Measles

Question 1

disease status

Answer 1

notifiable disease in the UK

Question 2

measles

Answer 2

archetypal childhood infection
usually self-limiting, but not trivial
complications in ~10% requiring hospital admission
fatality rates 1 in 5000 in the UK

Question 3

vaccination

Answer 3

MMR
1 year and 3 years 4 months
reduced the disease

Question 4

transmission

Answer 4

acute infection caused by ssRNA
one of the most contagious infectious diseases
airborne transmission via resp droplets
these spread to surfaces where the virus can remain transmissible for up to 2 hrs - no need for direct patient-patient contact
incubation 10-12 days
infectivity from 4 days before rash till 4 days after rash

Question 5

epidemiology

Answer 5

depends on the uptake of the MMR vaccine
still the leading cause of vaccine-preventable childhood mortality in the world
MMR vaccine coverage ~92% in the UK

Question 6

presentation

Answer 6

rash that lasts at least 3 days
fever for at least one day plus at least one of:
Cough
Conjunctivitis
Coryza

2-4 day prodrome with fever, cough, runny nose, mild conjunctivitis, diarrhoea
koplik spots are pathognomonic (present in 60-70% during prodrome and up to 3 days post rash)

maculopapular rash first seen on the forehead and neck, before spreading involving the trunk and finally the limbs over 3-4 days
may become confluent in some areas

fever, which may be >40
non-productive cough
patient clearly ill
periorbital oedema and photophobia may be present

Question 7

investigations

Answer 7

salivary swab sent to lab for measles specific antigen
(IgM) taken within 6 weeks of onset
RNA detection in salivary swab or other samples

Question 8

DDx

Answer 8

rubella
parvovirus B19
scarlet fever
HSV type 7
kawasaki disease
toxic shock syndrome

Question 9

management

Answer 9

uncomplicated measles usually self-limiting
treat Sx with paracetamol, brufen and fluids
monitor for signs of complications

Question 10

complications

Answer 10

bronchopneumonia
giant cell pneumonitis
acute demyelinating encephalitis (seizures, headache–> coma)
diarrhoea
hepatitis
hypoglycaemia
patients with vit A deficiency more at risk of death and blindness

can cause a potentially deadly pneumonitis in pregnancy, as well as increased risk of miscarriage, prematurity, low BW