V Acute viral illness of childhood

V Specific virus of Genus Morbillivirus , a

member of paramyxovirus family
V Incubation period range 7 to 18 days(usually 10
days)
V Prodromal symptom fever , malaise , cough,
coryza , conjunctivitis (pink eye)

3/6/2011
1
ash (5-6 days)
V Maculo-papular (non-vesicular ), then confluent
V Evolves from face to trunk then to limbs
V Fades in order of appearance, often with peeling

V Koplik spot on buccal mucosa shortly before

onset of rush and for about 1-3 days
subsequently

3/6/2011
2
V Period of from 4 days prior to
infectivity: onset of rash to 5 days
after appearance of
rash

V Mode of human-to-human via

transmission airborne droplet
spread, direct contact
with nasal or throat
secretions, etc
3/6/2011
3
V Äiarrhoea,
V Pneumonia,
V Malnutrition and Vit. A deficiency,
V Otitis media,
V Encephalitis (including sub-acute
sclerosing panencephalitis, SSPE)
V Median case fatality ratio (CF) of measles
1.63%
V Case fatality ratio in developing countries
ranging from 5 ² 30% depending on the
nutrition status of the patient and the
effectiveness of the health services
3/6/2011
4
V Measles virus was
V Enders in 1954
isolated by
V Measles vaccine first
V 1958
used in clinical trial
V Live vaccine was
V 1963
licensed for use
V Introduced in
V 1985
National programme
in india
V Second dose V 1989

recommended in

3/6/2011
5
^ inica case definition:
V Any person in whom a clinician suspects
measles infection, or
V Any person with fever and maculo-
papular rash (i.e. non-vesicular) and
cough, coryza (i.e. runny nose) or
conjunctivitis (i.e. red eyes).
£aboratory criteria for diagnosis
V Presence of measles-specific IgM
antibodies.
3/6/2011
6
Measles is considered an eradicable
disease due to
V the single serotype,
V effective vaccine,
V lack of naturally occurring non-human
reservoirs
V high clinical expression of the disease

3/6/2011
7
V Measles vaccine is lyophilized and
reconstituted with pyrogen free double
distilled sterile water (provided by the
manufacturer) immediately prior to
administration by injection.
V Äose is 0.5 ml and should be
administered subcutaneously in the right
upper arm.
V The site is important for survey purpose.
3/6/2011
8
V Measles vaccine can be safely frozen
without loss of potency. But diluents
should never be frozen.
V Measles vaccine should always be
reconstituted only with the diluent
provided by the manufacturer. Before
reconstitution both vaccine and diluent
should be brought to the same
temperature range (+2 to +8 °C).
3/6/2011
9
V Each 0.5 ml dose of reconstituted
vaccine should contain a minimum
infective dose of at least 1,000 viral
TCIÄ50 (median tissue culture infective
doses).
V econstitution time should be recorded
on each vaccine vial lable.
V econstituted vaccine must be discarded
4 hours after dilution.
3/6/2011
10
V Most of the live, attenuated measles vaccines
used now originate from the Edmonston strain of
measles virus isolated by Enders and Peebles in
1954.
V Attenuated Edmonston B-vaccine, which was
licensed in the United States in 1963 and widely
used until 1975.
V Well known vaccine strains derived from the
original Edmonston isolate include the Schwarz,
the Edmonston²Zagreb (widely used in India)
and the Moraten strains, all in widespread use
since the 1960s.

3/6/2011
11
V Measles vaccines are available, either as
single-antigen vaccines or in
combination with either rubella or
mumps and rubella vaccines.
V When the M or MM vaccines are used,
the protective immune response to each
of the components remains unchanged
V Target herd immunity for measles
control 95%
3/6/2011
12
V Vaccine should be stored at 2 to 8 °C
V Transported in vaccine carriers with 4
frozen icepacks.
V The vaccine is also very sensitive to
sunlight and should always be kept away
from sunlight.

