Measles
Measles
The following case definition is an epidemiological and not a diagnostic tool:
Fever and maculopapular rash with any one of the following:
- cough
- coryza/runny nose
- conjunctivitis
Suspect measles in any child fulfilling the case definition.
An acute, highly contagious, viral, childhood exanthem. Incubation period: 8–14 days from exposure to 1st symptoms and 14 days between appearance of rash in source and contact.
Complications include:
- Pneumonia
- Feeding difficulties
- Laryngo-tracheo-bronchitis (croup)
- Severe diarrhoea
- Encephalitis
- Otitis media
- Stomatitis
- Corneal ulceration
- Subacute sclerosing panencephalitis
Diagnostic criteria
- Prodromal (catarrhal) phase:
- Duration 3–5 days, fever, runny nose (coryza), cough, conjunctivitis, Koplik’s spots, followed 3–5 days later with maculopapular rash.
- The rash begins to fade after 3 days in the order of its appearance leaving temporary darker staining. If fever is still present after the third day of the rash, a complication should be suspected.
Investigations
Serum measles IgM antibodies for confirmation of diagnosis
Management
- Notify provincial EPI manager prior to confirmation
- Only admit high risk patients:
- children less than 6 months old
- immune compromised/suppressed children
- children with severe malnutrition
- children with complications
- Minimal exposure to strong light, if patient is photophobic isolate the patient in a separate room, if possible away from other children.
- All entering the room to wear mask, gloves and gown.
- Patient is infectious for 4 days after onset of rash, longer if HIV-infected.
- if pneumonia with hypoxia, give humidified oxygen by means of nasal cannula
All patients
Vitamin A, oral, as a single daily dose for 2 days
- < 1 year 100 000 units
- > 1 year 200 000 units
Complications Pneumonia Antibiotics, empirical
To cover S. aureus and Gram-negative infection. Total duration of therapy: 5–7 days
- Ampicillin, IV, 25–50 mg/kg/dose, 6 hourly PLUS
- Gentamicin, IV, 7.5 mg/kg once daily PLUS
- Cloxacillin, IV, 50 mg/kg/dose 6 hourly
When child improves follow with oral therapy to complete 5–7 days treatment
- Amoxicillin, oral, 30 mg/kg/dose 8 hourly PLUS
- Cephalexin, oral, 7.5 mg/kg/dose, 6 hourly
Conjunctivitis and corneal dryness: Chloramphenicol ophthalmic ointment 1%, inserted 6 hourly for5 days. If corneal clouding/ulceration suspected, obtain urgent ophthalmologic consultation. Treat Croup, Diarrhoea, Convulsions according to protocols
Management of Contacts
- Measles vaccine: Immunise children older than 6 months if unvaccinated and less than 72 hours since exposure. Immunise all children > 6 months of age if outbreak occurs.
- Gamma globulin IM, 0.25 mL/kg If contact less than 6 mo or immunodeficient and less than 3 to 6 days after exposure.