Infectious measles

Measles virus is transmitted by direct contact with infectious droplets or by airborne spread. In temperate areas, the peak incidence of infection usually occurs during late winter and spring. Patients infected with wild type measles virus are contagious from ۴ days before the rash through ۴ days after appearance of the rash. Measles is an acute viral disease characterized by fever, cough, coryza, and conjunctivitis, followed by a maculopapular rash beginning on the face and spreading cephalocaudally and centrifugally. During the prodromal period, a pathognomonic enanthema, Koplic spots, may be present. Complications of measles including otitis media, bronchopneumonia, laryngotracheobronchitis (croup), and diarrhea occur commonly in young children and immunocompromised hosts. Case fatality rates are increased in children younger than ۵ years, pregnant people, and immunocompromised children, including children with leukemia, HIV infection, and severe malnutrition (including vitamin A deficiency). Measles virus infection can be confirmed by: ۱- detection virus RNA by NAAT ۲- detection IgM ۳- a fourfold increase in measles IgG in paired acute and convalescent serum specimens ۴- isolation of virus in cell culture. No specific antiviral therapy is available. WHO currently recommends vitamin A for all children with measles, regardless of their country of residence. In people who are not immunocompromised, use of vaccine is recommended for post exposure prophylaxis and in pregnant and people who are immunocompromised, immune globulin use for post exposure prophylaxis. Available data suggest that measles vaccine, if administered within ۷۲ hours of measles exposure to susceptible individuals, will provide protection or disease modification. In some cases either IGIM or IGIV can be administered within ۶ days of exposure to prevent or modify measles in people who do not have evidence of measles immunity. For children who receive IGIM for modification or prevention of measles after exposure, measles vaccine (if not contraindicated) should be administered ۶ months after IGIM administration and ۸ months after IGIV administration provided the child is at least ۱۲ months of age.