Measles - prevention, signs, treatment. Treatment of mumps in children What is measles how is it manifested
refers to acute viral infectious diseases, characterized by a combination of catarrhal symptoms with a specific exanthema. The measles virus enters the body through airborne droplets. The incubation period lasts up to 2 weeks, sometimes up to 1 month. The catarrhal period of measles is manifested by cough, fever, cervical lymphadenitis. It is replaced by a period of rashes with the staged appearance of rash elements characteristic of measles. Recovery begins after 1-2 weeks from the onset of measles. Diagnosis of measles is usually based on clinical findings. Treatment is predominantly symptomatic, aimed at lowering body temperature, detoxification, and increasing the body's resistance.
ICD-10
B05
General information
refers to acute viral infectious diseases, characterized by a combination of catarrhal symptoms with a specific exanthema.
Exciter characteristic
The measles virus is RNA-containing, belongs to the genus Morbillivirus. In external environment unstable, inactivated upon drying, exposure to sunlight, ultraviolet irradiation, when heated to 50 ° C. The virus is able to survive at room temperature for 1-2 days, while cooling (optimal temperature for viability: from -15 to -20 ° C) remains active for several weeks.
A sick person is a reservoir and source of infection. Isolation of the infection begins in the last 1-2 days of incubation, the entire prodromal period and continues for 4 days of the rash period. In some cases, the time of contagiousness is delayed up to 10 days from the appearance of exanthema. Asymptomatic carriage of measles is not observed.
The measles virus is transmitted through an aerosol mechanism by airborne droplets. The patient releases the pathogen into the environment during coughing, sneezing, just by exhaling air and talking. A finely dispersed suspension is carried around the room with an air current. Due to the weak resistance of the virus, the contact-household route of transmission is excluded. When a pregnant woman is infected with measles, transplacental transmission of the infection is possible.
People are extremely susceptible to measles, after the transfer life-long intense immunity is preserved. The disease usually occurs in childhood In adults, measles is rare and much more severe. The peak incidence occurs in the winter-spring period, the minimum number of cases is recorded in August-September. The incidence of measles has decreased significantly in recent years due to routine vaccination of the population.
measles pathogenesis
The virus enters the body through the mucous membrane of the upper respiratory tract, replicates in the cells of their integumentary epithelium and spreads throughout the body with blood flow, accumulating in the structures of the reticuloendothelial system. The measles virus has a tropism for integumentary tissues (skin, conjunctiva, mucous membranes oral cavity and respiratory tract).
V rare cases possible defeat by the virus of the brain with the development of measles encephalitis. The epithelium of the mucous membrane of the respiratory system affected by the virus sometimes undergoes necrosis, opening access for bacterial infection. It is believed that the causative agent of measles is able to persist in the body for a long time, causing a slow infection leading to the occurrence of systemic diseases (scleroderma, systemic lupus erythematosus, multiple sclerosis, etc.).
measles symptoms
The incubation period for measles lasts 1-2 weeks, in cases of immunoglobulin administration it is extended up to 3-4 weeks. The typical course of measles occurs with a succession of three stages: catarrhal, rashes and convalescence. The catarrhal period begins with a rise in temperature and the development of signs of general intoxication. Fever can reach extremely high numbers, patients complain of intense headache, insomnia, chills, severe weakness. In children, the symptoms of intoxication are largely smoothed out.
Against the background of intoxication syndrome, a dry cough appears in the very first days, mucopurulent rhinorrhea, conjunctivitis (accompanied by intense swelling of the eyelids) with purulent discharge, photophobia. In children, hyperemia of the pharynx, graininess of the posterior wall of the pharynx, and a puffy face are expressed. In adults, catarrhal symptoms are less pronounced, but regional lymphadenitis may occur (mostly affected cervical lymph nodes). Lung auscultation notes harsh breathing and dry wheezing. Sometimes the disease is accompanied by a weakening of intestinal activity, dyspeptic symptoms (nausea, vomiting, heartburn, belching).
The first febrile wave is usually 3-5 days, after which the body temperature decreases. The next day, the temperature rises again and intoxication and catarrhal phenomena worsen, and Filatov-Koplik-Velsky spots are noted on the mucous membrane of the cheeks - a specific clinical sign of measles. The spots are located on the inner surface of the cheeks opposite the small molars (sometimes passing to the gum mucosa), they are white areas slightly raised above the surface, surrounded by a thin strip of hyperemic mucosa (a type of "semolina porridge"). As a rule, when a rash appears, these spots disappear; in adults, they can persist during the first days of the rash period. Simultaneously or slightly earlier than the Filatov-Koplik-Velsky spots, an enanthema appears on the soft and, partially, hard palate, which is red spots the size of a pinhead of irregular shape. After 1-2 days, they merge and cease to stand out against the background of general hyperemia of the mucosa.
