Measles

B05

*Notifiable condition

DESCRIPTION

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 first symptoms and 14 days between appearance of rash in source and contact.

Complications include:

  • pneumonia,
  • feeding difficulties,
  • laryngotracheobronchitis (croup),
  • diarrhoea,
  • encephalitis,
  • otitis media,
  • stomatitis, and
  • corneal ulceration.

Subacute sclerosing panencephalitis is a rare long-term complication.

DIAGNOSTIC CRITERIA

Clinical

  • 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.

GENERAL AND SUPPORTIVE MEASURES

  • Notify provincial EPI manager when case is suspected, 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.
  • Screen outpatient waiting areas for children with measles.
  • If pneumonia with hypoxia, give humidified oxygen by nasal cannula.

MEDICINE TREATMENT

All patients

  • Vitamin A, oral, as a single daily dose for 2 days.
    • If < 6 months of age: 50 000 units.
    • If 6 – 12 months of age: 100 000 units.
    • If > 1 year of age: 200 000 units.

For fever

  • Paracetamol, oral, 10–15mg/kg/dose, 6 hourly as required until fever subsides.

Pneumonia

Also see Pneumonia .

Empiric antibiotics for suspected secondary bacterial infection:

To cover S. pneumoniae and Gram negative infection. Total duration of therapy: 5–7 days.

  • Amoxicillin/clavulanic acid, IV, 25mg/kg/dose 8 hourly

When child improves follow with oral therapy to complete 5–7 days treatment:

  • Amoxicillin/clavulanic acid, oral, 30mg/kg/dose 12 hourly.

Penicillin allergy
See Allergies to penicillins .

In very severe progressive or unresponsive pneumonia consider use of aciclovir for possible herpes infection.

Croup

See Laryngotracheobronchitis, acute viral (croup) .

Diarrhoea

See Diarrhoea, acute .

Encephalitis

See Meningo-encephalitis/encephalitis, acute viral .

Convulsions

See Status epilepticus (convulsive) .

Conjunctivitis

  • Chloramphenicol ophthalmic ointment 1%, inserted 6 hourly for 5 days.

If corneal clouding/ulceration present obtain urgent ophthalmologic consultation.

Management of contacts

Immunise children older than 6 months if unvaccinated and less than 72 hours since exposure.
Between 3 and 6 days after exposure and for contacts less than 6 months old:

  • Human Normal Immunoglobulin, IM, 0.25mL/kg.

If immunodeficient:

  • Human Normal Immunoglobulin, IM, 0.5 mL/kg.

Immunise all children > 6 months of age if outbreak occurs.

REFERRAL

  • Children in need of intensive care unit.
  • Children with depressed level of consciousness.
  • Children with corneal ulceration/opacity.