Measles: Difference between revisions
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The characteristic measles rash is classically described as a generalized, [[maculopapular]], [[erythematous]] rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing [[itch]]ing. The rash is said to "stain", changing colour from red to dark brown, before disappearing.{{Fact|date=February 2008}} |
The characteristic measles rash is classically described as a generalized, [[maculopapular]], [[erythematous]] rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing [[itch]]ing. The rash is said to "stain", changing colour from red to dark brown, before disappearing.{{Fact|date=February 2008}} |
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== Headline text == |
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==Diagnosis and treatment== |
==Diagnosis and treatment== |
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Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three ''C''s. Observation of [[Koplik's spots]] is also diagnostic of measles. |
Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three ''C''s. Observation of [[Koplik's spots]] is also diagnostic of measles. |
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Some patients will develop [[pneumonia]] as a sequela to the measles. Histologically, a unique cell can be found in the paracortical region of hyperplastic lymph nodes in patients affected with this condition. This cell, known as the [[Warthin-Finkeldey cell]], is a multinucleated giant with eosinophilic cytoplasmic and nuclear [[Inclusion bodies|inclusions]].{{Fact|date=March 2008}} |
Some patients will develop [[pneumonia]] as a sequela to the measles. Histologically, a unique cell can be found in the paracortical region of hyperplastic lymph nodes in patients affected with this condition. This cell, known as the [[Warthin-Finkeldey cell]], is a multinucleated giant with eosinophilic cytoplasmic and nuclear [[Inclusion bodies|inclusions]].{{Fact|date=March 2008}} |
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and you can also have aids |
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==Transmission== |
==Transmission== |
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Revision as of 17:47, 13 June 2008
| Measles | |
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| Specialty | Infectious diseases  |
| Measles virus | |
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| Measles virus | |
| Virus classification | |
| Group: | Group V ((−)ssRNA)
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| Genus: | |
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| Measles virus | |
Measles, also known as rubeola, is a disease caused by a virus, specifically a paramyxovirus of the genus Morbillivirus.
Measles is spread through respiration (contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing a house with an infected person will catch it[citation needed]. Airborne precautions should be taken for all suspected cases of measles.
The incubation period usually lasts for 4–12 days (during which there are no symptoms). Infected people remain contagious from the appearance of the first symptoms until 3–5 days after the rash appears.
Reports of measles go as far back to at least 600 B.C. however, the first scientific description of the disease and its distinction from smallpox is attributed to the Persian physician Ibn Razi (Rhazes) 860-932 who published a book entitled "The Book of Smallpox and Measles" (in Arabic: Kitab fi al-jadari wa-al-hasbah). In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide.[1] In 1954, the virus causing the disease was isolated from an 11-year old boy from the US, David Edmonston, and adapted and propagated on chick embryo tissue culture.[2] To date, 21 strains of the measles virus have been identified.[3] Licensed vaccines to prevent the disease became available in 1963.
German measles is an unrelated condition caused by the rubella virus.
Symptoms
The classical symptoms of measles include a fever for at least three days, the three Cs—cough, coryza (runny nose) and conjunctivitis (red eyes). The fever may reach up to 40° Celsius (104° Fahrenheit). Koplik's spots seen inside the mouth are pathognomonic (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.
The characteristic measles rash is classically described as a generalized, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing itching. The rash is said to "stain", changing colour from red to dark brown, before disappearing.[citation needed]
Headline text
Diagnosis and treatment
Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three Cs. Observation of Koplik's spots is also diagnostic of measles.
Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens. In cases of measles infection following secondary vaccine failure IgM antibody may not be present. In these cases serological confirmation may be made by showing IgG antibody rises by Enzyme immunoasay or complement fixation. In children, where phlebotomy is inappropriate, saliva can be collected for salivary measles specific IgA test.[citation needed]
Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis.
There is no specific treatment or antiviral therapy for uncomplicated measles. Most patients with uncomplicated measles will recover with rest and supportive treatment.
