Epidemiology of measles

2.  Measles is a highly contagious respiratory infection
that's caused by a RNA virus- paramyxovirus that
infects only humans.
Also known as Rubeola meaning Red Spots.
 Common among young chidren,transmitted by
respiratory droplets and direct contact with nasal or
throat secretions of infected persons.

3.  It is an acute viral infection characterized by a
final stage with a maculopapular rash erupting
successively over the neck and face, trunk,
arms, and legs, and accompanied by a high fever.
 Measles kills more children than any other
vaccine preventable disease. Before the
widespread use of vaccine, 90% of children had
contracted measles by the age of 10 years. An
effective vaccine has been available since the
1960s

4.  Francis Home, a Scottish physician, demonstrated in
1757 that measles is caused by an infectious agent in
the blood of patients.
 Panum Peter Ludwig (1820-1885) was a denish
physician ,who carried a classic study of
epidemiology of measles during an epidemic on the
faroe island in 1846.

5.  Al-Razi (A Persian doctor)was the first physician in
history who described in details the symptoms and
signs of smallpox and measles based on clinical
examination.
 In 1954, John F. Enders and Dr. Thomas C. Peebles
collected blood samples from several ill students
during a measles outbreak in Boston, Massachusetts,
they succeeded in isolating measles in 13-year-old
David Edmonston’s blood.

6.  Measles is endemic throughout the world.
 In the past, epidemics tended to occur irregularly .
 it is rarely subclinical.
 Prior to the use of measles vaccine, the peak
incidence was among children 5-10 yr of age.

7.  The WHO estimated that over 40 million cases still
occurs in worldwide contributing to 530000 deaths
including 182000 in SEA region as reported in 2003.
 Now Measles mortality has been reduced from
733000 in 2000 to 164000 in 2008
 The coverage with measles vaccine has increased
from 1.3% in 1985 to 74% in 2009.However each
year about 15 % of 26 million infant remain
unimmunized and are at potential risk of measles
infection.

8.  In India measles is a major cause of morbidity and a
significant contributor to childhood mortality.
 Prior to the immunization programme ,cyclical
increase in the incidence were recorded every third
year
 With immunization coverage the interval between
cyclical peak increased and intensity minimized

9.  The retrospective data indicate declining trend of
measles in India
 During 1987 about 2.47 lakh cases reported,whereas
after implementation of UIP the number came down
to 23348 with 33 deaths in 2014
 However the estimates are much higher as large
number of cases go unreported
 WHO estimates ,measles is responsible for about 2
percent of under-5 mortality in India

10. EPIDEMIOLOGICAL DETERMINANTS:-
AGENT FACTORS:-
 A)AGENT:-Measles virus, the cause of measles, is an
RNA virus of the genus Morbillivirus in the family
Paramyxoviridae. Only one serotype is known.
 It cannot survive outside the human body,and can be
easily destroyed by heat,acid and drying
 It can retain infectivity when stored at sub zero
temperature,at 4-6 degree celcius ,it can survive for
6 months and at -20 degree celcius can survive for 2-
3 years.

11.  B)Source Of Infection- The only source of infection is
the case of measles,No carrier state is known.
 C)Infective Material-The secretion of nose,and
respiratory tract of a case of easles during prodormal
phase and early stages of the rash.
 D)Communicability:-Highly infectious during the
prodormal period and at the time of eruption.
Communicability decreases with appearance of
rashes. The Period of communicability is 4 days
before and 4 days after the appearance of rashes

12. HOST FACTORS:
 A)Age-Incidence is high among children between 6
months to 3 years in developing countries,Infant
below 6 months escapes because of maternal
antibodies ,they get through milk.
 B)Sex- Equal in both sexes.
 C)Immunity-No age is immune if there was no previous
immunity, One attack of measles confers lifelong
immunity .Immunity after vaccination is quite solid
and life long.
 D)Nutrition-Malnutrition increases the susceptibility of
child, Mortality is 400 times higher in malnourished
child compared to healthy counterpart.

13. ENVIORNMENTAL FACTORS:
 In temperte climates ,measles is common during
winter season and early spring(January to April)
because of overcrowding indoors,poor enviornmental
conditions,Poor housing ,and Overcrowding favours
the disease transmission.

14.  After entering the body through respiratory tract by
droplet infection, the virus quickly pass to the
nearest lymph node multiply there and leak into the
bloodstream ,reaches R.E cells of liver, spleen and
bone marrow ,where they multiply and destroys
cells and flow again to blood stream in sufficient
number as to affect many tissue in body mainly
respiratory mucosa ,alimentary mucosa, conjunctiva
and skin.
 The symptoms are mainly due to inflamatory
reaction in these areas.

15.  Incubation period is commonly 10 days from
exposure to onset of fever ,14 days to
appearance of rashes, patients are infectious
from about 4 days before developing the rash
until 4 days after rash.

