Measles- an acute childhood infectious disease caused by a virus.
Background
Transmission- airborne transmission and respiratory droplets e.g. coughing and sneezing
Symptoms
Reference-
Affects people of all ages but most common infants <1yr old and immunocompromized people
morbillivirus of the paramyxovirus family.
incubation period 10-14 days with a further 2–4 days of prodromal symptoms (including malaise, fever, and cough) before the characteristic skin rash develops.
Complications
CNS - convulsions, Encephalitis, blindness, Subacute sclerosing panencephalitis (SSPE)
GI- diarrhoea
2⁰ infection- Otitis media, Pneumonitis, Tracheobronchitis, Pneumonia
Adults, immunocompromized, chronically ill and malnourished children most susceptible to complications
approx 10-20% occur in developed countries
pregnancy- risk of miscarriage
Diagnosis
Differential
Herpes virus type 6 (roseola infantum)
Rubella
Streptococcal infection (for example scarlet fever)
Early meningococcal disease
Parvovirus B19
Kawasaki disease
infectious mononucleosis.
Hx of symptoms- cough and coryzal symptoms, and conjunctivitis, and fever of 39ºC or more without antipyretics, and maculopapular rash.
immunization history and travel hx, family hx
contact history- contact public health to identify if an outbreak
Fever increases during the prodromal phase to around 39ºC at about the time the rash appears, and then gradually decreases.
Koplik's spots may appear on the buccal mucosa at the end of the prodromal phase, around the same time as the rash, and disappear over the next couple of days. These consist of 2–3 mm red spots with white or blue-white centres
Prodromal phase- occurs 10–12 days after contracting the infection. Lasts for 2–4 days before the rash becomes apparent. Symptoms include increasing fever, malaise, cough, rhinorrhoea, and conjunctivitis
The rash is erythematous and maculopapular and may become confluent as it progresses.It appears on the face and behind the ears first (when other symptoms tend to be at their most severe), before descending down the body to the trunk and limbs, and forming on the hands and feet last, over the course of about 3–4 days. The rash fades after it has been present on an area for about 5 days, with the total duration of rash being up to 1 week, after which time the person should feel better.
exclude any differentials
report to public health- notifiable disease
Management
if person under 1, pregnant or immunocompromized seek immediate advice
usually self limiting- fluids, rest, paracetamol or brufen for symptom relief
avoid school or work for at least 4 days after rash but ideally to fully recover
avoid contact with susceptible people
safety netting if complications develop e.g SOB, convulsions, uncontrolled fever
information leaflet provided on measles
support and advise to attend for immunizations
Referral
if develops serious complications
advise hospital prior to admission of diagnosis, to prepare for isolation
people over 1, not immuncompromized or pregnant, has no contraindications to MMR and are susceptible to measles, offer immediate vaccination
Ideally, the MMR vaccine should be given within 3 days of contact with a possible case of measles and repeated after an interval of at least one month.
children younger than 18 months old when they receive the second dose, and this is within 3 months of the first dose, the routine pre-school dose (i.e. a third dose) should still be given.
children younger than 12 months of age when they receive their first dose, two further doses will be required at the normal ages in accordance with the Childhood Immunization Programme.