Measles

Ahmad Khan & Ali Sikander

A1 64th
 Cause
• Measles is a highly contagious infectious disease caused
by measles virus.

An electron micrograph of Measle virus

• Measle Virus is a single-stranded, negative-sense,
enveloped RNA virus of the genus Morbillivirus within
the family Paramyxoviridae.

• Measles is so contagious that if one person has it, 90% of

nearby non-immune people will also become infected.

An diagram of Morbillivirus
 History of the Virus

• Zoonotic origins, having evolved from rinderpest, which infects

cattle.

Rinderpest virus
• Began causing infections in humans as early as the 4th century BC
or as late as after AD 500.

• The first systematic description of measles, and its distinction from

smallpox and chickenpox, is credited to the Persian physician
Muhammad ibn Zakariya al-Razi (860–932), who published The
Book of Smallpox and Measles.

• Licensed vaccines to prevent the disease became available in 1963.

Muhammad ibn Zakariya al-Razi
The Historical Development of
Different Measles Vaccine
 Pathophysiology

1. Once the measles virus gets onto the

mucosa, it infects the epithelial cells
in the trachea or bronchi.

2. Measles virus uses a protein on its

surface called H protein, to bind to a
target receptor on the host cell, which
could be CD46.
Drawing of the measles virus attaching to the lining of the trachea

3. Once bound, F protein helps the virus

fuse with the membrane and
ultimately get inside the cell.
 Signs and symptoms

• Symptoms typically begin 10–14 days after exposure.

Maculopapular rash on the abdomen

• The classic symptoms include fever (as high as 104 °F), after 3 days of measles infection

cough, coryza, conjunctivitis (red eyes) and maculopapular

rash.

• Koplik's spots seen inside the mouth are diagnostic for

measles, but are temporary and therefore rarely seen.

Koplik's spots on the third pre-eruptive day

 Diagnosis
• Diagnosis is apparent from clinical picture but laboratory confirmation is strongly
recommended.

• Diagnosis can be one with confirmation of positive measles IgM antibodies.

• Or with the detection of measles virus RNA from throat, nasal or urine specimen by
using the reverse transcription polymerase chain reaction assay.

WHO Recommended Surveillance Standard

 Treatment

• There is no specific antiviral treatment if measles develops.

• Medications are generally aimed at treating superinfections,

maintaining good hydration with adequate fluids, and pain relief. Ibuprofen tablets

• Treatment is supportive, with ibuprofen or paracetamol to

reduce fever and pain and, if required, a fast-acting medication
to dilate the airways for cough.

• The use of vitamin A during treatment is recommended to

decrease the risk of blindness
Sources of Vitamin A
 Prevention
• Mothers who are immune to measles pass antibodies to
their children while they are still in the womb, especially if
the mother acquired immunity through infection rather than
vaccination.

• In developed countries, it is recommended that children be

immunized against measles at 12 months, generally as part
of a three-part MMR vaccine (measles, mumps, and rubella).

• A second dose of the vaccine is usually given to children MMR Vaccine

between the ages of four and five, to increase rates of

immunity.
• In developing countries where measles is common, the WHO
recommends two doses of vaccine be given, at six and nine
months of age.

• The MMR vaccine is 95% effective for preventing measles

after one dose if the vaccine is given to a child who is 12
months or older; if a second dose of the MMR vaccine is
Measles Vaccine
given, it will provide immunity in 99% of children.

A graph showing effect of

Vaccines on Measles Cases in
England and Wales
 Epidemiology

• Wild-type measles viruses have been divided

into eight clades containing 24 genotypes.
The eight clades are designated A to H, with
numerals to identify the individual
genotypes.

• Its continued circulation in a community

depends on the generation of susceptible
hosts by birth of children. In communities
that generate insufficient new hosts the
disease will die out.

• In 2011, the WHO estimated that 158,000 A map showing distribution of measles genotype
deaths were caused by measles. This is down
from 630,000 deaths in 1990.
• In developed countries the mortality rate is lower, for example in England and
Wales from 2007 to 2017 death occurred between two and three cases out of
10,000.

• In populations with high levels of malnutrition and a lack of adequate healthcare,

mortality can be as high as 10%.

• In 2012, the number of deaths due to measles was 78% lower than in 2000 due to
increased rates of immunization among UN member states.