The total duration of the catarrhal period is 3-5 days in children and about a week in adults. After that comes the period of rash. The measles rash initially develops on the scalp and behind the ears and spreads to the face and neck. By the second day, the rash covers the torso and shoulders. On the third day, the rash covers the limbs and begins to turn pale on the face. This sequence of rashes is characteristic of measles, is significant for differential diagnosis sign.
The measles rash is a bright maculopapular exanthema, prone to the formation of confluent curly groups with intervals of unchanged skin. The rash in adults is more pronounced than in children; in severe cases, it can become hemorrhagic. In the period of rashes, catarrhal symptoms increase and fever and intoxication are aggravated.
The period of convalescence occurs 7-10 days after the onset of the disease (in adults, the duration of measles is longer), the clinical symptoms subside, the body temperature returns to normal, the elements of the rash regress (similar to the order of appearance), leaving behind light brown areas of increased pigmentation, disappearing after 5- 7 days. At the site of pigmentation, pityriasis peeling remains for some time (especially on the face). In the period of convalescence, a decrease in the immune factors of the body's defense takes place.
Mitigated measles is an atypical clinical form of infection that occurs in passively or actively immunized individuals or who have previously had measles. It differs by a longer incubation period, mild or absent symptoms of intoxication and a shortened period of catarrhal manifestations. Exanthema typical of measles is noted, but rashes can appear immediately on all parts of the body or in the reverse (ascending from the limbs to the face) sequence. Filatov-Koplik-Velsky spots are often not detected.
Another atypical form is abortive measles - its onset is the same as in normal cases, but after 1-2 days the symptoms subside, the rash spreads to the face and trunk, after which it regresses. Fever in the abortive form usually occurs only on the first day of the rash. Sometimes subclinical forms of measles are detected using serological methods.
Complications of measles
Measles is most often complicated by secondary bacterial pneumonia. In young children, the resulting inflammation of the larynx (laryngitis) and bronchi (bronchitis) sometimes lead to the development of a false croup that threatens asphyxia. Sometimes stomatitis is noted.
In adults, measles can contribute to the development of meningitis and meningoencephalitis, as well as polyneuritis. A rare but rather dangerous complication is measles encephalitis. Currently, there is a theory of the development of autoimmune diseases, according to which the measles virus may be involved in the pathogenesis of these conditions.
Diagnosis of measles
Diagnosis of measles is successfully carried out on the basis of clinical manifestations. General analysis blood shows a picture characteristic of a viral infection: lymphocytosis against the background of moderate leukopenia (or the concentration of white blood cells remains within the normal range), plasmacytosis, increased ESR. In adults, a reduced concentration of neutrophils and lymphocytes and the absence of eosinophils may be noted.
The results of specific bacteriological and serological studies(rarely used in clinical practice) are retrospective. If pneumonia is suspected, a lung x-ray is required. With the development of neurological complications, a patient with measles is shown a consultation with a neurologist, rheoencephalography, EEG of the brain. A lumbar puncture may be indicated to diagnose meningitis.
measles treatment
Measles is treated on an outpatient basis, patients with a severe complicated course are hospitalized, or according to epidemiological indications. Bed rest is prescribed for the entire febrile period. Sufficiently effective etiotropic therapy has not yet been developed; treatment consists in relieving symptoms and preventing complications. Drinking plenty of water is recommended as a measure to reduce toxicosis. Intensive detoxification measures are performed in cases of extremely severe course.
Patients need to observe oral and eye hygiene, avoid bright light. As a pathogenic symptomatic therapy prescribe antihistamines, antipyretics, vitamins and adaptogens. V early dates disease significantly improves the course of taking interferon. In case of a threat of a secondary infection, broad-spectrum antibiotics are prescribed. Measles encephalitis requires the appointment of high doses of prednisolone and other intensive care measures.
Forecast and prevention of measles
Uncomplicated measles usually ends in complete recovery, there are no cosmetic defects after the rash. An unfavorable prognosis may be in the event of measles encephalitis.
Specific prophylaxis of measles consists in routine vaccination of the population with ZhIV (live measles vaccine). The first vaccination against measles is carried out in children at 12-15 months, revaccination is carried out at 6 years. Isolation of patients lasts up to 10 days, limiting contact with unvaccinated and not ill children - up to 21 days from the onset of the disease.
Measles is an infectious disease and one of the leading causes of death in young children worldwide. Measles. WHO fact sheet. Measles is caused by a virus from the paramyxovirus family.
The first symptoms appear 10-12 days after infection. The disease begins with high temperature, runny nose and cough, watery eyes. Gray-white spots form on the inside of the cheeks.
A few days later, patients develop a rash in the form of red-brown spots. It starts on the face and on the head, then gradually descends lower.
