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Measles
Measles or RubeolA, is an acute viral illness
caused by a virus in the family paramyxovirus,
genus Morbillivirus.
Measles is characterized by a prodrome of fever and
malaise, cough, coryza, and conjunctivitis, followed by a
maculopapular rash.
Measles is usually a mild or moderately severe
illness. However, measles can result in
complications such as pneumonia,
encephalitis and death.
Epidemiology
• In 1980, before widespread global use of measles
  vaccine, an estimated 2.6 million measles deaths
  occurred worldwide. In 2001, to accelerate the
  reduction in measles cases achieved by vaccination,
  the World Health Organization (WHO) and the United
  Nations Children's Fund (UNICEF) developed a strategy
  to deliver 2 doses of measles-containing vaccine (MCV)
  to all children through routine services and
  supplementary immunization activities (SIAs) and
  improved disease surveillance. After implementation of
  this strategy, the estimated number of annual measles
  deaths worldwide decreased from 733,000 in 2000 to
  164,000 in 2008.
Transmission
Measles transmission is airborne by
respiratory droplet nuclei spread or it can be
transmitted by direct contact with infected
nasal or throat secretions.
Incubation Period
The incubation period is approximately ten
days, but varies from 7 to 18 days from
exposure to the onset of fever. It is usually 14
days until the rash appears.
Risk Factors
Anyone who never had measles and has never
been vaccinated.
Babies younger than 12 months old, because they
are too young to be vaccinated.
Adults who were vaccinated before 1968,
because some early vaccines did not give lasting
protection.
A very small percentage of vaccinated children
and adults who may not have responded well to
the vaccine.
Clinical Features
• Clinical features of measles include prodromal
  fever, a severe cough, conjunctivitis, coryza
  and Koplik’s spots on the buccal mucosa.
  These are present for three to four days prior
  to rash onset.
The most important clinical predictors are included in the
  clinical case definition for measles which is an illness
  characterised by all the following features:
 generalised maculopapular rash, usually lasting three or more
  days
 fever (at least 38°C if measured) present at the time of rash
  onset
 cough, coryza, conjunctivitis and Koplik’s spots
 The characteristic red, blotchy rash appears on the third to
  seventh day. It begins on the face before becoming
  generalised and generally lasts four to seven days.
 Measles infection (confirmed virologically) may rarely occur
  without a rash.
ASSESSMENT
PROBLEM IDENTIFIED
                   STAGE                                 DATA                                   (NURSING DIAGNOSIS)

Pre-eruptive Stage                    •   fever                                      •   Hyperthermia

(patient is highly communicable)      •   catarrhal symptoms – start in the nasal    •   Pain
                                          cavities; then in the conjunctivae,        •   Risk for impaired gas exchange
                                          oropharynx, progress to the bronchi        •   Risk for impaired breathing pattern
                                          resulting successively in rhinitis,
                                          conjunctivitis and then bronchitis.
                                      •   Respiratory symptoms – which appear
                                          first as a common cold, and sneezing
                                          nasal discharges, steadily progress into
                                          a distressing and annoying cough that
                                          persists up to convalescence.

Eruptive Stage/Stage of Skin Rashes   •   Anorexia                                   •   Imbalance nutrition: less than body
                                                                                         requirement
                                      •   Exanthem sign – means eruption in the
                                          skin                                       •   Impaired skin integrity

                                      •   Maculopapular Rashes – appears 2-7         •   Hyperthermia
                                          days after onset                           •   Activity Intolerance
                                      •   High fever – increases steadily            •   Fatigue
                                      •   Irritability
                                      •   Diarrhea
                                      •   Pruritis
                                      •   Lethargy
                                      •   Occipital lymphadenopathy

Stage of Convalescence                •   Rashes – fade in the same manner as
                                          they appeared, from the face
                                          downwards, leaving a dirty brown
                                          pigmentation and finely granular which
                                          maybe noted for several days.
                                      •   Fever – gradually subsides as the
                                          eruptions disappear on the hands and
                                          feet
DIAGNOSIS
Clinical diagnosis of measles requires a history
of fever of at least three days, with at least
one of the three C's (cough, coryza,
conjunctivitis). Observation of Koplik's spots is
also diagnostic of measles.
Alternatively, laboratory diagnosis of measles can
be done with confirmation of positive measles
IgM antibodies or isolation of measles virus RNA
from respiratory specimens. In patients where
phlebotomy is not possible, saliva can be
collected for salivary measles-specific IgA testing.
Positive contact with other patients known to
have measles adds strong epidemiological
evidence to the diagnosis. The contact with any
infected person in any way, including semen
through sex, saliva, or mucus, can cause infection.
MANAGEMENT
•   There is no specific treatment for measles. Most patients with uncomplicated
    measles will recover with rest and supportive treatment. It is, however, important
    to seek medical advice if the patient becomes more unwell, as they may be
    developing complications. Patient should be monitored for the development of
    bacterial infections which should be treated with appropriate antibiotics on the
    basis of clinical and bacteriological finding

•   The patient may also take over-the-counter medications such as acetaminophen
    (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve
    the fever that accompanies measles. Don’t give aspirin to children because of the
    risk of Reye’s syndrome — a rare but potentially fatal disease.

