Measles

What is measles?
Measles is a highly infectious disease caused by a virus. Measles kills more children than any other vaccine preventable disease. Because the disease is so infectious, it tends to occur as epidemics, which may cause many deaths especially among malnourished children.

How is measles spread?
Measles is spread through contact with nose and throat secretions of infected people and in airborne droplets released when an infected person sneezes or coughs. A person with measles can infect others for several days before and after he or she develops symptoms. The disease spreads easily in areas where infants and children gather, for example in health centres and schools.

What are the signs and symptoms of measles?
The first sign of infection is a high fever which begins approximately 10–12 days after exposure and lasts several days. During this period, the patient may develop a runny nose, a cough, red and watery eyes, and small white spots inside his or her cheeks. After several days, a slightly raised rash develops, usually on the face and upper neck. Over a period of about three days, the rash spreads to the body and then to the hands and feet. It lasts for five or six days and then fades. The incubation period from exposure to the onset of the rash averages 14 days, with a range of seven to 18 days.

What are the complications of measles?
Unimmunized children under five years of age, and especially infants, are at highest risk for measles and its complications, including death. Infected infants may suffer from severe diarrhoea, possibly causing dehydration. Children may also develop inflammation of the middle ear and severe respiratory tract infections. Pneumonia is the most common cause of death associated with measles. This is usually because the measles virus weakens the immune system. The pneumonia may be caused by the measles virus itself or by secondary bacterial infection. Encephalitis, a dangerous inflammation of the brain, may also develop. Severe measles is particularly likely in poorly nourished children, especially those who do not receive sufficient vitamin A, who live in crowded conditions, and whose immune systems have been weakened by HIV/AIDS or other diseases. Measles is a major cause of blindness among children in Africa and other areas of the world with endemic measles. Children who recover from measles are immune for the rest of their lives.


What is the treatment for measles?

Clinical case definition of suspected measles
Any person in whom a clinician suspects measles
Or
Any person with:
• fever, and
• generalized maculopapular (i.e. nonvesicular) rash, and
• cough, coryza (i .e. runny nose) or conjunctivitis (i.e. red eyes).

General nutritional support and the treatment of dehydration with oral rehydration solution are necessary. Antibiotics should only be prescribed for ear infections and severe respiratory tract infections. It is important to encourage children with measles to eat and drink. All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements given 24 hours apart. Giving vitamin A can help prevent eye damage and blindness. Vitamin A supplementation reduces the number of deaths from measles by 50%.

Vitamin A treatment dosage

Management of complications
Treat Mouth Ulcer with Gentian Violet (GV)
• Treat the mouth ulcer twice daily
• Wash hands
• Wash the child’s mouth with a clean soft cloth wrapped around the finger and wet with salt water
• Paint the mouth with ½ strength gentian violet (0,25% dilution)
• Wash hand again
• Continue using GV for 48 hours after the ulcers have been cured
• Give paracetamol for pain relief

Treat eye infection with tetracycline eye ointment
• Clean both eyes 4 times daily
• Wash hands
• Use clean cloth and water to gently wipe away pus
• Then apply tetracycline eye ointment in both eyes 4 times daily
• Squirt a small amount of ointment on the inside of the lower lid
• Wash hand again
• Treat until there is no pus discharge
• Do not put anything else in the eyes

How is measles prevented?
Measles is prevented by immunization with measles vaccine. Measles is highly transmissible; almost all non-immune children contract measles if exposed to infection. To reduce the risk of infection in hospitals, all children between the ages of six and nine months who have not received measles vaccine and who are admitted to a hospital should be immunized against measles. If the children’s parents do not know whether they have received measles vaccine, the child should still be immunized. If a child has received measles vaccine before nine months of age, a second dose should be administered at nine months or as soon as possible after nine months.MS001