Symptoms last 7-10 days, then disappear.
How to cure measles?
Since measles is a virus, it is not affected by antibiotics. And there is no specific treatment for measles. So you have to endure until the body itself copes with the disease.
The maximum that can be done is to support a person, give him a full meal, make sure that there is no dehydration, and hope that complications do not happen.
What are the complications of measles and why are they dangerous?
Complications are the reason why measles is deadly.
Due to measles, encephalitis and cerebral edema, otitis media develop, the mucous membranes of the eyes and intestines become inflamed. Sometimes blindness and weakened immunity remain as consequences.
Why do complications develop?
From the fact that the body and immunity are not strong enough to resist the virus. Most often, complications affect:
- Children under the age of five, because it is the little ones who get sick the most.
- Weak children who are malnourished.
- People with HIV or other chronic diseases.
According to WHO, now complications develop in every fifth sick person. Measles: know the risks, check your status, protect yourself. That is why you should not think that it is better to get sick with measles: the risk of a severe course of the disease and death is too high.
In addition, measles is dangerous for pregnant women because it threatens the life and health of the fetus.
How not to get measles?
Measles is easily transmitted from person to person. And if there is no against this disease, then there is only one way not to get infected: not to contact with the sick. The problem is that a person is contagious a few days before the first symptoms appear.
Only immunity that is developed after an illness or after vaccination saves from measles.
Will the vaccine really help?
Measles vaccines are highly effective. Children are vaccinated twice: a year and six years. After that, immunity appears in 95-98% of those vaccinated. If the child is not yet a year old, then the vaccine is administered only for special indications, if the baby has been in contact with the sick and if he is six months old.
After vaccination, immunity lasts up to 25 years. If a vaccinated person still gets sick (this is rare, but it happens), then measles proceeds without complications and is much easier than usual.
Even if given within 72 hours of being exposed to an infected person, the vaccine can help overcome measles exposure. Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP).
I'm an adult, do I have anything to fear?
In fact, measles is not a childhood disease. It is highly contagious and anyone can get sick. Indeed, cases among adults are extremely rare, and here's why:
- In countries where there are not enough vaccines, there are many epidemics. There, residents encounter measles all the time. Only adults already have immunity, because they were ill when they were small. Children do not have immunity, so they immediately fall ill.
- Since 1980, active vaccination against measles has been carried out. Because of this, there are practically no epidemics in developed countries and many simply do not encounter the virus throughout their lives. Adults and children are protected by herd immunity.
- When not enough people in a country are vaccinated, an epidemic breaks out, as happened now. If at the same time the older generation was vaccinated, the children who did not receive the vaccines get sick again.
That is, if an unvaccinated and unrecovered adult meets a sick person, he will also become infected, because the measles virus does not ask for a passport.
Do adults also need to be vaccinated against measles?
Yes, if you have not been vaccinated or do not know if you are immune. If you have been vaccinated for a long time, it makes sense to check whether immunity has been preserved and pass.
By the way, even if you have immunity, then an extra measles vaccine will not do any harm. The body will react to it in the same way as to the measles virus, that is, you will not get sick and nothing terrible will happen.
If you or your children are not vaccinated, then get immunized.
Measles is highly contagious viral infection, with predominantly airborne transmission of the pathogen. The likelihood of getting measles is high, even with a short contact with the patient.
Before the introduction of routine measles vaccination, the maximum incidence was observed in patients under sixteen years of age. At the same time, measles in children under two years of age often ended in death.
In this regard, for a long time measles had a more “stressful” name “children's pestilence (plague)”.
Attention! According to WHO data for 2018, out of 10 million measles cases, 140 thousand died. (WHO information from December 5, 2019)
The main victims of the disease are children under 5 who have not been vaccinated. That is the most defenseless part of the population. WHO Director-General Tedros Adhanom Ghebreyesus emphasized that measles is a highly controlled disease. However, according to him, in 2019 the situation became even worse. The number of cases of infection has increased by almost 3 times compared to 2018.
We emphasize the gap in vaccination.
Measles is an acute anthroponotic (the main carrier of the virus is a patient with measles) viral disease, accompanied by the appearance of intoxication-febrile symptoms, lesions of the upper respiratory tract (upper Airways), as well as the appearance of a specific rash on the mucous membranes of the mouth and skin.
Measles is a classic DCI (children's droplet infections), so the disease is less common in adults. However, in older patients, measles is more severe and more often accompanied by the development of severe complications.
Attention! Measles vaccination does not guarantee protection against the disease.
Measles after vaccination is recorded in seventy percent of vaccinated people. This is due to the fact that the measles vaccine maintains a tense immunity for ten to fifteen years, and then there is a significant decrease in measles immunity.
Therefore, the maximum number of measles cases (out of those vaccinated) is observed among high school students, students, recruits in the army, etc.
