Spm Measles

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MEASLES



MEASLES - INTRODUCTION

yAlso called as RUBEOLA/ RED SPOTS

yAcute highly infectious disease of childhood

yCaused by MYXOVIRUS

yCLINICAL FEATURES:

fever

catarrhal symptoms of URI

(CORYZA,COUGH)

typical rash



PROBLEM STATEMENTyEndemic in all parts of world

y

Leading cause of death among vaccine preventable diseases

yCyclical increase in incidence of measles

for every 2-3yrs



EPIDEMOLOGICAL DETERMINANTS

AGENT

AGENT

ENVIRONMENT

ENVIRONMENTHOST

HOST



AGENT FACTORSyAGENT:

yCaused by PARAMYXOVIRUS



AGENT FACTORS

AGENT RNA myxovirus

SOURCE OF INFECTION Case , subclinical measles

INFECTIVE MATERIAL Secretions of

nose,throat,respiratory tract

COMMUNICABILITY Prodromalstage,at the time of

eruption( 4 days before & 5

days after rash)



HOST FACTORS



ENVIRONMENTAL FACTORS

yOvercrowding



TRANSMISSIONyDROPLET infection



INCUBATIONP

ERIODy10 days from exposure to onset of fever

and 14 days to appearance of rash

yWhen artificially induced, by-passing

respiratory tract incubation period ± 7

days average



CLINICAL FEATURES

PRODROMAL

ERUPTIVE PHASE

POST-MEASLES



PRODROMAL STAGEyBEGINS : 10 days after infection

yLASTS : until 14 days

y

CLINICAL FEATURES:fever

coryza with sneezing,cough

nasal discharge

redness of eyes, lacrimation, photophobia

vomitting&diarrhoea



KOPLIK S SPOTS

yPathognomic of measles

yTable salt crystalsappear on the buccalmucosa opposite to1st& 2nd molar teeth

ySmall, bluish whitespots on red basesmaller than pin head

size



ERUPTIVE PHASEyCLINICAL FEATURES:

typical dusky-red macular papular

rashes begins behind the ear

spreads rapidly on face & neck

next 2-3 days

lower extremities

KOPLIK SPOTS and TYPICAL RASH



POST-MEASLES STAGE

yLoss of weight & remain weak

yFailure to recover

y

Growth retardationyDiarrhoea

yCancrumoris

yPy ogenic infections

yCandidosis

yReactivation of pulmonar y TB



COMP

LICATIONSyMeasles associated diarrhoea

yPneumonia

yOtitis media

yFebrile convulsions

y

Subacutesclerosingpanencephalitis paralysis , involuntary movements, muscle

rigidity & coma



SSPE



PREVENTIONyAchieving an

immunisation rate of over 95%

yOn-going immunisation

against measles throughsuccessive generation

change



3 STAGES OF PREVENTIONyCONTROL:

reduction of incidence to an acceptable level

yOUTBREAK PREVENTION:

aggressive immunisation strategies

yELIMINATION:

reduction of incidence levelto

zero

yWHO defn/: absence of endemic measles for a

period of more than or equal to 12 mon in the

presence of adequate surveillance or

y Incidence<1/100000 population



ySTRATEGIES:y CATCH UP: 1 time vaccination targeting age

of 9 mon- 14 yrs

yKEEP UP: routine services aimed atvaccinating more than 95% of each successive birth cohort

yFOLLOW UP: subsequent nationwidevaccination campaign conducted every 2-4 yrstargeting usually all children born after the

catch up campaign.



VACCINATIONy Measles is best prevented b y active immunisation

y Live attenuated vaccines are recommended

y It is safe & effective



VACCINES

yAll vaccines are TISSUE

CULTURE vaccines

Chick embryo

Human diploid cell

yThe vaccine is presented as

freeze dried product.

It is important to store the

vaccine at recommended temp.



VACCINATION SCHEDULEyWHO recommends immunisation at 9 months

of age .

y Immunisation before the age of 9 mth rendered

ineffective by natural antibodies throughmothers

y If there is measles outbreak this can be

lowered to 6 mths

if immunised between 6-9mon 2nd dose should

be given on 9thmon provided 4wks after 1st

dose

yVIT-A dropsgiven along with the vaccine



ADMINISTRATION:Single SC dose of 0.5ml

Diluting fluid for reconstituting the

vaccine must be kept cold at 4 to 80 C

reconstituting vaccine should be kept onice with in one hr

REACTIONS:

fever for 1 to 2 daysrash for 1 to 3 days

due to multiplication of attenuated virus

IMMUNITY: LIFELONG



CONTRAINDICATIONS:pregnancy

deficient cell mediated immunity

steroids



ADVERSE EFFECTS OF

VACCINEyToxic shock syndrome occurs when

vaccine is contaminatedused in more than one session on same

day or next day



COMBINED VACCINEyMMR

y

MMRVyMR



IMMUNOGLOBULIN:WHO recommended dose is 0.25ml/kg

It should be given within 3 to 4 days of

exposure



CONTROL MEASURES

Isolation for 7days after

onset of rash

Immunisation of contacts

within 2 days of exposure

Prompt immunisation atthe beginning of an

epidemic

Spm Measles

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