Measles

Measles is a highly contagious acute viral infection. Transmission is by air (inhalation of micro-droplets emitted by an infected person). In developing countries, it mainly affects children aged 1 to 3 years. Measles can be prevented by vaccination.

For more information, refer to the Support guide of a measles outbreak, MSF.

MeaslesClinical signs :

– The incubation period is 10 to 12 days.

Phase invasion or catarrhal phase (2 to 4 days)

• High fever (39-40 ° C), dry cough, runny nose and / or conjunctivitis (red eyes and watery)

• Sign Koplick: seedlings of red stains on the inside of the cheeks, with their center a bluish-white dot. This sign is pathognomonic of measles, but is not always easy to identify or present during the examination.

Phase eruption (5-6 days)

• On average 3 days after the onset of symptoms, rash maculopapular erythematous papules, non pruritic, erasing is to pressure. The rash develops in a downward topography forehead and face, neck and trunk (Day 2), abdomen and lower limbs (3rd and 4th day).

• Meanwhile, signs of catarrh oculorespiratory regress. In the absence of complications, fever disappears when the eruption reaches feet.

• The rash disappears around the 5th day in a downward topography (ie d as it appeared, from head to toe).

– The eruptive phase followed by desquamation during 1 or 2 weeks, very pronounced on dark skin: the skin takes on a striped appearance.

In practice, a patient with fever and maculopapular rash and at least one of the following: cough or runny nose or conjunctivitis, is a clinical case of measles.

Complications:

Complications are frequent and systematic search:

– Respiratory and ENT: pneumonia, otitis media, croup

– Ocular: purulent conjunctivitis, keratitis, xerophthalmia (risk of blindness)

– Digestive: diarrhea, stomatitis

– Acute malnutrition induced or aggravated by measles

– Neurological: febrile convulsions; rarely: encephalitis (1 case / 1000)

Among these complications, pneumonia and dehydration following diarrhea are the immediate causes of the most frequent death.

Course of action and treatment:

– Hospitalization criteria:

• Inability to drink / eat / suck or vomiting

• Convulsions or consciousness disorders

• Severe form of acute laryngotracheobronchitis

• severe respiratory infection

• diarrhea with dehydration

• Acute malnutrition

• Achievement of the cornea (pain, photophobia, opacity)

The treatment is done on an outpatient for patients who have any of these criteria.

– Eviction / Isolation

The infectious period begins the day before the onset of signs and persists 4-5 days after onset of rash:

• Triage of suspected cases of measles in the waiting rooms

• Eviction cases treated as outpatients during this period

• Isolation of hospitalized cases

– Treatment

• Treat fever in all cases (paracetamol PO).

• Systematically Prevent complications or treat if they are present:

Respiratory and ENT:

Prevention:

Desobstruction nasopharynx with sodium chloride 0.9% + amoxicillin PO: 80 to 100 mg / kg / day in 2 divided doses for 5 days

Treatment:

– Acute Pneumonia

– Purulent otitis

– Acute Laryngitis

Eye:

Prevention:

Cleaning the eyes with clean water 2 times / day + retinol (vitamin A) PO 1:

Children <6 months: 50,000 IU once daily on D1 and D2

Children 6 to 12 months: 100 000 IU once daily on days 1 and 2

Children> 1 year: 200 000 IU once daily on days 1 and 2

Treatment:

– Purulent conjunctivitis or keratitis

– Xerophthalmia

Digestive:

Treatment:

– Oral candidiasis

– Mouth ulcers: gentian violet 0.5%.

If deep or malodorous ulcers, add:

amoxicillin PO: 80 to 100 mg / kg / day in 2 doses + metronidazole PO: 20 to 30 mg / kg / day in 3 divided doses for 5 days

Dehydration:

Prevention:

Give the child.

Plan A WHO in case of diarrhea without dehydration.

Treatment:

Plan B or C according to the WHO the importance of dehydration.

Malnutrition:

Prevention:

Increase intake or frequency of feedings, split meals (every 2-3 hours), promote foods during illness and convalescence.

Treatment:

– Inability to drink or eat: gastric tube for the shortest possible duration.

– Acute malnutrition: therapeutic management of malnutrition.

Febrile seizures:

Prevention:

Treatment of fever (paracetamol); wet wrap in case of febrile peak.

Treatment:

– Seizures.

Prevention:

– No chemoprophylaxis of contacts.

– Vaccination:

High coverage (> 90%) significantly reduced the incidence of the disease and the risk of epidemics.

• Routine Immunization (EPI): a dose of 0.5 ml to be administered by deep SC or IM from the age of 9 months.

• When there is a high risk of infection (population grouping, epidemics, malnutrition, children born to mothers infected with HIV, etc.): a dose at age 6 months (between 6 and 8 months) then a dose from the age of 9 months (observe an interval of one month minimum between the 2 injections).

  1* Retinol also reduces the risk of severe complications in general and the risk of death.

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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