Measles: Definition, Symptoms and Transmission

Measles Definition

• Measles is an infectious viral disease causing fever and a red skin rash, typically in childhood
• Measles is an acute and highly communicable viral disease
• Measles symptoms are prodromal fever, conjunctivitis, coryza, cough and Koplik's spots on the buccal mucosa

Koplik Spots

• Koplik spots (or Koplik's sign) are a prodromic viral enanthem of measles
• Koplik spots manifest two to three days before the measles rash
• Koplik spots are characterized as clustered, white lesions on the buccal mucosa(opposite the lower 1st & 2nd molars)
• Koplik spots are pathognomonic for measles
• Koplik spots typically involve the buccal and labial mucosa
• Koplik spots presents as irregular, patchy erythema with tiny central white specks → 'grains of salt' appearance

Measles - Agent of Transmission

• Measles is caused by RNA virus, of the Paramyxo virus family, genus Morbillivirus
• Source of measles infection comes from other cases, but not from carriers
• Measles has no animal reservoir
• Infective measles material comes from nasal secretion, respiratory tract and throat
• Measles is highly infectious during prodromal period and at eruption
• The secondary attack rate of measles is greater than 80%

Measles - Agent of Infection

• Measles is caused by Morbilivirus, a family of Paramyxoviridae
• Measles virus contains hemagglutinin (H), fusion (F), matrix (M), lipid membrane, phosphoprotein (P), RNA, and large protein (L)

Measles - Mode of Transmission

• Measles is airborne by droplet spread, direct contact with throat secretions
• Measles incubation period is about 10 days varying from 7-18 days, usually 14 days
• Measles cause is a virus replicating the nose and throat of infected individuals
• Infected droplets from coughs, sneezes, or talking in measles patients spray into the air
• Infected droplets may land on surfaces and remain active and contagious for several hours
• Measles can be contracted by putting fingers in the mouth or nose, or rubbing eyes after touching an infected surface

Measles - Period of Communicability

• Measles communicability begins slightly before the beginning of the prodromal rash, until the second day of the rash
• After the second day of rash, communicability becomes minimal

Measles - Host Factors

• Measles is most common in those aged 6 months to 3 years, even up to 10 years
• Measles incidence is equal in both sexes
• Measles gives life long immunity
• Malnourished children are more susceptible to measles

Measles - Risk Factors

• Not being vaccinated increases the likelihood of developing measles
• Traveling internationally to developing countries where measles is more common increases the risk of catching the disease

Measles - Signs and Symptoms

• The symptoms of measles develop around 10 days after infection
• Measles presents with cold-like symptoms, such as a runny nose, sneezing, and a cough
• Measles presents with sore, red eyes that may be sensitive to light
• Those infected with measles can have a high temperature (fever), reaching around 40°C (104F)
• Measles infected can develop Koplik's spots, small greyish-white spots on the inside of the cheeks
• Measles classic signs include four-day fevers (the 4 D's) and the three C's which are: cough, coryza, and conjunctivitis
• Measles usually resolves after about three weeks
• Measles patients develop a red-brown blotchy rash in a few days
• Measles usually starts on the head or upper neck before spreading outwards to the rest of the body

Measles - Treatment

• Measles treatment is symptomatic
• Increase fluid intake
• Paracetamol or Calpol Mixture (PCM) can be taken
• Antibiotics can be taken if there is a bacterial infection, such as pneumonia or an ear infection

Measles - Isolation Precautions

• Airborne precautions are needed for measles patients
• Measles is small enough to be suspended in the air for long periods of time
• The preferred placement is in an airborne infection isolation room (AIIR)
• If possible, choose a single patient room with special air handling and ventilation capacity
• Employees who are not immune should not enter the room unless necessary
• Non-immune people must wear approved respirator masks and visitors need nursing or medical staff assistance to determine immune status (i.e., natural disease, immunization)
• Immune visitors do not need a mask, but nonimmune visitors should be discouraged
• If visitation is essential, the nonimmune visitor must wear a surgical mask
• An N95 mask filters at least 95% of the air particulates

Measles - Patient Education

• Give medicine as directed and call the healthcare provider if the medicine is not working as expected
• Do not give aspirin to children under 18 years of age, because the child could develop Reye syndrome if taking aspirin
• Reye syndrome is a life-threatening condition causing brain and liver damage
• Antibiotics should be fully administered, even if the child feels better
• Cough medicine and acetaminophen or ibuprofen may needed to treat fever and discomfort
• Keep children away from others, especially people who have never had measles or an MMR shot
• Keep children away from pregnant women or people with long-term medical problems
• Keep children home from school or day care until the fever and rash are gone, which takes about eight days

