Measles and Rheumatic Fever

Question 1

What causes measles?

Answer 1

paramyxovirus

Question 2

How does measles spread?

Answer 2

Aerosolised droplets; can stay in the air for up to TWO HOURS

**Makes it highly transmissible –> most infectious disease we know of

Question 3

What is the incubation period of measles?

Answer 3

10-21 days

Question 4

What are the main symptoms of Measles?

Answer 4

Cough
Coryza
Fever
Conjunctivitis
Koplik’s spots

(The 4 ‘C’s of measles

Morbilliform Rash

Question 5

What are the complications of measles

Answer 5

Vitamin a Deficiency –> poor qualitiy of GI and respiratory mucosa –> increased risk of infections

Corneal Disease (from Vit A deficiency)

Diarrhoa

Sepsis

Post Measles immunosuppression

Encephalitis
- Subacute Sclerosisng Panencephalitis –> long term complication of measles that causes chronic brain damage from persistent CNS measles infection
Presents >7 years after initial infection
- Acute Demyelinating
- Inclusion body

**Secondary bacterial infection = greatest cause of death in measles

Question 6

What is the R number of Measles?

Answer 6

12-18!!!!!

Question 7

Is measles potentially a disease we could eradicate?

Answer 7

yes

no animal vector
no chronic infection (apart from chronic encephalitis)
effective vaccine

Question 8

Describe the rash in measles

Answer 8

Usually occurs after a couple of days of cough, coryza, fever

Morbilliform

Face –> trunk –> limbs

Question 9

How do you diagnose measles?

Answer 9

1. Case definition (useful in an outbreak) –> only need a few confirmed lab cases before you can switch to case definition as a means of diagnosis
2. IgM Antibodies (blood or saliva)
3. RNA PCR

Question 10

How do you manage measles?

Answer 10

1. Supportive care
2. Vitamin A Supplements

±antibiotics for concurrent bacterial illness
± fluid management in diarrhoeal illness
± topical chloramphenicol (eye)

Question 11

What are the doses of Vitamin A supplementation in measles?

Answer 11

Vit A Capsules, 2 doses in 2 days

• <6 mo 50,000iu
• 6-12mo 100,000iu
• > 12mo 200,000iu

Question 12

What are risk factors for Measles outbreaks?

Answer 12

Refugee camps
Areas of unpopulated populations
Immunocompromised people
Unvaccinated mothers anc children

Question 13

How much of a population needs to be vaccinated to prevent an outbreak of measles?

Answer 13

95%

Question 14

What is the case fatality rate of measles during epidemics?

Answer 14

Between 3-15%

Question 15

What type of vaccine is measles? Can it be given to pregnant women?

Answer 15

Live attenuated vaccine

Cannot be given to pregnant women

Question 16

Give 10 ways in which you could manage a measles outbreak?

Answer 16

■ As soon as the alert is sounded, an outbreak management committee responsible for organising the response is created or reactivated at each level.
■ The role of the committee is to define the strategies, organise free care, coordinate the partners, monitor implementation, draw up the projected budget and prepare the evaluation of the response.
■ A reliable data entry and transmission system is essential to detecting the outbreak, monitoring its course and orienting the response.
■ Epidemiological data analysis is done each week at all levels.
■ Patient care is decentralised to shorten the time between the onset of symptoms and the start of treatment. ■ Treatment is free of charge.
■ Patients are isolated.
■ The distribution of treatments kit facilitates supply.
■ Treatments should be available at all health care facilities throughout the outbreak. Regular monitoring of treatment availability a lows supply planning.
■ Analysing the specific attack rates by age group and location helps determine which areas to vaccinate first and the age of the target population.
■ The choice of outbreak response vaccination strategy is guided by the risk of spread of the epidemic.
■ Emergency vaccination campaign preparation should take no more than two weeks.
■ Information and social mobilisation are implemented as soon as the outbreak is confirmed.
■ A broad range of media should be used to transmit messages.
■ Set up an effective Cold Chain supply to ensure good quality of vaccine is maintained

(Taken from MSF guidelines on Measles Outbreaks)

Question 17

Is there a measles prophylaxis for contacts?

Answer 17

No - unvaccinated people should be vaccinated, however.

Question 18

What bacteria causes Rheumatic Fever?

Answer 18

Group A beta haemolytic strep

Question 19

How do you diagnose Rheumatic Fever?

Answer 19

1. Clinical diagnosis using the Jones Criteria
2. ±Centor Criteria
3. • Culture on blood agar

Question 20

What is the Jones Criteria

Answer 20

A clinical diagnostic tool used in Rheumatic Fever. +ve for RF if patient has 2 major criteria or 1 major + 2 minor

MAJOR:
- Chorea
- Carditis
- Polyarthritis (Migratory)
- Subcutaneous Nodules
- Erythema Marginatum

MINOR
- Fever
- Raised ESR/CRP
- Arthralgia
- prolonged PR interval on ECG

Question 21

Lots of people get Group A Beta Haemolytic strep but not many get RF - why?

Answer 21

Increased susceptibility with each repeated infection

SO

In a lot of countries we give out antibiotics regular for sore throat, meaning we curb a lot of GAS early

In places where it is not adequately treated there is a risk of worse outcomes

Question 22

How do you manage rheumatic fever?

Answer 22

1. Aspirin 80-100mg/kg OD for 2/52
   FOLLOWED BY:
2. Aspirin 60-70mg/kg OD for 3-6/52
3. Treatment of GAS with IM Benzathine Penicillin STAT
4. Secondary Prophylaxis

±Steroids if Carditis
± Haloperidol for Chorea

Question 23

What is the secondary prophylaxis for ARF?

Answer 23

IM Benzathine Penicillin every 4 weeks

Continue at least until the age of 18 if no heart disease

If heart disease then continue at least until the age of 30 but consider lifelong (as per WHO)