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07-SEPTEMBER-2008 03:17:44 - Measles Measles Classification and external resources Skin of a patient after 3 days of measles infection. ICD-10 B05..- ICD-9 055 DiseasesDB 7890 MedlinePlus 001569 eMedicine derm/259 ped/1388 MeSH D008457 Measles virus Measles virus Measles virus Virus classification Group: Group V -ssRNA Order: Mononegavirales Family: Paramyxoviridae Genus: Morbillivirus Type species Measles virus Measles is a disease caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. 'German measles' is an unrelated condition caused by the rubella virus. 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.1 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.2 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.3 To date, 21 strains of the measles virus have been identified.4 Licensed vaccines to prevent the disease became available in 1963. Contents 1 Symptoms 2 Diagnosis and treatment 3 Transmission 4 Complications 5 Public health 6 Recent outbreaks 6.1 United States 7 See also 8 References 9 External links 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 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 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 and replicates in the lymphatic system, urinary tract, conjunctivae, blood vessels and central nervous system of its new host.5 The role of epithelial cells is uncertain, but the virus must infect them to spread to a new individual.6 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 scarring7 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 second dose is usually given to children between the ages of four and five, in order to increase rates of immunity. 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.8 A 2005 measles outbreak in Indiana was attributed to children whose parents refused vaccination.9 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.10 Scientific evidence provides no support for the hypothesis that MMR plays a role in causing autism.11 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 1995.12 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 126,000.13 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 2015.13 Recent outbreaks Main article: Measles outbreaks in the 2000s In 2007, a large measles outbreak in Japan caused a number of universities and other institutions to close in an attempt to contain the disease.1415 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.citation needed Many children in ultra-Orthodox Jewish communities were affected due to low vaccination coverage.1617 As of 2008 the disease is endemic in the United Kingdom and epidemics have been reported in Austria, Italy and Switzerland. Low vaccination rates are responsible.18 United States 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. 19 Outbreaks are still occurring, however, following importations of measles viruses from other world regions. In June 2006, an outbreak in Boston resulted after a resident became infected in India,20 and in October 2007, a Michigan girl who had been vaccinated contracted the disease overseas.21 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,2223 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.24 By July 9, 2008, a total of 127 cases were reported in 15 states including 22 in Arizona25, making it the largest US outbreak since 1997 when 138 cases were reported.26 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 7 different outbreaks. There were no deaths, and 15 hospitalizations. 11 of the cases had received at least one dose of the measles vaccine. 122 of the cases involved children who were unvaccinated or whose vaccination status was unknown. Some of these were under the age of one year old, and so below the age when vaccination is recommended, but in 63 cases the vaccinations had been refused for religious or philosophical reasons. Many of the cases involved church groups and the home schooled. 27 See also Infectious disease List of epidemics MMR vaccine Rubella German measles Roseola baby measles References ^ New York City Departrment of Health and Mental Hygiene http://www.nyc.gov/html/doh/html/imm/immmea.shtml ^ Torrey EF and Yolken RH. 2005. Their bugs are worse than their bite. Washington Post, April 3, p. B01. ^ Live attenuated measles vaccine 1980. EPI Newsl 2 1: 6. PMID 12314356. ^ Rima BK, Earle JA, Yeo RP, et al 1995. Temporal and geographical distribution of measles virus genotypes. J. Gen. Virol. 76 5: 1173-80. PMID 7730801. ^ Skalka, Anna M.; Johnson, Flint; Enquist, L. W.; Racaniello, Vincent R. 2003. Principles of Virology: Molecular Biology, Pathogenesis, and Control of Animal Viruses, 2nd ed., American Society Microbiology. ISBN 1-55581-259-7. ^ Leonard VH, Sinn PL, Hodge G, et al 2008. Measles virus blind to its epithelial cell receptor remains virulent in rhesus monkeys but cannot cross the airway epithelium and is not shed. J. Clin. Invest. 