3/6/2011
13
EACTION CASE TO ÄOSE ATIO

V Local reaction at injection

V 1 in 10
site
V Fever
V 1 in 6 to 1 in 20
V ash
V 1 in 10
V Febrile seizure
V 1 in 3,000
V Thrombocytopenia
V 1 in 30,000
V Anaphylactic reaction
V 1 in 100,000
V Anaphylaxis
V 1 in 1,000,000
V Encephalopathy
V <1 in 1,000,000

3/6/2011
14
V Injection adrenalin (1:1000) solution ² 2
ampoules
V Injection Hydrocortisone (100 mg) ² 1 vial
V Äisposable Syringe (insulin type) having 0.01
ml graduations and 26G IM needle ² 2 sets
V Äisposable Syringe (5 ml) and 24/26G IM
needle ² 2 sets
V Scalp vein set ² 2 sets
V Tab Paracetamol (500 mg) - 10 tabs
V I/V fluids (inger lactate/Normal Saline): 1 unit
in plastic bottle
3/6/2011
15
V I/V fluids (5% Äextrose): 1 unit in plastic bottle
V IV drip set: 1 set
V Cotton wool + adhesive tape : 1 each
V AEFI reporting form (FI) Label showing: Äate of
inspection, Expiry date of Inj. Adrenaline and
shortest expiry date of any of the components
V Ärug dosage tables for Inj Adrenaline and
Hydrocortisone
V At hospital setting, Oxygen support and airway
intubation facility should be available.

3/6/2011
16
VMeasles vaccination should be avoided in high
fever or serious disease and pregnancy.
V Persons with a history of an anaphylactic
reaction to neomycin, gelatin or other
components of the vaccine should not be
vaccinated.
V Persons who are severely immunocompromised
as a result of congenital disease, HIV infection,
advanced leukaemia or lymphoma, serious
malignant disease, or treatment with high-dose
steroids, alkylating agents or antimetabolites, or
in persons who are receiving
immunosuppressive therapeutic radiation

3/6/2011
17
V Administration of immunoglobulins or
other antibody-containing blood products
may interfere with the immune response to
the vaccine.
V Vaccination should be delayed for 3² 11
months after administration of blood or
blood products, depending on the dose of
measles antibody.
V Following measles vaccination,
administration of such blood products
should be avoided for 2 weeks, if possible

3/6/2011
18
3/6/2011
19
V Providing the first dose of measles vaccine to
successive cohorts of infants;
V ïnsuring that all children have a second
opportunity for measles vaccination;
V ïnhancing measles surveillance with
integration of epidemiological and laboratory
information;
V Improving the management of every measles
case 3/6/2011
20
V è






 
 


 
by 2005 (compared with 1999
estimates)
V To achieve and maintain interruption of
indigenous measles transmission in large
geographical areas with established
elimination goals

3/6/2011
21
V In controlled studies measles vaccine efficacy is
89% when given at 9 months and 99% when
given at >12 months of age.
V Actual vaccine effectiveness , under field
conditions, is usually lower. It is 85% when given
at 9 months and 95% when given at >12 months
of age.
V The peak antibody response occurs 6 to 8 weeks
after infection or vaccination. Immunity
conferred by vaccination against measles has
been shown to persist for at least 20 years and is
generally thought to be life long for most
individuals.

3/6/2011
22
 Post-vaccination

Age at vaccination
Seroconversion Susceptibility

9 month 85% * 15%

(Developing world)

12- 15 months
95% * 5%
(Industrialized countries)
å


 
 
3/6/2011
23
 S s ti ilit Imm nit S s ti ilit
C v rag Effi a
f r aft r aft r

First d s
9 m nths
100% x 90% x 85% = 77% (23%)

S nd
d s > 12 23% x 90% x 95% = 20% (3%)
m nths

T tal m lativ ff t f 2 d s s: 97% (3%)

3/6/2011
23
VPrevious coverage evaluation surveys have
shown that mean national coverage with measles
vaccine has never exceeded 70%. With 85%
vaccine effectiveness for vaccination at 9 months,
actual protection was offered to only 60% of
annual birth cohorts (70% × 85% = 60%).
V A second opportunity measles immunization
given at or above one year of age (>95%
effectiveness) along with simultaneous increase
in first dose coverage in the population is an
effective way to reduce the proportion of
susceptible children in the community and to
prevent measles outbreaks

3/6/2011
25
V Incountries aiming at reducing mortality
from measles, immunization coverage
should be •90% at the national level and
•80% in each district.
V Countries aiming at measles elimination
should achieve •95% coverage with both
doses in every district.

