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Measles 

Measles

Chapter:
Measles
Author(s):

H.C. Whittle

and P. Aaby

DOI:
10.1093/med/9780199204854.003.070506_update_001

Update:

Epidemiology—an estimated 164 000 people still die of measles each year.

Measles in Europe—misleading medical articles, anti-vaccine sentiments, and religious or superstitious beliefs are hampering control.

Prevention of measles in HIV-infected and severely malnourished children—WHO recommends measles vaccination in the acute phase, followed by a second dose on recovery.

Survival benefit of two doses of measles vaccine in infancy—two doses of Edmonston–Zagreb measles vaccine in infancy reduces case fatality to 30% lower than in controls receiving a single dose of measles vaccine at 9 months of age.

Eradication—prospects of fulfilling WHO’s aim of eradication by 2020.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 30 March 2017

Measles is a single-stranded RNA virus that is spread by aerosolized droplets and is highly transmissible. It causes a spectrum of disease ranging from mild in the well nourished to severe in the malnourished or immunosuppressed: mortality is 3 to 10% in Africa.

Clinical features—10 to 14 days after infection the viral prodrome typically consists of runny nose and fever, sometimes also diarrhoea or convulsions; signs include mild conjunctivitis, red mucosae, and (on the buccal mucosa) Koplik’s spots. After 14 to 18 days a morbilliform rash first appears on the forehead and neck, then spreads to involve the trunk and finally the limbs. Other manifestations include severe conjunctivitis (especially in those who are vitamin-A deficient), pneumonitis and enteritis (which may cause profuse diarrhoea). Early complications include (1) pneumonia—caused by secondary bacterial infection and responsible for most deaths; (2) stomatitis—caused by herpes simplex virus and/or candidal infection; (3) enteritis—due to candidal or bacterial superinfection; (4) eye infection—corneal ulceration may be caused by some combination of measles itself, herpes simplex infection, vitamin A deficiency, and use of traditional eye medicines; more than half of childhood blindness in Africa is related to measles; (5) skin and other infections, e.g. pyoderma; (6) encephalitis—occurs in 0.1 to 0.2% of cases; probably attributable to a neuroallergic process; mortality is 10 to 15%, and 25% of children are left with permanent neurological disability. Late complications include malnutrition, giant cell pneumonia and subacute sclerosing panencephalitis.

Diagnosis and treatment—diagnosis is primarily clinical, but signs may be less clear cut in vaccinated subjects. Detection of measles-specific IgM antibody or detection of measles antigen in saliva or urine may clinch the diagnosis if the rash is mild or atypical. Management is supportive, including administration of vitamin A, and with prompt treatment of secondary infections.

Prevention—(1) Passive immunization—human immunoglobulin is highly effective if given within 2 or 3 days of exposure and should be administered to those in whom vaccination is contraindicated. (2) Active immunization—live vaccine is often given in the developed world as one component of a trivalent mumps/measles/rubella (MMR) vaccine at 14 to 16 months of age. However, this is not appropriate for children in developing countries, who are infected by measles at a much earlier age, where substantial successes in controlling the disease has been obtained with a strategy combining (a) catch-up—a one-time mass campaign covering everybody aged 9 months to 14 years, regardless of previous measles or immunization; (2) keep-up—achieving a high coverage for each birth cohort; (3) follow-up—subsequent mass campaigns covering all children every 3 to 5 years; and (4) mop-up—campaigns that target children who are difficult to reach or during outbreaks. This strategy has eliminated measles from Latin America.

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