name | Measles |
---|---|
icd10 | |
icd9 | |
image width | 180 px |
diseasesdb | 7890 |
medlineplus | 001569 |
emedicinesubj | derm |
emedicinetopic | 259 |
emedicine mult | |
meshid | D008457 }} |
Measles (also sometimes known as English 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 living space with an infected person will catch it. An asymptomatic incubation period occurs nine to twelve days from initial exposure and infectivity lasts from two to four days prior, until two to five days following the onset of the rash (i.e. four to 9 days infectivity in total).
An alternative name for measles in English-speaking countries is rubeola, which is sometimes confused with rubella (German measles); the diseases are unrelated.
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 color from red to dark brown, before disappearing. The measles rash appears two to four days after initial symptoms, and lasts for up to eight days.
Between the years 1987 and 2000, the case fatality rate across the United States was three measles-attributable deaths per 1000 cases, or 0.3% (177 deaths / 67,032 cases). In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates have been as high as 28%.
Patients with the measles should be placed on respiratory precautions. It is believed that patients should always be isolated from populations until recovery is confirmed, such as several days after disappearance of rash and symptoms of complications.
Humans are the only known natural host of measles, although the virus can infect some other primate species.
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 patients where phlebotomy not possible, saliva can be collected for salivary measles-specific IgA testing. Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis. The contact with any infected person in any way, including semen through sex, saliva, or mucus, can cause infection.
In developing countries where measles is highly endemic, WHO doctors recommend two doses of vaccine be given at six and nine months of age. The vaccine should be given whether the child is HIV-infected or not. The vaccine is less effective in HIV-infected infants, but the risk of adverse reactions is low. Measles vaccination programs are often used to deliver other child health interventions, as well, such as bed nets to protect against malaria, antiparasite medicine and vitamin A supplements, and so contribute to the reduction of child deaths from other causes.
Unvaccinated populations are at risk for the disease. Traditionally low vaccination rates in northern Nigeria dropped further in the early 2000s when radical preachers promoted a rumor that polio vaccines were a Western plot to sterilize Muslims and infect them with HIV. The number of cases of measles rose significantly, and hundreds of children died.
Claims of a connection between the MMR vaccine and autism were raised in a 1998 paper in The Lancet, a respected British medical journal. Later investigation by Sunday Times journalist Brian Deer discovered the lead author of the article, Andrew Wakefield, had multiple undeclared conflicts of interest, and had broken other ethical codes. The Lancet paper was later retracted, and Wakefield was found guilty by the General Medical Council of serious professional misconduct in May 2010, and was struck off the Medical Register, meaning he could no longer practise as a doctor in the UK. The research was declared fraudulent in 2011 by the BMJ. Scientific evidence provides no support for the hypothesis that MMR plays a role in causing autism.
In January 2010, a study of Polish children found vaccination with the measles, mumps, and rubella vaccine was not a risk factor for development of autistic disorder; in fact, the vaccinated patients had a slightly reduced risk of autistic disorder, although the mechanism of action is unknown, and the result may have been coincidental. The autism-related MMR study in Britain caused use 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. A 2005 measles outbreak in Indiana was attributed to children whose parents refused vaccination.
Some patients will develop pneumonia as a sequel to the measles. Other complications include ear infections, bronchitis, and encephalitis. Acute measles encephalitis has a mortality rate of 15%. While there is no specific treatment for measles encephalitis, antibiotics are required for bacterial pneumonia, sinusitis, and bronchitis that can follow measles.
All other treatment addresses symptoms, with ibuprofen, or acetaminophen (paracetamol) to reduce fever and pain and, if required, a fast-acting bronchodilator for cough. As for aspirin, some research has suggested a correlation between children who take aspirin and the development of Reye's syndrome. Some research has shown aspirin may not be the only medication associated with Reye's, and even antiemetics have been implicated, with the point being the link between aspirin use in children and Reye's syndrome development is weak at best, if not actually nonexistent. Nevertheless, most health authorities still caution against the use of aspirin for any fevers in children under 16.
The use of vitamin A in treatment has been investigated. A systematic review of trials into its use found no significant reduction in overall mortality, but it did reduce mortality in children aged under two years.
Mortality in developed countries is ~1/1000. In sub-Saharan Africa, mortality is ~10%. In cases with complications, the rate may rise to 20–30%. On average, ~450 children die every day from measles.
Even in countries where vaccination has been introduced, rates may remain high. In Ireland, vaccination was introduced in 1985. The number of cases was 99,903 in that year. Within two years, the number of cases had fallen to 201, but this fall was not sustained: case numbers in 1989, 1993 and 2000 were 1,248, 4,328 and 1,603, respectively. This country's example illustrates the need for vaccination rates greater than 95% to prevent the spread of measles.