In this regard, many parents find out why the measles vaccine is needed for children at all?
For reference. Measles vaccine reduces the risk of severe complications this disease. Vaccinated patients, as a rule, carry the disease in an erased form.
The ICD10 measles code is B05. Additionally, after the main one, a specifying code is indicated:
- 0 for measles complicated by encephalitis (B05.0);
- 1 - for measles complicated by meningitis;
- 2- for a disease complicated by pneumonia;
- 3- for measles, accompanied by the development of otitis media;
- 4- for measles with the development of intestinal complications;
- 8 - for a disease accompanied by the development of other specified complications (measles keratitis);
- 9 for uncomplicated measles.
The causative agent of measles
The causative agent of measles belongs to the paramyxovirus family. V environment measles viruses are rapidly destroyed, so infection occurs directly upon contact with an infected person (viruses are contained in saliva, sputum, etc.).
For reference. On clothes, toys, dishes, etc. viruses are quickly inactivated. Therefore, the contact-household mechanism of transmission of the virus has practically no effect on the spread of measles.
At low temperatures, the pathogen is able to survive longer in the environment.
The measles virus can spread over long distances. With the air flow, dust particles containing the virus can move to neighboring rooms, stairwells, etc.
Attention. The maximum susceptibility to measles occurs in children from one to five years. Children under three months of age born to a mother who has been vaccinated or has had measles do not get sick.
In the unvaccinated and those who have not had measles, a high level of susceptibility to the virus persists throughout their lives. Such patients can get measles after a fleeting contact with patients at any age.
The maximum incidence of measles is recorded in winter and spring, the minimum in autumn.
After suffering measles, a stable, lifelong immune resistance is formed.
The incubation period for measles viruses is from 9 to 17 days.
For reference. Isolation of the virus into the environment (the period of contagiousness of the patient) begins two days before the end of the incubation period and continues until the fourth day after the onset of rashes.
The pathogenesis of the development of the disease
The entry gate for infection is the mucous membranes lining the respiratory tract. Reproduction of cells occurs in the cells of the respiratory epithelium and regional lymph nodes.
After the third day of the incubation period, the 1st wave of viremia begins (the release of measles viruses into the blood). At this stage, a small amount of measles viruses enters the blood, so they can be neutralized by specific immunoglobulins (post-exposure prophylaxis).
Definition of disease. Causes of the disease
Measles(Morbilli) is an acute infectious disease caused by the measles virus, which affects the epithelium of the upper respiratory tract and skin. It is clinically characterized by a pronounced syndrome of general infectious intoxication, pathognomonic enanthema, maculo-papular rash, conjunctivitis, and a syndrome of damage to the respiratory tract (respiratory tract).
Etiology
Kingdom - viruses
Subkingdom - RNA-containing
Family - Paramyxoviridae
Genus Morbillivirus
measles species (Polinosa morbillarum)
Syndromically, the disease was described in 1890 by Dr. Belsky (Pskov), in 1895 by the children's doctor Filatov, and in 1898 by Dr. Koplik (USA).
The envelope of the virus has 3 layers: a protein membrane, a lipid layer and external glycoprotein complexes that form peculiar protrusions. The virus strains are antigenically identical, possess complement-fixing, hemagglutinating, hemolyzing properties and symplast-forming activity. CD-46 is the human receptor for the measles virus.
The virus is unstable in the external environment - it is sensitive to ultraviolet radiation, it dies in drops of saliva in 30 minutes, upon drying and action disinfectants- instantly. It tolerates low temperatures well. The virus can be isolated from various environments body (blood, urine, feces, swabs from the mucous membranes of the oropharynx, conjunctiva, cerebrospinal fluid).
Epidemiology
Anthroponosis. The source of the disease is an exclusively infected person, also with an atypical form of the disease. The infected person is contagious from the last 2 days of incubation until the 4th day from the moment the rash appears, inclusive - from the 5th day the infectiousness disappears.
Transmission mechanism: airborne (aerosol route), rarely transplacental (when a woman falls ill at the end of pregnancy). Theoretically, infection from recently vaccinated people is possible (but in practice this happens extremely rarely).
A vaccinated (recovered) and immune mother passes it on to her child (up to 3 months), that is, such children have innate immunity, which gradually decreases and disappears by 10 months - children become susceptible to the disease. Children are predominantly ill (carrying the disease relatively favorably), but recently there have been more and more reports of the development of measles in adults, in whom the disease is extremely difficult (the reasons are the mass refusal of preventive vaccinations).
There is a spring-winter season. After the transferred infection, a full course of vaccination develops a stable lifelong immunity.
Measles is one of the leading causes of death among young children.
In 2015, there were 134,200 measles deaths globally.
If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
measles symptoms
The incubation period for a typical form is from 9 to 11 days (in some cases up to 13).
