MEASLES (RUBEOLA)

Rubeola = Red Spot

Dr. Eman Khammas Alsadi
Community medicine lecturer
Definition:
An acute highly infectious disease
caused by measles virus ( of the
group myxovirus) and
characterized by fever,
conjunctivitis, coryza‫ رشح‬like
symptoms, and cough and Kopliks
spots (pathognomonic of measles)
on the buccal mucosa.‫مثلا لشكر ا لمنثور‬
‫ع ق د ي قفة حمره‬
A characteristic red rash appears on
the third to the seventh day on the
face first then it spreads to other
parts of the body. The rash is
confluent‫ مندمج‬and lasts for 4 to 7
days.
 Epidemiological features
Measles is endemic in almost all parts of the world. In the pre
vaccination era‫ دور‬it used to cause about 135 million cases and
up to 8 million deaths.
Nowadays it still causes about 30 million cases a year with one
million deaths.
The case fatality is about (2 /100 000 cases ) in developed
countries and ( 20-150 /100 000 )in developing countries.
Epidemics may occur when the proportion of susceptible
children reaches about 40%.
Countries in the world are in one of
three categories:
A. Control stage: Minimum incidence
with no epidemics.
B. Controlled epidemic (No epidemics)
which requires aggressive immunization
strategies.
C. Elimination or eradication stage.
.The level of incidence is zero
This can be achieved through a three-stage
immunization strategies
Catch up One time nationwide immunization
campaign (9 m-14y)
Keep up Routine vaccination of >95% of successive
cohorts .
Follow up Subsequent nationwide campaign‫حملة‬
every .2-4 years
Complications :
viral infection or superadded bacterial infection
are:
Neurological including
1- febrile convulsions,
2- encephalitis.‫اهم ش ي‬
3- subacute sclerosing pan encephalitis.

Respiratory: like
1-Otitis media ‫اهم ش ي‬
2- pneumonia, These complications
together with malnutrition are the main
causes of measles associated mortality.
Others. :
Measles tends to be severe in
malnourished children and is complicated
by severe mouth sores ,protein losing
enteropathy, ,dehydration ,severe skin
infection . Otitis media : inflammation of the middle ear
1. Diagnosis:
Based on clinical and epidemiological grounds
confirmed by the identification of viral antigens,
viral antibodies or the virus itself.

Reservoir: Man

Mode of transmission:
Droplet infection with nasal or throat secretions of
infected persons.
Less commonly air borne or soiled articles.
Incubation period: 8-13 days .‫مهمة‬
Period of communicability: From the beginning of the
prodromal stage till 4 days after the onset of typical
skin rash.
Susceptibility: General. Protection by natural maternal
antibodies may protect for the first 6-9 months of life.
Prevention:
1. Active immunization with measles vaccine at the
age of 9 months or MMR vaccine at the age of 15
months.
2. Health education to encourage timely immunization

MMR vaccine is an immunization vaccine

against Measles, Mumps, and Rubella
(also called German measles). 
Control of patients, contacts and
environment:
1.Notification to local authority.
2. Isolation. Only practical for schools.
3. Active immunization within 72 hours of exposure may limit
the spread of  infection.
4. Immunoglobulins :
given within 6 days of exposure may reduce the
risk of complication in those at higher risk of
complications.
They do not prevent clinical disease but may extend the
incubation period if they are given after the third day.

3- Earlier than this, prevention by immunoglobulins is possible

Eradication. It requires
1. An immunization coverage of at least
96% of children aged under one years
.2. Prevention of any immunity gap
GERMAN MEASLES (RUBELLA)
A mild febrile infection caused by rubella virus
(An RNA of the Togavirus family) characterized
by macular rash with very mild
constitutional‫ اساسي‬symptoms in children.
Postauricular, subocciptal or posterior cervical
lymphadenopathy is common but not
pathognomonic.
It is still worldwide infectious disease..Up to
50% of cases may occur without evident skin
rash.
From clinico-epidemiology, rubella is characterized by the following features:

1. Prodromal stage‫ا النذارية‬/ ‫ ا لمرحلة ا لتنبيهية‬: Short coryza like

features.

2. Lymphadenopathy involving post auricular, posterior cervical

and sub - occipital .

3. Skin rash stage: Small discrete macular rash starts in the face and then
spreads to the trunk and extremities.
4. Complications on infected patients:
In adults, rare complications may occur and include:

A-Arthralgia and arthritis.

B-Optic neuritis.
C-Thrombocytopenic purpra.
D-Myocarditis .
E-encephalitis.
Congenital Rubella Syndrome (when the infant .5
borne with congenital anomalies secondary to
intrauterine infection or borne with manifestations of
infection sometime after birth

These complications occur regardless of whether the

disease is clinical or sub clinical.

Infection inhibit cell division and lead to congenital

anomalies . The risk of congenital anomalies is as
:follows
Overall risk
of
Risk of Risk of Stage of
damage damage out fetal gestation
of infected infection (weeks)
fetuses

90% 100% 90% <11

20% 37% 55% 11-16
0% 0% 33% 17-26
0% 0% 53% 27-36
Common Congenital defects include:
A-Intrauterine death
B-Spontaneous abortion
C-Congenital anomalies including
1-Deafness, Cataract,
2. -Microophthalmia, Microcephaly,
3.-Mental retardation,
4. Glaucoma,
5-Congenital heart disease
Reservoir: Man
Incubation period: 14-23 days
Period of communicability: One week before to 4-7
days after onset of skin rash.

