Measles is a highly infectious childhood disease caused by the measles virus. It is characterized by fever and a rash. While the disease itself is usually not fatal, it can lead to serious complications like pneumonia, encephalitis, and malnutrition. Transmission occurs via respiratory droplets. There is no specific treatment for measles, but supportive care and vitamin A supplementation can help recovery. Immunization with the measles vaccine provides lifelong protection and is the most effective preventive strategy.

1. MEASLES
Mr. Abhijit Bhoyar
COMMUNICABLE
DISEASES

2. INTRODUCTION
 Measles is a highly infectious disease of childhood
caused by measles virus.
 It is characterized by fever, catarrhal symptoms of the
upper respiratory tract followed by typical rash.
 In our country, it is a major cause of ill health and
morbidity.

3.  It is a significant contributor to childhood mortality,
especially in the malnourished children below the age
of 3 years.
 Measles is endemic in all parts of the world and it
tends to occur in epidemics.

4. EPIDEMIOLOGY
 The causative agent of measles is the specific measles
virus, a RNA virus of the genus morbilli virus, of
paramyxoviridae family.
 Human body is the only reservoir of this infection.
 The only source of infection is a case of measles.

5.  Infective materials are secretions of nose, throat and
respiratory tract of the infected patient.
 The period of communicability is approximately 4
days before and 5 days after the appearance of rash.
 One attack of infection gives life-long immunity.

6.  Mode of transmission is mainly by droplet infections
and droplet nuclei.
 Portal of entry is the respiratory tract and sometimes
through conjunctiva.
 It can spread directly by air borne route or by indirect
contact with fomites.
 Incubation period is 10 to 15 days.

8.  Measles usually occurs in the children between the age
of one year and 5 years.
 Infants are protected by maternal antibodies up to 6
months of age.
 It is rare in infants of 6 to 12 months.
 Before 6 months it is uncommon.
 It may found around 6 months in mild form.
 Sometimes it may occur in older children. The disease
is found in very severe form in malnourished children.

9.  Measles usually occurs in winter and spring months
but may found in all seasons.
 It is common in poor community and related to social
belief as 'Curse of the goddess'
 Parents prefer to visit temple rather than consulting
doctor and usually provide neglected care and
negligible foods.

10. PATHOLOGICAL CHANGES
 Pathological changes are related to the invasion of
virus in the respiratory epithelium which results in
local multiplication and viremia.
 The infection spreads to reticulo-endothelial system
and causes secondary viremia which produces
systemic symptoms.

11.  Superficial blood vessels of skin and mucous
membrane are affected and formed inclusion
bodies.
 This multinucleated giant cell can be
demonstrated in both epidermis and oral
epithelium.

12. CLINICAL MANIFESTATIONS
 Clinical features of measles are manifested in
three stages,
Prodromal
or
pre-
eruptive
stage
Eruptive
stage
convalesce
nt or post-
measles
stage.

13. Prodromal (catarrhal) or pre-eruptive
stage
 Prodromal stage usually starts after 10 days of
infection and lasts 3 to 5 days.
 This stage is manifested with
 Fever,
 Malaise,
 Sneezing,
 Nasal discharge,.

15.  Lymphadenopathy
 Vomiting and diarrhea
 Koplik's spots,
 Brassy cough,
 Redness of eyes,
 Lacrimation and photophobia
Koplik
spot looks
like a small,
bluish-white
spot with a
red
background
on the inside
of the

17. Eruptive stage
 Eruptive stage is characterized by a typical irregular
dusky red macular or maculopapular rash which
found behind the ears and face first, usually 3 to 5 days
after the onset of the disease.
 Then it spreads to neck, trunk, limbs, palms and soles
in next 3 to 4 days.

18.  Fever usually rise again or regress gradually within 3
days.
 Anorexia, malaise and cervical lymphadenopathy may
present.
 Fever and rash usually disappear in 4 to 5 days in the
same order of appearance.

19.  There is fine shedding of superficial skin of face, trunk
and limbs, leaving brownish discoloration which may
persist for 2 months or more.

20. Convalescent or post-measles stage
 Convalescent stage is the period of disappearance of
constitutional symptoms, fever and rash. But usually
the child remains sick for number of days and lost
weight.
 There may be gradual deterioration into chronic illness
due to bacterial or viral infections, nutritional and
metabolic disturbances or other complications.

21. INVESTIGATIONS
 Usually clinical features help in diagnosis, no
investigations needed.
 But serological tests, viral isolation, ELISA test to
detect the presence of measles antibody and routine
blood examination can be done.

22. COMPLICATIONS
 Complications of measles are potentially dangerous and fatal
than the disease. The common complications are:
 Respiratory tract infections as bronchopneumonia, laryngitis,
laryngo-tracheo-bronchitis, bronchiolites, activation of primary
tuberculosis, otitis media and mastoiditis.
 These are most common complications causing long-term
problems.

23.  Neurological complications: These include
encephalitis, febrile convulsions, sub-acute sclerosing
panencephalitis, GB syndrome, cerebral
thrombophlebitis, brain abscess, hemiplegia,
retrobulbar neuritis, mental retardation, etc.
 CNS infections are most serious complications and
may be fatal.

24.  Gastrointestinal complications: These include
persistent diarrhea, appendicitis, stomatitis, enteritis,
cancrum oris (noma), etc
 Other complications are myocarditis, acute
glomerulonephritis, DIC and bleeding diathesis,
keratitis and corneal ulcer secondary to vitamin 'A'
deficiency, malnutrition, etc.

25. MANAGEMENT
 There is no specific management for measles.
 The symptomatic management is done with
antipyretic, antihistamines / antipruritics, cough
sedatives, vasoconstrictor nasal drops and vitamin 'A'
supplementations.

26.  Antibiotics may be given in superadded
bacterial infections.
 The use of antiviral drugs, gamma globulins and
steroids are doubtful.

27.  Good nursing care and supportive measures promote
the outcome.
 They include isolation, rest, calm and quiet
environment, dim light, good nourishing diet, adequate
amount of fluid, oral hygiene, general cleanliness,
meticulous skin care and daily bath, tepid sponge to
reduce fever, clearing nasal and mouth secretions, eye
care and careful observation for features of
complications.

28.  Early detection and management of
complications should be done promptly to
prevent poor prognosis

29. PREVENTIVE MEASURES
 Active immunization with live attenuated measles vaccine is
administered 0.5 mL subcutaneously in single dose at 9 to 12
months of age.
 A booster dose of measles vaccine is now recommended at the
age of 16 to 24 months.
 It provides protection to the susceptible children for the life
time.
 MMR vaccine can be administered for protection against
measles along with mumps and rubella.

30.  Passive immunization with gamma globulin can be
administered intramuscularly 0.25 mL/kg for infants
and 0.5 mL/kg for the children more than one year.
 It provides short term immunity.
 Isolation of the infected child and appropriate disposal
of infected materials are necessary to prevent spread of
infection to others.

31. PROGNOSIS
 Prognosis of a well-nourished child with measles is usually
good.
 Measles is self-limiting disease unless it is complicated.
 Approximately 90% of death may occur in severe respiratory
and neurological complications.
 The survivors of post measles long-term encephalopathy
sequelae may have neurological deficits