The onset of the disease is subacute (i.e., the main syndrome appears 2-3 days after the onset of the disease), however, with proper preparation of the doctor (identification of a pathognomonic enanthema - a rash on the mucous membranes), an acute onset can be determined (during the first day). In adulthood, due to the characteristics immune system these criteria may not be met.
Measles Syndromes:
- syndrome pronounced general infectious intoxication;
- syndrome of pathognomonic enanthema (Belsky-Filatov-Koplik spots);
- maculo-papular exanthema syndrome;
- conjunctivitis syndrome (pronounced);
- respiratory tract syndrome (pharyngitis, tracheobronchitis);
- syndrome of generalized lymphadenopathy (GLAP);
- hepatolienal syndrome.
The so-called early diagnosis of measles is described, including:
- difficulty in nasal breathing;
- redness of the right eyelid;
- subfebrile condition (permanent fever).
Typical complaints of patients: increasing weakness, lethargy, loss of appetite, sleep disturbances, "sand in the eyes", swelling of the lower eyelids, sometimes a runny nose, fever (up to 39 ° C). Then a sore throat joins, a dry cough, shortness of breath appear, there may be abdominal pain, diarrhea (layering of secondary flora), a rash appears (with its appearance, the syndromes of general infectious intoxication and respiratory tract damage intensify).
Objectively: one can note the appearance of a maculopapular rash that usually appears on the 3rd-4th day of illness, with a pronounced staging (face, neck; after the trunk, arms, thighs; then deer and feet, and at this moment it turns pale on the face). Eruptions are papules surrounded by a red spot, prone to confluence (but in the presence of clean areas), sometimes petechiae appear. After 3-4 days, the rash becomes pale and leaves behind brown spots and pityriasis peeling. Peripheral lymph nodes (occipital, posterior cervical and axillary) increase and acquire sensitivity. Conjunctivitis is pronounced (the conjunctiva is massively hyperemic, edematous, purulent discharge quickly joins). The appearance of the patient is characteristic: a puffy face, red (like a rabbit's) eyes, swelling of the nose and eyelids, dry chapped lips. On auscultation, dry rales are heard in the lungs. tachycardia, decreased blood pressure. The size of the liver and spleen increases (generalization of infection).
With pharyngoscopy in the oropharynx, hyperemia of the soft palate is visualized, on the mucous surface of the cheeks at the beginning of the disease, Belsky-Filatov-Koplik spots (small whitish spots with a narrow reddish border), which disappear when exanthema appears. Sometimes there is a spotted enanthema on the mucosa of the soft palate.
Mitigated measles has been described (in people who received specific anti-measles immunoglobulin during the incubation period), characterized by a prolongation of the incubation period up to 21 days, with a mild course.
In the abortive form of the disease, a typical onset is characteristic, but after 1-2 days clinical manifestations disappear.
There is a concept - a reaction to vaccination (with the initial introduction of a live measles vaccine), characterized by an increase in body temperature, catarrhal phenomena (inflammation) from the upper respiratory tract, a scanty subtle rash (more often develops in children and people with immunodeficiency).
In patients with severe immunodeficiency - AIDS (HIV, cancer patients, persons receiving systemic cytostatics after organ transplantation) - the course of the disease is extremely severe (mortality rate up to 80%).
Differential Diagnosis
Cases of measles are divided into:
- "Suspicious" - case acute illness with pronounced typical clinical signs measles (one or more);
- "Probable" - a case of acute illness with clinical signs of measles and an epidemiological relationship with another suspected or confirmed case of this disease.
- "Confirmed" is a case of measles classified as "suspicious" or "probable" after laboratory confirmation of the diagnosis. It may not meet the clinical definition of the case (atypical, erased forms).
If the diagnosis is not confirmed by laboratory (in case of impossibility laboratory research), then the "probable" case is classified as "confirmed".
The definitive diagnosis of measles is based on clinical findings with laboratory confirmation of the diagnosis and/or epidemiological association with other confirmed cases of the disease.
measles pathogenesis
The entrance gate is the mucous membrane of the upper respiratory tract and conjunctiva. The virus is adsorbed on the epithelium of the mucous membrane, then penetrates into the submucosal layer and regional The lymph nodes where it first reproduces. From the third day of the incubation period, the virus enters the bloodstream (the first wave of viremia). In the middle of the incubation period, the virus multiplies and concentrates in the organs of the reticuloendothelial system. Further, at the end of the incubation period, an active release of the virus into the blood occurs (the second period of viremia), and the virus, having increased epitheliotropy, causes damage to the skin (rash), mucous membranes (conjunctiva, upper respiratory tract, gastrointestinal tract). On the mucous membrane of the cheeks (in the region of the second lower molars), areas of micronecrosis of the epithelium appear, followed by desquamation (peeling; spots of Belsky-Filatov-Koplik).
