Measles FINAL

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A Reading on

MEASLES

In Partial Fulfillment of the

Requirements in NCM 102-RLE

IMCI ROTATION

Submitted to:

Edsel Omandac, RN

CLINICAL INSTRUCTOR

Submitted by:

Chrisel Joy dela Cruz, St.N

BSN 2I Group 3

March 3, 2011


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Measles Overview

Measles is best known for causing a rash in childhood, but measles can affect other parts of the body and sometimesoccurs in adults. Vaccination has significantly reduced the number of cases in the United States, although isolatedoutbreaks continue to occur.

There are two types of measles, each caused by a different virus. Although both produce a rash and fever, they arereally different diseases:

y The rubeola virus causes "red measles," also known as "hard measles" or just "measles." Although mostpeople recover without problems, rubeola can lead to pneumonia or inflammation of the brain (encephalitis).

y The rubella virus causes "German measles," also known as "three-day measles." This is usually a milderdisease than red measles. However, this virus can cause significant birth defects if an infected pregnantwoman passes the virus to her unborn child.

Measles Causes

y Both the rubeola and rubella viruses are spread through the respiratory route. This means they arecontagious through coughing and sneezing. In fact, the rubeola virus is one of the most contagious viruses

known to man. As a result, it can spread rapidly in a susceptible population. Infected people carry the virusin their respiratory tract before they get sick, so they can spread the disease without being aware of it.

y If people are immune to the virus (either through vaccination or by having had measles in the past), theycannot get the disease caused by that virus. For example, someone who had rubeola as a child would notbe able to get the disease again. Remember that rubella and rubeola are different viruses. An infection withone of these viruses does not protect against infection with the other.

Measles Symptoms

Rubeola ("red measles" or "hard measles")

Symptoms appear about 10-14 days after a person is infected with the rubeola virus. This is called the incubationperiod. During this period, the virus is multiplying. Symptoms occur in two phases.

The early phase begins with these symptoms:

y Fevery A run-down feelingy Coughy Red eyes (conjunctivitis)y Runny nosey Loss of appetitey The red measles rash develops from two to four days later.y The rash usually starts on the face, spreading to the trunk and then to the arms and legs.y The rash is initially small red bumps that may blend into each other as more appear. From a distance, the

rash often looks uniformly red.y People with measles may develop small grayish spots on the inside of the cheek, called "Koplik spots."

y The rash is usually not itchy, but as it clears up, the skin may shed (this looks like skin that is peeling aftersunburn).

Although red measles is usually a mild disease, a few serious complications may occur. Red measles makespatients more vulnerable to pneumonia and bacterial ear infections. Pneumonia as a complication of measles isespecially serious in infants and is responsible for most deaths in this age group. Inflammation of the brain(encephalitis) occurs about once in every thousand cases and is a serious complication that can be fatal.

Red measles is particularly severe in patients with weakened immune systems, including people who aremalnourished or have HIV.


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Rubella ("German measles")

German measles causes milder symptoms than red measles. The incubation period between getting the virus andgetting sick is 10 days to two weeks.

Initially, some people experience fatigue, low-grade fever, headache, or red eyes several days before the rashappears. These symptoms are more common in adults than in children.

y Swollen, tender lymph nodes may occur in the back of the neck.y The rash is light red to pink. It starts as individual spots which may merge together over time. The rash

usually starts on the face and moves down to the trunk.y The rash does not usually itch, but as it clears up, the skin may shed.

Adult women who get rubella may get painful joints for days to weeks after the infection. This affects the hands,wrists, and knees. Symptoms may be so mild that they are not even noticed, especially in children. Most symptomsresolve in a few days, but swollen lymph nodes may persist for a few weeks. The most feared complication of rubellais "congenital rubella," which occurs when an infected pregnant woman passes the virus to her unborn child. Amongother problems and birth defects, affected infants may have cataracts, heart defects, hearing impairment, andlearning disabilities. The risk of transmission is highest early in pregnancy. The virus may also cause miscarriage orstillbirth.

Measles according to WHO

Measles

Fact sheet N286December 2009

Key facts

y Measles is one of the leading causes of death among young children even though a safe and cost-effectivevaccine is available.

y In 2008, there were 164 000 measles deaths globally nearly 450 deaths every day or 18 deaths everyhour.

y More than 95% of measles deaths occur in low-income countries with weak health infrastructures.y Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2008 worldwide.y In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday

through routine health services up from 72% in 2000.

Measles is a highly contagious, serious disease caused by a virus.

