measles

Measles Saber AlZahraniSalem AlAnaziOctober 14, 2016

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Outlines

• Introduction.• History of Measles.• Etiology.• Virulence factors.• Signs and symptoms.• Epidemiology.• Transmission.• History of measles vaccine development.• Measles vaccine• Elimination Plan 2012-2020 • Outbreaks.• Treatment. • Complication.

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Measles-Introduction

Acute highly infectious viral disease , mainly affect children Also known as Rubeola Characterized by fever and respiratory symptoms followed

by typical rash. Associated with high morbidity and mortality in developing

countries.

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Outlines• Introduction.• History of Measles.• Etiology.• Virulence factors.• Signs and symptoms.• Epidemiology.• Transmission.• History of measles vaccine development.• Measles vaccine• Elimination Plan 2012-2020 • Outbreaks.• Treatment. • Complication.• MMR/autism.

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History of Measles

The first written description of measles provided in the 10th century by physician, Ibn Razi (Rhazes) who referred to the disease as hasbah, the Arabic word for “eruption.”

The term “Rubeola,” a Latin word, was first used to describe the disease in the Middle Ages.

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History of Measles

17th century Thomas Sydenham, “the father of English medicine,” described the clinical characteristics of measles.

In 1757, Francis Home, a Scottish physician first attempts at vaccination against measles in a manner similar to that of smallpox. He believed that measles is caused by infectious agent present in the blood.

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Etiology

The measles Virus(Genus: Morbillivirus)

Enveloped spherical virus Single stranded RNA virus.Only one serotype is knownNo animal reservoir.

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Virulence factors

1-Attachment: Hemagglutinin protein binds to CD46, a glycoprotein

found on the surface of most cells.

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Virulence factors(cont.)

2.Evade the immune system: The F (fusion) “Fusion Protein” is responsible for fusion of virus and host cell membranes.Immunosuppression: The measles virus blocks T H proliferation response to IL-2. –The measle’s Hemagglutinin protein and fusion proteins bind to lymphocytes and interrupt IL-2 cell signalling.

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Virulence factors(cont.)

3.Destruction of tissue:The maculopapular rash, which starts at the hairline and spreads over the whole body, is caused by immune T cells targeted to the infected endothelial cells of the small blood vessels. T-cell deficient individuals do not have the rash, but do have uncontrolled disease which usually results in death.the damage, as well as the control of the disease, is mostly caused by the immune system.

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Signs and symptoms

• The symptoms of measles generally appear about 7-14 days after a person is infected.• Measles typically begins with

• high fever,• cough,• runny nose (coryza), and• red, watery eyes (conjunctivitis)

• 2-3 days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth.

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Signs and symptoms (cont.)

• 3-5 days after symptoms begin, a rash breaks out. • It usually begins as flat red spots that appear on the

face at the hairline . • Rash than spread downward to the neck, trunk, arms,

legs, and feet. • When the rash appears, a person's fever may spike to

more than 40 C°.• After a few days, the fever drop and the rash fades

Skin of a patient after 3 days of measles infectionhttp://www.cdc.gov/measles/about/signs-symptoms.html

(Courtesy of J.H. Brien.)

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Signs and symptoms (cont.) 16

Outlines• Measles-Introduction.• History of Measles.• Etiology.• Virulence factors.• Signs and symptoms.• Epidemiology.• Transmission.• History of measles vaccine development.• Measles vaccine• Elimination Plan 2012-2020 • Outbreaks.• Treatment. • Complication.• MMR/autism.

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Epidemiology

• Measles is endemic throughout the world.• Before the availability of the vaccine, measles infected over

90% of children before they reached 15 years of age. • 2 million deaths and between 15,000 and 60,000 cases of

blindness annually worldwide• In the past, epidemics tended to appear in the spring in

large cities at 2-4-yr intervals as new groups of susceptible children were exposed.

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Transmission

• Direct contact by droplets spread through coughing or sneezing.

• Indirectly through fomites freshly contaminated with

respiratory secretions of infected patients.

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Transmission(cont.) 21


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History of measles vaccine development

• In 1954, John Enders and his pediatric fellow Dr. Thomas Peebles collected throat swap and blood samples from several ill students during a measles outbreak in Boston, Massachusetts. • They aim to isolate the measles virus and create a measles vaccine.

• They succeeded in isolating measles virus in 13-year-old David Edmonston.

• This strain of the virus was name as Edmonston strain in honour of the young student from whom the virus was initially isolated.

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History of measles vaccine development

• The Edmonston strain became the basis for the measles vaccines for many years.• In 1963, John Enders and colleagues transformed their Edmonston-B

strain of measles virus into a vaccine and licensed it in the United States 1963• discontinued in 1967 . has short-lived and incomplete immunity and

placed many recipients at risk for atypical measles infection.• Further attenuation of Edmonston strain developed two vaccines : • Moraten vaccine in 1968 in the US• Schwarz vaccine in 1965 most world countries

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Measles vaccine

• Measles vaccine is live attenuated vaccine.• usually combined with mumps and rubella (MMR) or

combined with mumps, rubella and varicella (MMRV)• Two doses of vaccine are recommended for children, and

for adults at high risk of exposure, health care workers and school personnel.• 1st dose at 12 months of age.• 2nd dose 18 months or 4–6 years of age before entry to

school.• People born before 1956 are considered immunised.