There is a specific immune restructuring of the body (disappearance of allergic reactions), anergy (secondary immunodeficiency) develops, leading to an exacerbation of chronic inflammatory diseases.
Giant reticuloendotheliocytes - Warthin-Finkeldey cells - are found in the lymphoid tissue.
From the 4th day from the appearance of rashes to the blood, class M antibodies begin to be detected.
Classification and stages of development of measles
1. according to the clinical form:
a) typical;
b) atypical:
- mitigated;
- reaction to vaccination
- abortive;
- asymptomatic.
2. By severity:
- light;
- average;
- heavy;
- extremely heavy.
Complications of measles
1. Specific (associated with the measles virus):
- false croup (hoarseness, choking, agitation in the initial period, swelling of the mucous membrane of the larynx);
- meningoencephalitis (typically severe course, impaired consciousness, meningeal and encephalitic symptoms);
- keratoconjunctivitis (may lead to blindness);
- subacute sclerosing panencephalitis (Dawson's encephalitis) is a very rare form of measles encephalitis. It is caused by the measles virus, which persists for a long time and accumulates in neurons and glial cells, which triggers inflammatory destruction and perivascular infiltration of the brain tissue. It is more often detected in children who have had measles before the age of two (obvious harm of not vaccinating the mother and subsequent vaccination of the child). Development occurs several years after the illness and usually leads to dementia and death within a few months. It is characterized by a very high titer of anti-measles antibodies in serum and CSF (cerebrospinal fluid). Apparently, this disease is the result of a reaction of a macroorganism to impaired replication of the measles virus in the brain. The prognosis is always unfavorable.
2. Caused by the addition of secondary bacterial flora:
Diagnosis of measles
- a detailed general clinical blood test (leukopenia, lymphocytosis and monocytosis, eosinopenia, ESR is normal); with the development of complications - appropriate changes.
- general clinical analysis of urine (with the development of glomerulonephritis - proteinuria, cylindruria, hematuria);
- biochemical blood tests (increased AST in myocarditis);
- bacterioscopy (in the initial period and during the first 2 days of the rash, detection in sputum, urine, nasopharyngeal mucus of Wartin-Finkelday cells) is not used in practice;
- serological diagnostics (detection of antibodies of classes M and G in the blood serum by ELISA, measles virus - by PCR) - the standard of laboratory diagnostics.
- PCR diagnostics is possible from the material of nasopharyngeal mucus, urine, cerebrospinal fluid.
With the development of complications, appropriate research methods are used according to the situation.
measles treatment
According to SP 3.1.2952-11 "Prevention of measles, rubella and mumps", in the Russian Federation, measles treatment is carried out in a boxed department of an infectious diseases hospital.
Mode - bed (the bed should be facing the head end of the window due to increased light irritability of the eyes).
The appointment of a common table with the exclusion of irritating substances from the diet, plentiful drinking is shown.
There is no specific treatment for the measles virus.
Purpose drug therapy depends on the severity of the disease, with mild forms of sufficiently enriched vitamin nutrition, a sufficient amount of liquid to drink.
In moderate forms, especially in adult patients, intravenous infusion solutions, expectorants, toilet of the oral cavity and conjunctiva with antiseptic solutions, means of normalizing cardiac tone may be indicated.
In severe conditions, the introduction of a specific anti-measles immunoglobulin, the introduction of hormones, antibiotic therapy (if complications are attached), intensive care and resuscitation measures are connected.
Patients are discharged upon normalization clinical picture, general laboratory parameters (blood and urine), but not earlier than the fifth day from the end of the rash.
Dispensary observation in uncomplicated cases - about one month, with the development of complications - up to two years.
Forecast. Prevention
In the focus of measles, a set of measures is being carried out to localize and eliminate it:
- when a focus of infection is detected in kindergartens, schools, as well as in organizations with round-the-clock stay of adults from the moment the first patient is detected until 21 days from the moment the last patient is detected, persons who have not had measles and have not been vaccinated against this infection are not allowed into the team;
- patients with measles are hospitalized without fail;
- persons who have been in contact with measles patients are placed under medical observation for 21 days from the date of detection of the last case of the disease in the outbreak;
- in the focus of infection, people are identified who are subject to immunization against this infection according to epidemic indications (that is, people who have been in contact with the patient (if a disease is suspected), who have not previously had measles, who have not been vaccinated, who do not have information about vaccinations against measles, as well as people who vaccinated against measles once - without age limit). Immunization is carried out within the first 72 hours from the moment the patient is identified. With an increase in the radius of the focus, the terms of immunization can be extended up to seven days from the moment the first patient is detected in the focus. Children who have not been vaccinated against measles, no later than the 5th day from the moment of contact with the patient, normal human immunoglobulin is administered.