It remains one of the leading causes of death among young children globally, despite the availability of a safe andeffective vaccine. An estimated 164 000 people died from measles in 2008 mostly children under the age of five.

Measles is caused by a virus in the paramyxovirus family. The measles virus normally grows in the cells that line theback of the throat and lungs. Measles is a human disease and is not known to occur in animals.


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All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements,given 24 hours apart. This can help prevent eye damage and blindness. Vitamin A supplements have been shown toreduce the number of deaths from measles by 50%.

Prevention

Routine measles vaccination for children, combined with mass immunization campaigns in countries with high caseand death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been inuse for over 40 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a childagainst measles.

The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses areproblems. It is equally effective in the single or combined form.

In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday throughroutine health services up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, asabout 15% of vaccinated children fail to develop immunity from the first dose.

Global health response

The fourth Millennium Development Goal (MDG 4) aims to reduce the under-five mortality rate by two-thirds between1990 and 2015. Recognizing the potential of measles vaccination to reduce child mortality, and given that measlesvaccination coverage can be considered a marker of access to child health services, routine measles vaccinationcoverage has been selected as an indicator of progress towards achieving MDG 4.

The Measles Initiative is a collaborative effort of WHO, UNICEF, the American Red Cross, the United States Centersfor Disease Control and Prevention, and the United Nations Foundation. The Initiative, together with other public andprivate partners, plays a key role in advancing the global measles strategy. This strategy includes:

y Strong routine immunization for children by their first birthday.y A 'second opportunity' for measles immunization through mass vaccination campaigns, to ensure that

all children receive at least one dose.

y Effective surveillance in all countries to quickly recognize and respond to measles outbreaks.y

B

etter treatment of measles cases, to include vitamin A supplements, antibiotics if needed, and supportivecare that prevents complications.

Measles in the Philippines

Although there is no treatment for measles, there is a very effective way of preventing it. This is with the use of themeasles vaccine. Indeed, and this is in answer to your question, it is possible to eliminate the disease completelyfrom the country by immunizing a certain percentage of the population with the vaccine. In fact, the Philippines hasalready attempted to do this. In 1998, our Department of Health (DoH) embarked on a countrywide measleselimination program called The Measles Elimination Campaign that aimed to eradicate measles in the Philippines by

the year 2008.

The first phase of that 10-year program, dubbed "Catch Up Measles Campaign," involved a month-long countrywidevaccination of children who are nine months to below 15 years of age. The well-conducted campaign was completedin April 1999 and reached more than 96 percent of the targeted children. The campaign was an unqualified success.The number of reported cases of the disease went down from an average of 12,000 (with 3,000 deaths) per annumbefore the start of the campaign to just 3,000 in 1999.

The second-phase of the program, dubbed Ligtas Tigdas was conducted in February 2004. As in the first phase,free measles vaccines were given, but this time only to all children between nine months and eight years of age.


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We now know that our efforts to completely eradicate measles by 2008 have not been that successful because latelast year an outbreak of the disease occurred in the Visayas and in the latter half of February 2010 measles outbreakwas reported in six areas in the Philippines, including Metro Manila. Health Secretary Esperanza Cabral said that anoutbreak of measles was declared in Tondo, Manila; Las Pias City; Dasmarinas, Cavite; San Francisco town inQuezon Province; and Balabagan town in Lanao del Sur. A total of 570 cases of measles have been recorded sinceFebruary with children aged one to nine as its common victims.

Dr. Renilyn Reyes, Center for Health Development regional coordinator for the Expanded Program for Immunizationblames the resurgence of measles in the Western Visayas area on the accumulation of the susceptibles or poorvaccination coverage.

To stem the outbreak, the DOH has sent health workers to different parts of the country to conduct immunizationservices against measles.

MEASLES-RUBELLA SUPPLEMENTAL IMMUNIZATIONACTIVITY INPASAY CITY

Health Assistant Secretary Paulynn Jean Rosell-Ubial (right), with Pasay City Mayor Antonino Calixto (left) and PasayCity Congresswoman Imelda Calixto-Rubiano, led the ceremonial Measles-Rubella Supplemental Immunizationactivity held at Barangay 179 covered court in Pasay City as the countrys pilot area for the Philippines commitmentto the 2008 World Health Assembly to achieve measles elimination. The DOH strategy of door-to-door measleselimination campaign will cover all children aged nine months to below eight years old. According to Asst. Sec. Ubial,

the said measles vaccination campaign, if successful, will make Pasay City the first local government unit to becertified measles-free in the country and in the world.

