Description Masele (Middle Low German) or Masel (Middle Dutch) which means “spot, blemish” An acute, contagious viral disease, usually occurring in childhood, characterized by eruption of red spots on the skin, fever, and catarrhal symptoms Also known as rubeola, hard measles, red measles, seven-day measles, eight-day measles, nine-day measles, 10-day measles, and morbilli. Etiologic agent Measles virus is the cause of measles.
Spherical, nonsegmented, single-stranded RNA virus in the Morbillivirus family Contains six structural proteins, three that are complexed to the RNA and three that are associated with the viral membrane envelope Two of the membrane envelope proteins are important in its pathogenesis The F (fusion) protein is responsible for fusion of virus and host cell membranes, viral penetration and hemolysis The H (hemagglutinin) protein is responsible for adsorption of the virus to cells. The virus is rapidly inactivated by heat, light, acidic pH, ether, and trypsin(an enzyme).
It has a short survival time (under 2 hours) in the air, or on objects and surfaces. Mode of Transmission Airborne Transmission: Droplet inhalation (coughing and sneezing) Direct contact with infected nasal or throat secretions Contaminated fomites Incubation Period usually 8-12 days on average After the incubation period, only symptoms can occur. Pathogenesis Measles first gains access to the body via the direct contact with nasal or throat secretions of infected people or by airborne transmission. The primary site of infection is the respiratory epithelium of the nasopharynx.
Two to three days after: A primary viraemia ensues which is responsible for spreading the virus throughout the rest of the R-E system and the respiratory system. Five to seven days after: A secondary viraemia follows whereby the virus is further spread to involve the skin, the viscera, kidney and bladder, lymphoid tissues, thymus, lymph nodes Signs and Symptoms Early measles symptoms can include: High fever (up to 105°F or 40. 6°C) Maculopapular Rash Cough Runny nose Sneezing Hacking cough Sore throat Redness and irritation of the eyes Tiredness Muscle and body aches Irritability Swelling of the eyelids Loss of Appetite
Koplik’s spots – one to two days before the rash appears, small red lesions with blue-white centers appear on the inside of the mouth and tongue, and occasionally on the whites of the eyes or inside the intestines. Complications: Secondary bacterial infection Pneumonia – is the main cause of death in measles Otitis Media – inflammation of the middle ear Bronchitis Giant-cell pneumonia (Hecht’s pneumonia) a protracted, fatal, interstitial viral pneumonitis seen only in children Eye conditions (corneal ulceration, keratitis, or blindness) Measles causes ear infections in nearly 1 out of every 10 children who get it.
Inflammation of the Nervous System (meningitis, encephalitis) 1 child in every 1,000 who get measles will develop encephalitis. – an inflammation of the brain that can lead to convulsions, and can leave your child deaf or mentally retarded. ) Thrombocytopenic purpura Transient hepatitis Measles in pregnancy – can lead to miscarriage, premature delivery, or a low-birthweight baby. Medical Intervention / Treatment Supportive Care: Intravenous (IV) fluids Medications to control fever or pain Antibiotics to treat secondary infections from bacteria Good nursing care Vitamin A as Part of Measles Treatment Low serum levels of vitamin A are associated with severe disease due to measles In developing countries, malnutrition, vitamin A deficiency, and severe measles are common. For these situations, the treatment of measles should include vitamin A medication for two days, starting as soon as a measles diagnosis is made. This treatment has been shown to decrease the risk of blindness and death. Pregnant women, infants younger than six to nine months, and people with weakened immune systems are given a shot of immune globulin, or antibodies against the measles virus.
A patient who develops an ear infection or shows signs of pneumonia will be treated with an antibiotic. Young children who become severely ill with measles may be given a large dose of vitamin A. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia Nursing Care Management Protect eyes of patients from glare of strong light as they are apt to be inflamed. Keep the patient in an adequately ventilated room but free from drafts and chilling to avoid complications of pneumonia. Teach, guide and supervise correct technique of giving sponge bath for comfort of patient.
Check for corrections of medication and treatment prescribed by physician. Children should not be given aspirin, however, because of the risk of Reye syndrome. High risk of infection related to the host and infectious agents. Identify high-risk children Rational: to ensure children avoid exposure Make a referral to a community health nurse if necessary. Rational: to ensure proper procedures at home. Monitor temperature Rational: increased body temperature is not expected to indicate an infection. Maintain good body hygiene. Rational: to reduce the risk of secondary infection from the lesions.
Give a little water absorption, but often a child or a favorite drink and fine food. Pain related to skin lesions, malaise Use a cool mist vaporiser, mouthwash, and tablets suck. Rational: to keep mucous membranes moist. Clean the eye with physiological saline solution Rational: to remove secretions or leprosy Keep your child cool. Rational: because the air is too hot can increase itching. Give a cold water bath and give a lotion such as calamine Rational: to reduce itching. Give analgesic, antipyretic, and antipruritus according to the needs and requirements. Rational: to reduce pain, lower body temperature, and reduce the itching.
Preventive Measures Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates. usually given at 12 months of age – (it should not be given in younger individuals because the presence of maternal antibodies may lead to a poor response) The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems In 2008, about 83% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.
Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose. This vaccine protects against both red measles and German measles. When this vaccine virus is given to a child, it replicates only a little before it is eliminated from the body. People who are potentially infectious with measles should minimize the risk of transmission by limiting contact with other people who may be susceptible to the disease. Contact should be limited until: A medical diagnosis, excluding measles, has been established The symptoms have resolved completely days have passed since the onset of the rash. People who are potentially infectious with measles should especially avoid: Public transportation Crowded area Why is it still one of the Leading Causes of Mortality in the Philippines? Highly Contagious Easily transmitted Measles transmission can occur any time, from about 4 days prior to the onset of the rash to 4 days after the onset. If one person has it, 90 percent of their susceptible close contacts will also become infected with the measles virus.
Complications resulted from poor health caused by poverty and malnutrition The associated secondary infections which apparently complicate the primary illness in malnourished children might be responsible for higher mortality and could be due to socioeconomic and environmental causes that are associated with poverty and malnutrition rather than due to malnutrition or measles per se. People have less knowledge on: Proper disposal of fomites Proper disposal of nose and throat discharges. Difficulty in transporting immunizing paraphernalia on isolated areas.
Strategies in the Eradication of Disease Expand child immunization goal for eliminating measles by undertaking house to house monitoring measles vaccination. Strengthen routine immunization against measles that is effective, and has resulted in significant reductions. Have a health education program – to inform or educate what are the preventive measures on what or how to control that kind of disease, like keeping your immune system healthy (taking Vitamin A, eating healthy, getting enough rest. ). To know what are the signs and symptoms for them to be aware if they already have that disease.
What to do if they are infected to control further spread that can make many people safe or free having that disease. Emphasize the need for immediate isolation when early catarrhal symptoms appear. If immune serum of globulin is available (gamma Globulin), explain this to the family and refer to physician or clinic giving this service. Observe closely the patient for complications during and after the acute stage. Teach, demonstrate, guide and supervise adequate nursing care indicated. Explain proceedings in proper disposal of nose and throat discharges. Teach concurrent and terminal disinfection.