measles - update
DESCRIPTION
Measles - updateTRANSCRIPT
MEASLES UPDATE
Dr.T.V.Rao MD 1
Early History of Measles
Reports of measles go back to at
least 700 years, however, the first
scientific description of the disease
and its distinction from smallpox
attributed to the Muslim physician
Ibn Razi(Rhazes) 860-932 who
published a book entitled "Smallpox
and Measles" (in Arabic: Kitab fi al-
jadari wa-al-hasbah). Dr.T.V.Rao MD
Serious disease as Per
WHO. It remains a leading cause of death among young children globally, despite the availability of a safe and effective vaccine. An estimated 197 000 people died from measles in 2007, mostly children under the age of five.
Dr.T.V.Rao MD
Measles - Parmyxoviridae
Measles is an infection
of the respiratory system
caused by a virus,
specifically a
Paramyxoviruses of the
genus Morbillivirus
Morbilliviruses, like other
paramyxoviruses, are
enveloped, single-
stranded, negative-
sense RNA viruses.
Dr.T.V.Rao MD
Measles Virus The measles virus is a spherical, no segmented, single-stranded RNA virus in the Morbillivirus family, closely related to the rinderpest and canine distemper viruses. It contains six structural proteins, three that are complexed to the RNA and three that are associated with the viral membrane envelope.
Dr.T.V.Rao MD
Fusion Protein
The F (fusion) protein is responsible for fusion of virus and host cell membranes, viral penetration and haemolysis. The H (hemagglutinin) protein is responsible for adsorption of the virus to cells.
There is only one serotype of Measles virus and no subtypes have yet been recognized
Dr.T.V.Rao MD
Measles
More than 20 million people worldwide are affected by measles each year. Measles outbreaks are common in many areas, including Europe. For many U.S. travellers and expatriates, the risk for exposure to measles can be high, but the illness can be prevented by a measles-containing vaccine
Dr.T.V.Rao MD
How the Measles is Spread
Measles is spread through
respiration (contact with fluids from
an infected person's nose and
mouth, either directly or through
aerosol transmission), and is highly.
The infection has an average
incubation period of 14 days (range
6-19 days) and infectivity lasts from
2-4 days prior to 2-5 days following
the onset of the rash. Dr.T.V.Rao MD
Measles threat to Developing
World In developing
countries, measles
affects 30 million
children a year
and causes 1
million deaths.
Measles causes
15,000-60,000
cases of blindness
per year. Dr.T.V.Rao MD
Measles a Childhood Infection
Age-specific attack rates may be highest in susceptible infants younger than 12 months, school-aged children, or young adults, depending on local immunization practices and incidence of the disease.
Dr.T.V.Rao MD
Patients on Physical
examination
Patients tend to appear moderately ill and uncomfortable because of their viral prodromal symptoms.
The Koplik spots are 1-2 mm, blue-gray macules on an erythematous base.
The measles rash is a Maculopapular erythematous rash that involves the palms and soles.
Lesion density is greatest above the shoulders, where macular lesions may coalesce
Dr.T.V.Rao MD
A rash is leading manifestations
Typically begins at the hairline and spreads caudally over the next 3 days as the prodromal symptoms resolve.
The rash lasts 4-6 days and then fades from the head downward.
Desquamation may be present but is generally not severe.
Complete recovery from the illness generally occurs within 7-10 days from the onset of the rash
Dr.T.V.Rao MD
Rash is a Prominent Feature
Dr.T.V.Rao MD
Risk factors for infection
Children with immunodeficiency due to HIV or acquired immunodeficiency syndrome (AIDS), leukaemia, alkylating agents, or corticosteroid therapy, regardless of immunization status
Dr.T.V.Rao MD
Spread of Virus
The highly
contagious virus is
spread by
coughing and
sneezing, close
personal contact
or direct contact
with infected nasal
or throat secretion
Dr.T.V.Rao MD
Early Symptoms in Measles
The incubation period from exposure
to onset of symptoms ranges from 8-
12 days. The prodromal phase is
marked by malaise, fever, anorexia,
and conjunctivitis, cough, and
coryza (the "3 Cs"). The entire
course of uncomplicated measles,
from late prodrome to resolution of
fever and rash, is 7-10 days. Cough
may be the final symptom to appear Dr.T.V.Rao MD
Beginning of Illness in
Measles Approximately 10 days after the initial exposure to the virus, the classic viral prodrome occurs.
