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Measles or RubeolA, is an acute viral illnesscaused by a virus in the family paramyxovirus,genus Morbillivirus.
Measles is characterized by a prodrome of fever andmalaise, cough, coryza, and conjunctivitis, followed by amaculopapular rash.
Measles is usually a mild or moderately severeillness. However, measles can result incomplications 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 Childrens 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.
TransmissionMeasles transmission is airborne byrespiratory droplet nuclei spread or it can betransmitted by direct contact with infectednasal or throat secretions.
Incubation PeriodThe incubation period is approximately tendays, but varies from 7 to 18 days fromexposure to the onset of fever. It is usually 14days until the rash appears.
Risk FactorsAnyone who never had measles and has neverbeen vaccinated.Babies younger than 12 months old, because theyare too young to be vaccinated.Adults who were vaccinated before 1968,because some early vaccines did not give lastingprotection.A very small percentage of vaccinated childrenand adults who may not have responded well tothe 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.
PROBLEM IDENTIFIED STAGE DATA (NURSING DIAGNOSIS)Pre-eruptive Stage • fever • Hyperthermia(patient is highly communicable) • catarrhal symptoms – start in the nasal • Pain cavities; then in the conjunctivae, • Risk for impaired gas exchange oropharynx, progress to the bronchi • Risk for impaired breathing pattern 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.Eruptive Stage/Stage of Skin Rashes • Anorexia • Imbalance nutrition: less than body requirement • Exanthem sign – means eruption in the skin • Impaired skin integrity • Maculopapular Rashes – appears 2-7 • Hyperthermia days after onset • Activity Intolerance • High fever – increases steadily • Fatigue • Irritability • Diarrhea • Pruritis • Lethargy • Occipital lymphadenopathyStage 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
DIAGNOSISClinical diagnosis of measles requires a historyof fever of at least three days, with at leastone of the three Cs (cough, coryza,conjunctivitis). Observation of Kopliks spots isalso diagnostic of measles.
Alternatively, laboratory diagnosis of measles canbe done with confirmation of positive measlesIgM antibodies or isolation of measles virus RNAfrom respiratory specimens. In patients wherephlebotomy is not possible, saliva can becollected for salivary measles-specific IgA testing.Positive contact with other patients known tohave measles adds strong epidemiologicalevidence to the diagnosis. The contact with anyinfected person in any way, including sementhrough 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 IMMUNIZATIONRoute SubcutaneousSite Outer part of upper left armNumber of Dose 1 doseAge at First Dose 9 monthsDosage 0.5mLStorage 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.