DOH steps up measles immunization activity

December 2, 2010 2:04 amMANILA, Dec. 1 The government has strengthened its Measles Vaccine Supplementary Immunization Activity (MVSIA) in a move to bring down the incidence of the disease in the country.This is in line with government effort to help the Philippines achieve the United Nations Millennium DevelopmentGoals of reducing by two-thirds the underfive mortality rate between 1990-2015.The MV SIA, according to a briefer submitted to President Benigno S. Aquino III by Health Secretary Enrique Ona, isaimed at eliminating measles through immunization of children aged nine-months to seven years old in one locality ina given time, especially in high-risk areas.The Department of Health (DOH) briefer stated that this effort will bring down the incidence of the disease bysustaining the interruption of the measles virus transmission.Measles is a highly contagious illness that continues to be a leading cause of death globally among children under

five years old despite the availability of a vaccine.DOH data showed that there are 5,175 measle cases from Jan. 1 to Oct. 9 this year, of which 21 deaths have beenreported.Measles rates in the Philippines have declined dramatically since the 1990s, in parallel with increased vaccinationusage.There is no specific treatment for measles. In well-nourished children, the disease is rarely serious, subsidingspontaneously in one to two weeks. But in poorly nourished children, the disease often complicates. The morecommon serious and often fatal complications of measles are pneumonia, diarrhea and encephalitis (inflammation ofthe brain).However, the use of the measles vaccine is a very effective way of preventing it. (PNA)

Latest Innovations about Measles vaccine

New Inhalable Measles Vaccine May Lead to Vaccines for Other Diseases

ScienceDaily (May 5, 2010) A team of researchers led by the University of Colorado at Boulder believe a drypowder, inhalable vaccine developed for measles prevention and slated for human clinical trials later this year in Indiawill lead to other inhalable, inexpensive vaccines for illnesses ranging from tuberculosis to cervical cancer.

The inhalable measles vaccine, developed by a team led by CU-Boulder chemistry and biochemistry ProfessorRobert Sievers, involves mixing "supercritical" carbon dioxide with a weakened form of the measles virus. Theprocess produces microscopic bubbles and droplets that are dried to make the inhalable powder, which is dispensedinto the mouths of patients using a small, cylindrical plastic sack with an opening like the neck of a plastic waterbottle.


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According to the World Health Organization, measles is one of the leading causes of death among young children. In2008 there were an estimated 164,000 measles deaths in children worldwide -- nearly 450 deaths a day -- and Indiaaccounts for about two-thirds of global measles deaths in infants and children. "Clinical trials are the next vital step inmaking this vaccine widely available," he said.

"One of our primary goals of this project is to get rid of needles and syringes, because they frighten some people,they hurt, they can transmit diseases and there are issues with needle disposal," he said. With the new technology,

the inhaled powder is sent directly into the lungs, a good target since measles attacks through the respiratory tract,said Sievers. "A person taking a deep breath from the sack is effectively vaccinated."

Sievers will give a presentation on the subject at the Eighth European Conference on Supercritical Fluid Applicationsto be held May 9-12 in Graz, Austria.

Phase One of the clinical trials to test the safety and efficacy of the measles inhalant product are slated to start thissummer in Pune, India, and will involve about 180 people, said Sievers. Phase Two of the India clinical trials areexpected to involve a larger number of patients.

Sievers, also a fellow at CU's Cooperative Institute for Research in Environmental Sciences, said the measlesvaccine development idea grew out of atmospheric chemistry research he and his students were conducting. Theteam was attempting to determine the chemistry of specific air pollutants in particular regions of the world and howpeople inhale and process tiny airborne droplets of pollutants.

As part of the measles project, Sievers and his students and colleagues invented and patented a device known asthe Carbon Dioxide Assisted Nebulization with a Bubble Dryer, or CAN-BD, in which two mixed streams of fluid arerapidly expanded to atmospheric pressure where the tiny bubbles and droplets are dried by mixing them with warmnitrogen. The resulting, inhalable-sized vaccine bits are embedded in micro-particles of sugars and amino acids, hesaid.

Aktiv-Dry is a Boulder spinoff company Sievers co-founded in 2002 with Professor John Carpenter of the University ofColorado School of Pharmacy and Brian Quinn, current president of Aktiv-Dry. The company, which employs about10 people including former CU-Boulder students, currently is developing CAN-BD for the marketplace.

"This project came out of the University of Colorado, and Aktiv-Dry is partially owned by the university through theUniversity of Colorado Technology Transfer Office," said Sievers. "I've had 40 CU-Boulder students who have earned

their doctorates under me through the years, and it was those students and their work that really positioned us at theright time to gain significant funding for this project."