Fever
Non-productive cough
Coryza
Conjunctivitis
Additional prodromal symptoms may include malaise, myalgias, photophobia, and periorbital oedema.
Dr.T.V.Rao MD
Koplik Spots leading clue to Measles
With in 2-3
days, the
pathognomonic
Koplik spots
typically arise on
the buccal,
gingival, and
labial mucosa
Dr.T.V.Rao MD
Risk factors for severe Measles
Malnutrition
Underlying
immunodeficien
cy
Pregnancy
Vitamin A
deficiency
Dr.T.V.Rao MD
Mortality Rate in Measles
The mortality rate
associated with
uncomplicated measles
in immunocompetent,
well nourished children
is low but raises rapidly
with malnourishment
(marked in African
children ), in
immunocompromised,
and to lesser extent with
age.
Dr.T.V.Rao MD
Modified Measles
Modified measles occurs in
children who have received
serum immunoglobulin after their
exposure to measles. The
measles symptom complex may
still occur, but the incubation
period is as long as 21 days,
with the same symptoms as
measles but milder. Dr.T.V.Rao MD
Atypical Measles
When they are exposed to the measles virus, a mild or non-existent prodrome of fever, headache, abdominal pain, and myalgia's precedes a rash that begins on the hands and feet and spreads centrally.
The rash is most prominent in the body creases and may be macular, haemorrhagic vesicles, petechial, or urticarial.
Complications may include pneumonia, pleural effusion, hilar lymphadenopathy, Hepatosplenomegaly, hyperesthesia, or paraesthesia.
Atypical measles occurs in individuals who were previously immunized with the killed measles vaccine between 1963 and 1967 and who have incomplete immunity.
Dr.T.V.Rao MD
Sub acute sclerosing pan encephalitis
SSPE
SSPE is a neurodegenerative disease
caused by persistent infection of the brain
by an altered form of the measles virus.
Neither the biology underlying the viral
persistence nor the triggering mechanism
for viral reactivation is well understood. In
most cases, infected children remain
symptom-free for 6-15 years after acute
measles infection[
Dr.T.V.Rao MD
Sub acute sclerosing pan
encephalitis Sub acute sclerosing pan encephalitis (SSPE) is a rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection of immune resistant measles virus (which can be a result of a mutation of the virus itself). 1 in 100,000 people infected with measles develop SSPE. SSPE is 'incurable' but the condition can be managed by medication if treatment is started at an early stage.
Doctortvrao’s ‘e’ learning series
Dr.T.V.Rao MD
Clinical Presentation of
SSPE
Characterized by a history of primary measles infection usually before the age of 2 years, followed by several asymptomatic years (6–15 on average), and then gradual, progressive psycho neurological deterioration, consisting of personality change, seizures, myoclonus, ataxia, photosensitivity, ocular abnormalities, spasticity, and coma.
Dr.T.V.Rao MD
The Progress of SSPE
The initial symptoms of SSPE usually involve
regressive changes in intellect and personality.
Within several months, the psychological
symptoms are compounded by neurological
ones, most often consisting of myoclonic jerks. A
relentless mental and motor deterioration then
ensues, culminating in extreme neurologic
dysfunction and death within several years of the
onset of symptoms. Our patient's clinical course
reflected this typical natural history.
Dr.T.V.Rao MD
Diagnosis of Measles
Most cases of Measles are diagnosed clinically, usually in patient’s home or in General practice
Direct Virological confirmation is difficult in most of the Developing countries
Dr.T.V.Rao MD
Diagnosis by Microscopy
Production of multinucleate giant cells with inclusion bodies is path gnomonic for measles. During the prodromal phase, such cells are detectable in the NPS (nasopharyngeal secretions). This is more rapid and practical than virus isolation
Doctortvrao’s ‘e’ learning series
Dr.T.V.Rao MD
Diagnosis with
Immunofluorescence Direct and indirect
immunofluorescence have been used extensively to demonstrate MV antigens in cells from NPS specimens. This technique can also be applied to the urine as such cells may be present in the urine 2 to 5 days after the appearance of the rash
Dr.T.V.Rao MD
Diagnosis by Viral Isolation
Measles virus can be isolated form a variety of sources, e.g. throat or Conjunctival washings, sputum, urinary sediment cells and lymphocytes. Primary human kidney (HEK) cells are the best, although primary monkey kidney can be used as well. Continuous cell lines such as Vero cells can also be used
Dr.T.V.Rao MD
Diagnosis by Serology
Diagnosis of measles
infection can be made if
the antibody titres rise by
4 fold between the acute
and the convalescent
phase or if measles-
specific IgM is found.
