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PLAGUES AND PEOPLE - LEC 8 - Measles.docx

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Health Studies
Caroline Barakat

PLAGUES AND PEOPLE LEC 10: Measles – Rubella (Rubeola, hard measles, red measles, morbilli, hasbah) common, acute, viral infectious disease common in children Symptoms: fever, typical red, blotchy rash combined with cough, coryza, or conjunctivitis it is a vaccine preventable Etiology and Epidemiology virus called Morbillivirus of the family Paramyxoviridae -does not survive drying on a surface, it can survive drying in microdroplets in the air infection of the respiratory system -incubation period 7-14 days -highly contagious -humans are the only hosts transmitted by nose and throat secretions of infected persons (droplet spread) direct contact and by indirect contact through freshly soiled articles and airborne transmission no reservoir for measles only in humans -person to person chain 1. Rash appears 12-14 days after contact with an infected person 2. Infectivity is greatest 3-4 days before the rash appears 3. Contagious nature of disease – respiratory route of transmission 4. Life-long immunity period of communicability is from before the beginning of the prodromal phase of the disease to 4 days after the start of the rash  no carrier incubation time from time of exposure to onset of fever of about 10 days with a range from 8 to 13 days incubation period from time of exposure to rash onset is about 14 days primarily an endemic disease of children -epidemics occurring every 2 to 5 years -greatest incidence is in children under 2 years old Epidemic measles has a winter-spring seasonality in temperate climates and a less marked hot-dry seasonality in equatorial regions -b/c of the indirect effect of climate on socioeconomic conditions and populations movements. in more remote isolated populations, measles is not endemic and disease is dependent upon introduction of the virus outside affecting all age groups -severity among certain populations are most likely the result of nutritional and environmental factors measles mortality is highest in the very young and the very old -in malnourished children in the developing world, the case fatality rate may be as high as 5 to 10 percent or more Pre-vaccine period – approx. 130 million cases and 7-8 million measles related deaths annually worldwide (child mortality rate, 7%) virus still affects 50 M annually and causes more than 1 million deaths highest incidence in developing countries & naïve population acute child fatality rate in industrialized nations is 0.1%-0.2% Distribution and Incidence worldwide distribution according to Expanded Programme in Immunization, global coverage estimated at 55 % for children under 1 year of age (52 percent in developing countries) -currently averting over 40 million cases and over 1 million deaths resulting from the disease each year in Third World countries populated areas: measles both endemic and epidemic, over 90 percent of adult population will show serologic evidence of prior infection remote areas: measles is not endemic which may produce large outbreaks Immunology infants usually have passive immunity to measles as a result of maternal antibodies acquired transplacentally from immune mothers -protects infant for 6-9 months measles infection induces a lifelong immunity -can be checked by: serologic tests fluorescent antibody techniques and isolation of the virus from patients during the acute phase of the disease Different age for vaccinations -developed country – 15 months of age is recommended -developing country – 9 months of age is recommended Clinical Manifestations and Pathology 3 stages prodromal phase typically includes symptoms of fever, cough, coryza, and conjunctivitis -photophobia -inflammation of the eye’s outer membrane -during the late prodromal phase, small whitish specks on the reddened areas of the mucosal lining of the mouth called Koplik’s spots -sore throat develops -period continues for 3-7 days until blotchy reddish rash appears -rash usually appears first on the head then body then outward to limbs lasting about 4-7 days -after its peak, all symptoms and signs begin to recede and the rash fades in the same order it appeared Exanthem Stage -1-2 days later, rash begins on the face and the neck -lesions spread to the torso and hands and feet -initially, the colour is dark red -slowly fades to a purplish colour and then
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