Measles is an acute, highly infectious childhood disease caused by a paramyxovirus. It presents with fever, cough, coryza and a characteristic rash. While clinical features include prodrome, eruption and recovery phases, complications can include pneumonia, encephalitis and death. Transmission occurs from infected individuals and it is more prevalent in developing countries like India. Prevention through vaccination and immunoglobulins can provide up to 99% protection. WHO and India's strategies aim to eliminate measles through widespread vaccination coverage.

2. Aastha Mishra
2017 batch

3. Synopsis
-Introduction
-Causative agent
-Epidemiological factors
Measlesin INDIA
-Complications
-Prevention
Problemstatement
-Outbreakcontrol measures
-Eradicationof measles
-Summary

4. INTRODUCTION
Measles (RUBEOLA) is an acute highlyinfectious disease of
childhood.
Generally the symptoms are fever, catarrhal symptoms of
respiratory tract such as cough, coryza followed by a typical rash.
Measles is associated with high morbidity and mortalityin
developing countries.
Measle occur only in HUMANS. There is no animal reservoir of
infection.

5. MEASLES

6. CAUSATIVE AGENT
Measles is generally causedby a specific virus of the group
MYXOVIRUSES.
It is an RNA PARAMYXOVIRUS.
This virus cannot survive outside the human body for any
length of time , but retains infectivity when stored at sub-
zero temperature.
This virus has been grown in cell cultures.

7. EPIDEMIOLOGICAL
DETERMINANTS
 AGENT FACTORS
 AGENT– RNA PARAMYXOVIRUS
 SOURCEOF INFECTION–the only source of infectionis A CASE OF MEASLES.
 INFECTIVEMATERIAL– Secretions of the nose,throat, respiratory tract of a case of
measles during prodromal stageand earlystageof rash
 COMMUNICABILITY–highly infectious, but it declines after the appearance of rash.
PERIOD= 4 days before and 4 days afterthe appearance of rash. PREVENTION-
isolationof the patient.
 SECONDARYATTACKRATE – infection confers life long immunity, rare.

8. HOST FACTORS
 AGE– Affects virtually everyone in infancy or childhood.
 Between 6 months and 3 years of age in developingcountries, and
above 5 years in developed countries.
 SEX- incidence equal
 IMMUNITY- No age is immune. One attackconfers life long immunity.
 Infants are protected by maternal antibodies upto6 months of age.
 NUTRITION– severe in malnourished child, possibly relatedto cell
mediatedimmunity.

9. ENVIRONMENTAL FACTORS
 Paramyxovirus can spread in any season.
 Tropical zones = most cases occur during dry season
 Temperate zones= duringwinterseason
 Epidemics of measlesare common in INDIAduringwinter and early
spring (JANUARYTO APRIL)
 TRANSMISSION
 Directly fromperson to person = droplet infection
 The portal of entry is RESPIRATORYTRACT.

10. INCUBATION PERIOD
Incubation period is commonly 10 days fromexposure
to onset of fever
14 days to appearance of rash
When measles infection is artificially induces,
incubation period is shortened to around 7 days.
 CLINICAL FEATURES
 1) PRODROMALSTAGE
 2) ERUPTIVEPHASE
 3) POST–MEASLESSTAGE

11. PRODROMALSTAGE
 Begins 10 days after the infection and lasts until day 14
 Characterized by fever, coryza with sneezing and nasal discharge ,cough,
redness of eyes, lacrimation and often photophobia
 Before the appearance of rashes, KOPLIK’SSPOT like table salt crystals
appear on the buccal mucosaopposite the first and second molars
 KOPLIK’SSPOTS– They are small , bluish white spotson a red base,
usually smaller than the head of a pin.
 Their presence is PATHOGNOMONICto measles.