According to the WHO, measles is a leading cause of vaccine-preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by a vaccination campaign led 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 WHO. Globally, measles fell 60% from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Estimates for 2008 indicate deaths fell further to 164,000 globally, with 77% of the remaining measles deaths in 2008 occurring within the Southeast Asian region.
Five out of six WHO regions have set goals to eliminate measles, and at the 63rd World Health Assembly in May 2010, delegates agreed a global target of a 95% reduction in measles mortality by 2015 from the level seen in 2000, as well as to move towards eventual eradication. However, no specific global target date for eradication has yet been agreed to as of May 2010.
Measles is an endemic disease, meaning it has been continually present in a community, and many people develop resistance. In populations not exposed to measles, exposure to a new disease can be devastating. In 1529, a measles outbreak in Cuba killed two-thirds of the natives who had previously survived smallpox. Two years later, measles was responsible for the deaths of half the population of Honduras, and had ravaged Mexico, Central America, and the Inca civilization.
In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide. During the 1850s, measles killed a fifth of Hawaii's people. In 1875, measles killed over 40,000 Fijians, approximately one-third of the population. In the 19th century, the disease decimated the Andamanese population. In 1954, the virus causing the disease was isolated from an 11-year old boy from the United States, David Edmonston, and adapted and propagated on chick embryo tissue culture. To date, 21 strains of the measles virus have been identified. While at Merck, Maurice Hilleman developed the first successful vaccine. Licensed vaccines to prevent the disease became available in 1963.
On February 19, 2009, 505 measles cases were reported in twelve provinces in northern Vietnam, with Hanoi accounting for 160 cases. A high rate of complications, including meningitis and encephalitis, has worried health workers, and the U.S. CDC recommended all travelers be immune to measles.
On 1 April 2009, the disease broke out in two schools in North Wales. Ysgol John Bright and Ysgol Ffordd Dyffryn, two schools in Wales, have had the outbreak and are making sure every pupil has had the measles vaccine.
In 2007, a large outbreak in Japan caused a number of universities and other institutions to close in an attempt to contain the disease.
Approximately 1000 cases of the disease were reported in Israel between August 2007 and May 2008 (in sharp contrast to just some dozen cases the year before). Many children in ultra-Orthodox Jewish communities were affected due to low vaccination coverage. As of 2008, the disease is endemic in the United Kingdom, with 1,217 cases diagnosed in 2008, and epidemics have been reported in Austria, Italy and Switzerland.
In March 2010, the Philippines declared an epidemic due to the continuously rising cases of measles.
As of May 2011, over 17,000 cases of measles have so far been reported from France between January 2008 and April 2011, including 2 deaths in 2010 and 6 deaths in 2011. Over 7,500 of these cases fell in the first three months of 2011, and Spain, Turkey, Macedonia, and Belgium have been among the other European countries reporting further smaller outbreaks. The French outbreak has been specifically linked to a further outbreak in Quebec in 2011, where 327 cases have been reported between January and June 1, 2011, and the European outbreaks in general have also been implicated in further small outbreaks in the USA, where 40 separate importations from the European region had been reported between January 1 and May 20.
As of July 2011, 1,145 children have died of 115 600 cases in the DRC, which is also battling deadly outbreaks of cholera and polio.
In August 2011, an outbreak in New Zealand has seen 94 confirmed cases in Auckland alone.
Between January 1 and April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported in the United States to the CDC, 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.
By July 9, 2008, a total of 127 cases were reported in 15 states (including 22 in Arizona), making it the largest U.S. outbreak since 1997 (when 138 cases were reported). Most of the cases were acquired outside of the United States and afflicted individuals who had not been vaccinated.
By July 30, 2008, the number of cases had grown to 131. Of these, about half involved children whose parents rejected vaccination. The 131 cases occurred in seven different outbreaks. There were no deaths, and 15 hospitalizations. Eleven of the cases had received at least one dose of the measles vaccine. Children who were unvaccinated or whose vaccination status was unknown accounted for 122 cases. Some of these were under the age when vaccination is recommended, but in 63 cases, the vaccinations had been refused for religious or philosophical reasons.
On May 24, 2011 the Centers for Disease Control and Prevention reported that the United States has had 118 measles cases so far this year. The 118 cases were reported by 23 states and New York City between Jan 1 and May 20. Of the 118 cases, 105 (89%) were associated with cases abroad and 105 (89%) of the 118 patients had not been vaccinated.
Category:Dutch loanwords Category:Mononegavirales Category:Pediatrics Category:Virus-related cutaneous conditions
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