Measles is now uncommon as a result of widespread measles immunisation; however, outbreaks continue to occur in most parts of the world. - **Transmission**: droplet, direct contact. - **Incubation period**: 7–18 days (usually 14 days) prior to the appearance of a rash. - **Infectious period**: 1–2 days prior to symptom onset to 4 days after the onset of rash. Measles is highly infectious. # Clinical features - **Prodrome**: fever, conjunctivitis, coryza, cough and Koplik spots (white spots on a bright red buccal mucosa). - **Rash**: appears 3–4 days later; erythematous and blotchy; starting at hairline and moving down the body, before becoming confluent; lasts 4–7 days and may desquamate in the second week. - prodrome of fever, conjunctivitis, coryza, cough - koplik spots d3 - rash 3-4 days later (erythematous and blotchy, starting hairline and moving down body before becoming confluent. May desquaminate week 2) **Complications include**: - Otitis media (1 in 4) - Pneumonia (1 in 20) - Encephalitis (1 in 2000) - Subacute sclerosing panencephalitis (SSPE; 1 in 25 000) otitis media, laryngitis, tracheobronchitis, bronchiolitis, pneumonitis, severe diarrhea, and acute encephalitis. The virus itself can also cause pneumonia. Bacterial superinfection can also occur. The populations that are at high risk for severe disease or complications include children younger than 5 years old, adults older than 20 years old, pregnant women, and the immunocompromised.  **Subacute sclerosing panencephalitis** (SSPE) is a rare but fatal complication of measles. SSPE is a slow progressive infection of the central nervous systems (CNS) that results from a prior measles infection. It is thought to be due to continual measles infection of the CNS.  The mean time of onset of SSPE is **7 years after measles infection**. Symptoms include behavior change,  decreased intellect, ataxia, and myoclonic seizures followed by progressive neurologic change and death # Contacts of confirmed measles cases - Measles, mumps, rubella (MMR) vaccine within 72 hours of exposure to unimmunised children >9 months of age (another dose should be given at 12 months of age or 4 weeks after the first dose, whichever is later). - Normal human immunoglobulin (NHIG) should be given IM within 7 days if: - MMR contraindicated, or if >72 hours since exposure - Exposed pregnant women have had only 1 dose of MMR - Note pregnant high risk - Notify public health #infectious_diseases # OSCE - [ACEM 2020.1 st 22](x-devonthink-item://83F559E7-C76B-4EC6-8BF1-EDC1709C8C78)