Download Measles ICD-10 B05 1.14.1 Identification Acute systemic viral

Measles
ICD-10 B05
Identification 1.11.1
Acute systemic viral infection. The prodromal phase lasts 2–4 days (range 1–7 days). It is
characterized by fever, which increases in stepwise fashion, often peaking as high as 103°–
105°F. This is followed by the onset of cough, coryza (runny nose), or conjunctivitis. Koplik
spots, a rash (enanthem) present on mucous membranes, is considered to be
pathognomonic for measles. It occurs 1–2 days before the rash to 1–2 days after the rash,
and appears as punctate blue-white spots on the bright red background of the buccal
.mucosa
The measles rash is a maculopapular eruption that usually lasts 5–6 days. It begins at the
hairline, then involves the face and upper neck. During the next 3 days, the rash gradually
proceeds downward and outward, reaching the hands and feet. The maculopapular lesions
are generally discrete, but may become confluent, particularly on the upper body. Initially,
lesions blanch with fingertip pressure. By 3–4 days, most do not blanch with pressure. Fine
desquamation occurs over more severely involved areas. The rash fades in the same order
.that it appears, from head to extremities
Complications include diarrhea, dehydration, stomatitis, inability to feed, and bacterial
.)infections (skin and elsewhere
Clinical case definition
Any person with fever and generalized maculopapular (non-vesicular) rash and cough,
coryza (i.e. runny nose) or conjunctivitis (i.e. red eyes). OR
.Any person in whom a clinical health worker suspects measles infection
Case classification
Clinically confirmed: a case that meets the clinical case definition
Laboratory confirmed: (only for outbreak confirmation and during the elimination phase): A
case that meets the clinical case definition and is laboratory confirmed (presence of
measles-specific IgM antibodies); A case meeting clinical definition and epidemiologically
linked by direct contact to a laboratory-confirmed case in which rash onset occurred 7-18
.days earlier
Infectious agent 1.11.1
)Measles virus (genus Morbillivirus, family Paramyxoviridae
Occurrence 1.11.1
. Measles in Iraq
1222
1211
1222
1212
121 12112
1211
1222
2121
1222
1222
1221
112
121
222
1221
2221
1221
1221
-
-
1222
1222
Year
212 Cases
.In temperate areas, measles disease occurs primarily in late winter and spring
Reservoir 1.11.1
.Humans. Asymptomatic carrier state has not been documented
Mode of transmission 1.11.2
Airborne by droplet spread; or
•
Direct contact with the nasal and throat secretions of infected persons or via object
(e.g. toys) that has been in close contact with an infected person
Incubation period 1.11.2
•
After infection there is an asymptomatic incubation period of 10-12 days, with a range from
.7 to 18 days from exposure to the onset of fever
Period of communicability 1.11.2
.Measles is most infectious from 4 days before the rash until 1-2 days after rash onset
Susceptibility and resistance 1.11.2
Measles is highly contagious one person can infect 90% of the people close to that person
who are not immune. Measles is more severe in malnourished children, particularly those
.with vitamin A deficiency. The case-fatality rate may be as high as 25%
Methods of control 1.11.2
a Preventive measures1.11.2
Iraq has a routine immunization policy which requires a dose of single antigen measles
vaccine at 9 months, a dose of MMR (measles-mumps-rubella vaccine) at 15 months, and
another dose of MMR at school entry. However, supplementary measles immunization
.campaigns may be required in order to reduce the risk of a measles outbreak
b Control measures1.11.2
For uncomplicated cases: Give Vitamin A immediately upon diagnosis and ensure the child
receives a second dose the next day (can be given to mother to administer at home). Advise
.)the parent to treat the child at home (control fever and provide nutritional feeding
For cases with non-severe eye, mouth or ear complications: Children can be treated at
home. Give Vitamin A immediately upon diagnosis and ensure that the child receives a
second dose the next day (can be given to mother to administer at home). If pus draining
from the eyes, clean eyes and treat with 1% tetracycline eye ointment. If mouth ulcers, treat
with gentian violet. If pus draining from the ear, clean ear discharge and treat with
antibiotics for 5 days (amoxycillin –1st line- or cotrimoxazole-2nd line-, as per national ARI
policy and IMCI guidelines). Treat malnutrition and diarrhea, if present, with sufficient fluids
.and high quality diet
For cases with severe, complicated measles (any general danger signs, clouding of cornea,
deep or extensive mouth ulcers, pneumonia): Refer urgently to hospital. Treat pneumonia
with an appropriate antibiotic. If clouding of the cornea or pus draining from the eye, clean
eyes and apply 1% tetracycline eye ointment. If the child has any eye signs indicating
Vitamin A deficiency (i.e. night blindness, Bitôt spots, conjunctival and corneal dryness,
corneal clouding or corneal ulceration), then he or she should receive a third dose of Vitamin
.A 2-4 weeks later
c Epidemic measures1.11.2
.Inform the Health Authorities if one or more suspected cases are identified
.Confirm the suspected outbreak, following WHO guidelines
•
•
•
Investigate suspected case: check if it fulfills the case definition, record date of
.onset, age and vaccination status
.Confirm the diagnosis: collect blood specimen from 3-5 initial reported cases
.Assess the extent of the outbreak and the population at risk
:Implement outbreak response measures
•
•
•
Give priority to proper case management and immunization of groups at highest risk
o
(e.g. children 6 months – 5 years) as soon as possible in neighboring areas not yet affected
.by the outbreak and where the outbreak is likely to spread
Promote social mobilization of parents in order to assure previously unvaccinated
.children 6 months – 5 years of age are immunized
o
The presence of several cases of measles in an emergency setting does not preclude
o
a measles immunization campaign. Even among individuals who have already been exposed
to, and are incubating the natural virus, measles vaccine, if given within three days of
.exposure, may provide protection or modify the clinical severity of the illness
Isolation is not indicated and children should not be withdrawn from feeding
.programs
o
Management of the disease 1.11.12
Severe complications from measles can be avoided though supportive care that
ensures good nutrition, adequate fluid intake and treatment of dehydration with WHOrecommended oral rehydration solution. This solution replaces fluids and other essential
elements that are lost through diarrhea or vomiting. Antibiotics should be prescribed to
.treat eye and ear infections, and pneumonia
All children in developing countries diagnosed with measles should receive two
doses of vitamin A supplements, given 24 hours apart. This can help prevent eye damage
and blindness. Vitamin A supplements have been shown to reduce the number of deaths
.from measles by 50%