Measles

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

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

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

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.

Transmission

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

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.

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.

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.

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.

ASSESSMENT

STAGE DATA

PROBLEM IDENTIFIED

(NURSING DIAGNOSIS)

Pre-eruptive Stage

(patient is highly communicable)

• fever

• catarrhal symptoms – start in the nasal cavities; then in the conjunctivae, oropharynx, progress to the bronchi 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.

• Hyperthermia

• Pain

• Risk for impaired gas exchange

• Risk for impaired breathing pattern

Eruptive Stage/Stage of Skin Rashes • Anorexia

• Exanthem sign – means eruption in the skin

• Maculopapular Rashes – appears 2-7 days after onset

• High fever – increases steadily

• Irritability

• Diarrhea

• Pruritis

• Lethargy

• Occipital lymphadenopathy

• Imbalance nutrition: less than body requirement

• Impaired skin integrity

• Hyperthermia

• Activity Intolerance

• Fatigue

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

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.

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.

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.

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

• 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

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

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.