Measles

B05.0-4/B05.8-9

• Case definition
• Description
• General measures
• Medicine treatment
• Referral

Note: notifiable medical condition.

CASE DEFINITION

• Fever.

AND

• Red maculopapular (blotchy) rash.

AND

• Cough or coryza (runny nose) or conjunctivitis.

Inform the local EPI co-ordinator about all cases of suspected measles, (i.e. which fulfil the case definition criteria). Send clotted blood and throat swabs to confirm (or exclude) a diagnosis of measles.

DESCRIPTION

A viral infection that is especially dangerous in malnourished children or in children who have other diseases such as TB or HIV/AIDS.
Initial clinical features, that occur 7–14 days after contact with an infected individual, include:

• coryza
• conjunctivitis which may be purulent
• fever
• cough
• diarrhoea

After 2–3 days of the initial clinical features, a few tiny white spots, like salt grains appear in the mouth (Koplik spots).
The skin rash appears 1–2 days later, lasting about 5 days and:

• usually starts behind the ears and on the neck
• then on the face and body
• thereafter, on the arms and legs

Secondary bacterial infection (bronchitis, bronchopneumonia, and otitis media) may occur, especially in children with poor nutrition or other concomitant conditions.

GENERAL MEASURES

• Isolate the patient in the clinic to prevent spread.
• In the clinic utilise face masks and gloves when examining the patient.
• Counsel the caregiver to isolate the patient in the home (if feasible).
• Reduce exposure of children < 12 months of age and pregnant women to the index patient.
• Ensure that the caregiver and other close contacts have been previously immunised.

MEDICINE TREATMENT

All children < 5 years of age with measles should be given an extra dose of vitamin A, unless the last dose was received within a month:

• Vitamin A (retinol), oral, as a single dose.

In children < 5 years of age, give the 1st dose immediately. If the child is sent home, the caregiver should be given a 2nd dose to take home, which should be given the following day.

Administration of a vitamin A capsule

• Cut the narrow end of the capsule with scissors.
• Open the child’s mouth by gently squeezing the cheeks.
• Squeeze the drops from the capsule directly into the back of the child’s mouth. If a child spits up most of the vitamin A liquid immediately, give one more dose.

For fever with distress:

Children

• Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See paediatric dosing tool.

Adults

• Paracetamol, oral, 1 g 4–6 hourly when required.
  • Maximum dose: 15 mg/kg/dose.
  • Maximum dose: 4 g in 24 hours.

Children with diarrhoea:

Treat according to Acute diarrhoea in children

Children with pneumonia (1st dose before referral):

• Amoxicillin, oral, 45 mg/kg/dose. See: Pneumonia in children.

Children with otitis media:

• Amoxicillin, oral, 45 mg/kg/dose. See PHC STG and EML Otitis media, acute.

Severe penicillin allergy: (Z88.0)

Children

• Macrolide, e.g.:
  • Azithromycin, oral, 10 mg/kg/dose daily for 3 days. See paediatric dosing tool.

LoEIII [2]

Purulent conjunctivitis:

• Chloramphenicol, 1%, ophthalmic ointment 8 hourly into lower conjunctival sac.

REFERRAL

• All adults.
• Children <6 months of age.
• Children who are malnourished or immunocompromised, or who have TB.
• Where serious complications are present. These include:
  • stridor/croup
  • pneumonia
  • dehydration
  • neurological complications
  • severe mouth and eye complications

Provide emergency treatment, if needed, before referral