Definition: An Acute highly communicable infection characterized by fever, rashes and symptoms referable to upper respiratory tract; the

eruption is preceded by about 2 days or coryza, during which stage grayish pecks (Koplik spots) may be found on the inner surface of the cheeks. A morbilliform rash appears on the 3rd or 4th day affecting face, body and extremities ending in branny desquamation. Death is due to complication (e.g. secondary pneumonia, usually in children under 2 years old. Measles is severe among malnourished children with fatality of 95-100%. Etiologic Agent: Filterable virus of Measles Source of Infection: Secretion of nose and throat of infected persons. Modes of Transmission: 1. 2. 3. Directly by being sprayed with droplets emanating from a cough or sneeze Indirectly with articles newly contaminated with respiratory secretions from a patient. Probably Airborne Incidence peak age is about 1-5 years old in congested urban areas and at early school age in less crowded sections. Immunity from the disease is long lasting while passive immunity transmitted transplacentally from mothers who have had measles may last about 5-6 months. The live attenuated vaccine confers almost lifelong immunity while

the inactivated antigen gives an immunity 0f 6-18 months. Incubation Period:

10-12 days; one attack usually confers a lasting immunity 8 days shortest; 20 days longest

Period of Communicability: During the period of coryza or catarrhal symptoms 9 days (from 4 days before and 5 days after rash appears)

Clinical Manifestations:

1.

Pre-eruptive Stage

2.

patient is highly communicable fever catarrhal symptoms start in the nasal cavities; then in the conjunctivae, oropharynx, progress to the bronchi resulting successively in rhinitis, conjunctivitis and then bronchitis.

Respiratory symptoms which appear first as a common cold, and sneezing nasal discharges, steadily progress into a distressing and annoying cough that persists up to convalescence. Eruptive Stage/Stage of Skin Rashes exanthem sign means eruption in the skin

3.

Anorexia and irritability are disturbing particularly at the height of the fever Diarrhea, pruritis, lethargy and occipital lymphadenopathy Stage of Convalescence

Maculopapular Rashes appears 2-7 days after onset With high fever increases steadily

Rashes fade in the same manner as they appeared, from the face downwards, leaving a dirty brown

pigmentation and finely granular which maybe noted for several days. Fever gradually subsides as the eruptions disappear on the hands and feet Treatment: No theraphy is indicated for uncomplicated measles, Gamma globulin although effective in prophylaxis is no value once symptoms are evidence. Patient should be monitored for the development of bacterial infections which should be treated with appropriate antibiotics on the basis of clinical and bacteriological findings. The patient may also take over-the-counter medications such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve the fever that accompanies measles. Dont give aspirin to children because of the risk of Reyes syndrome a rare but potentially fatal disease. Maintain bedrest and provide quiet activities for the child. If there is sensitivity to light, keep room darkly lit. Remove eye secretions with warm saline or water. Encourage the patient not to rub the eyes. Administer antipyretic medication and tepid sponge baths as ordered. A cool mist vaporizer can be used to relieve cough. Apply antipruritic medication to prevent itching. Isolate child until fifth day of rash. Methods of Prevention and Control 1. 2. 3. 4. 5. Avoid exposing children to any person with fever or with acute catarrhal symptoms Isolation of cases from diagnosis until about 5-7 days after onset of rash Disinfection of all articles soiled with secretion of nose and throat Encourage by health department and by private physician of administration of measles immune globulin to susceptible infants and children under 3 years of age in families or institutions where measles occurs. Live attenuated and inactivated measles virus vaccines have been tested and are available for use in children

with no history of measles, at 9 months of age or soon thereafter Public Health Nursing Responsibilities 1. 2. 3. 4. 5. 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.

6. Teach concurrent and terminal disinfection. Nursing Care 1. 2. 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.

3. 4.

Teach, guide and supervise correct technique of giving sponge bath for comfort of patient. Check for corrections of medication and treatment prescribed by physician.

What is Measles?
Measles is a disease generally affects children and can occur in other age groups. Measles is a viral infection of respiratory system with distinct red spots followed by a rash in skin; occurs primarily in children. Measles is a highly communicable or contagious disease, which is characterized by general malaise, fever, nasal congestion, conjunctivitis, sneezing, a brassy cough, and eruption in the entire body.

Types of Measles
There are two types of measles, they are German measles or rubella, which forms rashes on the skin and it last about three days and rubeola or regular measles, is the second type that last about seven days. Roseola is another infectious disease prevalent among children Roseola forms rashes and which comes and goes in 24 to 48 hours.

Measles Causes
The measles virus is communicable or contagious; the infection can be spread from one person to another. The person having measles sneezes or coughs, releases or expels water droplets, which carry the virus and it can infect anyone who come into contact with them. Sometime or occasionally air is the medium for the spreading the virus.

Symptoms and signs

usually start from eight to twelve days after getting exposure to the virus. Then the rash appears in the skin after fourteen days of exposure. person can spread the disease within one to days before any symptoms appear. It is continued to be contagious three to five days before appearance of the rash and four to five days after the rash starts.

When to need medical Care

Generally, immediate emergency is not required for the measles. But the affected patient should be taken to the doctor to evaluate any general malaise, fever, nasal congestion, conjunctivitis, sneezing, a brassy cough, which accompany rash in children.

Exams and Tests

The doctor may diagnose by taking physical exam and studying the history of measles patient. In doubtful cases, the doctor may have particular specialized blood test to diagnose properly.

Self-Care at Home
There is no proper cure for measles; But one can take necessary steps at home to make total course of disease more adjustable and tolerable. Giving sufficient bed rest to the child so he feels more comfortable. If the child has fever higher than 100.5F, then the child should be given sponge bath with lukewarm water to upper body and the face. Plenty of liquid should be given to drink to avoid dehydration. Cough medicines to be given as approved for children, this can help in control the cough. A vaporizer or humidifier can be used to ease the cough. Pain reliever and medicine for fever to be given to children such as Children's Motrin, Ibuprin, Pediaprofen and Children's Advil according to the symptoms. One has to be very careful giving medicines to children because if aspirin is given to a child then he may have Reye syndrome that is another disease. Benadryl or Calamine lotion should be applied on the effected parts to ease the itch occur due to the rash. Child fingernails should be trimmed or to be put inside the gloves to avoid scratching the rash excessively and which can hurt more.

Extra steps to be followed up

Few rare complications may be experienced in children having weak immune system during the course of measles attack then a doctor to be consulted immediately.

Prevention and summary

Vaccination and immunization has minimized the disease to great extend. Medically, initial measles immunization is done to the children from age 12- 15 months. The second immunization is done to the children enter to school or middle school level.