Some patients will develop pneumonia as a sequela to the measles. Histologically, a unique cell can be found in the paracortical region of hyperplastic lymph nodes in patients affected with this condition. This cell, known as the Warthin-Finkeldey cell, is a multinucleated giant with eosinophilic cytoplasmic and nuclear inclusions.[citation needed] and you can also have aids
Transmission
The measles is a highly contagious airborne pathogen which spreads primarily via the respiratory system. The virus is transmitted in respiratory secretions, and can be passed from person to person via aerosol droplets containing virus particles, such as those produced by a coughing patient. Once transmission occurs, the virus infects the epithelial cells of its new host, and may also replicate in the urinary tract, lymphatic system, conjunctivae, blood vessels, and central nervous system.[4]
Patients with the measles should be placed on droplet precautions.
Humans are the only known natural hosts of measles, although the virus can infect some non-human primate species.
Complications
Complications with measles are relatively common, ranging from relatively mild and less serious diarrhea, to pneumonia and encephalitis (subacute sclerosing panencephalitis), corneal ulceration leading to corneal scarring[5] Complications are usually more severe amongst adults who catch the virus.
The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 percent are common. In immunocompromised patients, the fatality rate is approximately 30 percent.
Public health
Measles is a significant infectious disease because, while the rate of complications is not high, the disease itself is so infectious that the sheer number of people who would suffer complications in an outbreak amongst non-immune people would quickly overwhelm available hospital resources. If vaccination rates fall, the number of non-immune persons in the community rises, and the risk of an outbreak of measles consequently rises.
In developed countries, most children are immunized against measles by the age of 18 months, generally as part of a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than this because children younger than 18 months usually retain anti-measles immunoglobulins (antibodies) transmitted from the mother during pregnancy. A "booster" vaccine is then given between the ages of four and five. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune. In developing countries, measles remains common.
Unvaccinated populations are at risk for the disease. After vaccination rates dropped in northern Nigeria in the early 2000s due to religious and political objections, the number of cases rose significantly, and hundreds of children died.[6] A 2005 measles outbreak in Indiana was attributed to children whose parents refused vaccination.[7] In the early 2000s the MMR vaccine controversy in the United Kingdom regarding a potential link between the combined MMR vaccine (vaccinating children from mumps, measles and rubella) and autism prompted a comeback in the measles party, where parents deliberately infect the child with measles to build up the child's immunity without an injection. This practice poses many health risks to the child, and has been discouraged by the public health authorities.[8] Scientific evidence is mixed for the hypothesis that MMR plays a role in causing autism.[9][10] However, the MMR scare in Britain caused uptake of the vaccine to plunge, and measles cases came back: 2007 saw 971 cases in England and Wales, the biggest rise in occurrence in measles cases since records began in 1995.[11]
According to the World Health Organization (WHO), measles is a leading cause of vaccine preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by partners in the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the World Health Organization (WHO). Globally, measles deaths are down 60 percent, from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Africa has seen the most success, with annual measles deaths falling by 75 percent in just 5 years, from an estimated 506,000 to 126,000.[12]
The joint press release by members of the Measles Initiative brings to light another benefit of the fight against measles: "Measles vaccination campaigns are contributing to the reduction of child deaths from other causes. They have become a channel for the delivery of other life-saving interventions, such as bed nets to protect against malaria, de-worming medicine and vitamin A supplements. Combining measles immunization with other health interventions is a contribution to the achievement of Millennium Development Goal Number 4: a two-thirds reduction in child deaths between 1990 and 2015."[12]
