Lexi Gassman

Dr.Bassett
6 April 2017
Infectious Disease

1. Background: What is the nature of the disease-causing agent? Is it a bacterium, a virus, a

prion, a protozoon, or a parasite? What is its life cycle?
Measles is an infectious disease that is cause by a virus. It is highly contagious and it
spreads easily from person to person through the air through coughing and sneezing. Measles
starts with a fever, runny nose, red eyes, and sore throat. These symptoms are followed by a rash
that spreads all over the body ("Measles | Rubeola | MedlinePlus", 2017). The life cycle of the
measles starts when the Hemaggulutinin and Fusion proteins mediate transmission of the measles
virus into host cells in the human respiratory tract. The virus is absorbed into the host when the
proteins bind to the CD46 and CD150 host cellular receptors. Once uncoated in the host cell the
RNA polymerase transcribes the viral RNA genome into mRNA. The viral protein functions to
formulate new helical capsids doe the replications of the virus, which leaves the host cell through
the process of budding. While the transmission of the measles virus initially infects the upper
respiratory tract, replication of the virus in the epithelial can spread to the virus to the lymph
nodes and replication in the lymphatic system can spread to other organs such as skin, liver, and
kidneys. The pathogens infect human epithelial cells (“Life Cycle”, 2017).

2. History: How long have humans known about this pathogen? When and how was it
discovered? Describe the changes in our knowledge and attitudes toward this disease throughout
history.
Measles was first described by Rhazes, who was a Persian philosopher and physician, in
the 10th century A.D. as a disease that is “more dreaded than smallpox” (Mandal, 2017). Francis
Home, who was a Scottish physician, proved in 1757 that measles is caused by an infectious
agent in the blood of patients. Prior to 1963, when the measles vaccine was licensed almost
everyone got measles. There was approximately three to four million cases of measles each year
and there were about 450 deaths. Whenever the measles vaccine became available the number of
measles cases dropped by 99 percent (Clinaero, 2017). In 1978, CDC went about setting a goal
to eliminate measles from the USA by 1982, however, this goal was not meet. By 1981 the
number of reported cases of measles was less than 80% less compared to the previous year’s
cases. There was an outbreak of the measles in 1989 among students who were vaccinated so it
was recommended by the America Academy of Pediatrics and the American Academy of Family
Physicians to have get a second dose of the vaccine for all children. Following this
recommendation and improvements in the first dose of the vaccine measles cases declined even
more. Measles was declared eliminated from the USA in 2000 ("Measles | History Of Measles |
CDC", 2017).

3. Epidemiology: Describe the prevalence and transmission of this disease.

a. Where (in the world) is the disease prevalent?
Measles is a common disease in many parts of the world, including areas in Europe, Asia,
the Pacific, and Africa. Many of the cases in the USA today are the result from international
travel. Although the disease can be brought into the USA by unvaccinated people who were
infected in other countries, they spread measles to others which can cause outbreaks of measles
("Measles | For Travelers | CDC", 2017).
b. How many people are typically infected at any point in time?
There was approximately three to four million cases of measles each year and there were
about 450 deaths. Whenever the measles vaccine became available the number of measles cases
dropped by 99 percent (Clinaero, 2017).
c. What is the rate of new infections?
In 2016 there were 70 cases of measles reported from 16 different states. In 2015 there
were 188 cases of measles reported from 24 different states. In 2014 the USA experienced a
record number of measles cases with 667 cases from 27 different states which according to the
NCIRD was the greatest number of cases since measles elimination was documented in 2000.
The majority of the people who got measles were unvaccinated (“Measles | Cases and Outbreaks
| CDC, 2017).
d. Who is especially at risk of contracting the disease (age, gender, occupation, lifestyle,
economic status)?
Unvaccinated children have the highest risks of getting measles. Unvaccinated pregnant
women are also at a great risk. Any person who has not been vaccinated or who was vaccinated
but did not develop an immunity to the measles can be infected. Measles are still very common
in developing countries particularly in Africa and Asia. There is an overwhelming majority of
measles deaths that occur in countries with low per capita incomes and weak health
infrastructures (“Measles”, 2017).
e. What are the rates of morbidity and mortality?
1 out of 4 cases are hospitalized. 1 per 1,000 cases have encephalitis which is
inflammation of the brain. 1-2 per 1,000 cases end in death. Each year there are 267,000 cases of
measles reported and 146,000 estimated deaths, mostly in children. There are common
complications of the measles that include ear infections and diarrhea. There are some severe
complications such as pneumonia and encephalitis, these complications can result in
hospitalization and even death. (Clink 2017).
f. What is (are) the reservoir(s) of the pathogen?
Humans are the sole reservoir for the measles (Moss & Strebel, 2017).
g What is (are) the mode(s) of transmission?
The modes of transmission are through the air. It is highly contagious and it spreads
easily from one person to the next person (“Measles | Rubeola | MedlinePlus.", 2017).
h. Why is this disease on the PA Dept. of Health list of Reportable Diseases?
Measles is highly contagious and because of it is highly recommended to be vaccinated
from the measles in the USA when people who are not vaccinated come into the USA they can
spread the measles virus to others which can lead to an outbreak because not everyone does get
vaccinated (“Measles | Rubeola | MedlinePlus.", 2017).

