MEASLES Richard Moriarty, MD University of Massachusetts Medical School

1. MEASLES Richard Moriarty, MD University of Massachusetts Medical School

2. Measles • Cause: RNA myxovirus • Hosts: man and monkeys • Spread: respiratory droplets • Incubation: 2 weeks • Attack rate: 90% • Attack leads to lifelong immunity • 30-40 million cases annually • 242,000 deaths in 2006

3. Measles Symptoms • Incubation: 14 days • Fever • Cough • Coryza • Conjunctivitis • Malaise – “miserable” • Koplik spots • Rash: cephalo-caudad spread

8. Measles Mortality • West Africa – 12% • Displaced populations – up to 30% • Developed countries – 0.02% • Overcrowding promotes spread • Poor nutrition increases complication risk • Measles often followed by other diseases • Measles makes bad nutrition worse • Vitamin A deficiency increases CFR

9. Measles: Differential Diagnosis • Scarlet fever • Staphylococcal toxin diseases • Rubella • Drug rash – SJS • Infectious mononucleosis • Dengue

10. Measles Complications • Bacterial superinfection • Respiratory: pneumonia (bacterial or giant cell), croup, bronchiolitis • GI tract: diarrhea, malnutrition • Skin: desquamation • Eyes: conjunctivitis, corneal ulcer, blindness • Mouth: buccal ulceration, cancrum oris • Hemorrhage • Acute encephalitis 1:1000

13. Measles Complications – cont. • Decreased cell-mediated immunity • Reduced CMI may reduce rash but increase risk of giant cell pneumonia • Activation of latent TB

14. Measles Treatment • Supportive care • Fever therapy • Hydration • Vitamin A • 200,000 IU once > age 1 year • 100,000 IU once if age 6-12 months • If eye complications 200,000 IU daily X 2 D

16. Measles Prevention • One serotype • Live attenuated vaccine • Monovalent, bivalent or trivalent • Usually given at 9, 12 or 15 mos after maternally acquired IgG has fallen • Contraindicated in pregnancy, malignancy • Side effects: fever rash 5-10%

17. Measles Vaccine Coverage