Kiara Denise Tamayo

BSN II-A

MEASLES
Definition
- Measles is a highly contagious, serious disease caused by a virus.
- It is caused by a virus in the paramyxovirus family and it is normally passed
through direct contact and through the air. The virus infects the respiratory tract,
then spreads throughout the body. Measles is a human disease and is not
known to occur in animals.
- After a bout of measles, a person gains immunity for the rest of their life. They
are very unlikely to contract measles a second time.

Types of Measles
- Atypical measles occurs in people who received a killed measles vaccine
between 1963 and 1967. When exposed to measles, these individuals come
down with an illness that has symptoms such as high fever, rash, and sometimes
pneumonia.
- Modified measles occurs in people who’ve been given post-exposure
immunoglobulin and in infants who still have some passive immunity. Modified
measles is typically milder than a regular case of measles.
- Hemorrhagic measles is rarely reported. It causes symptoms like high fever,
seizures, and bleeding into the skin and mucus membranes.

Causative Agent
- Measles is a highly contagious illness caused by a virus that replicates in the
nose and throat of an infected child or adult. Then, when someone with measles
coughs, sneezes or talks, infected droplets spray into the air, where other people
can inhale them.
- The infected droplets may also land on a surface, where they remain active and
contagious for several hours. You can contract the virus by putting your fingers
in your mouth or nose or rubbing your eyes after touching the infected surface.
- About 90 percent of susceptible people who are exposed to someone with the
virus will be infected.
Complication of Measles
- Common:
 Otitis media
 Bronchopneumonia
 Laryngotracheobronchitis
 Diarrhea
- Severe:
 Encephalitis
 Respiratory complications
 Neurologic complications
 Subacute sclerosing panencephalitis (SSPE)
Stages of Illness
- Incubation Phase: The incubation phase typically lasts 8 to 12 days after exposure to
the virus and does not have any symptoms. The prodromal phase begins at the onset
of the first symptoms, which begin gradually and include a fever, a cough, a runny
nose, and red eyes. Usually, the fever is the first symptom noticed by parents. The
fever rises steadily and may reach maximum temperatures of 103F to 104F. At the
height of the fever, the rash develops.
- Prodromal (Catarrhal) Phase: The runny nose with a profuse watery discharge,
nasal congestion, and sneezing becomes prominent. Typically, there is a pronounced
cough, which is hoarse, dry, and hacking. Some children may complain of tightening in
the chest. The red eyes are characterized by increased tearing, eye pain that may be
severe, and sensitivity to light. Other symptoms that are frequently observed during
the prodromal phase include fatigue, irritability, a decreased appetite, a headache,
abdominal pain, and a dry mouth and throat.
- One of the characteristic findings of measles is the presence of spots, known as "Koplik
spots," inside the mouth. These tiny pinpoint blue-white spots begin as a few lesions on
the inside of the cheeks, typically occurring 1 to 2 days before the rash, and increase
rapidly in number over the next 24 hours. They begin to fade as the rash appears, and
usually disappear by the second day of the rash.
- Illness (Rash) Phase: Approximately two to four days after the onset of the
symptoms, the rash appears, marking the beginning of the rash phase. The symptoms
of the prodromal phase worsen with the onset of the rash, but then begin to decrease
in severity. The measles rash is a flat or slightly raised rash, and is not itchy. It first
appears as irregular spots on the upper forehead or behind the ears and on the neck.
Within 24 hours, it progresses to the entire face, head, and neck. Over the next two to
four days, the rash extends to the chest, back, and extremities, including the palms of
the hands and the soles of the feet. It remains most prominent on the face, especially
on the cheeks.
- Recovery Phase: After four to five days, the rash begins to subside, marking the
beginning of the recovery phase. Sometimes, a very fine flaking of the skin is noted as
the rash fades. About 10 to 14 days after developing the rash, the child is back to a
normal level of activity.

Mode of Transmission
- It is spread by coughing and sneezing, close personal contact or direct contact
with infected nasal or throat secretions.
- The virus remains active and contagious in the air or on infected surfaces for up
to 2 hours. It can be transmitted by an infected person from 4 days prior to the
onset of the rash to 4 days after the rash erupts.

