3. MEASLES (RUBEOLA)
■ Measles is an accute highly contagious disease of
childhood caused by specific virus of group
myxoviruses.
4. Measles (Rubelloa)
■ It is clinically characterized by fever, upper respiratory
symptoms, followed by typically rashes.
■ Measles is associated with high morbidity and mortality in
developing countries.
5. Problem statement
■ Measles is endemic virtually in all parts of the world.
■ •Tends to occur in epidemics when the proportion of susceptible
children reaches about 40 percent
■ •Affects childhood population.
■ •Major cause of morbidity and childhood mortality.
7. Epidemiological determinants
Agents factors
■ The virus can not survive out side human body for any length of time, but
retain infectivity when stored at sub zero temperature.
■ The virus has been grown in cell culture
8. Epidemiological determinants
Agents factors
■ (B) SOURCE OF INFECTION
■ Only source of infection is the case of measles.
■ Carriers are not known to occur.
■ There is some evidence to suggest that subclinical measles
occurs.
■
9. Epidemiological determinants
Agents facto
■ (c) INFECTIVE MATERIAL:
■ Secretions of nose, throat , respiratory tract of a case of
measles, during the prodromal period, the early stages of the
rash.
10. Epidemiological determinants
Agensts factors
■ d) COMMUNUCABLITY
■ Measles is highly infectious during the prodromal period, at the
time if eruption. Communicability decline rapidly after
appearance of the rash.
11. Epidemiological determinants
Agents factors
■ The period of communicability is 4 days before, 5 days after the
appearance of the rash.
■ Isolation of the patients for a week from the onset of the rash
cover the period of communicability.
13. Host Factors
■ Age
■ Affect every one in infancy, childhood between 6 months to 3
years in developing countries, where environmental conditions
are generally poor, older children usually over 5 years in
developed countries.
14. Host Factors
■ b) Sex: Incident is equal.
■ (c) Immunity: No age is immune. One attack confers life long
immunity. Second attack attacks are rare.
15. Host Factors
■ infants are protected by maternal antibodies up to 6
months of age, maternal antibodies may persist
beyond 9 months.
■ Immunity after vaccination is quite solid, long
16. Host Factors
■ d) Nutrition
■ Malnourished child carry, mortality 400 times higher than well-
nourished children having measles.
■ This may be possibly related to poor cell mediated immunity
response, secondary to malnutrition.
17. Host Factors
■ Additionally, severe malnourished children excrete measles
virus for longer period than better nourished children, indicating
prolonged risk to themselves, intensity of spread to others.
18. Environmental factors
■ Moderate climate measles is winter disease, due to peoples
crowed together indoors. Epidemics of measles are common
during winter and early spring (January April)
19. Transmission
■ From person to person mainly are droplet infection
and droplet nuclei, from 4 days before onset of rash
until 5 days thereafter.
■ The portal of entry is the respiratory tract infection.
Virus installed in conjunctiva can cause infection.
22. Pre-eruptive stage
■ Begin 10 days after infection and last for 14 days.
■ It is characterized by fever, sneezing, nasal discharge,
cough, redness of eyes, lacrimation, photophobia, may be
vomiting and diarrhea
■ day or two before appearance of the rash kopliks spots
appear on buccal mucosa apposite 1st and 2nd premolar.
■ They are small bluish white spots on a red base smaller than
head of a pin.
23. Eruptive stage
■ Typical dusky red , macular or maculopapular rash, which
begin behind ear spread rapidly in few hours over face and
neck extend down takes 2-3 days extend to lower extremities
■ Rash is discrete/separate but often confluent and spotted.
■ Fever disappear another 3-4 days show end of the disease.
■ The rash fades in the same order of appearance leaving
brownish discoloration, which persist for 2 months more.
■ Diagnosis of measles is based on typical rash and kopliks
spots .
24. Post measles stage
■ here may be growth retardation, diarrhea, candidiasis,
reactivation of pulmonary tuberculosis.
25. Complications
■ The most common complications are measles
associated diarrhea, pneumonia, otitis media,
encephalitis and SSPE (Sub-acute sclerosing pan-
encephalitis.
26. Measles And Chicken Pox
■ It has been noted that sometimes measles and
chicken pox may occur together,and one most
remarkable finding in there cases of double
infection is that the first infection may dimnish
the severity of the rash of the second infection.
27. ■Treatment
■ No specific antiviral treatment
■ Severe complications from mealses can be
reduced through supportive care that
ensures,good nutrition, adequate fluid intake
and treatment of dehydration with W.H.O
recommend oral rehydration solution.
■ Antibiotics should be prescribed to treat eye
and ear infections and pneumonia.
28. Treatment
■ •All children in developing countries diagnosed
with measles should receive two doses of vitamin
A supplements,given 24 hrs apart.
■ •This can prevent eye damage and blindness.
■ •Vitamin A supplements have been shown to
reduce the number of deaths from mealses by
50%.
29. ■ Prevention of Measles is of two types.
■ 1.Active prevention:
■ Measles vaccine,combined vaccine MMR
■ 2. Passive prevention:
■ By Gamma Globulin.
Prevention
30. Prevention
■ In may 1974,WHO officially launched a programme to protect all
children of world against 6 vaccine preventable disease.
■ •Measles Vaccine introduced through U.I.P(universal
immunization programme in 1985).
31. Prevention
■ Measles VACCINE:
■ 1.Freezed dried vaccine contains live attenuated
virus stored at 2-8C.
■ 2.Dose:0.5ml,Route: Subcutaneous.
■ 3.Time of administration:09 months.
■ 4.Duration of vaccine:Life long.
■ 5.Efficay of Vaccine:95%
■ 6.Side effects:Fever,Rash, Rarely SSPE.
34. Prevention
■ Immunoglobulin
■ By administration of immunoglobulin (Human) in the
incubation period, measles can be prevented.
■ • Dose recommended by WHO 0.25 ml per kg body weight
is given 3 -4 days of exposure
■ The person passively immunized, should given live vaccine
8 to 12 weeks later.
■ •Immunoglobulin need is reduced because of effective live
attenuated vaccine.
36. Control measures
■ •Following control measures have been recommended;
■ (a ) isolation for 7 days after onset of rash.
■ (a)immunization of contacts within 2 days of exposure ( if
vaccine is contraindicated immunoglobulin should be given
within 2to 4 days of exposure.
■ (b)immunization at begging of epidemic is essential to limit
the spread.
37. Challenges For Measles
Elimination
■ •Weak immunization system.
■ •High infectious nature of measles.
■ •Inaccessible population in certain areas.
■ •Refusal to immunization.
■ •Lack of human and financial resources.
■ •Changing epidemiology (adolescents/adults).
38. W.H.O Enhanced
Measles Eradications
Strategy
■ •Catch-up:One time only vaccination campaign is conducted
among children aged 09 months to 14 years irrespective of
their previous vaccination status.
■ •Keep up: Efforts are then made to vaccinate at least 95% of
each newborn cohort through routine immunization by age of
12 months.
■ Follow up:To assure High immunity among preschool
children indiscriminate follow up measles vaccination
campaign are conducted every 04 years.