•   Maintain bedrest and provide quiet activities for the child. If there is sensitivity to
    light, keep room darkly lit. Remove eye secretions with warm saline or water.
    Encourage the patient not to rub the eyes. Administer antipyretic medication and
    tepid sponge baths as ordered. A cool mist vaporizer can be used to relieve cough.
    Apply antipruritic medication to prevent itching. Isolate child until fifth day of rash.
Prevention of Measles

• Avoid exposing children to any person with fever or with acute
  catarrhal symptoms
• Isolation of cases from diagnosis until about 5-7 days after onset of
  rash
• Disinfection of all articles soiled with secretion of nose and throat
• Encourage by health department and by private physician of
  administration of measles immune globulin to susceptible infants
  and children under 3 years of age in families or institutions where
  measles occurs.
• Live attenuated and inactivated measles virus vaccines have been
  tested and are available for use in children with no history of
  measles, at 9 months of age or soon thereafter
• Live attenuated measles vaccine is recommended for
  all persons unless specific contra-indications to live
  vaccines exist.

• It is recommended that this vaccine be given as
  measles-mumps-rubella (MMR) vaccine at 9 to 12
  months of age and a second dose at four years of age
  (prior to school entry). The second dose is not a
  booster but is designed to vaccinate the approximately
  five per cent of children who do not seroconvert to
  measles after the first dose of vaccine
GUIDE ON MEASLES IMMUNIZATION

Route                 Subcutaneous
Site                  Outer part of upper left arm
Number of Dose        1 dose
Age at First Dose     9 months
Dosage                0.5mL
Storage Temperature   -15 to -25 °C
EVALUATION
• PROGNOSIS

  While the vast majority of patients survive measles, complications
  occur fairly frequently, and may include bronchitis,
  and panencephalitis which is potentially fatal. Also, even if the
  patient is not concerned about death or sequela from the measles,
  the person may spread the disease to an immunocompromised
  patient, for whom the risk of death is much higher, due to
  complications such as giant cell pneumonia. Acute measles
  encephalitis is another serious risk of measles virus infection. It
  typically occurs two days to one week after the breakout of the
  measles exanthem, and begins with very high fever, severe
  headache, convulsions, and altered mentation. Patient may become
  comatose, and death or brain injury may occur.
Measles