Measles - Complications

• Measles can lead to bacterial ear infection
• Measles may lead to bronchitis, laryngitis or croup which is the inflammation of the larynx
• Measles can inflame the inner walls of main air passageways of the lungs (bronchial tubes)
• Pneumonia is a common complication, and can be fatal for immunocompromised individuals
• Encephalitis, an inflammation of the brain, may cause vomiting, convulsions, and, rarely, coma or death
• Pregnancy problems may occur, such as pregnancy loss, preterm labor or low birth weight
• Measles can lead to low platelet count (thrombocytopenia)
• Immunization with live attenuated vaccine (MMR) is given to infants for prevention and control
• Authorities need to be notified of cases
• Patient sputum or nasal discharge must be disposed of safely
• Contacts must be investigated
• Since measles is contagious from about four days before to four days after the rash breaks out, those infected should avoid interacting with others during this period

Mumps

• Mumps name comes from the British word "to mump", meaning grimace or grin
• Patient appearance with parotid gland swelling can seem like a grin
• Mumps is an infection with the mumps virus, which is an RNA (ribonucleic acid) virus from the family Paramyxovirus & Rubella virus

Mumps - Agent

• Mumps comes from the Myxovirus parotidis -RNA virus
• Sourch of mumps infection comes from respiratory fluids and milk
• Mumps period of communicability is 4-6 days of onset of symptom
• Secondary attack rate of mumps is 86%

Mumps - Risk Factors

• The age and sex factors of mumps are 5-15 years and girls are more common
• There is lifelong immunity from mumps
• Environmental factors of winter and spring are seasonal
• Mumps spreads through droplet
• Mumps incubation period is 2-3 weeks

Mumps - Clinical Features

• Mumps can present as parotid swelling, ovaritis, pancreatitis, ear ache, orchitis, sore throat, difficult swallowing, fever, tiredness, muscle and body aches, loss of appitite or chills
• Sore throat may be a hallmark sign
• Salivary glands will swell
• Virus spreads throughout the body to testes, ovary, pancreas, thyroid, and salivary glands

Mumps - Diagnosis

• Diagnosis is made from symptoms, medical conditions, current medications or family/medical history
• Diagnoses of mumps are based on physical exam findings
• A blood test can check for antibodies to the mumps virus
• Throat culture can check for the virus in the fluid that surrounds the brain and spinal cord (CSF)
• Mumps spread by coughing and sneezing or touching something infected with the mumps virus
• Transmission is possible a few days prior to the onset of swelling of the salivary glands to 9 days after the onset of symptoms
• The virus enters the body, then travels to the back of the throat, nose, and lymph glands in the neck, where it multiplies

Mumps - Prevention

• MMR vaccine helps prevent measles, mumps, and rubella
• Children 1 year of age and older get 2 doses, usually between ages 15 and 18 months and again between 4 and 6 years

Mumps - Isolation Precautions

• S/S of mumps illness should be cared for using droplet precautionsThese pathogens do not remain infectious over long distances in a healthcare facility
• Special air handling and ventilation are not required to prevent droplet transmission

Mumps - Patient Education

• Call the doctor if you suspect that your child has mumps
• If your child has been diagnosed with mumps, keep track of his or her temperature and call the doctor if goes above 101° (38.3° Celsius)
• Mumps can also involve the brain and its membranes, call the doctor immediately if your child has any of the following: stiff neck, convulsions (seizures), extreme drowsiness, severe headache, or changes of consciousness

Mumps - Complications

• Mumps can lead to deafness, meningitis due to infection of the fluid and lining covering the brain and spinal cord, myocarditis, arthritis or infertility as infection can spread to ovaries
• Watch for abdominal pain, indicating involvement of the pancrease or ovaries
• in boys, watch out for high fever with pain, swelling of testicles
• Isolation until subsiding of swelling is necessary
• Bed rest until swelling subsides
• Restrict liquid and soft foods to prevent acid exposure
• Additional complications can be orchitis, epididymitis, oophoritis, spontaneous abortion, sensori neural hearing loss, meningitis or encephalitis

Rubella Description

• Rubella name is derived from a Latin term meaning "little red"
• Rubella is sometimes called German Measles or 3-day Measles
• Rubella exanthema starts on the face and neck and spreads centrifugally to the trunk and extremities within 24 hours
• Rubella exanthema begins to fade on the face on the second day and disappears throughout the body by the end of the third day
• Rubella is a generally mild disease caused by it's virus

Rubella - Infection Agent

• Rubella is caused by an RNA virus (Togavirus family), Genus Rubivirus
• Rubella virus is an ss - RNA virus with a Diameter of 50 - 70 nm and Enveloped Spherical shape
• Rubella carries hem agglutinin and multiplies in the cytoplasm of infected cell

