Measles

Definition:

Also known as Rubeola, an acute highly communicable infection characterized by fever, rashes and symptoms referable to upper respiratory tract; the eruption is preceded by about 2 days or coryza, during which stage grayish pecks (Koplik spots) may be found on the inner surface of the cheeks. A morbilliform rash appears on the 3rd or 4th day affecting face, body and extremities ending in branny desquamation.

Death is due to complication (e.g. secondary pneumonia, usually in children under 2 years old. Measles is severe among malnourished children with fatality of 95-100%. Infection confers life-long immunity.

Etiologic Agent: Filterable virus of Measles

Source of Infection: Secretion of nose, mouth and throat of infected persons.

Modes of Transmission:

1. Directly - by being sprayed with droplets emanating from a cough or sneeze
2. Indirectly - with articles newly contaminated with respiratory secretions from a patient.
3. Probably Airborne

• Incidence peak age is about 1-5 years old in congested urban areas and at early school age in less crowded sections.
• Immunity from the disease is long lasting while passive immunity transmitted transplacentally from mothers who have had measles may last about 5-6 months. The live attenuated vaccine confers almost lifelong immunity while the inactivated antigen gives an immunity 0f 6-18 months.
• Recent data suggests that cases is on the rise again in the United States and Canada due to the unsubstantiated claim that measles vaccine is associated with autism. In fact, various studies by government and non-government agencies disputing these claims.

Incubation Period:

• 10-12 days; one attack usually confers a lasting immunity
• 8 days shortest; 20 days longest

Period of Communicability:

• During the period of coryza or catarrhal symptoms - 9 days (from 4 days before and 5 days after rash appears)

Clinical Manifestations:

1. Pre-eruptive Stage
   • patient is highly communicable
   • fever
   • catarrhal symptoms - start in the nasal cavities; then in the conjunctivae, oropharynx, progress to the bronchi resulting successively in rhinitis, conjunctivitis and then bronchitis.
   • Respiratory symptoms - which appear first as a common cold, and sneezing nasal discharges, steadily progress into a distressing and annoying cough that persists up to convalescence.
2. Eruptive Stage/Stage of Skin Rashes
   • exanthem sign - means eruption in the skin
     • Maculopapular Rashes - appears 2-7  days after onset
     • With high fever - increases steadily
     • Anorexia and irritability - are disturbing particularly at the height of the fever
     • Diarrhea, pruritis, lethargy and occipital lymphadenopathy
3. Stage of Convalescence
   • Rashes - fade in the same manner as they appeared, from the face downwards, leaving a dirty brown pigmentation and finely granular which maybe noted for several days.
   • Fever - gradually subsides as the eruptions disappear on the hands and feet

Tests:

• Usually none (most diagnosis is based clinically)
• Measles serology
• Viral culture (rarely done)

Treatment:

No therapy is indicated for uncomplicated measles, Gamma globulin although effective in prophylaxis is no value once symptoms are evidence. Patient should be monitored for the development of bacterial infections which should be treated with appropriate antibiotics on the basis of clinical and bacteriological findings.

The patient may also take over-the-counter medications such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve the fever that accompanies measles. Don’t give aspirin to children because of the risk of Reye’s syndrome — a rare but potentially fatal disease.

Maintain bedrest and provide quiet activities for the child. If there is sensitivity to light, keep room darkly lit. Remove eye secretions with warm saline or water. Encourage the patient not to rub the eyes. Administer antipyretic medication and tepid sponge baths as ordered. A cool mist vaporizer can be used to relieve cough. Apply antipruritic medication to prevent itching. Isolate child until fifth day of rash.


Prognosis


Prognosis is very good specially for those who do not develop complications like bronchitis, encephalitis (1 of 1000 cases), ear infections and pneumonia.

Methods of Prevention and Control

1. Avoid exposing children to any person with fever or with acute catarrhal symptoms
2. Isolation of cases from diagnosis until about 5-7 days after onset of rash
3. Disinfection of all articles soiled with secretion of nose and throat
4. Encourage by health department and by private physician of administration of measles immune globulin to susceptible infants and children under 3 years of age in families or institutions where measles occurs.
5. Live attenuated and inactivated measles virus vaccines have been tested and are available for use in children with no history of measles, at 9 months of age or soon thereafter

Public Health Nursing Responsibilities

1. Emphasize the need for immediate isolation when early catarrhal symptoms appear .
2. If immune serum of globulin is available (gamma Globulin), explain this to the family and refer to physician or clinic giving this service.
3. Observe closely the patient for complications during and after the acute stage.
4. Teach, demonstrate, guide and supervise adequate nursing care indicated.
5. Explain proceedings in proper disposal of nose and throat discharges.
6. Teach concurrent and terminal disinfection.

Nursing Care

1. Protect eyes of patients from glare of strong light as they are apt to be inflamed.
2. Keep the patient in an adequately ventilated room but free from drafts and chilling to avoid complications of pneumonia.
3. Teach, guide and supervise correct technique of giving sponge bath for comfort of patient.
4. Check for corrections of medication and treatment prescribed by physician.