Measles is re-emerging in modern era

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.

Transmission

  • 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 manifestation

Clinical manifestations of measles are as follows:

  • High fever
  • Enanthem
  • Cough 
  • Coryza
  • Conjunctivitis
  • 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.
  • Encephalitis.
  • Hemorrhagic or “black measles.”
  • Keratitis.
  • Thrombocytopaenia.
  • Myocarditis.
  • Bacteremia, cellulitis, TSS.
  • Still births.
  • Birth defects.

Measles vaccine

Routine vaccination:

  • 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:

  • 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




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