1. Measles

2. Measles or RubeolA, is an acute viral illness
caused by a virus in the family paramyxovirus,
genus Morbillivirus.

3. Measles is characterized by a prodrome of fever and
malaise, cough, coryza, and conjunctivitis, followed by a
maculopapular rash.

4. Measles is usually a mild or moderately severe
illness. However, measles can result in
complications such as pneumonia,
encephalitis and death.

5. Epidemiology
• In 1980, before widespread global use of measles
vaccine, an estimated 2.6 million measles deaths
occurred worldwide. In 2001, to accelerate the
reduction in measles cases achieved by vaccination,
the World Health Organization (WHO) and the United
Nations Children's Fund (UNICEF) developed a strategy
to deliver 2 doses of measles-containing vaccine (MCV)
to all children through routine services and
supplementary immunization activities (SIAs) and
improved disease surveillance. After implementation of
this strategy, the estimated number of annual measles
deaths worldwide decreased from 733,000 in 2000 to
164,000 in 2008.

6. Transmission
Measles transmission is airborne by
respiratory droplet nuclei spread or it can be
transmitted by direct contact with infected
nasal or throat secretions.

7. Incubation Period
The incubation period is approximately ten
days, but varies from 7 to 18 days from
exposure to the onset of fever. It is usually 14
days until the rash appears.

8. Risk Factors
Anyone who never had measles and has never
been vaccinated.
Babies younger than 12 months old, because they
are too young to be vaccinated.
Adults who were vaccinated before 1968,
because some early vaccines did not give lasting
protection.
A very small percentage of vaccinated children
and adults who may not have responded well to
the vaccine.

9. Clinical Features
• Clinical features of measles include prodromal
fever, a severe cough, conjunctivitis, coryza
and Koplik’s spots on the buccal mucosa.
These are present for three to four days prior
to rash onset.

10. The most important clinical predictors are included in the
clinical case definition for measles which is an illness
characterised by all the following features:
 generalised maculopapular rash, usually lasting three or more
days
 fever (at least 38°C if measured) present at the time of rash
onset
 cough, coryza, conjunctivitis and Koplik’s spots
 The characteristic red, blotchy rash appears on the third to
seventh day. It begins on the face before becoming
generalised and generally lasts four to seven days.
 Measles infection (confirmed virologically) may rarely occur
without a rash.

11. ASSESSMENT

12. PROBLEM IDENTIFIED
STAGE DATA (NURSING DIAGNOSIS)
Pre-eruptive Stage • fever • Hyperthermia
(patient is highly communicable) • catarrhal symptoms – start in the nasal • Pain
cavities; then in the conjunctivae, • Risk for impaired gas exchange
oropharynx, progress to the bronchi • Risk for impaired breathing pattern
resulting successively in rhinitis,
conjunctivitis and then bronchitis.
• Respiratory symptoms – which appear
first as a common cold, and sneezing
nasal discharges, steadily progress into
a distressing and annoying cough that
persists up to convalescence.
Eruptive Stage/Stage of Skin Rashes • Anorexia • Imbalance nutrition: less than body
requirement
• Exanthem sign – means eruption in the
skin • Impaired skin integrity
• Maculopapular Rashes – appears 2-7 • Hyperthermia
days after onset • Activity Intolerance
• High fever – increases steadily • Fatigue
• Irritability
• Diarrhea
• Pruritis
• Lethargy
• Occipital lymphadenopathy
Stage of Convalescence • Rashes – fade in the same manner as
they appeared, from the face
downwards, leaving a dirty brown
pigmentation and finely granular which
maybe noted for several days.
• Fever – gradually subsides as the
eruptions disappear on the hands and
feet

13. DIAGNOSIS
Clinical diagnosis of measles requires a history
of fever of at least three days, with at least
one of the three C's (cough, coryza,
conjunctivitis). Observation of Koplik's spots is
also diagnostic of measles.

14. Alternatively, laboratory diagnosis of measles can
be done with confirmation of positive measles
IgM antibodies or isolation of measles virus RNA
from respiratory specimens. In patients where
phlebotomy is not possible, saliva can be
collected for salivary measles-specific IgA testing.
Positive contact with other patients known to
have measles adds strong epidemiological
evidence to the diagnosis. The contact with any
infected person in any way, including semen
through sex, saliva, or mucus, can cause infection.

15. MANAGEMENT
• There is no specific treatment for measles. Most patients with uncomplicated
measles will recover with rest and supportive treatment. It is, however, important
to seek medical advice if the patient becomes more unwell, as they may be
developing complications. Patient should be monitored for the development of
bacterial infections which should be treated with appropriate antibiotics on the
basis of clinical and bacteriological finding
• The patient may also take over-the-counter medications such as acetaminophen
(Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve
the fever that accompanies measles. Don’t give aspirin to children because of the
risk of Reye’s syndrome — a rare but potentially fatal disease.
• Maintain bedrest and provide quiet activities for the child. If there is sensitivity to
light, keep room darkly lit. Remove eye secretions with warm saline or water.
Encourage the patient not to rub the eyes. Administer antipyretic medication and
tepid sponge baths as ordered. A cool mist vaporizer can be used to relieve cough.
Apply antipruritic medication to prevent itching. Isolate child until fifth day of rash.

16. Prevention of Measles
• Avoid exposing children to any person with fever or with acute
catarrhal symptoms
• Isolation of cases from diagnosis until about 5-7 days after onset of
rash
• Disinfection of all articles soiled with secretion of nose and throat
• Encourage by health department and by private physician of
administration of measles immune globulin to susceptible infants
and children under 3 years of age in families or institutions where
measles occurs.
• Live attenuated and inactivated measles virus vaccines have been
tested and are available for use in children with no history of
measles, at 9 months of age or soon thereafter

17. • Live attenuated measles vaccine is recommended for
all persons unless specific contra-indications to live
vaccines exist.
• It is recommended that this vaccine be given as
measles-mumps-rubella (MMR) vaccine at 9 to 12
months of age and a second dose at four years of age
(prior to school entry). The second dose is not a
booster but is designed to vaccinate the approximately
five per cent of children who do not seroconvert to
measles after the first dose of vaccine

18. GUIDE ON MEASLES IMMUNIZATION
Route Subcutaneous
Site Outer part of upper left arm
Number of Dose 1 dose
Age at First Dose 9 months
Dosage 0.5mL
Storage Temperature -15 to -25 °C

19. EVALUATION
• PROGNOSIS
While the vast majority of patients survive measles, complications
occur fairly frequently, and may include bronchitis,
and panencephalitis which is potentially fatal. Also, even if the
patient is not concerned about death or sequela from the measles,
the person may spread the disease to an immunocompromised
patient, for whom the risk of death is much higher, due to
complications such as giant cell pneumonia. Acute measles
encephalitis is another serious risk of measles virus infection. It
typically occurs two days to one week after the breakout of the
measles exanthem, and begins with very high fever, severe
headache, convulsions, and altered mentation. Patient may become
comatose, and death or brain injury may occur.