Measles

Clinical features: Measles is a serious respiratory infection. It is characterized by prodrome fever (up to 105 ° F) as well as malaise, cough, coryza, and conjunctivitis - three “C” -, pathognomonic patches (Koplik spots) followed by the icon maculopapular rash external. The rash usually appears about 14 days after exposure. The rash spreads from the head to the trunk to the lower extremities. Patients are considered infectious diseases from 4 days before 4 days after the onset of the rash. Significantly, sometimes immune compromised patients do not have a rash. The virus: Measles is caused by a single-row, coagulated RNA virus with 1 serotype. It is classified as a member of the Morbillivirus genus in the family Paramyxoviridae. Humans are the only germs in the measles virus. Background: In the decade before the livelihoods of the live measles vaccine were approved in 1963, an average of 549,000 people were infected with measles, and 495 deaths each year in the United States. It is estimated, however, that an estimated three to four million people get measles each year; most cases have not been reported. Of these reported cases, approximately 48,000 people were hospitalized for measles and 1,000 people became chronically disabled due to acute encephalitis caused by measles each year. In 2000, it was announced that measles was eradicated in the United States. Termination is defined as the absence of transmission of measles virus in a specified area, such as a region or country, for 12 months or more with an effective monitoring system. However, measles and mumps outbreaks occur every year in the United States as measles spreads to many parts of the world, including Europe, the Middle East, Asia, the Americas, and Africa. Since 2000, when the measles outbreak was announced in the US, the annual number of cases has dropped from just under 37 in 2004 to 1,282 in 2019. The majority of cases in the United States were between unprotected individuals. Measles infections occur as a result of importation by people who were infected with the virus while in other countries as well as potential infections in those exports. Measles is more likely to spread and cause the emergence of communities where groups of people are not vaccinated. Outbreaks appear to be exacerbated during the Americas' recent exposure to measles and mumps. In recent years, measles outbreaks have appeared in more frequently visited countries, including, but not limited to, the Philippines, Ukraine, Israel, Thailand, Vietnam, England, France, Germany, and India, where major outbreaks have been reported.

Complications: Common complications of measles include otitis media, bronchopneumonia, laryngotracheobronchitis, and diarrhea. Even in healthy children before, measles can cause serious illness that requires hospitalization. One in 1,000 people with measles will have acute encephalitis, which often results in permanent brain damage. One in three children out of every 1,000 infected with measles will die from respiratory and neurological problems.

The external iconic Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal debilitating neurological disorder characterized by deteriorating behavioral and cognitive impairment and seizures that usually occur 7 to 10 years after a measles infection.

People at high risk of complications: People at high risk of serious illness and measles problems include: Newborns less than 5 years of age, adults over the age of 20, pregnant women, people with compromised immune systems, such as leukemia, and HIV infection. Transmission: Measles is one of the most contagious diseases; Up to 9 out of 10 people who are easily infected close to a measles patient will develop measles. The virus is transmitted through direct contact with infectious droplets or airborne pathogens when an infected person breathes, coughs, or sneezes. The measles virus can remain airborne for up to two hours after the infected person has left the area.

Laboratory and diagnostic tests: Health care providers should consider measles in patients with fever and clinical symptoms associated with measles, especially if the person has recently traveled internationally or has been exposed to a person with the febrile rash. Healthcare providers are required to report suspected measles cases to the local health department. Laboratory verification is important for all rare measles cases and all outbreaks. IgM antibody detection in serum and measles RNA by real-time polymerase chain reaction (RT-PCR) in the respiratory model are the most common ways to confirm measles infection. Healthcare providers should receive both a serum sample and a throat swab (or nasopharyngeal swab) from patients suspected of having measles when they first come in contact with them. Urine samples may also contain the virus, and if possible, collecting both respiratory and urine samples may increase the chances of contracting the measles virus. Cellular analysis can also be performed to determine the type of measles virus. Genotyping is used to design methods for transmitting the measles virus. Genetic data can help link or remove linking cases and can raise the source of imported cases. Genotyping is the only way to differentiate between wild-type measles virus and outbreaks caused by recent measles vaccinations.

Evidence of Immunity: Acceptable evidence of measles protection includes at least one of the following: written documentation of adequate vaccination: one or more doses of measles vaccine used on or after the first birthday of kindergarten children and adults, two doses of measles vaccine against school-age children and high-risk adults, including college students, health workers, and international travelers, laboratory evidence for the immune system *, verification of measles in the laboratory, was born before 1957. Healthcare providers and health departments should not accept oral reports of vaccinations without written documentation as proof of vaccination. Vaccination: Measles can be prevented with a measles vaccine, which is widely used as a combination vaccine for measles-mumps-rubella (MMR). The measles-mumps vaccine-rubella-varicella (MMRV) vaccine can be used in children aged 12 to 12 months to protect against measles, mumps, rubella, and varicella. A measles vaccine with one antigen is not available. One dose of MMR vaccine is approximately 93% effective in measles prevention; two doses are approximately 97% effective. Almost anyone who does not respond to the measles portion of the first dose of MMR vaccine aged 12 months or older will respond to the second dose. Therefore, the second dose of MMR is given to deal with primary immunization failure.

Vaccine recommendations: Children: The CDC recommends standard childhood immunizations for the MMR vaccine starting with the first dose at 12 to 15 years of age, and the second dose at 4 to 6 years or at least 28 days following the first dose. The measles-mumps-rubella-varicella (MMRV) vaccine is available for children from 12 months to 12 years of age; the minimum time between doses is three months. Students in post-secondary education institutions: Post-secondary school students without proof of measles vaccine require two doses of the MMR vaccine, the second dose being given no later than 28 days after the first dose. Adults: People born in 1957 or later who have no evidence of measles vaccination should receive at least one dose of the MMR vaccine. International travelers: People 6 months or older who will be traveling internationally should be protected from measles. Before international travel infants, 6 to 11 months of age should receive a single dose of the MMR vaccine.  Babies 12 months or older should have the dosage of 2 doses of the MMR vaccine (the first dose of the MMR vaccine should be given if they are 12 months or older; the second dose is within 28 days after the first dosage). Adolescents and adults born during or after 1957 without evidence of measles protection should have the dual dosage of the MMR vaccine, a second dose given within 28 days after the first dose. Infants who receive one dose of the MMR vaccine before their first birth should receive two additional doses according to the usually recommended schedule (one dose at 12 to 15 months of age and one dose at 4 to 6 years of age or at least 4 days). The measles-mumps-rubella-varicella (MMRV) vaccine is also available for children from 12 months to 12 years. If used in place of the MMR vaccine, the first dose should be given 12 months or more, and the second dose within three months after the first dose. MMRV should not be given to anyone older than 12 years.

Samina Zaheer (Health Tips, Health Care).