118 7: 2448-2458. doi:10.1172/JCI35454. PMID 18568079. ^ 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 on 2007-08-13. ^ 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. ^ Dillner L 2001-07-26. The return of the measles party, Guardian. Retrieved on 2007-08-13. ^ Rutter M 2005. Incidence of autism spectrum disorders: changes over time and their meaning. Acta Paediatr 94 1: 2-15. doi:10.1080/08035250410023124. PMID 15858952. ^ Torjesen I 2008-04-17. Disease: a warning from history. Health Serv J: 22-4. PMID 18533314. ^ a b UNICEF Joint Press Release ^ The Public Health Agency of Canada Travel Advisory. Retrieved on 2008-05-02. ^ Norrie, Justin May 27, 2007. Japanese measles epidemic brings campuses to standstill, The Sydney Morning Herald. Retrieved on 2008-07-10. ^ Stein-Zamir, C.; G. Zentner, N. Abramson, H. Shoob, Y. Aboudy, L. Shulman and E. Mendelson February 2008. Measles outbreaks affecting children in Jewish ultra-orthodox communities in Jerusalem. Epidemiology and Infection 136 2: 207-214. doi:10.1017/S095026880700845X. PMID 17433131. ^ Rotem, Tamar August 11, 2007. Current measles outbreak hit ultra-Orthodox the hardest, Haaretz. Retrieved on 2008-07-10. ^ http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18919 ^ paho.org. Retrieved on 2007-12-05. ^ Measles outbreak shows a global threat - The Boston Globe. Retrieved on 2007-12-05. ^ Jesse, David October 4, 2007. Measles outbreak may have spread, The Ann Arbor News. Retrieved on 2008-07-10. ^ cdc.gov. Retrieved on 2008-05-02. ^ JS Online: Measles outbreak brewing, city health officials say ^ cdc.gov MeaslesUpdate. Retrieved on 2008-05-02. ^ Rotstein, Arthur July 9, 2008. Response curtailed measles outbreak, The Associated Press. Retrieved on 2008-07-10. ^ Dunham, Will July 9, 2008. Measles outbreak hits 127 people in 15 states, Reuters. Retrieved on 2008-07-10. ^ Stobbe, Mike August 21, 2008. Jump in US measles cases linked to vaccine fears, The Associated Press. Retrieved on 2008-08-21. External links Wikimedia Commons has media related to: Measles 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 v d e Infectious diseases - Virus diseases A80-B34, 042-079 CNS Encephalitis/ meningitis DNA virus: Progressive multifocal leukoencephalopathy RNA virus: Subacute sclerosing panencephalitis - Lymphocytic choriomeningitis - Tick-borne meningoencephalitis unknown: Encephalitis lethargica Eye DNA virus: Cytomegalovirus retinitis Other RNA virus: Rabies - Myelitis: Poliomyelitis Post-polio syndrome - Tropical spastic paraparesis Skin and mucous membrane lesions DNA virus, Herpesviridae: Herpes simplex - Chickenpox - Herpes zoster - KSHV DNA virus, other: Poxviridae Smallpox, Monkeypox, Cowpox, Vaccinia, Molluscum contagiosum - exanthem Roseola, Fifth disease - HPV Wart RNA virus: exanthem Measles, Rubella - picornavirus Hand, foot and mouth disease, Foot-and-mouth disease Digestive system Hepatitis DNA virus: B RNA virus: A - D - C - E - G Gastroenteritis DNA virus: Adenovirus RNA virus: Rotavirus - Norovirus - Astrovirus - Coronavirus Respiratory system RNA virus, IV: Acute viral nasopharyngitis - Severe acute respiratory syndrome RNA virus, V: Influenza/Avian influenza - Human parainfluenza viruses - RSV - hMPV Other/varied: Infectious mononucleosis - Viral pneumonia Sexually transmitted DNA virus: HPV Genital warts, Cervical cancer RNA virus, retrovirus: HIV AIDS, AIDS dementia complex - Adult T-cell leukemia Oncovirus DNA virus: Hepatitis B - HPV - Kaposi's sarcoma-associated herpesvirus RNA virus: Hepatitis C - HTLV Systemic DNA virus: Cytomegalovirus RNA virus: Mumps - Bornholm disease - Coxsackie B v d e Exanthema Viral RNA virus: Measles 1st disease - Rubella 3rd disease DNA virus: Slap cheek 5th disease - Roseola 6th disease uncertain: Duke's disease 4th disease Bacterial Scarlet fever 2nd disease Retrieved from http://en..org/wiki/Measles Categories: Dutch loanwords | Viral diseases | Mononegavirales | PediatricsHidden categories: All articles with statements | Articles with statements since February 2008 | Articles with statements since March 2008 | Articles with statements since July 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Afrikaans العربية Avañe'ẽ Aymar Català Česky Dansk Deutsch Eesti Español Esperanto Ù?ارسی Français Galego í•œêµì–´ Bahasa Indonesia Italiano עברית Kurdî / كوردی Latina Lëtzebuergesch Magyar Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português Română РуÑ?Ñ?кий SlovenÄ?ina SlovenÅ¡Ä?ina Suomi Svenska తెలà±?à°—à±? ไทย Tiếng Việt УкраїнÑ?ька ä¸æ–‡ This page was last modified on 25 August 2008, at 21:56
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