13. KOPLIK’S SPOTS

14. ERUPTIVE PHASE
 Characterized by a typical ,dusky-redmacular or maculo-popular
rash.
 Begins behind the earsand spreads rapidly in a few hours over
the face and neck and extends down the body .
 It takes 2-3 days to progress to lower extremities
 The rash fades in the same order of appearance leaving a
brownish discoloration whichmay persist for 2 months or more.

15. RASHES DEVELOPED DURING
ERUPTIVE PHASE

16. POST MEASLES STAGE
 The childwill have lost weight and will remain weak for a number
of days.
 Failure to recover
 Gradual deterioration into chronic illness due to increased
susceptibility to other bacterial and viral infections
 Maybe growthretardation , diarrhea , pyogenic infections,
reactivation of pulmonary tuberculosis

17. MEASLES – IN INDIA
 In INDIA, MEASLES – a majorcontributor to childhoodmortality
 Prior to immunization program, cyclical increase in the incidence of
measles were recoreded every THIRDYEAR .
 Several outbreaks are recordedin tribal and remote areas.
 1987- 2.47 lakh cases were reprted , wheras after implementation of UIP,
reduced to 23,348 cases with 33 deaths in 2014.
 But in INDIAthe estimates are much higher because a large numberof
cases go unreported.
 WHO – Measles – 2%of under 5 deathin INDIA

18. MEASLES IN INDIA

19. MEASLES IN INDIA

20. DIAGNOSIS
Diagnosis of measles is basedon the TYPICAL RASHand
KOPLIK’S SPOT seen in oral mucosa.
The diagnosis would normally be incorrect in any febrile
exanthemin which red eyes andcough are absent
In developedcountries, where measles is uncommon ,
specificIgMantibodies are usedfor diagnosis.

21. COMPLICATONS
 Measles is oftenregarded as an unimportant infection, But this is not true.
 The mostcommoncomplications are
 1)Measles– associateddiarrhea
 2)Pneumonia, Respiratorycomplications
 3)OTITISMEDIA( it is a groupof inflammatorydiseases of the middle
ear)
 Out of all these , Pneumonia is the most common life threatening
complication
 It occurs less than10% in developed countries and 20- 80 % cases in
developing countries.

22. COMPLICATIONS
NEUROLOGICAL COMPLICATIONS
 1) febrile convulsions
 2) encephalitis
 3) sub – acute PAN- encephalitis
PREGNANCY
Not known to cause congenital abnormalities to the foetus.
Spontaneous abortion and Premature babies.
Vitamin A
50,000 IU for < 6 months
100,000 IU for < 6-11 month
200,000 IU for children > 12 months

23. MEASLES AND CHICKENPOX
 Sometimes measles and chickenpox occur together
 First infection may diminish the severity of the second infection

24. PREVENTION OF MEASLES
 Measles Vaccination
 Immunogobulins
 MEASLES VACCINATION
 A) Vaccine– Only liveattenuated vaccines are used
 Presentedas a freeze driedproduct
 Eachdose = 0.5 ml contains > 1000 viral infective units of the vaccine strain
 Also containsorbitol , hydrolysedgelatin, a small amount of neomycin
 Reconstitutedvaccine loses 50% potency= 1 hour at 20 degree Celsius
 All potency = at 37 degree Celsius
 Also sensitive to sunlight , storedin darkin coloured glass vials.

25.  AGE– WHOexpandedprogramon immunization recommends immunization
at 9 months of age.
 This has been adoptedin INDIA
 Developed countries = at 12 months of age
 ADMINISTRATION– reconstituted vaccine , generally administered
subcutaneously, also intramuscularly
 REACTIONS– Wheninjected intothe body, the virus multiplies and induces a
mild measles illness( fever and rash ) , 5-10 days after immunization
 Fever 1-2 days / Rash – 1-3 days
 No spreadof vaccines fromvaccines to contacts
 IMMUNTY– This vaccine has convincingly demonstrated to provide immunity
to evenmalnourishedchildren
 Immunity develops 11-12days after vaccination