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Measles vaccine (con.) • The efficacy of 1 dose at 12 months of age is about 95%, whereas 2

doses provide immunity in 99% of recipients.

• Common Side Effects of MMR Vaccine• Sore arm from the shot• Fever• Mild rash• Temporary pain and stiffness in the joints.

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Measles vaccine (con.)Who should not get vaccinated ?

1. Pregnant women

2. Children with primary immunodeficiency

3. Untreated tuberculosis, cancer, or organ transplantation

4. Those receiving long-term immunosuppressive therapy

5. severely immunocompromised HIV-infected children

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Measles vaccine (con.)

• HIV-infected children without: 1. Severe immunosuppression. 2. Evidence of measles immunity. may receive measles vaccine.

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Measles vaccine (con.)Adverse reactions associated with LAVs 30

http://vaccine-safety-training.org/live-attenuated-vaccines.html


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Number of estimated measles death (in thousands) globally 2000-2010

Measles is considered the leading cause of death among children around the world

Source: WHO global measles & rubella strategic plan

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Global Measles and Rubella Strategic Plan 2012-2020

• In 2012, the M&R Initiative launched a new Global Measles and Rubella

Strategic Plan which covers the period 2012-2020.

• The Plan provides clear strategies for country immunization managers,

working with domestic and international partners, to achieve the 2015

and 2020 measles and rubella control and elimination goals.

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Global Measles and Rubella Strategic Plan 2012-2020 (cont.)

• By the end of 2015 the plan aims: • to reduce global measles deaths by at least 95% compared

with 2000 levels;• to achieve regional measles and rubella elimination goals.• By the end of 2020 the plan aims:• to achieve measles and rubella elimination in at least 5

WHO regions

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Outbreaks 36

Outbreaks 37

• On 20 March 2014, • the World Health Organization (WHO) announced that measles elimination had

been achieved by Australia.• 2015 (74 cases).

Outbreaks 38


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Treatment

• No specific antiviral treatment exists for measles virus.

• Isolation for 7 days after the onset of rash.

• Severe complications can be avoided through :1. Adequate fluid intake.2. Treatment of dehydration with WHO-recommended oral rehydration solution. 3. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia. 4. All children in developing countries diagnosed with measles should receive two doses of

vitamin A supplements (to restores low vitamin A levels during measles that occur ) . This can help prevent eye damage and blindness. -Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%

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Complication Corneal scarring causing blindnessVitamin A deficiency

(Common) EncephalitisOlder children, adults

≈ 0.1% of cases

Chronic disability

Pneumonia &Diarrhea (Common)

Diarrhea common in developing countries

Pneumonia ~ 5-10% of cases, usually bacterial

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MMR/autism controversy in 1997

• Following publication of studies claiming an association between natural and vaccine strains of measles virus and autism.

• WHO, commissioned a literature review by an independent researcher of the risk of autism associated with MMR vaccine

• The Global Advisory Committee on Vaccine Safety (GACVS) concluded that no evidence exists of a causal association between MMR vaccine and autism.

• Thus, WHO recommends that there should be no change in current vaccination practices with MMR.

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Laboratory diagnosis

NOSE AND THROAT SWAB

URINALYSIS

BLOOD EXAMS

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References: • Ani, Saad S Al. 2016. "Measles (Rubeola) ".• Artenstein, Andrew W. 2009. Vaccines: A Biography: Springer Science & Business Media.• Baker, Jeffrey P. 2011. "The First Measles Vaccine." Pediatrics 128 (3): 435-437. doi: 10.1542/peds.2011-1430.• Prevention, Centers for Disease Control and. 2016. Measles Vaccination. Accessed 6/10/2016, • Desai, Shalini, Amanda Shane, and Rosamund Lewis. 2012. "Measles." CMAJ : Canadian Medical Association

Journal 184 (16): 1811-1811. doi: 10.1503/cmaj.111574.• Jakab, Zsuzsanna, and David M. Salisbury. "Back to Basics: The Miracle and Tragedy of Measles Vaccine." The

Lancet 381 (9876): 1433-1434. doi: http://dx.doi.org/10.1016/S0140-6736(13)60908-3.• Mbbs, Siva. 2012. "Measles Elimination." • MacFadden, Derek R., and Wayne L. Gold. 2014. "Measles." CMAJ : Canadian Medical Association Journal 186 (6): 450-450. doi: 10.1503/cmaj.130958.• Omer, Saad B., Girish S. Hiremath, and Neal A. Halsey. 2010. "Respiratory Administration of Measles Vaccine."

The Lancet 375 (9716): 706-708. doi: http://dx.doi.org/10.1016/S0140-6736(09)62028-6.• Organization, World Health. 2012. "Global Measles and Rubella Strategic Plan: 2012–2020. 2012." Report No.:

ISBN 978 (92): 4. • World Health Organization 2016. Measles. WHO. http://www.who.int/mediacentre/factsheets/fs286/en/.• P.Gourisankaran. 2013. "Measles.“• Patil, Rajkumar. 2016. "Measles, Mumps &Rubella (Mmr).“• Sapon, Divine Grace P. 2013. "Measles."

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http://dx.doi.org/10.1016/S0140-6736(13)60908-3

http://dx.doi.org/10.1016/S0140-6736(09)62028-6

http://www.who.int/mediacentre/factsheets/fs286/en/

measles

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