16.  There are two stages of measles,
 Prodromal Stage
 Exanthematous Stage

17.  This is also called as Pre-eruptive or catarrhal
stage,begins 10 days after infection and last
until day 14.
Characterised by
 FEVER
 CORYZA
 NASAL DISCHARGE
 COUGH
 REDNESS OF EYES /PHOTOPHOBIA

18.  KOPLIK SPOT-
 One or two days before the appearance of rashes,
Koplik’s spot appear on the buccal mucous
membrane by side of the second molar tooth around
the orifice of the Stenson’s duct, lasting for about 3-
4 days.
(Pathognomonic of
measles.
Small bluish white spot
on a red base looking
like grains of salts)

19.  Often cervical lymphadenopathy and febrile
convulsions occurs
 The prodromal stage lasts for about 3 days.

20.  Rashes appears on the 4th day of fever ,First
behind the ear,then on forehead ,face and
down the trunk,slowly taking 2-3 days to
progress to hands and lower extremities.
 Rashes are pink in colour (dull red),valvety and
maculopapular ,they remain descrete but often
becomes confluent and blotchy

22.  From the 5th or 6th day the rashes begins to
disappear in the same order as they had
appeared.
 Lesions disappears completely from face, but
on trunks they leave brownish discoloration,
which persist about 6-8 weeks.
 The CFR varies from 5-30% depending upon
nutritional status and development of
complications

23. Post Measles Complications grouped into
following groups-
 Respiratory Complications
 Gastrointestinal Complications
 Neurological Complications
 Ophthalmic Complications

24. Respiratory
Complications
Croup
Pneumonia
Otitis Media

25. Acute
Gastroenteritis
Severe
Dehydration
Malnutrition
Gastrointestinal Complications

26. Neurological Complication
Febrile Convulsions Encephalitis
Subacute Sclerosing
Panencephalitis (SSPE)
Other Rare Complications:
Multiple sclerosis.Retrobulbar
neuritis,Toxic encephalopathy
etc

27. Ophthalmic
Complications
Conjunctivitis
Corneal
Ulceration

28.  Isolation in well ventilated room
 Concurrent disinfection of nasal and throat
secretions
 Light and clean clothes
 Antipyretics to control fever
 Plenty of water and fruit juice because of loss
of appetite
 Correction of malnutrition with high quality diet

29.  Prophylactic Antibiotics can be given
 Attendants to use mask and gown
 Watch for complications
 Vitamin A for measles case management
Vitamin A supplementation is required in all cases
of severe measles, A High dose of vitamin A is
given after diagnosis and repeated next day .
Age Day1 Following Day
0-6 months - 50000 IU - 50000 IU
6-11 months - 100000 IU- 100000 IU
> 12 months - 200000 IU 200000 IU

30.  This is done by Active and Passive Immunization:-
Active Immunization-
Done by using live attenuated vaccine.
Two groups-
1.Single Antigen-
 A)Aerosolized vaccine(Edmonston Zagreb Stain)
 B)Heat stable vaccine(Schwartz/Moraten Stain)

31.  2.Measles vaccine of multiple antigen :
MMR(Measles,Mumps,Rubella vaccine)
Measles Vaccine-
Nature- live virus vaccine of single antigen in freeze
dried form
Diluent- Sterile distilled water
Dose- 0.5 ml
Route- Subcutaneous in the upper arm or
antrolateral aspect of thigh
Schedule-Two doses are recommended as per
NIP, one during 9-12 months, second during
16-24 months

32.  Immunity –develops 10-12 days after
vaccination and last lifelong
 Protective value-One dose confers 95%
protection
 *IAP schedulde 2014 says,no need to use single
strand measles vaccine,It recommends to use
MMR1 at 9 months and MMR2 at 15 months.

33.  This is done by human normal immunoglobulin
 It is non specific
 Given to those young children who came in contact
with case of measles and are not immunized.
 Given within 1 week of exposure.
 Dose-0.25-0.5 ml per kg body weight
(Approx 250 mg for infants ,500 mg for children
below 1 year)
 Route-Intramascular

34. This was supported by WHO,UNICEF,and American
Red Cross by adopting strategies:
 Catch Up Campaigns-To cover susceptible children
with second dose of measles vaccine to achieve
coverage of 90% with meticulous planning.
 Follow Up Campaign- after 2-4 years in area covered
in catch up campaign to cover susceptible cohort

35. Goals and Objectives:
1.Reduce at least 90% mortality by 2013 as compared
to 2000.
2.Achieving at least 90% coverage with measles
vaccine
3.Collection of good quality epidemiological data
through active surveillance-IDSP(Integrated Disease
Surveillance Programme)
4.Elimination of measles by 2020 in India

36.  Strengthining of routine Immunization
 Surveillance of measles
 Case Management
 Second Opportunity

37. Park’s Textbook of Preventive and Social Medicine-24th
Edition
Textbook of Community Medicine by AH Suryakantha
4th Edition
Textbook of Community Medicine by Sunder Lal -5th
Edition
Image sources- Google and Wikipedia