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Measles

  • 2. Measles or RubeolA, is an acute viral illness caused by a virus in the family paramyxovirus, genus Morbillivirus.
  • 3. Measles is characterized by a prodrome of fever and malaise, cough, coryza, and conjunctivitis, followed by a maculopapular rash.
  • 4. Measles is usually a mild or moderately severe illness. However, measles can result in complications such as pneumonia, encephalitis and death.
  • 5. Epidemiology • In 1980, before widespread global use of measles vaccine, an estimated 2.6 million measles deaths occurred worldwide. In 2001, to accelerate the reduction in measles cases achieved by vaccination, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) developed a strategy to deliver 2 doses of measles-containing vaccine (MCV) to all children through routine services and supplementary immunization activities (SIAs) and improved disease surveillance. After implementation of this strategy, the estimated number of annual measles deaths worldwide decreased from 733,000 in 2000 to 164,000 in 2008.
  • 6. Transmission Measles transmission is airborne by respiratory droplet nuclei spread or it can be transmitted by direct contact with infected nasal or throat secretions.
  • 7. Incubation Period The incubation period is approximately ten days, but varies from 7 to 18 days from exposure to the onset of fever. It is usually 14 days until the rash appears.
  • 8. Risk Factors Anyone who never had measles and has never been vaccinated. Babies younger than 12 months old, because they are too young to be vaccinated. Adults who were vaccinated before 1968, because some early vaccines did not give lasting protection. A very small percentage of vaccinated children and adults who may not have responded well to the vaccine.
  • 9. Clinical Features • Clinical features of measles include prodromal fever, a severe cough, conjunctivitis, coryza and Koplik’s spots on the buccal mucosa. These are present for three to four days prior to rash onset.
  • 10. The most important clinical predictors are included in the clinical case definition for measles which is an illness characterised by all the following features:  generalised maculopapular rash, usually lasting three or more days  fever (at least 38°C if measured) present at the time of rash onset  cough, coryza, conjunctivitis and Koplik’s spots  The characteristic red, blotchy rash appears on the third to seventh day. It begins on the face before becoming generalised and generally lasts four to seven days.  Measles infection (confirmed virologically) may rarely occur without a rash.
  • 12. PROBLEM IDENTIFIED STAGE DATA (NURSING DIAGNOSIS) Pre-eruptive Stage • fever • Hyperthermia (patient is highly communicable) • catarrhal symptoms – start in the nasal • Pain cavities; then in the conjunctivae, • Risk for impaired gas exchange oropharynx, progress to the bronchi • Risk for impaired breathing pattern resulting successively in rhinitis, conjunctivitis and then bronchitis. • Respiratory symptoms – which appear first as a common cold, and sneezing nasal discharges, steadily progress into a distressing and annoying cough that persists up to convalescence. Eruptive Stage/Stage of Skin Rashes • Anorexia • Imbalance nutrition: less than body requirement • Exanthem sign – means eruption in the skin • Impaired skin integrity • Maculopapular Rashes – appears 2-7 • Hyperthermia days after onset • Activity Intolerance • High fever – increases steadily • Fatigue • Irritability • Diarrhea • Pruritis • Lethargy • Occipital lymphadenopathy Stage of Convalescence • Rashes – fade in the same manner as they appeared, from the face downwards, leaving a dirty brown pigmentation and finely granular which maybe noted for several days. • Fever – gradually subsides as the eruptions disappear on the hands and feet
  • 13. DIAGNOSIS Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the three C's (cough, coryza, conjunctivitis). Observation of Koplik's spots is also diagnostic of measles.
  • 14. Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens. In patients where phlebotomy is not possible, saliva can be collected for salivary measles-specific IgA testing. Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis. The contact with any infected person in any way, including semen through sex, saliva, or mucus, can cause infection.
  • 15. MANAGEMENT • There is no specific treatment for measles. Most patients with uncomplicated measles will recover with rest and supportive treatment. It is, however, important to seek medical advice if the patient becomes more unwell, as they may be developing complications. Patient should be monitored for the development of bacterial infections which should be treated with appropriate antibiotics on the basis of clinical and bacteriological finding • The patient may also take over-the-counter medications such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve the fever that accompanies measles. Don’t give aspirin to children because of the risk of Reye’s syndrome — a rare but potentially fatal disease. • Maintain bedrest and provide quiet activities for the child. If there is sensitivity to light, keep room darkly lit. Remove eye secretions with warm saline or water. Encourage the patient not to rub the eyes. Administer antipyretic medication and tepid sponge baths as ordered. A cool mist vaporizer can be used to relieve cough. Apply antipruritic medication to prevent itching. Isolate child until fifth day of rash.
  • 16. Prevention of Measles • Avoid exposing children to any person with fever or with acute catarrhal symptoms • Isolation of cases from diagnosis until about 5-7 days after onset of rash • Disinfection of all articles soiled with secretion of nose and throat • Encourage by health department and by private physician of administration of measles immune globulin to susceptible infants and children under 3 years of age in families or institutions where measles occurs. • Live attenuated and inactivated measles virus vaccines have been tested and are available for use in children with no history of measles, at 9 months of age or soon thereafter
  • 17. • Live attenuated measles vaccine is recommended for all persons unless specific contra-indications to live vaccines exist. • It is recommended that this vaccine be given as measles-mumps-rubella (MMR) vaccine at 9 to 12 months of age and a second dose at four years of age (prior to school entry). The second dose is not a booster but is designed to vaccinate the approximately five per cent of children who do not seroconvert to measles after the first dose of vaccine
  • 18. GUIDE ON MEASLES IMMUNIZATION Route Subcutaneous Site Outer part of upper left arm Number of Dose 1 dose Age at First Dose 9 months Dosage 0.5mL Storage Temperature -15 to -25 °C
  • 19. EVALUATION • PROGNOSIS While the vast majority of patients survive measles, complications occur fairly frequently, and may include bronchitis, and panencephalitis which is potentially fatal. Also, even if the patient is not concerned about death or sequela from the measles, the person may spread the disease to an immunocompromised patient, for whom the risk of death is much higher, due to complications such as giant cell pneumonia. Acute measles encephalitis is another serious risk of measles virus infection. It typically occurs two days to one week after the breakout of the measles exanthem, and begins with very high fever, severe headache, convulsions, and altered mentation. Patient may become comatose, and death or brain injury may occur.