Recent Outbreaks
Indigenous measles were declared to have been eliminated in North, Central, and South America; the last endemic case in the region was reported on November 12, 2002. [13] Outbreaks are still occurring, however, following importations of measles viruses from other world regions. In June 2006, there was an outbreak in Boston which resulted from a resident who had recently visited India.[14] In 2007, the country Japan has become a nidus for measles. Japan has suffered a record number of cases, and a number of universities and other institutions in the country have closed in an attempt to contain the outbreak.[15][16]Major outbreak of measles was registered in the beginning of 2008 in Israel. There were about 1000 cases of the decease since August 2007 and till May 2008 (in sharp contrast to just some dozen cases year before). Majority of infected are children from ultra-Orthodox families which refused vaccination. In Michigan in the fall of 2007, a confirmed case of measles occurred in a girl who had been vaccinated and who apparently contracted it overseas. There were at least 6 other suspected cases, all among children who had been vaccinated. There was outbreak having originated in Switzerland which has spread to countries such as Austria and the United States.[17] Between January 1 and April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported in the United States to the Centers for Disease Control and Prevention,[18], the most reported by this date for any year since 2001. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status.[19]
The largest outbreak in the United States so far this year is underway in Pima County, Arizona. 22 cases have been confirmed as of June 06, 2008. The outbreak began in mid-February. All Physicians and health care employees are now being required to be vaccinated. The outbreak has spread into Pinal County, Arizona where one infant has contracted the virus. The host carrier has been identified and all of the 22 people who have the measles in Arizona have been linked together.[20]
See also
References
- ^ Torrey EF and Yolken RH. 2005. Their bugs are worse than their bite. Washington Post, April 3, p. B01.
- ^ Live attenuated measles vaccine. EPI Newsl. 1980 Feb;2(1):6.
- ^ Rima BK, Earle JA, Yeo RP, Herlihy L, Baczko K, ter Muelen V, Carabana J, Caballero M, Celma ML, Fernandez-Munoz R 1995 Temporal and geographical distribution of measles virus genotypes. J Gen Virol 76:11731180.
- ^ Flint SJ, Enquist LW, Racaniello VR, and AM Skalka. Principles of Virology, 2nd edition: Molecular Biology, Pathogenesis, and Control of Animal Viruses.
{{cite book}}: Text "2004" ignored (help)CS1 maint: multiple names: authors list (link) - ^ http://www.iceh.org.uk/files/tsno4/resources/no04.doc
- ^ "Measles kills more than 500 children so far in 2005". IRIN. 2005-03-21. Retrieved 2007-08-13.
{{cite news}}: Check date values in:|date=(help) - ^ Parker A, Staggs W, Dayan G; et al. (2006). "Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States". N Engl J Med. 355 (5): 447–55. doi:10.1056/NEJMoa060775. PMID 16885548.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ Dillner L (2001-07-26). "The return of the measles party". Guardian. Retrieved 2007-08-13.
{{cite news}}: Check date values in:|date=(help) - ^ Rutter M (2005). "Incidence of autism spectrum disorders: changes over time and their meaning". Acta Paediatr. 94 (1): 2–15. PMID 15858952.
- ^ Singh V (2002). "Abnormal Measles-Mumps-Rubella Antibodies and CNS Autoimmunity in Children with Autism". J. Biomed. Sci. 9: 359–364.
- ^ Torjesen I (2008-04-17). "Disease: a warning from history". Health Serv J: 22–4. PMID 18533314.
- ^ a b UNICEF Joint Press Release
- ^ "paho.org". Retrieved 2007-12-05.
- ^ "Measles outbreak shows a global threat - The Boston Globe". Retrieved 2007-12-05.
- ^ "mdn.mainichi-msn.co.jp".
- ^ "The Public Health Agency of Canada Travel Advisory". Retrieved 2008-05-02.
- ^ JS Online: Measles outbreak brewing, city health officials say
- ^ "cdc.gov". Retrieved 2008-05-02.
- ^ "cdc.gov MeaslesUpdate". Retrieved 2008-05-02.
- ^ http://www.kold.com/Global/story.asp?S=8444616
http://www.columbiabasinherald.com/articles/2008/05/06/news/news02.txt
External links
- WHO.int - 'Initiative for Vaccine Research (IVR): Measles', World Health Organization (WHO)
- Measles FAQ from Centers for Disease Control and Prevention in the United States
- Case of an adult male with measles (facial photo)