Measles is re-emerging in modern era.
Measles virus is a single-stranded, lipid-enveloped RNA virus in the family Paramyxoviridae and genus Morbillivirus. Human are only host of the measles virus. Measles virus does not grow in other animals.
- Measles virus enter human body through the respiratory tract or conjunctivae. It spread by droplet or aerosols from infected person. Infectious period lasts from 3 days before to up to 4-6 days after the onset of rash.
- 90% of those who got exposed and had not been vaccinated before suffer measles.
- Viable virus may be suspended in air for as long as 1 hr after the patient with the source case leaves a room.
Clinical manifestations of measles are as follows:
- High fever
- Prominent exanthem.
- Incubation period of 8-12 days
Course of disease
- Mild fever followed by
- Onset of conjunctivitis with photophobia, coryza, a prominent cough, and increasing fever.
- Koplik spots are the enanthem and are the pathognomonic sign of disease.
- The rash begins on the forehead (around the hairline), behind the ears, and on the upper neck as a red maculopapular eruption.
- It then spreads downward to the torso and extremities, reaching the palms and soles in up to 50% of cases.
- The exanthem frequently becomes confluent on the face and upper trunk.
- With the onset of the rash, symptoms begin to subside.
- The rash fades over about 7 days in the same progression as it evolved, often leaving a fine desquamation of skin in its wake.
- Of the major symptoms of disease, the cough lasts the longest, often up to 10 days.
- In more severe cases, generalized lymphadenopathy may be present, with cervical and occipital lymph nodes especially prominent.
Inapparent measles infection
- Subclinical form of disease may occur.
- Individuals who have acquired passive antibodies.
- Rash may be less sever or rarely may be absent.
- These patients do not shed virus and do not transmit virus to their household contacts.
Complications of measles
- Pneumonia – bronchiolitis obliterans.
- Croup, tracheitis, and bronchiolitis.
- Acute otitis media.
- Sinusitis and mastoiditis.
- Activation of pulmonary tuberculoses.
- Diarrhea and vomiting – dehydration.
- Appendicitis or abdominal pain.
- Febrile seizures.
- Hemorrhagic or “black measles.”
- Bacteremia, cellulitis, TSS.
- Still births.
- Birth defects.
- Minimum age: this vaccine is now replaced with MR/MMR vaccine and it is administered at minimum age of 9 months or 270 completed days.
- Catch-up vaccination beyond 12 months should be MMR.
- Measles-containing vaccine can be administered to infants aged 6 through 11 months during outbreaks.
- These children should be re-vaccinated with two doses of measles-containing vaccines; the first at ages 12 through 15 months and at least 4 weeks after the previous dose, and the second dose at ages 4 through 6 years.
Dr Yatin Bhole MBBS DCh DNB
Bhole Children Clinic
Pediatrician in Ravet