Every thing you want to know about Measles

Measles (Rubeola/Morbilli)

Definition of Measles:

-          an acute, contagious and exanthematous disease that usually affects children which are susceptible to URTI.

Etiologic Agent: Filtrable virus that belongs to genus Morbilivirus of the family paramyxoviridae.

- rapidly inactivated by heat, ultraviolet light, and extreme degrees of acidity and alkalinity.

Incubation Period  of Measles

·         10 to 12 days

·         Single attack conveys a lifelong immunity.

Period of Communicability: usually lasts about 9 to 10 days, from the beginning of the prodromal symptoms to the fading of the rash.

·         The disease is communicable 4 days before and 5 days after the appearance of rashes.

·         The disease is most communicable during the height of rash.

Sources of Infection:

·         patient’s blood

·         Secretions from the eyes, nose and throat.

Mode of Transmission of Measles

1. Through direct contact with the droplets spread through coughing & sneezing

2. Indirect contact (articles or fomites freshly contaminated with respiratory secretions of infected patients.

Pathognomonic Sign of Measles

 Koplik’s spots  - inflammatory lesions of the buccal mucous glands with superficial necrosis.

2. They appear on the mucosa of the inner cheek opposite to the second molars, or near the junction of the gum and the inner cheek.

3. They usually appear 1 to 2 days before the measles rash.

Clinical Manifestations of Measles  (3 Stages)

1. Pre-eruptive stage

a. fever

b. catarrhal symptoms (rhinitis, conjunctivitis, photophobia, coryza)

c. respiratory symptoms start from common colds to persistent coughing

d. enanthema sign (Koplik’s spot)

2. Eruptive stage

a. the rash is usually seen late on the 4th day.

b. maculo-papular rash appears first on either the cheeks, bridge of the nose, along the hairline, at the temple or at the earlobe.

c. the rash is fully developed by the end of the second day and all symptoms are at their maximum at this time.

d. High grade fever comes on and off.

e. Anorexia and irritability.

f. Abdominal tympanism, pruritus, lethargy

g. The throat is red and often extremely sore.

h. As fever subsides, coughing may diminish, but more often it hangs on for a week or two, become looser and less metallic.

3. Stage of Convalescence

a. rashes fade away in the manner as they erupted.

b. fever subsides as eruption disappears.

c. when the rashes fade, desquamation begins.

d. symptoms subside and appetite is restored.

Diagnostic Procedures of Measles

·         Nose and throat swab

·         Urinalysis

·         Blood exams (CBC, leukopenia, leukocytosis)

·         Complement fixation or hemogglutinin test

Modalities of Treatment of Measles

·         Anti-viral drugs (Isoprenosine)

·         Antibiotics if with complication

·         Supportive therapy (oxygen inhalation, IV fluids)

Unfavorable Signals of Measles

1. Violent onset with high grade fever

2. Fading eruption with rising fever

3. Hemorrhagic or black measles

4. Persistence of fever for 10 days or more

5. Slight eruptions accompanied by severe symptoms, especially those of encephalitis.

Nursing Management of Measles

1. Isolation of the patient is necessary (the room must be quiet, well ventilated, and must have subdued light)

2. Control the patient’s high temperature with warm or tepid sponges.

3. Skin care is utmost.

4. Provide oral and nasal hygiene.

5. Care of the eyes. The patient is sensitive to light. Keep eyes free of secretions.

Preventive Measures of Measles

Immunization with:

·         Anti-measles at the age of 9 months, as single dose

·         Mumps, measles, rubella (MMR) vaccine to be given at 15 months, 2nd dose at 11 to 12 years.

·         Measles vaccine should not be given to pregnant women or to persons with active tuberculosis, leukemia, lymphoma or depressed immune system.