What is Measles? History, Natural Progression, Outcomes
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MeaslesAn Introduction
Ron Waldman, MD, MPHProfessor of Global Health
Milken Institute School of Public HealthGeorge Washington University
National Press FoundationFebruary 23, 2015
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Panum’s Observations
7,782 inhabitants No cases for 65 years 6,000 cases incubation period 10-14 days in affected villages, 19/20 fell ill older people spared (0/98) death: 23/1,000
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Panum’s Observations
Of the 6,000 cases, “[t]here was not a single one in which it was justifiable to attribute the affection to a miasmatic origin, while at the same time it was everywhere clear that the disease had spread from man to man…”
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Symptoms
10-14 days after exposure: fever cough runny nose sore throat conjunctivitis (Koplik’s spots) generalized rash – large, red blotchy spots
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Stages of Measles
incubation period, after infection non-specific illness (prodrome) acute illness and rash phase recovery and convalescence
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Complications of Measles
• Common– ear infection (1 in 10)– diarrhea (1 in 10)
• Severe– pneumonia (1 in 20)– encephalitis (1 in 1000) – convulsions, deafness– Blindness (was leading cause in children in 2004)– death (1 in 1000)
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Long-term Complications of Measles
Sub-acute Sclerosing Panencephalitis (SSPE)
-- fatal-- develops 7-10 years following full recovery-- 4-11 cases/100,000 cases of measles
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Measles -- Treatment
• Non-specific– hydration– food– analgesic, e.g., acetaminophen
• Vitamin A supplementation if indicated
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Routes of Transmission of Communicable Diseases
• Airborne (no direct contact required)• Droplet• Sexual• Animal or insect• Food/water• Health care settings
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"Sneeze" by James Gathany - CDC Public Health Image library ID 11162.
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Herd Immunity (1)
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Herd Immunity (2)
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Major Causes of Death in Refugee Populations
Sudan: Wad Kowli CampFebruary, 1985
Somalia: Gedo Region, 7 Camps January, 1980
Source: Centers for Disease Control and Prevention, Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues. MMWR, 1992;41(No. RR-13):8.
MeaslesARIMalariaDiarrheaOther
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Measles in the World, 2013• Measles is one of the leading causes of death among young children even
though a safe and cost-effective vaccine is available.
• In 2013, there were 145 700 measles deaths globally – about 400 deaths every day or 16 deaths every hour, but down from 2.6 million in 1980.
• Measles vaccination resulted in a 75% drop in measles deaths between 2000 and 2013 worldwide.
• In 2013, about 84% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000.
• During 2000-2013, measles vaccination prevented an estimated 15.6 million deaths making measles vaccine one of the best buys in public health.
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Coverage with 1st dose of Measles-containing vaccine (line) and Measles case reports (bars), WHO Africa Region, 1980-2013
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Pertussis: Global Trends and Vaccine Uptake
Berger S. Pertussis: Global Status 2013. www.gideononline.com/ebooks/disease
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"Runderpest in Nederland 18e eeuw" by Jacobus Eussen - Henk Povée in:Tien eeuwen tussen Lek en IJssel, 2004 ISBN 90 6868 378 0. Licensed under Public Domain via Wikimedia
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