MEASLES

Dr.Manibharathi.G, Msc(n), Ph.D(N)

Professor
 Introduction

• Measles is an acute viral respiratory illness.

• Measles, also known as rubeola, is one of the most

contagious infectious diseases, with at least a 90%
secondary infection rate in susceptible domestic
contacts.
• Despite being considered primarily a childhood
illness, measles can affect people of all ages.
• Measles is marked by prodromal fever, cough,
coryza, conjunctivitis, and pathognomonic enanthem
(ie, Koplik spots), followed by an erythematous
maculopapular rash on the third to seventh day.
• Infection confers life-long immunity.
 DEFINITION
• Measles or Rubeola, is an acute viral illness
caused by a virus in the family
paramyxovirus, genus Morbilli virus.
• Measles is characterized by a prodrome of fever
and malaise, cough, coryza, and conjunctivitis,
followed by a maculopapular rash.
 CAUSES

• The cause of measles is the measles virus, a single-

stranded, negative-sense enveloped RNA virus of the
genus Morbilli virus within the family
Paramyxoviridae.

Host:- Humans are the natural hosts of the virus; no

animal reservoirs are known to exist.
 Mode of transmission

This highly contagious virus is spread by coughing and

sneezing via close personal contact or direct contact with
secretions.
 CONTIN...
• Environment:- Travel to areas where measles is endemic or
contact with travelers to endemic areas could cause measles.
• Immunodeficiency:- Children with immunodeficiency due to
HIV or AIDS, leukemia, alkylating agents, or corticosteroid
therapy, regardless of immunization status, are likely to contract
measles.
• Absence of antibodies:-Infants who lose passive antibody before
the age of routine immunization easily contracts measles.
 Pathophysiology

• Infection is transmitted via respiratory droplets, which can

remain active and contagious, either airborne or on
surfaces, for up to 2 hours.
• Initial infection and viral replication occur locally in
tracheal and bronchial epithelial cells.
• After 2-4 days, measles virus infects local lymphatic

tissues, perhaps carried by pulmonary macrophages.

 continu...
• Following the amplification of measles virus in regional
lymph nodes, a predominantly cell-associated viremia
disseminates the virus to various organs prior to the
appearance of a rash.
 continu...
• Measles virus infection causes a generalized
immunosuppression marked by decreases in delayed-
type hypersensitivity, interleukin (IL)-12 production
and antigen-specific lymphoproliferative responses
that persist for weeks to months after the acute
infection.
 Clinical Manifestations

• The incubation period from exposure to onset of

measles symptoms ranges from 7 to 14 days (average,
10-12 days).
• High fever. The first sign of measles is usually a high
fever (often >104o F [40o C]) that typically lasts 4-7
days.
The symptoms of measles always

include fever and

• three Cs:

 cough

 coryza, or runny nose

 conjunctivitis
 CONTINU....

• Prodromal phase symptoms:-

This prodromal phase is marked by malaise,

fever, anorexia, and the classic triad of conjunctivitis,
cough, and coryza (the “3 Cs”).
• Koplik’s spots:- Small spots (Koplik spots) can be
seen inside the cheeks during this early stage.
Koplik spots
 CONTIN
• Exanthem:-

The characteristic exanthem generally appears 2-4

days after the onset of the prodrome and lasts 3-5 days;
the exanthem usually appears 1-2 days after the
appearance of Koplik spots; mild pruritus may be
associated, on average, the rash develops about 14 days
after exposure, starting on the face and upper neck and
spreading to the extremities.
 Assessment and Diagnostic Findings

• Although the diagnosis of measles is usually

determined from the classic clinical picture,
laboratory identification and confirmation of the
diagnosis are necessary for the purposes of public
health and outbreak control.
 CONTIN....
• The measles virusAntibody assays.
• sandwich-capture IgM antibody assay, offered through
many local health departments and through the CDC, is the
quickest method of confirming acute measles; laboratories
can confirm measles by demonstrating more than a 4-fold
rise in IgG antibodies between acute and convalescent sera,
although relying solely on rising IgG titers for the diagnosis
delays treatment considerably.
 CONTIN....

