EPIDEMIOLOGY & CONTROL
MEASURES OF MEASLES
Professor Dr. AB Rajar, MBBS, Dip-Diab, MPH, Ph.D. CPHE
Director of Research and Innovative Center
[IBN-E-SINA UNIVERSITY]

● After one hour lecture the students will be
able to understand the:
○ Define measles and mention key facts
○ Describe the importance of the agent,
host, and environmental factors of
measles.
○ Describe the preventive and control
measures for measles.
LEARNING OBJECTIVES

● Even though a safe and cost-effective vaccine is available, in
2018, there were more than 140 000 measles deaths globally,
mostly among children under the age of five.
● Measles vaccination resulted in a 73% drop in measles deaths
between 2000 and 2018 worldwide
● In 2018, about 86% of the world's children received one dose of
the measles vaccine by their first birthday through routine health
services – up from 72% in 2000.
● During 2000- 2018, measles vaccination prevented an estimated
23.2 million deaths making the measles vaccine one of the best
buys in public health.
KEY FACTS

INTRODUCTION

 One of the top five causes of vaccine-
preventable deaths in the world
 Easy to prevent – the vaccine costs less than
US$1 and gives life-long immunity
 Found in every part of the world – measles
outbreaks have taken place on every
continent and in all climates
 One of the most contagious diseases – 90%
of those exposed to the measles virus will
catch it if they do not have immunity
INTRODUCTION

 Definition:
 It is an acute highly infectious
disease of childhood caused by a
specific virus of the group
myxovirus.
MEASLES

 AGENT FACTORS:
 Agent: RNA Paramyxovirus.
 Source of Infection: A case of measles.
 Infective Material: Secretions of the nose, throat
& respiratory of a case of measles during the
prodromal period & the early stages of the rash.
 Period of Communicability: 4 days before & 5
days after the appearance of the rash
EPIDEMIOLOGY

MEASLES VIRUS

EPIDEMIOLOGY

 HOST FACTORS:
 Age:
1=B/W 6 months & 3 years of age in developing countries.
2= Over 5yrs in developed countries.
 Sex: incidence is equal.
 Immunity: No age is immune, however, one attack confers
lifelong immunity.
 Nutrition: Measles tend to be very severe in the malnourished
child.
 Time: The measles virus can spread during any season but is
most prevalent from January to April.
EPIDEMIOLOGY

 MODE OF TRANSMISSION:
 Direct: From person to person by droplet infection &
droplet nuclei.
 Indirect: Through articles freshly soiled with nasal &
throat secretions.
 Portal of Entry: Respiratory tract.
 Incubation Period:
● It varies from 10-14 days, in most cases, it is 10-11
days.
EPIDEMIOLOGY

CLINICAL FEATURES

C/F of Measles

 PRODROMAL STAGE:
● Characterized by Fever, Redness of the eye, Lacrimation,
Photophobia, Vomiting, and Diarrhea.
 KOPLICK’S SPOTS:(Pathognomonic sign of measles)
a. It occurs a day or 2 before the appearance of the rash.
b. It appears on the buccal mucosa opposite the first &
second upper molars.
c. They are small, bluish-white spots on a red base smaller
than the head of the pin.
CLINICAL FEATURES

MEASLES - Koplik’s spots

 ERUPTIVE STAGE:
 This phase is characterized by a typical, dusky-red,
macular or maculopapular rash, which begins behind
the ears, spreads rapidly in a few hours over the face
& neck, extends down the body taking 2 to 3 days to
progress to the lower extremities.
 In absence of complications disappear in another 3 to
4 days in the same order of appearance leaving a
brownish discoloration that may persist for 2 months
or more.
CLINICAL FEATURES

ERUPTIVE STAGE

PATHOGENESIS

 POST-MEASLES STATE:
 Growth retardation
 Susceptibility to other infections
 Pneumonia (20-80%)
 Diarrhea
 Pyogenic infections
 candidiasis, and reactivation of
pulmonary tuberculosis.
CLINICAL FEATURES

TREATMENT

● Isolation for 7 days after the onset of rash
● No specific antiviral treatment.
● Suppurative care: good nutrition, adequate fluid
intake, and treatment of dehydration.
● Antibiotics: to treat eye and ear infections, and
pneumonia
TREATMENT

● All children diagnosed with measles should
receive two doses of vitamin A supplements,
given 24 hours apart.
● Vitamin A can help prevent eye damage and
blindness.
● Vitamin A supplements reduce the deaths from
measles by 50%.
TREATMENT

COMPLICATIONS

 Pneumonia,
 Otitismedia,
 Encephalitis,
 Keratitis,
 Conjunctivitis,
 Myocarditis,
 Reactivation of
primary complex.
COMPLICATIONS

 CONTROL OF PATIENTS & CONTACTS:
● Notification to the health authorities.
● Isolation for 7 days after the appearance of the rash
& for 14 days from school for contacts.
● Disinfection of the articles soiled by discharges.
● Immunization of contacts.
● Investigations of contacts under 3 years of age.
● Investigations of the source of infection.
CONTROL & PREVENTION

 PREVENTION OF MEASLES:
 ACTIVE IMMUNIZATION:(Vaccination)
● A live attenuated virus freeze-dried vaccine s/c at left
deltoid in 0.5cc, according to the EPI schedule.
● Immunity:
It develops 11-12 days after vaccination & appears to
be of long duration probably for life.
● Contacts:
Susceptible individuals over the age of 9-12 months may
be protected against measles provided that the vaccine
is given within 3 days of exposure.
CONTROL & PREVENTION

MEASLES VACCINE

● LIVE VIRUS VACCINE
● Freeze-dried (lyophilized) and used with diluent
● Store vaccine at 2°-8° C (but can be frozen)
● Protect from light at all times
● Efficacy:
 85% at 9months (EPI schedule)
 95% at 12-15months
● Duration of immunity: lifelong
MEASLES VACCINE

 PASSIVE IMMUNIZATION:
● It can be done by the administration of Immunoglobulin
(human) early in the incubation period at 0.25ml/kg
body wt.
● It should be given within 3-4 days of exposure.
● Live measles vaccine should be given 8-12 wks., later of
passive immunization.
MEASLES VACCINE

Q-1 Measles virus is transmitted through airborne droplets and
is one of the leading causes of respiratory infections mostly
seen in children of developing countries.
● Which of the following statements is not correct about
the epidemiologic features of measles?
a. More than one serotype of the virus has been identified
b. Humans are the only reservoir
c. Infection confers lifelong immunity
d. Infection can be transmitted from the mother to the
fetus

Q-2 The symptoms of the measles virus infection develop
within 2 to 5 days, the most common is skin rashes.
• Which of the following are not the other
symptoms related to measles?
a) Red and watery eyes
b) Runny nose
c) High-grade fever
d) Enlarged salivary glands

Q-3 Each of the following statements about the measles
vaccine is correct, EXCEPT?
a. The vaccine was first introduced in 1963
b. It is available only in a monovalent form
c. The vaccine can be introduced to the child as
early as 12 months of age
d. The vaccine contains live, attenuated virus

+Thank You
Any Question?