The epidemic of measles and the outbreak of diphtheria in recent years

By Diksha Cheetoo Roll number 10

What is measles?
Also known as morbilli or rubeola Caused by virus of same name, family of paramyxoviridae viruses. It is one of the most contagious infectious diseases, with at least a 90% secondary infection rate in susceptible domestic contacts.. It can affect people of all ages, despite being considered primarily a childhood illness.

Symptoms and Complications

Measles is marked by prodromal fever, cough, coryza, conjunctivitis and pathognomonic enanthem ( eg koplik spots), followed by an erythematous maculopapular rash on the third to seventh day. Infection confers life-long immunity. A generalized immunosuppression that follows acute measles freqently predisposes patients to bacterial infections like otitis media and bronchopneumonia.

 How is measles transmitted?

Droplets transfer the infections. Although the sick person may be in isolation, the disease may still spread from room to room. Anybody who has not already had measles can be infected. Infants up to four months of age will not be infected if their mother has had measles herself because they will be protected by her antibodies. The incubation period - the time between infection and the outbreak of the condition - is usually one to two weeks. Patients are infectious from four days before the onset of the rash until five days after it appears.

Why the outbreak?

From 2 to 5% of people do not respond to their first dose of measles vaccine, which is why a booster dose is recommended. More than 99% of people develop immunity to measles after two doses of a measles vaccine, like MMR. A booster dose of MMR was not first recommended in 1989, so many adults born before 1985 may not have had two doses of MMR.

 Measles is fatal in about 0.2% of cases. The measles virus is spread by respiratory droplets and can stay in an area for up to two hours after a person with measles symptoms has left. People with measles are contagious from four days before they develop the measles rash to four days after it goes away.

 In approximatetly 0.1% cases, measles causes acute encephalitis. Subacute sclerosing panencephalitis (SSPE) is a rare chronic degenerative disease that occurs several years after measles infection.

A suspected case of measles is defined as:

Any person with generalised maculo-papular rash and fever plus cough or coryza or conjunctivitis Or any person whom the clinician suspects measles Blood specimen collected are sent to labs. An outbreak is confirmed when 3 or more measles lab-confirmed cases are detected in a health facility or district Subsequent cases are detected by epidemiological link.

epidemiology
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M 1 1 1 1 3 7 2 7 0 0 0 0 0 0 0 6 1 8 7 0 1 0 2 0 5 2 6 0 4 0 3 E 2 5 2 3 8 7 0 8 5 A 7 S L E S

D 0 5 0 0 0 0 0 0 0 0 0 0 0 I P H T H E R

0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0

 In 2001 countries of WHOAFR, became par of a global initiative of reducing the number of measles death by 50% by 2005. Recommended strategies: Increasing routine coverage for the first dose of measles containing vaccine (MCV1) for all children Providing a second opportunity for measles vaccination through supplemental immunization activities(SIA) Improving measles case-managemnt Establishing case-based surveillance with labconfirmation of all suspected measles cases

vaccination
Dr.John Franklin Enders, known as "The Father of Modern vaccines", who earned the Nobel Prize in 1954, was able to use the cultivated virus to develop a measles vaccine in 1963 Dr. Maurice Hilleman ,a pioneer in the development of vaccinations, developed the MMR vaccine in 1971, which treats measles, mumps and rubella in a single shot followed by a booster dose.

vaccination
MCV1 is administered through routine services to children aged 9 months Average increase from 57% to > 90% in 2001. ( 98% in 2010) As from 2003 a second booster dose of MCV (MCV2) through routine services has been reported coverage of >98% in 2008

SIAs
Provide a second opportunity for measles immunisation to all children including those not vaccinated with MCV1 and those previously vaccinated Approximately 15% of children vaccinated with a single dose at age 9 months will not develolp immunity to measles Consists of a one time catch up SIA, targeted to a wide range, which aims to reduce susceptibility to measles in the population

 This is followed by periodic follow up SIAs targeting children born since the last SIAs, thus reducing the accumulation of susceptible children in new birth cohorts Hence the 777 cases of measles in 2003 has been partly due to this follow up not being completed Measles surveillance This was put in practice by december 2008 by AFR But no established measles case-based surveillance in accordance with WHOAFR measles surveillance guidelines.

Diphtheria
Diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheriae. It is characterized by sore throat, low fever and a pseudomembrane on the tonsils,pharynx and/or nasal cavity. A milder form of diphtheria can be restricted to the skin. Less common consequences include myocarditis(about 20% of cases) and peripheral neuropathy(about 10% of cases).

Signs and symptoms

The symptoms of diphtheria usually begin two to seven days after infection. Symptoms of diphtheria include fever of 38C or above, chills, fatigue, bluish skin coloration, sore throat, hoarseness, cough, headache, difficulty swallowing, painful swallowing, difficulty breathing, rapid breathing, foulsmelling bloodstained nasal discharge and lymphadenopathy.]

 Symptoms can also include cardiac arrhythmias, myocarditis, and cranial and peripheral nerve palsies.

vaccines
No diphtheria-only vaccine is available. The diphtheria vaccine is available as: DTaP (Diphtheria, Tetanus, acellular Pertussis vaccine) DTaP in combination with Haemophilus influenzae type b (Hib) vaccine DTaP in combination with hepatitis B and inactivated polio vaccines

 DTaP in combination with Hib, hepatitis B and inactivated polio vaccines DT or Td (in combination with tetanus vaccine) Tdap (Tetanus, reduced diphtheria, acellular Pertussis)

Immunization
The immunization service is been going on since 1960 Coverage of DTP is 99% (2010) 5 cases in 2009 Reasons are: Immigrant children not adequately immunised Secondary vaccine failure Unimmunised Mauritian children.