• Viral culture.
• Throat swabs and nasal swabs can be sent on viral
transport medium or a viral culturette swab to isolate
the measles virus; urine specimens can be sent in a
sterile container for viral culture.
 CONTIN....
• Reverse-transcription polymerase chain reaction
(PCR).
Reverse-transcription polymerase chain reaction (PCR)
evaluation is highly sensitive at visualizing measles virus
RNA in blood, throat, nasopharyngeal, or urine specimens
and, where available, can be used to rapidly confirm the
diagnosis of measles.
 CONTIN....
• Chest Radiography
• If bacterial pneumonia is suspected, perform chest
radiography; the frequent occurrence of measles
pneumonia, even in uncomplicated cases, limits the
predictive value of chest radiography for bacterial
bronchopneumonia.
 Medical Management
• Hydration:-Maintenance of good hydration and
replacement of fluids lost through diarrhea or emesis
is a primary concern.
• Hospitalization:-Hospitalization may be indicated
for the treatment of measles complications (eg,
bacterial super infection, pneumonia, dehydration,
croup).
 CONTIN....
• Antibiotic therapy:- Secondary infections (eg, otitis
media or bacterial pneumonia) should be treated with
antibiotics; patients with severe complicating infections
(eg, encephalomyelitis)
• Postexposure prophylaxis.

• Prevention or modification of measles in exposed

susceptible individuals involves the administration of
measles virus vaccine or human immunoglobulin (Ig).
 Pharmacologic Therapy
• Medications used in the treatment or prevention of measles
include vitamin A, antivirals (eg, ribavirin), measles virus
vaccine, and human immunoglobulin (Ig).
• Vitamin A:- two doses of vitamin A given 24 hours apart
are recommended; a third age-specific dose should be
given 2 to 4 weeks later to children with clinical signs and
symptoms of vitamin A deficiency.
 CONTIN....

• Antivirals:- Measles virus is susceptible to ribavirin in

vitro; although ribavirin (either IV or aerosolized) has
been used to treat severely affected and
imunocompromised adults with acute measles (IV plus
intrathecal high-dose interferon alfa), no controlled trials
have been conducted; ribavirin is not approved by the
US Food and Drug
 CONTIN....
• Vaccines:- The live MMR vaccine is used to induce
active immunity against viruses that cause measles,
mumps, and rubella.
• Immunoglobulins:- Human Ig prevents or modifies
measles in susceptible individuals if administered
within 6 days of exposure.
 Complications of measles

Common: Severe:
• Otitis media •Encephalitis
• Bronchopneumonia •Respiratory complications
• Laryngo •Neurologic complications
•Sub acute sclerosing
tracheobronchitis
panencephalitis
• Diarrhea
 prevention

• The only way to prevent measles is to get the

measles, mumps, and rubella (MMR) vaccine. 
• Vaccine:- MMR vaccine given at 12 to 15
months old (first dose) and again at 4 to 6
years (booster dose)
 Nursing Diagnosis
• Impaired social interaction related to isolation from friends.
• Risk for impaired skin integrity related to raking pruritus.

• High risk of infection related to the host and infectious

agents.
• Acute pain related to skin lesions and irritated mucous
membranes.
 Nursing Interventions
Isolation:-
•  The child will need to be on isolation precautions to decrease
transmission within the community.
• emphasize the need for immediate isolation when early
catarrhal symptoms appear.
Skin care.:-
• Measles causes extreme pruritus; nursing interventions include
keeping the patient’s nails short.
• encourage long pants and sleeves to prevent scratching,
keeping skin moist with health care provider recommended
lotions.
• avoiding sunlight and heat.
Eye care.:-
• Treat conjunctivitis with warm saline when
removing eye secretions and encourage patient
not to rub eyes.
• protect the eyes from the glare of strong light.
Hydration. 
• Encourage oral hydration.
• medical literature encourages the use of oral
rehydration solution.
Temperature control:-
•  Antipyretics should be administered to the
patient as ordered for a temperature greater
than 100.4 Fahrenheit unless directed else wise
by a healthcare provider.
• be sure to remind parents not to administer
aspirin due to the risk of Reye’s syndrome.