Measles is a highly contagious viral disease characterized by fever, cough, coryza, conjunctivitis, and a maculopapular rash. It is caused by the measles virus, which is transmitted via airborne droplets. The virus has an incubation period of 10 days on average before the onset of symptoms. Diagnosis is usually clinical based on symptoms, but can be confirmed by detecting measles-specific IgM antibodies or isolating the virus. Prevention relies on active immunization with two doses of the live attenuated measles vaccine, typically administered as part of the MMR vaccine at 9 months and 15 months of age.

2. MEASLES
Dr. Muhammad Sajjad Sabir
DCH , MCPS, FCPS
Assist Prof of Paediatrics

3. DEFINITION
 Measles is an acute highly contagious viral disease
caused by measles virus
characterized by
 Fever
 Cough , coryza ,conjunctivitis
 Koplik spots
 Maculopapular rash

4. ETIOLOGY
Measles Virus
 RNA virus ( Paramyxo virus family)
 One antigenic type
 Rapidly inactivated by heat and light

5.  Source of infection Patients of measles,
No carriers
No animal reservoir
 Routes of transmission air-borne / droplet
 immunity permanent acquire after disease
 Incidence equal in both sexes
 Epidemic features season: winter and spring
age: 6 months to 5 years old
EPIDEMIOLOGY

6.  Measles is one of the most highly infectious
diseases known
 Highly infectious during prodromal period and at
the time of eruption
 90% of people without immunity sharing a house
with an infected person will catch it.
Communicability

7. Spread of Virus-droplet infection
 The highly contagious
virus is spread by
coughing and
sneezing, close
personal contact or
direct contact with
infected nasal or
throat secretion-

8.  INFECTIVITY
It lasts from 4 days
before to 5 days
after the onset of
the rash
 INCUBATION
PERIOD
The infection has n
average incubation
period of 10 days
(range 6-19 days)

9. Measles Pathogenesis
● Respiratory transmission of virus
● Replication in nasopharynx and regional
lymph nodes
● Primary viremia 2-3 days after exposure
● Secondary viremia 5-7 days after exposure
with spread to tissues

10. Incubation period (from exposure to onset of symptoms)
Approximately 10 days( 6~18days) after
the initial exposure to the virus, the classic
viral prodrome occurs
Beginning of Illness in Measles

11. The prodromal phase is marked by
malaise, fever, anorexia, and
conjunctivitis, cough, and coryza (the "3 Cs")
Koplik’s spots
Additional prodromal symptoms may include
malaise, myalgias, photophobia, and
periorbital oedema
Beginning of Illness in Measles
Prodromal phase 3~4 days

12. Koplik Spots leading clue to Measles
 With in 2-3 days,
the pathognomonic
Koplik spots
typically arise on
the buccal, gingival,
and labial mucosa

13. KOPLIK SPOT
Source:
http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lo
res.jpg

14.  Time: the3~5 days after fever ; but the 4th day
is most common
 Shape: maculopapular
 Sequence: face → trunk→ limbs
 The temperature rise continuously and
accompanied with toxic symptoms
 Persists 5-6 days
 Fades in order of appearance
Measles Eruption stage

15. Rash is a Prominent Feature

16. Sequence: behind the ear → along the
hairline →face → neck → chest → back→
abdomen → limbs→ hand and feet

17. Convalescent stage
 brown staining
 fine branny desquamation
 course:10-14 days
 complete healing

18.  Atypical measles
1 . mild measles;
2 . severe measles (toxic and shock type
measles);
3. hemorrhagic measles;
4 . variant measles.

19. Duration of Symptoms in Measles
 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

20. Risk factors for severe measles
 Malnutrition
 Immunodeficiency
 Pregnancy
 Vitamin A deficiency

21. Mortality Rate in Measles
 Low mortality rate associated with
uncomplicated measles in
immunocompetent, well nourished children
 The mortality rate high with
 malnourishment
 immunocompromised, and
 to lesser extent with age

22. 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

23. Atypical Measles
 When they are exposed to the measles virus, a mild or
nonexistent prodrome of fever, headache, abdominal
pain, and myalgias precedes rash

 Rash begins on the hands and feet and spreads
centrally.
 The rash is most prominent in the body creases and
may be macular
 Atypical measles occurs in individuals who were
previously immunized with incomplete immunity

