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Measles Issue Toolkit

This thin-section transmission electron micrograph reveals the ultrastructural appearance of a single virus particle, or "virion", of measles virus.This patient presented on the third pre-eruptive day with "Koplik spots" indicative of the beginning onset of measles. In the prodromal or beginning stages, on the signs of the onset of measles is the eruption of "Koplik spots" on the mucosa of the cheeks and tongue, which appear as irregularly-shaped, bright red spots often with a bluish-white central dot.

Eyes of a child with measles.

This was a patient who presented with Koplik's spots on palate due to pre-eruptive measles on day 3 of the illness.

Image Credits: CDC

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Measles is a highly contagious respiratory disease caused by a virus. The disease of measles and the virus that causes it share the same name. The disease is also called rubeola.

Measles causes fever, runny nose, cough and a rash all over the body. About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. For every 1,000 children who get measles, one or two will die. Other rash-causing diseases often confused with measles include roseola (roseola infantum) and rubella (German measles).

Click here for an overview of the measles disease.


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Measles (Rubeola)General infromation about measles from the CDC.
MeaslesThe measles information search from MedlinePlus.

2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

Issued by the Healthcare Infection Control Practices Advisory Committee (HICPAC).
Measles Vaccination

Measles is the most deadly of all childhood rash/fever illnesses. The disease spreads very easily, so it is important to protect against infection. To prevent measles, children (and some adults) should be vaccinated with the measles, mumps, and rubella (MMR) vaccine. Two doses of this vaccine are needed for complete protection. Children should be given the first dose of MMR vaccine at 12 to 15 months of age. The second dose can be given 4 weeks later, but is usually given before the start of kindergarten at 4 to 6 years of age.

Immunization for Healthcare Workers Because of their contact with patients or infective material from patients, many healthcare workers (HCWs) (e.g., physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, hospital volunteers, and administrative staff) are at risk for exposure to and possible transmission of vaccine-preventable diseases. Maintenance of immunity is therefore an essential part of prevention for HCWs.
MMWR: Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP).This report presents new recommendations adopted in June 2009 by CDC's Advisory Committee on Immunization Practices (ACIP) regarding use of the combination measles, mumps, rubella, and varicella vaccine.
ACIP Provisional Recommendations

This web page provides information for healthcare providers on the most recently voted upon recommendations of the Advisory Committee on Immunization Practices (ACIP) that have yet to be officially approved by HHS and CDC.

MeaslesGeneral information about measles from the WHO.
Employee Vaccination RecordA record template provided by the ADA.