The main method of specific prevention and protection of the population against measles is vaccination. The measles vaccine has been used for over 50 years. It is safe, effective and inexpensive. Immunization of one child against measles costs about one US dollar. Immunization of the population against measles is carried out within the framework of the national calendar of preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications.
The current generation of young parents learn about measles only from booklets in the clinic or after talking with a pediatrician. Thanks to such an achievement of science as vaccinations, this infection is remembered only at the moments of random outbreaks of the disease. And if more than 95% of the population were vaccinated in every country, then measles would be forgotten forever.
What is measles and how does it manifest itself? Are her symptoms dangerous? What are the features of the course of the disease in adults and young children? Does the disease have complications? What methods of treatment and prevention of measles are used? What you need to know about this, unfamiliar to many, infection?
What is measles
How do viruses manage to survive for so long in nature and in the human environment? Often we ourselves contribute to their spread, ignoring elementary hygiene standards and doctors' advice on the prevention of diseases caused by these microorganisms. The virus has its own characteristics that help it stay active for a long time.
What is measles? is an acute infection caused by a virus that affects the upper respiratory tract. One of the characteristic signs of measles is a rash all over the body.
What should be remembered about measles and its pathogen?
- The virus is very sensitive to almost all detergents, so regular wet cleaning with one of these substances will help prevent the spread of the disease to the rest of the family.
- On a dry surface, the microorganism remains in droplets of mucus at a temperature of 12 to 15 ºC for only a few days. But this may be enough to infect.
- Even today, measles remains one of the most dangerous childhood diseases, claiming the lives of thousands of children every year.
- The measles virus suppresses the activity of protective cells in the body, reducing immunity.
- The virus infects the inner layer of blood vessels, which contributes to the spread of rashes and diseases.
- Measles is transmitted only from person to person, but its "brothers" are the causative agents of distemper in dogs and cattle.
- It is believed that measles after an illness causes lifelong immunity, but there have been cases of re-infection. This happens because the microorganism can persist in the human body for a long time, so complications often arise.
- Until recently, measles was common only among children, now the infection has “aged”, there are outbreaks of the disease among adolescents and the adult population.
How measles is transmitted
The disease is spread only among humans. The source is a sick person who infects others in the last days of the incubation period. There are several options for infection:
Human susceptibility to the measles virus is very high. It is believed that communication with the patient during the day causes disease in 40% of people, and three-day contact in 80% of others.
The average incubation period for measles is 9-11 days. But depending on the human body and its reaction to the presence of the virus, incubation period it can be shorter or it is lengthened, that is, it happens from 7 to 28 days. There have been cases of asymptomatic disease, when the virus was detected in the blood by chance, during the study of loved ones.
Outbreaks of the disease occur with a certain frequency; in some regions it is possible to meet with an infection approximately once every 8–10 years, with the exception of cases of imported infection. Outbreaks or epidemics of measles occur if there are layers of people susceptible to the microorganism. Epidemics occur more often in closed preschool and school institutions:
When is the virus most active? Considering that it persists for a long time in the environment at medium temperatures, the optimal period for the spread of infection is the end of spring and the beginning of summer. The classic time of year for the active reproduction of the virus used to be winter and spring. But due to mass vaccination, the measles virus has adapted and more often leads to the development of the disease in the warm season.
Periods of development of the disease
There are four periods of development of the disease:
- incubation;
- premonitory;
- the period of rashes or active noticeable manifestations;
- recovery.
In most cases, this is how measles proceeds. But with incorrect or untimely treatment, or when the virus causes a fulminant infection, one more stage can be conditionally distinguished - complications.
measles symptoms
Before the appearance of a symptom familiar to everyone - a rash all over the body, there are two stages of active reproduction of the virus in the human body.
The most successful outcome of measles is a complete recovery without any consequences. But this does not happen in 100% of cases, but much less.
Features of the course of measles in adults
The symptoms of measles in an adult are still the same: a sharp increase in temperature, the appearance of spots in the mouth and all over the body. But, besides this, in the development of the disease in adults there are some features.
Many severe manifestations of measles are often due to the age of vaccination. In some cases, the addition of a secondary infection is important, because the measles virus significantly weakens the immune system, which contributes to the growth of opportunistic diseases.
Measles and pregnancy
Any, even, at first glance, the most mild infection, dangerous for a pregnant woman and her unborn baby. Many viruses and bacteria penetrate the placenta, so expectant mothers are always at risk for developing infectious diseases.
But in the case of this infection, the opinions of physicians were divided. Some scientists believe that measles during pregnancy does not pose a threat to the child and is tolerated quite easily. Others argue that a baby infected in the first 8 weeks of pregnancy is at high risk of congenital malformations (in almost 85% of cases). At later terms up to 12 weeks, this figure is slightly reduced and amounts to 50% of cases.
