We searched PubMed with the terms: measles, measles vaccine, measles pneumonia, measles and bacteria, measles and secondary infection, measles and control, measles and elimination, measles and young infants, and measles and tuberculosis. The Cochrane database was searched for reviews of measles. We also did an internet search on measles control or elimination, looking for reports of national strategies for measles control, and a search of the WHO website. Many other references were found in the
SeminarMeasles: not just another viral exanthem
Section snippets
Virology
Measles virus is a spherical, enveloped, single-stranded RNA virus belonging to the genus Morbillivirus in the family paramyxoviridae.3 The virion is composed of six structural proteins, three of which form the viral envelope and three the ribonucleoprotein core. The nucleoprotein is the major component of the ribonucleoprotein core, the other two parts being the large protein and the phosphoprotein. The large protein contains the enzyme RNA polymerase, which catalyses the transcription and
Pathophysiology and immunology
Measles infection is acquired via the respiratory tract, and occasionally through the conjunctivae. Virions enter the local lymphatic system, either free or associated with macrophages, and are transported to the regional lymph nodes where they multiply before reaching the reticuloendothelial system. The reticuloendothelial infection is followed by a second viraemia through which the skin and the respiratory tract become infected and the disease is manifest after an incubation of 10–12 days.
Measles in young infants
In developing countries, measles is characterised by high incidence and mortality in infants younger than 9 months who are too young to have been vaccinated against the disease, according to the schedule recommended by WHO.51, 52, 53, 54 Infants have a higher risk of mortality and multisystem involvement than older children.50, 55 Young infants are more likely to be secondary cases of measles within a household than index cases, and case fatality when measles is acquired within a household is
Clinical issues
WHO has published standardised primary and first-level referral hospital case-management programmes for measles, which include recommendations on treatment and supportive care in outpatient and inpatient health facilities.86, 87 In the integrated guidelines for the primary-care management of the sick child (IMCI) in developing countries, a child is classed as having measles if he or she has a generalised rash and one of the following: cough, running nose, or red eyes. Children with measles are
Control and outbreak prevention or eradication
The fight against measles can be divided into three battles: control, outbreak prevention, and eradication. These battles can be waged at different times in different places, according to needs and resources.
The aim of control is to reduce the occurrence of measles and any associated deaths. As vaccination coverage increases, the epidemiology of the disease changes substantially and in a complex way, providing great advantages for communities even if target levels for elimination are not
Conclusion
Measles is a challenge for all countries. Effort needs to be put into sustaining the infrastructure necessary for vaccine delivery in low-income countries, as well as into development of novel vaccines and addressing technical questions about elimination schedules. Further research is necessary to address many public health and clinical issues relating to measles (panel 2). Measles represents a specific opportunity for high-income countries to contribute to the health and survival of children
Search strategy
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