| Clinical guidelines - Diagnostic and treatment manual |
|Chapter 8 - Viral infections|
- Also called rubeola and morbilli, it is one of the commonest childhood infectious exanthems. Among children in developing countries it is a serious illness with high mortality, especially when associated with malnutrition. Measles often precipitates acute malnutrition. Prevention by universal immunization of young children must always be a high priority.
- Measles is never subclinical, however recent studies have shown that the severity of the disease is related to the infective dose of virus. Crowding tends to increase mortality.
These must be looked for in all patients.
- Serious signs: persistent fever with darkening of the rash ("black measles") and subsequent desquamation.
- Stomatitis: compromises sucking and eating.
- Laryngitis: distinguish a benign prodromal laryngitis from that due to a secondary infection, which may be severe.
- Croup and otitis media.
- Bronchopneumonia: usually severe; gram negatives or staphylococcus.
- Diarrhea: either due to virus or from a secondary infection.
- Vitamin A deficiency: keratoconjunctivitis. Measles increases the con-sumption of vitamin A and often precipitates xerophthalmia.
- Encephalitis: caused by the measles virus itself; it occurs on about the 5th day of the rash.
- Malnutrition: precipitated by anorexia, stomatitis, fever, vomiting, diarrhea and other complications. Also important are frequent harmful cultural taboos that impose fasting upon a child with measles.
- Active case-finding during epidemic, if practical (home visits).
- Treat the fever .
- Keep well hydrated .
- Observe closely for complications.
- Give prophylaxis against conjunctivitis: drops or ointment.
- Give prophylaxis against xerophthalmia: vitamin A
100,000 IU in single dose on day 1, day 2 and day 8
After 1 year:
200,000 IU in single dose on day 1, day 2 and day 8
- Encourage good oral hygiene .
- Maintain adequate protein-calorie intake: educate mothers (especially if cultural taboos against feeding exist), continue breast feeding, provide supplementary feeding if available (but do not admit to a feeding center until after infectious period).
- Antibiotics are often given prophylactically:
penicillin V (PO): 100,000 IU/kg/d divided in 3 doses x 5 days
cotrimoxazole (PO); 60 mg of SMX/kg/d divided in 2 doses x 5 days
(dispensary - hospital)
- Treat secondary infections with antibiotics:
ampicillin: 100 mg/kg/d divided in 3 doses or (per os, IM or IV according chloramphenicol: 75 mg/kg/d divided in 3 doses to gravity x 7-10 days) or cotrimoxazole: 60 mg of SMX/kg/d divided in 2 doses
-Give supportive therapy for meningoencephalitis:
Adequate hydration, good nursing, nasogastric feeding and control convulsions with diazepam .
- Education of mothers must be part of the MCH program.
· A single injection gives good protection. Ideally should be given at the age of 9 months, but is often given later.
· Measles immunization is one of the highest priorities in refugee settings and other situations where crowding, poor hygiene and precarious nutritional status combine to encourage both transmission and the emergence of complications.
· There is an Oxfam/WHO measles immunization kit that is designed for emergency situations. Newly arrived refugee populations should be immunized during the first days of the emergency and all new arrivals should be immunized on entering. The target age-group is children from 9 months to 12 years (up to 5 years if resources are very scarce).