26.  CONTACTS– susceptible contacts 9-12months protectedwithMV but
within3 days of exposures
 Because incubation period by vaccines = 7 days, but incubation period of
naturallyacquired measles =10 days
 CONTRAINDICATIONS– combinedvaccines should be avoidedby patients
with highfever, pregnantwoman
 Earlystage of HIV not a contradindication
 SADVERSE EFFECTSOF VACCINE– toxic shocksyndrome TSS .
 MEASLESAND HIV
 routinelyadministeredto suspectible but asymptomaticHIV positive
childrenand adults
 Areas withhigh incidence of HIV- vaccinationat 6 age months

27. COMBINED VACCINE
Combinedwith other live attenuatedvaccines
MMR VACCINE = measles, mumps , rubella
MMRVVACCINE = measles, mumps, rubella andvaricella
MR = measles andrubella

28. IMMUNOGLOBULINS
Prevented by immunoglobulins ( human ) early in the
incubation period
Dose – 0.25 ml/kg of body weight.
Should be given within 3-4 days of exposure

29. PROBLEM STATEMENT
 Measles is endemic virtually in all parts of the world. Epidemics-
proportion of susceptible children reaches about 40%.
 When the disease is introduced into a virgin community, more than
90% of the communitywill be affected.
 Measles is nowrare in industrialized countries, but still a common illness
in many developing countries.
 Primary reason- failureto deliverat leastonedoseof measlesvaccineto
all infants.

30. CHALLENGES
The challenges for elimination of Measles include
 High infectious nature of measles
 Populations that are inaccessible due to conflict
 Weak immunization systems
 The increasing refusal of immunization by some populations
 The changing epidemiology of measles whichhas led to increased
transmission among adolescents and adults.

31. WHO STRATEGY FOR ELIMINATION OF
MEASLES
 In 1980, before widespreaduse of measles vaccine , an estimated2.6 million
measles deathoccur worldwide.
 Recognizing this threat, WHOand UNICEF developed an accelerated measles
mortalityreductionstrategyof delivering 2 dosesof MEASLESCONTAINING
VACCINE[ MCV] to all children throughroutine services and supplementary
immunizing activities [ SIAS]
 Implementation -2001
 Estimated measles deathhas fallenfrom 7,33,000 in year 2000 to 1,14,900 in
year 2014.
 During the period2000 to 2014 ,measles vaccinationprevented 17.1 millioncases.

32. UPCOMING STRATEGY
WHO& UNICEF- GLOBALMEASLESANDRUBELLA
STRATEGICPLAN( 2012-2020)
AIMS:
1) Achieve andmaintain highlevels of population
immunity- 2 doses of MCR vaccines
2) Establish effective survilance to monitor disease and
evaluate progress.

33. OUTBREAK CONTROL MEASURES
The following control measures have been
recommended
 Isolation of the patient for 7 days after onset of the
rash
Immunization of contacts within 2 days of exposure
PROMPT IMMUNIZATION at the beginning of the
onset is essential to limit the spread

34. ERADICATION OF MEASLES
Like small pox, MEASLES is amenable to eradication
Favourable fact = Only 2 dose of vaccine is enough
New vaccines- heat stable
Immunization coverage of atleast 96%of children under 1
year of age

35. IMMUNIZATION COVERAGE
WITH VACCINES

36. SUMMARY
 Measles also known as rubeola is an acute highly infectious disease
 Causedby an RNA paramyxovirus
 Symptoms – coryza, cough, Koplik’s spot, typical rash
 Clinical features- Prodromal stage, eruptive phase, post-measles phase
 Transmission – only a case of measles
 More commonin developing countries, less commonin developedcountries
 Prevention– vaccination, immunoglobulins
 1 dose of vaccine – 99%of protection
 Combined vaccines – MMR , MMRV, MR
 Like chickenpox measles is amenable to eradication

37. PREVENTION IS BETTER THAN CURE