Diagnostic Tests
- Measles is diagnosed primarily on the clinical and physical examination findings.
The appearance of the rash is characteristic, and when found in association with
Koplik spots inside the mouth, an experienced physician can diagnose measles.
There also is a specific antibody blood test that can be used to confirm the
diagnosis.
- Antibody assays. The measles virus sandwich-capture IgM antibody assay,
offered through many local health departments and through the CDC, is the
quickest method of confirming acute measles; laboratories can confirm measles
by demonstrating more than a 4-fold rise in IgG antibodies between acute and
convalescent sera, although relying solely on rising IgG titers for the diagnosis
delays treatment considerably.
- Viral culture. Throat swabs and nasal swabs can be sent on viral transport
medium or a viral culturette swab to isolate the measles virus; urine specimens
can be sent in a sterile container for viral culture.
- Reverse-transcription polymerase chain reaction (PCR). Reverse-transcription
polymerase chain reaction (PCR) evaluation is highly sensitive at visualizing
measles virus RNA in blood, throat, nasopharyngeal, or urine specimens and,
where available, can be used to rapidly confirm the diagnosis of measles.
- Chest radiography. If bacterial pneumonia is suspected, perform chest
radiography; the frequent occurrence of measles pneumonia, even in
uncomplicated cases, limits the predictive value of chest radiography for
bacterial bronchopneumonia.
Medical Management
- No specific antiviral treatment exists for measles virus.
- Severe complications from measles can be reduced through supportive care that
ensures good nutrition, adequate fluid intake and treatment of dehydration with
WHO-recommended oral rehydration solution. This solution replaces fluids and
other essential elements that are lost through diarrhoea or vomiting. Antibiotics
should be prescribed to treat eye and ear infections, and pneumonia.
- All children diagnosed with measles should receive two doses of vitamin A
supplements, given 24 hours apart. This treatment restores low vitamin A levels
during measles that occur even in well-nourished children and can help prevent
eye damage and blindness. Vitamin A supplements have also been shown to
reduce the number of measles deaths.
- There are some interventions available for people who may have been exposed
to the virus. These can help prevent an infection or lessen its severity. They
include:
 a measles vaccine, given within 72 hours of exposure
 a dose of immune proteins called immunoglobulin, taken within six days of
exposure
- Your doctor may recommend the following to help you recover:
 acetaminophen (Tylenol) or ibuprofen (Advil) to reduce fever
 rest to help boost your immune system
 plenty of fluids
 a humidifier to ease a cough and sore throat
 vitamin A supplements

Nursing Intervention
- Interventions for a child with measles are:
 Isolation. Patients will need to be on isolation precautions to decrease
transmission within the community; emphasize the need for immediate
isolation when early catarrhal symptoms appear.
 Skin care. Measles causes extreme pruritus; nursing interventions include
keeping the patient’s nails short, encourage long pants and sleeves to prevent
scratching, keeping skin moist with health care provider recommended
lotions, and avoiding sunlight and heat.
  Eye care. Treat conjunctivitis with warm saline when removing eye secretions
and encourage patient not to rub eyes; protect the eyes from the glare of
strong light.
 Hydration. Encourage oral hydration; medical literature encourages the use
of oral rehydration solution.
 Temperature control. Antipyretics should be administered to the patient as
ordered for a temperature greater than 100.4 Fahrenheit unless directed
elsewise by a healthcare provider; be sure to remind parents not to
administer aspirin due to the risk of Reye’s syndrome.

Prevention
- To prevent measles, the MMR vaccine is given to children in two doses: the first
at 12 to 15 months and another prior to school entry at ages 4 to 6. The MMR
vaccine can be used in children age 12 months through 12 years. Children
between ages 1 and 12 may receive a “combination” vaccine called MMRV,
which contains both MMR and varicella vaccines. Adults should get the MMR
vaccine if they were born after 1956 unless they have already had measles.
- The MMR vaccine is contraindicated in patients who are pregnant or may
become pregnant within 4 weeks, patients with severe immunodeficiency, such
as severely symptomatic HIV infection, and those with a history of anaphylaxis
triggered by the vaccine or any of its components, including the antibiotic
neomycin. Teach patients that risks such as allergic reactions can occur with the
MMR vaccine, but getting the vaccine is much safer than getting measles.

Sources:
 https://www.healthline.com/health/measles
 https://www.who.int/news-room/fact-sheets/detail/measles
 http://www.pediatricweb.com/webpost/iframe/MedicalConditions_487.asp?t
ArticleId=172#targetText=Measles%20can%20be%20divided%20into,does%20
not%20have%20any%20symptoms.
 https://nurseslabs.com/measles/
 https://journals.lww.com/nursing/Fulltext/2015/04000/Measles__What_you_
need_to_know.17.aspx