The methods that can be
used include HAI, CF,
neutralization and ELISA
tests.
Dr.T.V.Rao MD
Diagnosis of SSPE
The presence of measles specific antibodies in the CSF is the most reliable means of laboratory diagnosis of SSPE. Demonstration of MV-specific antibodies in the CSF may be sufficient with, if necessary, demonstration of MV-specific restricted heterogeneity by isoelectric focusing
Dr.T.V.Rao MD
Treatment Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution (to replace fluids and other essential elements lost from diarrhoea or vomiting). Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.
Dr.T.V.Rao MD
Treatment options in Developing
Countries
All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of
deaths from measles by 50%.
Dr.T.V.Rao MD
VACCINATION The Vaccines are Live attenuated containing Edmonston B or Schwartz strains which will give seroconversion rate of 90%.
The immunity produce may be life long.
Dr.T.V.Rao MD
Measles vaccine is given as
MMR Vaccine
The measles vaccine is
often incorporated with
rubella and/or mumps
vaccines in countries
where these illnesses
are problems. It is
equally effective in the
single or combined form
The combination
proved to be effective
and safe
Dr.T.V.Rao MD
Measles Vaccine is cheap and
Effective
The measles
vaccine (in use for
40 years) is safe,
effective and
inexpensive. It
costs less than
one US dollar to
immunize a child
against measles.
Dr.T.V.Rao MD
Epidemiological Trends
Measles epidemics
occur every 2 year in
developed countries
in the absence of
widespread use of
vaccine
Poverty and
overcrowding
increases epidemics
Dr.T.V.Rao MD
Two doses of Measles Vaccine
Continued progress
depends on ensuring
that all children receive
two doses of measles
vaccine including one
dose by their first
birthday, strengthening
disease surveillance
systems, and providing
effective treatment for
measles.
Dr.T.V.Rao MD
Changing trends for a Booster Dose
About 15% of
vaccinated
children fail to
develop
immunity from
the first dose.)
Dr.T.V.Rao MD
Autism and Vaccination
In UK vaccine
uptake has fallen
recently due to
fear over its
safety, particularly
as cause of
Autism.
These fears have now
been confirmed as
Unsubstantiated. Dr.T.V.Rao MD
CDC disproves Autism
Theory The official perspective of the CDC is that there is no proven connection between live-virus vaccines and autism.
Neither the CDC nor proponents of the vaccine theories think that parents should avoid vaccines. Clearly, vaccines have saved untold lives, and will continue to do so.
Dr.T.V.Rao MD
WHO and UNICEF are
collaborating Strong routine immunization: for children by their first birthday.
A 'second opportunity' for measles immunization through mass vaccination campaigns, to ensure that all children receive at least one dose.
Effective surveillance in all countries to quickly recognize and respond to measles outbreaks.
Better treatment of measles cases, to include vitamin A supplements, antibiotics if needed, and supportive care that prevents complications.
Dr.T.V.Rao MD
Global Initiatives
The Measles Initiative - a
collaborative effort of WHO,
UNICEF, the American Red Cross,
the United States Centres for
Disease Control and Prevention,
and the United Nations Foundation -
and other public and private partners
play key roles in advancing the
global measles strategy Dr.T.V.Rao MD
Global Epidemiology
Approximately 30 million
measles cases are reported
annually. Most reported cases
are from Africa. In 1998, the
cases of measles per 100,000
total population reported to the
World Health Organization
Dr.T.V.Rao MD
Tropics and Measles
In tropical areas particular in Africa children under 1 year of age suffer more attacks, and mortality rate increases
Malnutrition is a major contributing factor.
Dr.T.V.Rao MD
Vaccination for Measles
Continues to be a Top Priority
Dr.T.V.Rao MD
Programme Created by Dr.T.V.Rao
MD for Medical and Paramedical
Students in Developing World
Dr.T.V.Rao MD