MeaslesAn Introduction

Ron Waldman, MD, MPHProfessor of Global Health

Milken Institute School of Public HealthGeorge Washington University

National Press FoundationFebruary 23, 2015

Panum’s Observations

7,782 inhabitants No cases for 65 years 6,000 cases incubation period 10-14 days in affected villages, 19/20 fell ill older people spared (0/98) death: 23/1,000

Panum’s Observations

Of the 6,000 cases, “[t]here was not a single one in which it was justifiable to attribute the affection to a miasmatic origin, while at the same time it was everywhere clear that the disease had spread from man to man…”

Symptoms

10-14 days after exposure: fever cough runny nose sore throat conjunctivitis (Koplik’s spots) generalized rash – large, red blotchy spots

Stages of Measles

incubation period, after infection non-specific illness (prodrome) acute illness and rash phase recovery and convalescence

Complications of Measles

• Common– ear infection (1 in 10)– diarrhea (1 in 10)

• Severe– pneumonia (1 in 20)– encephalitis (1 in 1000) – convulsions, deafness– Blindness (was leading cause in children in 2004)– death (1 in 1000)

Long-term Complications of Measles

Sub-acute Sclerosing Panencephalitis (SSPE)

-- fatal-- develops 7-10 years following full recovery-- 4-11 cases/100,000 cases of measles

Measles -- Treatment

• Non-specific– hydration– food– analgesic, e.g., acetaminophen

• Vitamin A supplementation if indicated

Routes of Transmission of Communicable Diseases

• Airborne (no direct contact required)• Droplet• Sexual• Animal or insect• Food/water• Health care settings

"Sneeze" by James Gathany - CDC Public Health Image library ID 11162.

Herd Immunity (1)

Herd Immunity (2)

Major Causes of Death in Refugee Populations

Sudan: Wad Kowli CampFebruary, 1985

Somalia: Gedo Region, 7 Camps January, 1980

Source: Centers for Disease Control and Prevention, Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues. MMWR, 1992;41(No. RR-13):8.

MeaslesARIMalariaDiarrheaOther

Measles in the World, 2013• Measles is one of the leading causes of death among young children even

though a safe and cost-effective vaccine is available.

• In 2013, there were 145 700 measles deaths globally – about 400 deaths every day or 16 deaths every hour, but down from 2.6 million in 1980.

• Measles vaccination resulted in a 75% drop in measles deaths between 2000 and 2013 worldwide.

• In 2013, about 84% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000.

• During 2000-2013, measles vaccination prevented an estimated 15.6 million deaths making measles vaccine one of the best buys in public health.

Coverage with 1st dose of Measles-containing vaccine (line) and Measles case reports (bars), WHO Africa Region, 1980-2013

Pertussis: Global Trends and Vaccine Uptake

Berger S. Pertussis: Global Status 2013. www.gideononline.com/ebooks/disease

"Runderpest in Nederland 18e eeuw" by Jacobus Eussen - Henk Povée in:Tien eeuwen tussen Lek en IJssel, 2004 ISBN 90 6868 378 0. Licensed under Public Domain via Wikimedia