3/6/2011
26
In May 2005, the 58th World Health
Assembly adopted the GIVS.
V To reduce global measles deaths by 90%
(compared with 2000 estimates) by 2010
V As of 2008, 192 of 193 Member States of
WHO use 2 doses of measles vaccine in
their national immunization programmes,
India being the only exception.

3/6/2011
27
1. High coverage of measles 1st dose
2. Sensitive laboratory supported
surveillance
3. Case management
4. 2nd opportunity for measles. There are 2
ways of providing 2nd opportunity they
are
a. outine 2nd dose of measles
b. Supplementary Immunization Activity
(SIA) for measles
3/6/2011
28
V Catch-up campaigns
V follow-up campaigns

V SIAs target large populations (entire

nations or large regions) and aim to achieve
immunization coverage of over 90%.
V Three weeks campaign periopd:
a. 1st week in educational institutes;
b. 2nd and 3rd weeks in existing UIP
outreach site.

3/6/2011
29
VA one-time event targeting multiple cohorts
in which susceptible children have
accumulated. The target age group depends
on the susceptibility profile of the
population.
V Äuring measles catch-up campaign all
children in the target age group will receive
a supplementary dose of measles vaccine
regardless of previous vaccination history
or illness.
V In this plan the target age group is 9 months
to <10 years old children
3/6/2011
30
V A periodic event (every 3-5 years, according to
the accumulation of susceptible) targeting
children born after catch-up campaign to
maintain low level of susceptibility.
V The periodicity depends on the routine
immunization coverage, the existence of pockets
of unprotected children and vaccine efficacy. The
target age group for immunization in these
campaigns should include all children aged over
nine months who were born after the previous
mass immunization (e.g. catch-up campaign).

3/6/2011
31
V Äuring the year 2008, there were 41144
cases & 96 deaths recorded in India and
the coverage of measles vaccine was
58.8%.
V Currently, the Indian National
Immunization Schedule incorporates
provision of a single dose of measles
vaccine at the age of 9 months, along with
Vit. A.
3/6/2011
32
V@ High coverage of first dose of measles
V r Second opportunity of measles in the
form of routine second dose of measles
or Supplementary Immunisation activity
(where the coverage of vaccine is less
than 80%)
V ˜ Case managementincluding
administration of vitamin A
V  Highly sensitive surveillance system

3/6/2011
33
Applying the 80% MCV1 coverage cut-off and applying ÄLHS-
3 survey data there are
u14 states qualify for catch-up campaign in 9 mo-10 yrs age
group
u21 states qualify for MCV2 through routine immunization in 16-
24 month age group.
u4 states viz. Äelhi, Goa, Poducherry & Sikkim already introduced 2nd dose
VOperational guidelines for Measles catch-up campaign
developed
VState planning for second opportunity of Measles started

3/6/2011
34
3/6/2011
35
V The Multi year strategic plan of the
government of India addresses the issue of
reducing the measles mortality by two-
thirds by 2010, compared to 2000 estimates.
V The plan emphasizes on achieving at least
90% coverage in 80% of the districts of the
country by 2009 and
V collection and use of good quality
epidemiological data from active
surveillance and outbreak investigation to
guide further action.

3/6/2011
36
To make an impact on measles mortality
reduction, a second opportunity for
measles immunization through routine
immunization will be considered in states
where -
V routine measles coverage exceeds 90%,
V good surveillance data is available and
V local resources are available to sustain
the strategy.
3/6/2011
37
V Measles is a killer of children
V Measles is a leading cause of death
V Everyone gets measles in the absence of vaccine
V Second opportunity strategy leads to substantial
mortality reduction
V Use four-point strategy to reduce measles mortality
V Ärive measles mortality reduction efforts through
improved surveillance
V Every measles outbreak deserve an investigation

3/6/2011
38
3/6/2011 3