Measles

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MEASLES Katie Townes, MD UMass Medical School
and HEARTT Emmanuel Okoh, MD Acting Director of
Pediatrics, JFKMC and HEARTT Adapted from a
lecture by Rick Moriarty, MD, UMass Medical
School (also a HEARTT doctor)
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Measles

• Cause RNA paramyxovirus
• Host humans only
• Spread respiratory droplets
• Incubation 1-2 weeks
• Attack rate gt90
• Attack leads to lifelong immunity
• 30-40 million cases annually
• 164,000 deaths in 2008

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Measles Symptoms

• Incubation 14 days
• Fever
• Cough
• Coryza
• Conjunctivitis
• Malaise miserable
• Koplik spots
• Rash cephalo-caudad spread
• Contagious 1 day prior to sx- 5 days after rash
  starts

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Measles Differential Diagnosis

• Scarlet fever
• Staphylococcal toxin diseases
• Rubella
• Drug rash SJS
• Infectious mononucleosis
• Dengue

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Diagnosis of Measles

• Clinical History and Physical
• -Koplik spots are pathognomonic
• Nasopharyngeal swab for viral culture
• Serology IgM positive from 4 days-60 days of
  illness, IgG positive after that.
• Not available in our current setting.

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Measles Mortality

• West Africa 12
• Displaced populations up to 30
• Up to 20 mortality in infants
• Developed countries 0.02
• More mortality in children lt5 years old
• Leading cause of vaccine-preventable death
  globally (40 of all vaccine-preventable deaths
  are due to measles)

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Measles Complications

• Overcrowding promotes spread
• Poor nutrition or immunocompromise increase
  complication risk
• Measles often followed by other diseases
  (superinfection)
• Vitamin A deficiency increases risk of blindness

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Measles Complications

• Bacterial superinfection (Staph aureus,
  pneumococcus, Ecoli, Pseudomonas)
• Respiratory pneumonia (viral, secondary
  bacterial, or giant cell), croup, bronchiolitis.
  Activation of latent Tb.
• GI tract diarrhea, malnutrition
• Skin desquamation
• Ears Acute otitis media

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Measles Complications

• Eyes conjunctivitis, corneal ulcer, blindness
• Mouth buccal ulceration, cancrum oris
• Hemorrhage
• Acute encephalitis 11000. Often fatal.
• Subacute sclerosing pan-encephalitis (1100,000)
  occurs years after acute illness. Demyelinating
  process.

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Measles Treatment

• Isolation
• Supportive care
• Fever therapy
• Hydration
• Consider antibiotics for superinfection
• Vitamin A
• 200,000 IU once gt age 1 year
• 100,000 IU once if age 6-12 months
• If eye complications 200,000 IU daily X 2 D, then
  repeat in 4 weeks

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Measles Vaccine

• One serotype
• Live Attenuated Vaccine
• Usually given at 9, 12 or 15 mos after maternally
  acquired IgG has fallen
• Ideally children would get second chance for
  measles vaccine (2 shots) per WHO recommendations
• -Not all children develop antibodies after 1st
  shot (85 success), so having 2nd shot should
  catch more children

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Measles Vaccine

• During outbreak, can vaccinate as early as 6
  months, but still need 9 month shot
• Contraindicated in pregnancy, malignancy. NOT in
  fever
• Side effects fever and rash 5-10
• Having a well-vaccinated population reduces the
  risk of babies lt6 months getting measles (herd
  immunity)

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Measles Vaccine Coverage
From 2000-2008, measles deaths dropped by 78
because of vaccination .
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Measles at JFK
From the Pedi Wards January 0
cases February 1 male 5 females March 1
male 1 female April 1 male 9 females May
6 males 2 females
This does not include the large number of
patients presenting to the OPD with simple
measles, or the children admitted and discharged
from the ER without admission to the wards.
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Liberia immunization schedule
http//www.who.int/vaccines/globalsummary/immuniza
tion/ScheduleSelect.cfm
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What next?

• Vaccinate, vaccinate, vaccinate!
• Every health care provider should encourage all
  kids to get vaccines, and all parents to
  vaccinate their children.
• Dont turn children away if they have fever (they
  may not come back!)
• Remember measles and its severe complications
  (which can occur years later) are completely
  preventable with a single shot.

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Thank you!