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.