24. Bronchopneumonia
Myocarditis
Laryngitis
Diarrhea
Otitis media
Encephalitis
COMPLICATIONS
SSPE
Haemorrhagic
Measles
Malnutrition
Death

25. Haemorrhagic Measles
 Sever form of measles
 Rash is confluent
 rash is hemorrhagic or
petechial
 Bleeding from
mouth,nose or bowel
 Death may occur before
rash

26. Subacute Sclerosing Panencephalitis
(SSPE)
 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

27. Diagnosis of Measles
 Most cases of Measles
are diagnosed
clinically
 Direct Virological
confirmation is difficult
in most of the
Developing countries

28. Laboratory confirmation
 Multinucleated giant cells are detected
in nasopharynx mucosa secretions
 Measles virus can be isolated in tissues
culture
 Antibody titer--measles-specific IgM
(ELISA tests)
 CBC--- WBC is relative low

29. DIFFERENTIAL DIAGNOSIS
 Rubella (German measles)
 Roseola infantum (exanthem subitum)
 Meningococcemia
 Scarlet fever
 Erythema infectiosum/ slapped cheek
(parvovirus B-19)
 Other viral exanthems
 Drug rashes

30. Management
 General therapy:
 rest
 Good nursing
 diet
 Symptomatic therapy: fever and cough
 Support therapy
 Vitamin A
 treatment of complications

31. Treatment options in Developing
Countreis
 All children in developing countries
diagnosed with measles should receive
two doses of vitamin A supplements,
given 24 hours apart
 6mo-12mo 1,00,000 U Blue Cap
 Above 1 yr 2,00,000 U Red Cap
 This can help prevent eye damage and
blindness
 Vitamin A supplements have been
shown to reduce the number of deaths
from measles by 50%

32. PREVENTION
 Control source of infection
 Interruption of transmissions
 Protection of the susceptible person

33. Measles Vaccine
Active immunization
Lived attenuated measles vaccine
at 9 months ( can be after 6mo)
post exposure : with in 2 days
Passive immunization
Immunoglobulin
<5 days prevent onset
>5 days relieve symptoms

34. VACCINATION
 The Vaccines are Live
attenuated
seroconversion rate
of 90%
 The immunity
produce may be life
long

35. Two doses of Measles Vaccine
 All children receive two doses of
measles vaccine
 First dose at 9 months
 Second dose at 15 months
 The measles vaccine (in use for 40
years) is safe, effective and relatively
inexpensive

36. Measles vaccine as MMR Vaccine
 The measles vaccine is
often incorporated with
rubella and mumps
vaccines in countries where
these illnesses are
problems
 The combination proved
to be equally effective and
safe

37. Measles vaccine is given as MMR
Vaccine
Doses of MMR vaccine
 First dose at 12-15
months
 Second dose after 6
months
 Third dose between
4-6 yrs age

38. Vaccination for Measles continues to
be a Top Priority

40. QUIZ

41. Measles Clinical Case Definition
 Cough, coryza, or conjunctivitis
 Temperature >38.3 C (101 F)
 Generalized rash lasting >3 days

43. 3 Cs of Measles

44. Clinical features
 3 Cs (Cough, Coryza & Conjunctivitis)
 Koplik spots
 Four days fever (400
c)
 Generalized, maculopapular,erythematous
rash.

45. Coryza
 catarrhal inflammation of the mucous
membrane in the nose with discharge of
mucus

46. Measles Clinical Features
● Incubation period 10-12 days
● Prodrome 2-4 days
■ stepwise increase in fever to 103°F–105°F
■ cough, coryza, conjunctivitis
■ Koplik spots (rash on mucous membranes)
● Rash
■ 2-4 days after prodrome, 14 days after exposure
■ persists 5-6 days
■ begins on face and upper neck
■ maculopapular, becomes confluent
■ fades in order of appearance

47. Measly Look

48. Measly Look
 Red eyes
 Puffy eyelids
 Swollen bridge of nose
 Copious nasal discharge
 Toxic look
 Maculopapular , erythematous rash.

49. Post Exposure Immunization
Active immunization with
Lived attenuated measles vaccine
should be done with in 2 days post
exposure
WHY?