Measles

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history

• 1970-80s sub-Saharan children mortality &50%, majority of which owing to measles
• 1880s devastating measles outbreak in Fiji introduced by foreign ships resulted in 20-30% of Fijian population died from measles

complications

• acute phase death directly due to viral damage
  • black-pigmented rashes
• blindness by measles accompanied by vitamin A deficiency
  • ketatitis
• immune paralysis

relation with malnutrition

• still controversial, malnutrition first or measles first

risk for death from measles

• vit. A deficiency
• malnutrition - causation controversial
• in larger outbreak
• in larger household contact
• younger children
• HIV positive children

etiology of child death

• acute overwhelming infection in the first week
• secondary bacterial pneumonia in the second week
  • S. pneumoniae
  • S. aureus
  • air trapping is a feature - possible pneumothorax
• secondary viral infection
  • HSV
  • RSV
  • adenovirus
• post-measles syndrome
  • malnutrition
  • immune paralysis, immunomodulation

strategies to control

• isolation, theoretically good but useless in reality
• effective treatment with vit. A and antimicrobials
  • vit. A and antimicrobials for secondary bacterial infection can reduce mortality
• vaccination
  • maternal passive immunity wane in 6-9 months after birth
    • rational for the first vaccination after 9 months of age
  • 10% of primary vaccine failure in the first vaccination
    • rational for the second vaccination