MEASLES: RESULTING IMPOTENCY IF IGNORED

Measles is an acute infection and highly communicable viral disease of childhood. The virus is mixo-virus group. The clinical feature is characterized by prodromal catarrhal symptoms; fever, koplik’s spots on the buccal mucosa and typical dusky-red blotchy rash.
The typical maculo-papular rash develops first at the back of the ears and at the junction of the forehead and hairline and then whole of the face; within a few hours the rash spreads rapidly to involve the skin of the rest of the body. At first the rash is discrete but later it may become confluent and patchy especially in the face and neck.

Epidemiological Determinants:

 Occurrence: It is endemic in most part of the world. The disease is universal.

 Agent: It is caused by an RNA para-myxovirus. It is only one serotype. The virus cannot live outside the human body for any length of time.

 Source of infection: The only source of infection is a case of measles carrier is not known to occur.

 Infective Material: Secretions of nose, throat and respiratory tract of a case of measles during the prodromal period and the early stages rash.

 Communicability: It is highly infectious during the prodromal period and at the time of eruption. Communicability declines rapidly after the appearance of the rash. The period of communicability is approximately 4 days before and 5 days after the appearance of the rash.

 Host factor: Attacks everyone in infancy or childhood. In developing country the environmental condition is poor so 6 months to 3 years of children are more susceptible. Now it is declined due to vaccination.

 Sex: Incidence is equal in both sexes.

 Immunity: No age group is immune if there was no previous immunity. One attack of measles generally confers lifelong immunity. Second attack is rare. Infants are protected by maternal antibodies up to 9 months of age.

 Nutrition: Measles tends to be very severe in the undernourished child. Mortality is very high in undernourished child then the well nourished child.

 Environmental factor: It may occur in any season. Epidemic of measles is in winter season and early spring in our country (January & April). It is common in less socio-economic condition.

 Transmission: It occurs directly from person to person mainly by droplet infection from 4 days before onset of rash until 5 days there thereafter. The portal of entry is the respiratory tract.

 Incubation period: 10-14 days.

 Clinical features: There are three stages in the natural history of measles. These are:
(1) Prodromal or Pre-eruptive stage:
o Begins 10 days after infection.
o Lasts until 14th day.
o Characterized by fever, coryza with sneezing with nasal discharge, cough redness of eyes, lacrimation and often photophobia.
o Vomiting and diarrhoea may be present.
o A day or two before the appearance of the rash, Kaplik’s spots appear on the buccal mucosa opposite the first and second upper molars. They are small, bluish-white spots on a red base, smaller than the head of a pin.

(2) Eruptive stage
o This stage is characterized by a typical, dusky-red, macular or maculo-papular rash which begins behind the ears and spreads rapidly in a few hours over the face and neck and extends down the body taking 2 to 3 days to progress to the lower extremities.

(3) Post-measles stage
o The child will remain weak for a few days and lose weight to a great extent.
o The child will become susceptible to suffer from other viral or bacterial infection.
o There may be growth retardation, diarrhoea, cancrum oris, pyogenic infections, candidosis, reactivation of pulmonary tuberculosis etc.



 Prevention:
By vaccination. (EPI)


Complications: Complications with measles are relatively common. Some complications are:
 Relatively mild and less serious diarrhea
 Pneumonia
 Encephalitis (sub-acute sclerosing panencephalitis)
 Corneal ulceration leading to corneal scarring.
Complications are usually more severe amongst adults who catch the virus.
The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 percent are common. In immunocompromised patients, the fatality rate is approximately 30 %.
Vaccination can prevent this disease. So immunize your child against this as per schedule.