CDC LECTURES Learning Objectives: By the end of the lecture, the students should be able to describe: 1- The disease, its occurrence & susceptibility. 2- Causative agent, incubation period & communicability. 3- Mode of transmission , reservoir of infection & carrier state if any. 4- Principles of management (diagnosis & treatment). 5- Main preventive & control measures.

COMMUNICABLE DISEASES MEASLES Professor Qayser Sahib Al Habeeb Specialist in Internal and Community Medicine Department of Family and Community Medicine College of Medicine University of Duhok

MEASLES: ( ( Rubeola , Morbilli It is a highly communicable acute viral disease caused by measles virus a member of the --- genus : Morbillivirus --- family : Paramyxoviridae

Key Facts ■ The disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. ■ In 2014, there were 114 900 measles deaths globally “ ~ 314 deaths / day or 13 deaths / hour ” .

■ > 95% of measles deaths occur in low-income countries with weak health infrastructures. ■ During 2000-2014, vaccination 79% drop in measles deaths (~ 17.1 million deaths) making measles vaccine one of the best buys in public health

◙ I. P : 10 days ( 7-18 days ) ◙ MOT : ♦ airborne by droplets ♦ contact with sick children. ♦ less commonly by articles freshly soiled with nose and throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to 2 hours.

◙ C.P : Usually about 4 days before rash onset to 4 days after appearance of the rash. ◙ Reservoir : humans. ◙ Endemicity : worldwide --- In the pre vaccination era, measles was near universal infection of childhood --- Common and often fatal in developing countries

an erythematous base on the buccal mucosa Clinically: It starts with: ► a prodromal catarrhal stage (3-4 days ) fever, dry cough, running nose + conjunctivitis( red watery eyes & photophobia) + koplik’s spots (small with white/bluish center) on an erythematous base on the buccal mucosa

► Exanthematous stage (6 -7 days): starts with dusky maculo papular rash at the hairline, behind the ears and on the face, then spreads downwards slowly to the lower limbs ► Fever settles and the rash begins to fade (sometimes with brawny desquamation.)

Measles tends to be: ◙ Less severe in: - older children and teenagers ◙ More severe in: - adults > 20 yrs of age - children < 5 yrs of age ◙ A serious disease in: malnourished, vit.- deficient or immuno compromised pregnant women are also at risk of severe complications and the pregnancy may end in miscarriage or preterm delivery.

laryngo tracheo bronchitis Complications: ► may result from viral replication or secondary bacterial infection and include: otitis media, pneumonia, laryngo tracheo bronchitis diarrhea & encephalitis. ► In children who are borderline nourished, measles often precipitates acute kwashiorkor and exacerbates “vitamin A” deficiency, that may lead to blindness.

Those who recover from measles are immune for the rest of their lives. Deaths occur mainly in children < 5 yrs of age primarily from pneumonia & occasionally from encephalitis Those who recover from measles are immune for the rest of their lives.

◙ Clinical suspicion + koplik’s spots Diagnosis: ◙ Clinical suspicion + koplik’s spots ◙ Can be confirmed by: - IgM antibodies or rising titer - PCR can detect the virus

Treatment ◙ symptomatic ◙ antibiotics are used for complications ◙ vitamin A may improve outlook in uncomplicated disease

All children in developing countries diagnosed with measles should receive 2 doses of vitamin A supplements, given 24 hours apart. This treatment 1- can help prevent eye damage and blindness. 2- has been shown to reduce the number of deaths from measles by 50%.

◙ Active immunization ( L.A.V.) Preventive and Control Measures: ◙ Active immunization ( L.A.V.) ◊ key public health strategies to reduce global measles deaths are routine measles vaccination combined with mass immunization campaigns in countries with high case and death rates. ◊ Measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems.(equally effective in the single or combined form) ◊ Two doses of the vaccine are recommended to ensure immunity. ( ~ 15% failure after the first dose ) ◊ An aerosol-administered vaccine has been successfully developed & a heat stable vaccine is under development

◙ Improvement of nutrition of children Vitamin A supplementation : single dose of 100000 I.U orally for children above 1 year and 50000 I.U for those 6-12 months of age.

◙ Isolation: of limited value ◙ Exclusion from school : for 4 days after the appearance of the rash. ◙ Contacts : ♦ Immunization within 72 hours of exposure may provide protection ♦ Passive immunization within 6 days of exposure may be used for contacts whose risk of complications is very high e.g. ---- contacts < 1 yr. ---- pregnant women ---- immuno compromised persons

The Measles & Rubella Initiative Launched in 2001, is a global partnership led by -- the American Red Cross, -- United Nations Foundation, -- Centers for Disease Control and Prevention (CDC), -- UNICEF and WHO. The Initiative is committed to ensuring that : -- No child dies from measles or is born with congenital rubella syndrome; -- Reducing measles deaths by 95% by 2015; and -- Achieving measles and rubella elimination in at least 5 WHO regions by 2020.

Thank you