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Measles: Make Sure Your Child is Fully Immunized One of the best ways to protect children from measles and other vaccine-preventable diseases is to vaccinate them on time. Check your child's medical records to see if he or she is up to date on vaccinations.
Measles in the 21st CenturyBarely 20 years ago, such a high proportion of childhood deaths globally was attributable to measles that the going estimate of more than 1 million measles-related deaths per year was almost certainly an underestimate.
Measles Travels: Stay Healthy at the Summer OlympicsTraveling abroad—even to the Summer Olympic Games—can put you at risk for measles. Make sure you are up-to-date on measles vaccination before you leave for your trip. Put it on your travel checklist.
MMWR: Measles — United States, 2011The increased numbers of outbreaks and measles importations into the United States underscore the ongoing risk for measles among unvaccinated persons and the importance of vaccination against measles.
Latest European monthly measles monitoring report reviews 2011 surveillance dataThe latest European Monthly Measles Monitoring (EMMO) provides analyses of last year's measles surveillance data. In 2011, 30,567 cases of measles were reported by 29 European countries, roughly same number of cases last year but a four-fold increase compared to 2009 (7 175). Only two countries in Europe remained measles-free in 2011, Iceland and Cyprus.
Measles outbreak highlights issue for healthcare facilities A 2009 hospital-associated measles outbreak in Pennsylvania points to the potential of measles transmission in healthcare settings, according to a report from the Centers for Disease Control and Prevention.
No Seizure Risk From Measles Vaccine in Older ChildrenA large new study has ruled out concerns that children over 4 are at greater risk of seizures after getting a common measles-containing vaccine called MMRV. The vaccine — which combines the shot for measles, mumps and rubella, or MMR, with the vaccine for varicella, or chickenpox — is given to children in two steps, first as toddlers and then again between ages 4 and 6.
Measles death rate drops; still a major public health concernIn 2007 the World Health Organization set a goal to reduce measles deaths by 90% worldwide between 2000 and 2010.
Measles infected health care worker at Gwynedd surgeryA health care worker spent two days dealing with patients at a doctors surgery while infectious with measles.
Measles Outbreak Traced To Family Infected OverseasThe measles outbreak that's sickened 13 people in Boone and Hamilton counties has been traced to a family who was infected during a trip overseas, health officials said.
Measles: Make Sure Your Child is Fully ImmunizedOne of the best ways to protect children from measles and other vaccine-preventable diseases is to vaccinate them on time. Check your child's medical records to see if he or she is up to date on vaccinations.
The Resurgence of Measles: Guidance for CliniciansMeasles is one of the most contagious infectious diseases in humans. It is a major contributor to child mortality worldwide and kills approximately 1-3 of every 1000 infected individuals, even in developed countries.
AAP Measles Vaccination ReminderIn response to the 200,000 who may have been exposed to the person with measles at the Super Bowl Villagein Indianapolis last week, the American Academy of Pediatrics is reminding people "of how important it is to maintain high immunization rates against vaccine-preventable diseases."
Koplik's spotsKoplik spots are a prodromic viral enanthem of measles manifesting two days before the measles rash itself. They are characterized as clustered, white lesions on the buccal mucosa near each Stenson's duct (opposite the premolars) and are pathognomonic for measles.[1] The textbook description of Koplik spots is ulcerated mucosal lesions marked by necrosis, neutrophilic exudate, and neovascularization.[2] They are described as appearing like "grains of salt on a wet background", and often fade as the macular rash develops.
Measles: Are you looking for Koplik spots?Reports of measles outbreaks continue to increase in locations such as France, Africa, Southeast Asia, and other European countries reporting thousands of measles cases. Cases have been reported from 38 countries, including Serbia, Macedonia, and Turkey. Most cases reported have been in individuals who had not been vaccinated, and the contraction is often from individuals who are from other countries visiting the United States or from US residents visiting other countries.
Measles cases at 15 year high in US
There have been 220 cases of measles so far this year in the United States, more than triple the usual 60 to 70 cases per year, according to the Centers for Disease Control and Prevention. Europe had more than 26,000 cases reported from January through July of this year, with nine deaths, according to the World Health Organization. So far, no deaths have been reported in the United States this year.
Measles cases continue to surge in Europe and Africa, says UN agency
The United Nations World Health Organization (WHO) reported today that several large measles outbreaks have continued to spread in the past six months in Europe and Africa, and to a lesser degree in the Americas.
MMWR: Progress in Implementing Measles Mortality Reduction Strategies --- India, 2010--2011In 2005, an estimated 92,000 deaths occurred in India from measles among children aged <5 years.
Largest Measles Outbreak in Years Tells Cautionary Tale, Underscores Importance of VaccinationThis year’s jump in measles in the United States and Canada was costly and occurred among unvaccinated children and adults, suggest several studies being presented at the 49th annual meeting of the Infectious Diseases Society of America (IDSA).
Measles outbreak prompting vaccination program
A widespread measles outbreak has convinced Quebec's Public Health Department to launch a vaccination program in schools across the province.
Measles Takes Toll on AZ Hospitals
Some hospitals may be ill-prepared to handle a measles outbreak, researchers said.
US Measles Cases Reported in 2011 Highest Since 1996As of May 20, 118 cases of measles in people aged 3 months to 68 years had been reported in the United States this year, the highest number reported for this 19-week period in any year since 1996, according to the Centers for Disease Control and Prevention.
Hundreds possibly exposed to measles at college events The measles virus may have spread outside Salt Lake County, and public health officials are urging Utahns to get vaccinated earlier than usual.
Measles outbreaks prompt travel and vaccine advisories
Measles developments at the international and US levels are sparking fresh warnings about the disease, along with renewed efforts to get children vaccinated, according to several recent reports.
Measles cases on rise in BostonHealth officials tracking a measles outbreak said on Wednesday there are now a total of five confirmed and suspected cases in Boston.
Health department confirms 15th measles case in Minn.The Minnesota Department of Health has confirmed a 15th case of measles.
More measles cases in Minn.; officials push vaccineThe number of measles cases in Minnesota, all of them in Hennepin County, has grown to nine.
American Red Cross Calls On Global Health Community To Fight Measles Outbreak With measles spreading rapidly in the Democratic Republic of the Congo (DRC), putting thousands of children at risk, the American Red Cross today called on the Democratic Republic of Congo and members of the global health community to work together to launch an immediate response to the outbreaks.
MMWR: Measles Outbreaks and Progress Toward Measles Preelimination --- African Region, 2009--2010In 2008, the World Health Organization (WHO) African Region (AFR) measles technical advisory group (TAG) recommended establishing a measles preelimination goal, to be achieved by the end of 2012.
MMWR: Measles --- United States, January--May 20, 2011 Measles is a highly contagious, acute viral illness that can lead to serious complications and death.
MMWR: Notes from the Field: Measles Outbreak --- Hennepin County, Minnesota, February--March 2011On March 2, 2011, the Minnesota Department of Health (MDH) confirmed measles in a Hennepin County resident aged 9 months. As of April 1, investigation of contacts and heightened surveillance had revealed a total of 13 epidemiologically linked cases in Hennepin County residents. Of those cases, 11 were laboratory confirmed, and two were in household contacts of confirmed cases and met the clinical case definition for measles.
MMWR: Notes from the Field : Multiple Cases of Measles After Exposure During Air Travel --- Australia and New Zealand, January 2011 In January 2011, measles was diagnosed in three New Zealand residents recently returned from a 17-day trip to Singapore and the Philippines. On January 11, they had flown on a 7.5-hour flight from Singapore to Brisbane, Australia, remained in a transit lounge for 9.5 hours, and then continued on a 4-hour flight to Auckland, New Zealand. Searches in Australia and New Zealand for secondary cases among passengers on either flight resulted in the identification of three cases among passengers on the Singapore-to-Brisbane flight and five cases among passengers on the Brisbane-to-Auckland flight.

Measles outbreak underscores need for continued vigilance in health care settings

In a report published in The Journal of Infectious Diseases and available online, researchers identify preventive measures hospitals and health care facilities can implement to reduce the likelihood and decrease the economic impact of a future measles outbreak in these settings.

Gingival and other oral manifestations in measles virus infection

The measles virus is associated with a transient inhibition of the host response. Immunosuppression may create the necessary condition for the proliferation of pathobacteria associated with the observed pericoronitis and the other gingival lesions.
The dynamics of measles in sub-Saharan Africa Although vaccination has almost eliminated measles in parts of the world, the disease remains a major killer in some high birth rate countries of the Sahel.

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