The $20 million Aktiv-Dry research effort is funded by the Grand Challenges in Global Health Initiative, which wascreated by the Bill and Melinda Gates Foundation through the Foundation for The National Institutes of Health.Sievers' project addresses one of the 14 Grand Challenges -- the needle-free administration of vaccines bypulmonary or nasal aerosols.

David H. McAdams, a CU-Boulder doctoral student in the chemistry and biochemistry department working withSievers, said he switched his academic focus from atmospheric chemistry particle analytics to participate in themeasles project. "I saw an opportunity to use the analysis of such particulates to benefit mankind and to help savechildren by using inhalable vaccines."

The CU team recently tested the durability of the inhalant vaccine by shipping a batch from the Serum Institute of

India to CU-Boulder, then shipping the same batch two months later to the East Coast and back to Boulder. Thevaccine proved to be stable throughout the shipping process, indicating it likely would be effective under challengingenvironmental conditions encountered in developing nations, Sievers said.

The cost of an inhalant dose for measles developed by Sievers and his team is about 26 cents -- roughly the cost foran injectable form of the dose. As a practical matter, said Sievers, the treatment of patients with novel technologiesshould not be more expensive than standard treatment costs.


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The new technology could potentially be used to deliver tiny antibiotics particles to treat people with multi-resistanttuberculosis, said Sievers. While the antibiotic inhalant would likely be combined with oral doses and injections, theuse of CAN-BD would direct the antibiotic directly to the lungs where the disease is focused, said Sievers.

Another potential use for the CAN-BD technology is treating human papilloma virus, a sexually transmitted diseasethat causes cervical cancer. "More women in India today die of cervical cancer than from breast cancer, which is amuch bigger killer in the United States," he said. Current treatment for papilloma virus is a three-dose injection

regimen that costs about $300 -- a cost Sievers and his group would like to lower significantly for it to be distributed towomen who need it in developing nations.

Collaborators on the measles project include scientists from the Centers for Disease Control and Prevention in Atlanta, the National Jewish Medical and Research Center in Denver, Johns Hopkins University in Baltimore, theUniversity of Kansas, the Serum Institute of India in Pune, BD Technologies in Research

Inhalable Measles Vaccine Tested

ScienceDaily (Feb. 1, 2011) Sustained high vaccination coverage is key to preventing deaths from measles.Despite the availability of a vaccine, measles remains an important killer of children worldwide, particularly in less-developed regions where vaccination coverage is limited. A team of researchers, led by scientists at the JohnsHopkins Bloomberg School of Public Health and the University of Colorado, developed and successfully tested a drypowder, live-attenuated measles vaccine that can be inhaled. The novel vaccine was studied in rhesus macaques.

Results of the study are published in the January 31 edition of the journal PNAS.

The current measles vaccine requires two injections to provide full immunity -- one given at 9 to 12 months of ageand another later in childhood. Special training for needle and syringe injections is needed to administer the vaccine,which requires refrigeration and is shipped as a powder that must be reconstituted and kept on ice in the field clinic.Such injections increase the risk of exposure to blood borne diseases.

According to the study, the new dry powder measles vaccine provided the macaques complete protection frommeasles with a single vaccine dose. The vaccine was delivered by aerosol using either one of two dry powderinhalers, the PuffHaler and the BD Solovent. No adverse effects were observed.

"An effective dry powder vaccine would be tremendously helpful in less developed regions where resources are

limited," said Diane E. Griffin, MD, PhD, senior author of the study and chair of the W. Harry Feinstone Department ofMolecular Microbiology and Immunology at the Bloomberg School of Public Health. "This vaccine can be shipped aspowder and does not require reconstitution or special training to administer, which could greatly increase the easeand safety of measles vaccination worldwide."

Before a vaccine was developed in 1963, there were 130 million cases of measles each year resulting in more than 7million deaths annually. Measles deaths were estimated to be 164,000 in 2008. Human trials for the dry powdermeasles vaccine are in development in India.

"The tests of inhalable dry powder vaccine at Johns Hopkins provide confidence that it can safely be tested in humanvolunteers after regulatory permission is given by Indian authorities," said Robert Sievers, professor at the CUBoulder and a Fellow of the Cooperative Institute of Research in Environmental Sciences. He is also CEO of Aktiv-Dry LLC and co-inventor of the PuffHaler and the new vaccine microparticles.

The research was supported by grants from the Bill & Melinda Gates Foundation and the Foundation for NationalInstitutes of Health. Additional support was provided by the Marjorie Gilbert Scholarship Fund.


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Measles FINAL