4. Pathophysiology: Describe the pathogenic effects on cells, tissues, and organ systems.

a. Where in the body (what tissues/organs/cells) does the pathogen have its effects?
Measles is a highly contagious virus that lives in the nose and throat mucus of an infected
person. It is a highly contagious respiratory infection that's caused by a virus. It causes a total-
body skin rash and flu-like symptoms ("Measles", 2017).
 b. What damage does the pathogen inflict? How is this damage inflicted (e.g., is there
direct mechanical damage? is a toxin produced? does the immune response cause damage?)?
The measles virus generally comes in contact with the host lung tissues where it infects
the immune cells. The infected cells migrate to the lymph nodes where they transfer the virus to
B and T cells. The surface protein on the white blood cells serves as the virus’s point of entry.
The infected cells then migrate throughout the body releasing virus particles into the blood. The
next destinations for the measles virus are the liver, thymus, skin, lungs, and spleen. In very rare
cases the measles virus will cross the blood-brain barrier and cause very dangerous swelling in
the brain (Shultz, 2017). One classic sign of the measles is a rash that starts on the face and
moves down the body to the feet. The rash is an indicator of the inflammation that is occurring in
the skin. Immune cells detect the infection and respond by releasing chemicals to destroy the
viral invaders and puts the other immune cells into action. The chemicals that are released cause
swelling and damage to the host cells, which often is the result of the itchy skin rash (Shultz,
2017).

c. What is the time sequence of the disease (length of incubation, prodrome, illness,
decline, and convalescence)? Are there sequelae?
The measles symptoms start to appear 10 to 14 days after exposure to the virus. During
this time is when the virus incubates. Measles generally stats with a mild fever, with a persistent
cough, runny nose, and sore throat which lasts two to three days. The rash will then start to
appear in small red spots that are close together. The face is the first to break out then the rash
spreads down the body. While the rash is spreading to the rest of the body from the face the
fever will rise sharply. The measles rash will slowly go away first fading from the face and lastly
from the thighs and feet. A person is able to spread measles to someone else for about 8 days
after they have gotten the disease, starting 4 days before the rash appears and ending when the
rash has been present for 4 days ("Measles Symptoms - Mayo Clinic", 2017).

5. Response and Treatment

a. Describe the activity of the human immune system against the pathogen.
The rash and fever that accompany the measles are associated with the immune response
to the infection and corresponding with virus clearance. MV-specific antibody, CD4, and CD8 T
cells response are generated and contribute to virus clearance and protection from reinfection.
While this phase is happening the immune activation immunologic abnormalities are also
evident. The suppression of cellular immune responses contribute to increased risk to other
infections (DE, 2017).
b. What types of medical treatments exist? How effective are they? Describe how these
treatments affect the progression of the disease.
There is no specific medication that kills the measles virus. Treatment seeks to ease the
symptoms until the immune system is able to clear the infection. For most cases of the measles
rest and taking measures to reduce the fever are all that are needed for a recovery. Usually
symptoms go away within the time span of 7-10 days ("Measles | Health", 2017).
c. Describe prophylactic measures that can be taken to limit the risk of infection. Is there
a vaccine available?
The measles can be avoided by getting the measles, mumps, and rubella vaccine. If the
vaccine isn’t suitable for you there is a treatment called human normal immunoglobulin that can
be used if you are at immediate risk of getting the measles. The vaccine is given as part of the
regular NHS childhood vaccination program. The first dose is generally given to a child when
they are 12-13 months old and the second dose is given right before they start school usually 4-6
years old. Human normal immunoglobulin is a concentration of antibodies that give short-term
but immediate protection against measles ("Measles - Prevention - NHS Choices", 2017).

6. Socio-Politico-Economic Factors

a. Describe any historic or present day social, economic, or political issues that either
help or hinder limiting the spread of the disease.
In the developing world there are many different economic reasons that hinder the efforts
to stop the measles from spreading. The inability to afford the vaccine in other countries has lead
to the acceptance that measles is an unavoidable risk of life. The measles is believed to be a mild
disease except in populations that are living under unfavorable conditions. The vaccine is an
effective way to prevent the disease in an individual and the ability to control it in the
community if it is given at the age when maternal antibodies wan and the risk of infection
increases. There is no reason for the measles to claim its current number of morbidity and
mortality. With the extension of the Expanded Program of Immunization of the World Health
Organization, to help people in unfavorable living conditions in other countries receive the
vaccine, the impact of the measles should decrease significantly (F, 2017).

b. Suggest policies and practices that can be employed to help with limiting the public
spread of the disease.
Immunization from the measles is one way that helps the spread of infection. As with any
virus, good hygiene is important in helping to prevent the spread of disease. It is a popular
opinion of people that the measles is so rare that it is not necessary to be immunized but then
they travel out of the country and unknowingly bring the measles into the US. The most
important way to protect others and yourself is to make sure you are vaccinated (Conway, 2011).
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