9 months and 15 months
Route of administration: SUBCUTANEOUS (S/C)
Site of administration: R. Arm
Diluent: Distilled water/ Sterile water

19. A/E of measles vaccine:
 TSS (Toxic Shock Syndrome): Measles Vaccine should not be used after
4 hrs of opening of vial.
Fever
Severe watery diarrhoea/ vomiting

20. Contraindications of measles vaccine:
 Pregnancy
HIV/AIDS
Leukemia/ lymphoma
Patient under high dose of steroid

21. KOPLIK SPOT: Pathognomonic clinical feature
of Measles:
KOPLIK SPOT: Small, bluish-white spots on a red base were seen on the
buccal mucosa opposite the first and second lower molars.

22. MCQ
Q. Koplik spots are seen in:
a. Prodromal stage
b. Eruptive stage
c. Post measles stage
d. Incubation period

23. Ans: a (Prodromal stage)

24. MCQ
Q. Incubation period of Measles is:
a. 3 days
b. 10 days
c. 21 days
d. 30 days

25. Ans: b (10 days)

26. MCQ
Q. In Measles, infective period is:
a. 3 days before and 4 days after the appearance of rash
b. 4 days before and 3 days after the appearance of rash
c. 4 days before and 5 days after the appearance of rash
d. 5 days before and 4 days after the appearance of rash

27. Ans: c (4 days before and 5 days after the appearance of
rash)

28. MCQ
Q. Which of the following is not true of Measles:
a. High secondary attack rate
b. Only one strain causes infection
c. Not infectious in prodromal stage
d. Infection confers lifelong immunity

29. Ans: c (Not infectious in prodromal stage)

30. MCQ
Q. Which of the following is the “Least common complication” of
measles:
a. Diarrhoea
b. Pneumonia
c. Otitis media
d. SSPE

31. Ans: d (SSPE)

32. MCQ
Q. True about measles is all except:
a. Kopliks spot appear as rash disappears
b. It is prevented by both active and passive immunization
c. Otitis media and meningitis are the most common
complications
d. TB is aggravated in post measles

33. Ans: a (Kopliks spot appear as rash disappears)

34. MCQ
Q. All are true regarding measles vaccine:
a. Freeze dried live attenuated vaccine
b. Single intramuscular dose of 0.5 ml
c. Is occasionally associated with TSS
d. Contraindicated in pregnancy

35. Ans: b (Single intramuscular dose of 0.5 ml)

36. MCQ
Q. True about Measles rash appearance:
a. Along with Koplik spot
b. 1-2 days before Koplik spot
c. 1-2 days after Koplik spot
d. Post measles stage

37. Ans: c (1-2 days after Koplik spot)

38. MCQ
Q. A 1 year old immunized child presents to PHC with fever since 5 days.
Mother also gives a history of rash starting behind ear-pinna a day before
coming to OPD. On examination, child is having running nose and
congested eyes. What is most probable diagnosis?
a. Rubella
b. Mumps
c. Measles
d. Chickenpox

39. Ans: c (Measles)

40. Case-Scenario: measles

41. Case-Scenario:
Ans: Measles

42. KOPLIK’S SPOT: Pathognomonic clinical feature of Measles:
KOPLIK’S SPOT
KOPLIK SPOT: Small, bluish-white spots on a red base were seen on the buccal mucosa opposite the first
and second lower molars.

43. Papule vs Macule:

44. MEASLES

45. Catarrhal symptoms:
Catarrhal symptoms typically refer to symptoms associated with
inflammation of the mucous membranes, particularly those lining the
respiratory tract.
These symptoms can include:
Runny or stuffy nose
Coughing
Sneezing:
Sore throat:

46. THE END