Since there were cases of a baby being infected with measles even before childbirth, the virus crosses the placenta, which means that the child is not immune from the serious consequences associated with this disease. The first 12 weeks of pregnancy are accompanied by the laying and formation of the main systems and organs of the child, that is, at this time he is most vulnerable.
Therefore, the only recommendation for a pregnant woman is to avoid contact with measles patients. If there is a person infected with this disease in the family, the right decision for future mother is complete isolation. In the case when a woman is planning a pregnancy and many years have passed since the last vaccination, it is worth vaccinating again.
Measles in children
Toddlers tolerate measles almost as described in books. The classic development of the disease in children is as follows.
atypical measles
There are several options for a non-standard or unusual course of measles, which in most cases is associated with human immunity.
Complications after measles
Even a mild course of the disease leaves its mark on human health in the future. The main reason for this is suppression of the immune system.
The most common and dangerous complications include the following conditions.
- Laryngitis or laryngotracheobronchitis, inflammation of the mucous membrane of the larynx, trachea and bronchi. Often, all these processes occur simultaneously, they are characterized by hoarseness, coughing, wheezing in the chest area, stenosis of the larynx.
- After the main stages of the disease, pneumonia is a frequent continuation, from mild to severe, depending on the organism. There were cases when pneumonia ended in an abscess and pleurisy (inflammation of the pleura).
- A frequent complication is stomatitis, a phenomenon familiar to almost everyone. The appearance of white spots on the gums does not go away just like that, there have been cases of the appearance of a noma (oncological process of the face), ending in the death of the patient.
- The next severe complications of measles are diseases nervous system with the occurrence of encephalitis, meningitis and meningoencephalitis (inflammation of the brain and its membranes). They appear on the 3-15th day of illness, the course of meningitis is almost always favorable and ends in recovery, meningoencephalitis in 10-40% of cases is fatal.
In addition to all of the above diseases, after measles there are rare: tonsillitis, otitis media, pyelonephritis, diseases of cardio-vascular system.
Treatment
In the treatment of measles, there are several important points. To date, none has been developed effective method fight the virus. Therefore, the main stages of measles treatment are the appointment of symptomatic drugs.
How to treat measles? Patients are advised to take the following steps.
- With a mild course of the disease, home therapy is indicated: bed rest, plentiful warm drink, sparing diet, multivitamins are prescribed to avoid complications.
- Doctors often recommend rinsing your mouth with warm boiled water, chamomile decoction, chlorhexidine solution.
- In the case of the development of conjunctivitis, drops are instilled into the eyes based on antibacterial drugs besides this, the eyes need a sparing light regime, a person is in a room with a minimum amount of light.
- Antipyretic drugs are used. For this purpose, in the treatment of measles in children, Ibuprofen and Paracetamol are prescribed.
- The addition of a bacterial infection requires a change in treatment tactics, in which case antibiotics are additionally used.
- Additionally, drugs are used to support immunity.
- All complex cases of the disease are treated in the hospital.
Treatment of an infection is not an easy task and much depends not on timely prescribed drugs, but on caring for a sick person.
Measles prevention
There are two main types of measles infection prevention:
- routine vaccination;
- prevention in the focus of infection.
Measles vaccination is a planned procedure, which is accompanied by the compilation of a vaccination card for each child from the moment of his birth.
But what if one of the people around you gets sick?
- The patient must be isolated.
- All people who had contact with the sick person are separated for several weeks (from two to three, depending on the situation).
- The room where the patient with measles is located should be regularly ventilated and wet cleaned.
- If necessary, all contact persons (children from three to 12 months and future mothers) are injected with human immunoglobulin in the first 5 days from the moment of contact.
What you need to know about routine vaccination? When is the measles vaccine given?
- The introduction of the first dose of the vaccine protects children from developing measles in 85% of cases.
- Re-vaccination contributes to almost 100% protection.
- Thanks to universal vaccination coverage, the death rate has been reduced by three times.
- The vaccine protects against measles for a long time, for at least 20 years protective antibodies are in the blood of a person.
- Vaccinate only twice. The first vaccination against measles is done at 12 months. Revaccination is carried out at 6 years.
- Vaccination is given to all contact persons under 40 years of age who have not had measles and are not vaccinated.
- For protection, a live attenuated (significantly attenuated) vaccine is used.
- The three-component vaccine is more commonly used, since the vaccination schedule coincides with the immunization against rubella and mumps. But there are also monovaccines for older contact persons.
Measles is not only white spots on the mucous membrane of the cheeks and a red rash all over the body. This is the most severe infection, which occupies one of the first places in the world in terms of mortality in young children. Numerous post-infection complications have been associated with measles, including severe illness nervous system. The infection circulates only among people, so prevention should be universal.