Rubella - Transmission

• Rubella is transmitted through respiratory secretion
• Other ways of rubella transmission is droplet, vertical (from mother to baby during/after birth)
• Rubella is transferred across placenta, in breast milk, or via contact
• It spreads when an infected person coughs or sneezes, or spreads by direct contact with an infected person's respiratory secretions/mucus
• Incubation period is 2-3 weeks, average of 18 days
• Immunity is life-long

Rubella - Symptoms

• Red-pink skin rash made up of small spots
• Swollen glands around the head and neck
• A high temperature (fever)
• Cold-like symptoms such as a cough and runny nose
• Aching and painful joints are more common in adults

Rubella and Pregnancy

• Rubella only becomes a serious concern if a pregnant woman catches the infection during the first 20 weeks of her pregnancy
• Rubella can disrupt the development of the baby
• Birth defects from rubella is known as congenital rubella syndrome (CRS)
• Congenital rubella syndrome (CRS) includes growth retardation, cataracts, deafness, congenital heart defects, defects in other organs or mental retardation

Rubella - Diagnosis

• Tests can be conducted to identify rubella through blood and saliva tests
• Rubella is confirmed when samples test positive for certain antibodies
• IgM antibody indicates a new rubella infection
• IgG antibody indicates a rubella infection in the past or a rubella vaccination

Rubella - Treatment

• No specific treatment exists, but the condition improves within 7 to 10 days without treatment
• Paracetamol or Calpol Mixture (PCM) can treat fever and malaise
• Drink plenty of fluids
• Rest in bed as necessary

Rubella - Prevention and Control

• Congenital Rubella Syndrome can be prevented by effective immunization
• The MMR vaccine can help prevent measles, mumps, and rubella
• Children 1 year of age and older can get 2 doses of the MMR vaccine
• The first shot is typically given between 15 and 18 months and the second shot is given between ages 4 and 6 years
• Visitors to rubella rooms should not enter if they have never had rubella or are unsure if having mumps/measles vaccine

Rubella - Nursing Interventions

• Patients can develop an ear infectionor encephalitis
• Rest and medicines (Tylenol or non-aspirin pain reliever) can treat fever
• Prognosis for children affected by congenital rubella is poor which can cause other congenital conditions

Rubella - Isolation Precautions

• Healthcare workers/caregivers will need to wear protective items (masks, eye protection, gowns, gloves)
• Ensure pathogens do not remain infectious over long distances in a healthcare facility
• Patients should be in rooms without requiring special air handling or ventilation
• Visitors should not enter if they have never had rubella, the measles or MMR vaccine. All visitors should wear protective items

Chicken Pox

• Caused by varicella zoster virus which creates a rash of spots that looks like blisters all over the body
• Blisters are small and sit on area of red skin with the size of a pencil or eraser
• A painful skin rash is called shingles (herpes zoster) and typically strikes later in life

Chicken Pox - Contagiousness

• Chickenpox spreads easily, especially kids with siblings who are infected

Chicken Pox - Risk Factors

• Not having chickenpox increases risk, as does not being vaccinated
• Working with children increases risk of chicken pox
• Risk factors include new borns, pregnant women with no vaccination
• Those with medication induced immune deficiency or cancer/HIV are at risk
• Taking steroid medication increases risk
• People taking drugs that suppress their immune systems

Chicken Pox - Mode of Transmission

• Spreads through air by coughing/sneezing or direct contact with liquid coming from blisters.
• Chickenpox is contagious two days prior of rash erupting and ends when blisters are crusted over

Chicken Pox - Signs and Symptoms

• Chickenpox appears between 10-21 days of exposure and lasts between 5-10 days
• Chickenpox presents with raised pink or red bumps (papules) forming small blisters (vesicles) forming crusts
• Other symptoms include fever, loss of appetite, headache, tiredness or malaise

Chicken Pox - Complications

• Bacterial infections, dehydration, pneumonia, brain inflammation (encephalitis), toxic shock syndrome and Reye's syndrome

Chicken Pox - Health Education

• Avoid scratching
• Drink water
• Take balanced and frequent meals
• Take sponge bath
• Dabbing spots with calamine lotion, antihistamines, or loose clothes
• Avoid premature infants, people with weakened immune systems, or organ transplant receipients as contact risks spreading infection

Chicken Pox - Prevention

• Avoid contact with others until the rash has developed, but especially pregnant women or unvaccinated individuals
• Keeping the infected person away from nursery, school or work helps limit exposure
• Avoiding contact with "at-risk" groups such as those unvaccinated
• Regularly washing infected clothes or bedding reduces possible transference
• Taking chicken pox vaccine is effective