Measles (Rubeola)
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Measles is an acute, highly communicable (contagious) infectious viral disease caused by Measles virus (MeV) which is the member of the family Paramyxoviridae, genus Morbillivirus. The mode of transmission is airborne, by droplet spread through coughing or sneezing, or by direct contact with nasal or throat secretions of infected persons. It is the fourth leading cause of death in children less than 5 years of age in many African countries.
Case Definition
Suspected case:
Any person with fever and maculopapular (non-vesicular) generalized rash and cough, coryza or conjunctivitis (red eyes) or any person in whom a clinician suspects measles.
Confirmed case:
A suspected case with laboratory confirmation (positive IgM antibody) or epidemiological link to confirmed cases in an outbreak.
Clinical Diagnostic Criteria
- Generalized, reddish (erythematous), blotchy (maculopapular) rash
- History of fever usually above 38˚C (if not measured, then "hot" to touch)
- Dry cough; Sore throat; Runny nose (coryza)
- Inflamed eyes (conjunctivitis), tiny white spots with bluish-white centres on a red background found inside the mouth on the inner lining of the cheek- also called Koplik's spots.
- In addition, children with measles frequently exhibit a dislike of bright light (photophobia), and often have a sore red mouth (stomatitis).
Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days.
Laboratory Investigation
With coordination from the WHO, the Global Measles and Rubella Laboratory Network (GMRLN) performs case-based laboratory surveillance standardized methods to confirm Measles Infection by:
- Detection of viral RNA by RT-PCR (increasing role in case confirmation)
- Enzyme Immunoassay (EIA) for immunoglobulin M (IgM)
Pharmacological Treatment
Note: No specific antiviral treatment exists for measles virus
Adults:
A: paracetamol(PO) 1g 8hourly for 5days
AND
A: vitamin A (PO) 200000 IU stat
In case of ocular involvement, add
A: oxytetracycline eye ointment 1% apply once daily for 7 days
Children:
A: paracetamol (PO) 10–15mg/kg 8hourly for 5days
A: vitamin A if less than 1 year give 100,000IU (PO) stat and if over 1 year give 200,000IU
Prevention
- Routine measles vaccination for children combined with mass immunization campaigns.
- Administration of the first dose of measles-containing vaccine (MCV) at 9 months and 18 months in measles-endemic regions (Tanzania) and at 12–15 months in non-endemic regions.
- Accelerated immunization activities have had a major impact on reducing measles deaths.
- The World Health Organization (WHO) defines measles elimination as “the absence of endemic measles virus transmission in a defined geographical area (e.g. region or country) for at least 12 months in the presence of a surveillance system that has been verified to be performing well.
Public Health Control Measures
Efforts to reduce the secondary spread of measles include:
- Improve routine vaccine coverage through the IVD, and lead supplemental vaccination activities in areas of low vaccine coverage.
- Mobilize the community early to enable rapid case detection and treatment.
- Provide Vitamin A: Dose 1: immediately, Dose 2: next day.