Mode of transmission:

-Droplet or direct contact with nasopharyngeal

secretions of infected persons . ‫ن فسا لميزلز‬

-Newly borne babies shed large quantities of virus in

their pharyngeal secretions and urine. This forms an
important source of infection.
   
Susceptibility:
1-Generally Infants borne to immune mothers are
protected for about 6 months.
2-Natural infection induces life long immunity.
3-An age shift took place after wide scale use of
immunization
Prevention:
priurities are
1. Protect women in the child bearing age from
infection by immunization of adolescent girls
(Potential mothers)
2. Interruption of the transmission of infection during
childhood by universal immunization.
The strategies are
1. Active immunization with live attenuated virus in
the second year of life as single or in combined MMR
vaccine. The vaccine is contraindicated in pregnancy,
immunodeficient persons.

2. If pregnant women acquire infection early,

A-abortion may be considered.
B- Immunoglobulins may be useful alternative. Late in
.pregnancy nothing is to be worried about
Control of patient, contacts and
environment
1-Notification.
2-Isolation to protect pregnant women.
3-Immunoglobulines may modify infection if
given to high risk groups.
MUMPS
Acute viral disease caused by mumps virus, a member of
the paramyxovirus group.
The disease is characterized by fever, swelling and
tenderness of the salivary glands mainly the parotid gland
but sublingual and sub-maxillary glands may also be
involved.
Sub-clinical infection is common and may occur in about
30% of exposed susceptibles.

The main complications are

1. Orchitis in males which may occur in 15-25% of cases
and oopharitis in about  5% of female cases.
2. Sterility is one but rare complication.
3. Aseptic meningitis.
4. Others such as deafness, nephritis, neuritis, arthritis,
thyroiditis and mastitis.
Mumps during pregnancy may increase the risk of
abortion , but no evidence Suggest that it causes congenital
abnormalities.

Reservoir: Man

Mode of transmission: Droplet and direct contact

with saliva of infected persons.

Incubation period: 2-3 weeks, commonly 18 days.

 Period of communicability: From six days before the
appearance of swelling till 9 days after.
 A school child is isolated for 10-14 days.
 Susceptibility is general and natural immunity is life
long.
Prevention:
1. Active immunization with live attenuated vaccine
given any time after the first year of life either as single
or in combination with the vaccines of measles and
German measles the so called MMR. The vaccine is
protective in 95% but contraindicated in pregnancy
and immunocompromized persons.
 Control of patients, contacts and environment:
 1. Notification to local health authority
 2. Isolation for 9 days from the start of the
swelling.
 3. Concurrent disinfection.
 4. Immunization of susceptible contacts.
 Chickenpox
 It is an acute febrile illness caused by
Varicella-Zoster virus. It is characterized by
variable constitutional symptoms and
characteristic skin rash and sudden onset.
 The skin rash starts as maculopapular and
changes to vesicular in due course of the
disease.
 It is distributed mainly on the trunk
(centripetal) and polymorphic( more than
one type of rash exist at any time).
The importance of chickenpox lies in
two points:
Its differentiation from smallpox, which .1
.was common and serious disease
:The complications .2
1. Atypical pneumonia in adults and
encephalitis in children.

2. Neonates of non –immune mothers are at

special risk of complication when they
contract infection during or within few days
of delivery.

3. The same is true for those with leukemia

and those on corticosteroids
 Reservoir: Man
 Incubation period: 2-3 weeks
 Mode of transmission:
1. Direct contact,
2. droplet infection
3. indirectly through freshly contaminated
articles.
Period of communicability: From 5 days before
the appearance of rash till 6 days after the
.appearance of the last crop of rash
Susceptibility: General. Natural infection is
.followed by life-long immunity
 Prevention: No specific preventive
measure is available
 Control:
1. Notification to health authorities.
2. Isolation and concurrent disinfection.
3. Immuniglobulins with 4 days of
exposure are of value in people on
corticosteroids and neonates of non-
immune mothers
4. Exclude smallpox through careful
differentiation as follow
Prodromal symptoms severe Mild until just
                              for 2-4 days before rash before  rash
Skin rash
Type One crop and appears Several crops
over
Within 1-2 days several
days
Distribution Same stage and centrifugal Polymorphic
centripetal
Individual lesions   -Axilla spared Axilla involved
Palms and soles Palms and-
soles
Involved spared
oftenly
Circular Oval-
Deep Superficial-
- Vesicle are mutilocular Vesicles are
unilocula
Scar Depressed Superficial
 Chickenpox Smallpox Characteristic

Mild until just Severe Prodromal symptoms

before  rash for 2-4 days before rash

Several One crop and appears Skin rash

several days Within 1-2 days Type crops over

Polymorphic Same stage Distribution

centripetal and centrifugal .

1. Axilla involved 1. Axilla spared Individual lesions

2. Palms and soles 2. Palms and soles
3. spared oftenly 3. Involved
4. Circular
4. Oval 5. Deep
5. Superficial 6. Vesicle are mutilocular
6. Vesicles are unilocula

Superficial Depressed Scar

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