Disease-a-Month 59 (2013) 443–444
Contents lists available at ScienceDirect
Disease-a-Month journal homepage: www.elsevier.com/locate/disamonth
Measles Robin B. McFee, DO, MPH, FACPM, FAACT
Measles is caused by a Paramyxoviridae virus, which is enveloped and contains single stranded RNA.1–5 It is easily spread by inhalation of droplets and direct contact with nasal secretions; it is one of the most contagious of all infections.1,6,7 There are two forms—wild type
Fig. 1. The common rash of measles. Notice how similar it is to the rash associated with dengue (www.cdc.gov). 0011-5029/$ - see front matter & 2013 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.disamonth.2013.10.009
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R.B. McFee / Disease-a-Month 59 (2013) 443–444
and vaccine virus. Measles virus remains extremely infective for several hours as long as it remains moist and in aerosolized droplets. Like other childhood infections, including chickenpox, it is considered one of the diseases that have been controlled in the U.S.6,7 This perception notwithstanding, measles remains the cause of severe illness worldwide, including blindness and several outbreaks in the U.S. due to inadequately vaccinated persons, and it is considered one of the top ten causes of death in children.1–3 What we take for granted in terms of vaccine preventable diseases (VPD) that include measles, much of the world remains inadequately vaccinated.6,7 Moreover, there continue to be outbreaks in the U.S. among unimmunized or inadequately immunized individuals. In 2006, a computer programmer from India, who was infected with measles, arrived in Boston, Massachusetts. He went through a crowded, public office building, subsequently infecting several individuals. The public health response resulted in 23,000 doses of measles vaccine ordered and/or distributed in anticipation of the potential for a significant public health crisis. Measles is highly contagious. Fortunately the infection was contained. Interestingly, one has to wonder how many health care professionals could identify the exanthema, the rash associated with measles, given the widespread vaccination in the U.S. An estimated 93% of U.S. children are vaccinated against measles; compared to 56% in India. Global travel can bring infections from far-off lands into our waiting rooms, restaurants, churches, and communities with relative ease (Fig. 1). References 1. Rainwater-Lovett K, Nkamba HC, Mubiana-Mbewe M. Changes in measles serostatus among HIV-infected Zambian children initiating antiretroviral therapy before and after the 2010 measles outbreak and supplemental immunization activities. J Infect Dis. 2013;208(1):1747–1755. 2. Low C, Thoon KC, Lin R. Possible nosocomial transmission of measles in unvaccinated children in a Singapore public hospital. West Pac Surveill Response J. 2012;3(4):7–11. 3. Progress towards measles elimination in the Western Pacific Region, 2009–2012. Wkly Epidemiol Rec. 2013;88(23): 233–240. Schönberger K, Ludwig MS, Wildner M, Weissbrich B. Epidemiology of subacute sclerosing panencephalitis (SSPE) in Germany from 2003 to 2009: a risk estimation. PLoS One. 2013;8(7):e68909. 4. Goldacre MJ, Maisonneuve JJ. Hospital admission rates for measles and mumps in England: historical perspective. Lancet. 2013;382(9889):308–309. 5. McLean HQ, Fiebelkorn AP, Temte JL. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. MMWR Recomm Rep. 2013;62(RR-04):1–34. 6. Lassen SG, Schuster M, Stemmler M. Measles outbreak spreading from the community to an anthroposophic school, Berlin, 2011. Epidemiol Infect. 2013;July 3:1–8. 7. Measles. 〈http://WWW.cdc.gov〉.
Contents lists available at ScienceDirect
Disease-a-Month journal homepage: www.elsevier.com/locate/disamonth
Measles Robin B. McFee, DO, MPH, FACPM, FAACT
Measles is caused by a Paramyxoviridae virus, which is enveloped and contains single stranded RNA.1–5 It is easily spread by inhalation of droplets and direct contact with nasal secretions; it is one of the most contagious of all infections.1,6,7 There are two forms—wild type
Fig. 1. The common rash of measles. Notice how similar it is to the rash associated with dengue (www.cdc.gov). 0011-5029/$ - see front matter & 2013 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.disamonth.2013.10.009
444
R.B. McFee / Disease-a-Month 59 (2013) 443–444
and vaccine virus. Measles virus remains extremely infective for several hours as long as it remains moist and in aerosolized droplets. Like other childhood infections, including chickenpox, it is considered one of the diseases that have been controlled in the U.S.6,7 This perception notwithstanding, measles remains the cause of severe illness worldwide, including blindness and several outbreaks in the U.S. due to inadequately vaccinated persons, and it is considered one of the top ten causes of death in children.1–3 What we take for granted in terms of vaccine preventable diseases (VPD) that include measles, much of the world remains inadequately vaccinated.6,7 Moreover, there continue to be outbreaks in the U.S. among unimmunized or inadequately immunized individuals. In 2006, a computer programmer from India, who was infected with measles, arrived in Boston, Massachusetts. He went through a crowded, public office building, subsequently infecting several individuals. The public health response resulted in 23,000 doses of measles vaccine ordered and/or distributed in anticipation of the potential for a significant public health crisis. Measles is highly contagious. Fortunately the infection was contained. Interestingly, one has to wonder how many health care professionals could identify the exanthema, the rash associated with measles, given the widespread vaccination in the U.S. An estimated 93% of U.S. children are vaccinated against measles; compared to 56% in India. Global travel can bring infections from far-off lands into our waiting rooms, restaurants, churches, and communities with relative ease (Fig. 1). References 1. Rainwater-Lovett K, Nkamba HC, Mubiana-Mbewe M. Changes in measles serostatus among HIV-infected Zambian children initiating antiretroviral therapy before and after the 2010 measles outbreak and supplemental immunization activities. J Infect Dis. 2013;208(1):1747–1755. 2. Low C, Thoon KC, Lin R. Possible nosocomial transmission of measles in unvaccinated children in a Singapore public hospital. West Pac Surveill Response J. 2012;3(4):7–11. 3. Progress towards measles elimination in the Western Pacific Region, 2009–2012. Wkly Epidemiol Rec. 2013;88(23): 233–240. Schönberger K, Ludwig MS, Wildner M, Weissbrich B. Epidemiology of subacute sclerosing panencephalitis (SSPE) in Germany from 2003 to 2009: a risk estimation. PLoS One. 2013;8(7):e68909. 4. Goldacre MJ, Maisonneuve JJ. Hospital admission rates for measles and mumps in England: historical perspective. Lancet. 2013;382(9889):308–309. 5. McLean HQ, Fiebelkorn AP, Temte JL. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. MMWR Recomm Rep. 2013;62(RR-04):1–34. 6. Lassen SG, Schuster M, Stemmler M. Measles outbreak spreading from the community to an anthroposophic school, Berlin, 2011. Epidemiol Infect. 2013;July 3:1–8. 7. Measles. 〈http://WWW.cdc.gov〉.
