1. 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.

2. 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

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

4. 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 measles deaths globally “ ~ 314 deaths / day or 13 deaths / hour ” .

5. ■ > 95% of measles deaths occur in low-income countries with weak health infrastructures.
■ During ,
vaccination % drop in measles deaths
(~ 17.1 million deaths) making measles vaccine one of the best buys in public health

6. ◙ 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.

7. ◙ 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

8. 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

9. ► 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.)

10. 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.

19. 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.

20. 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.

21. ◙ 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

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

23. 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%.

24. ◙ 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

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

26. ◙ 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

27. 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 WHO regions by 2020.

28. Thank you