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Download Measles ICD-10 B05 1.14.1 Identification Acute systemic viral
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Transcript
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%