• Highly infectious
• Transmitted through respiratory droplets or airborne
• Fever, rash, cough, conjunctivitis and coryza
• CFR 0.1% - 10%
• Vitamin A deficiency increases mortality
Clinical features
• Incubation period from exposure to onset of fever is usually 10 days.
• Initial symptoms and signs are high fever, runny nose, coryza, cough, red eyes and Koplik spots (small white spots on the buccal mucosa).
• Characteristic erythematous (red) maculopapular (blotchy) rash appears on the 3rd to 7th day, starting behind the ears and on the hairline and then spreading to the rest of the body.
Case Definition of Suspected Measles
Any person in whom clinician suspects measles infection during last one month(OR)
Any person with fever and rash and cough, coryza (running nose) or conjunctivitis (red eyes) during last one month.
For epidemiological investigation, clinical measles would be a case within last 3 months
Measles death definition
“A death which occurs within one month [30 days] of onset of measles”
– The Global Epidemiology of Infectious Diseases, WHO-2004
Objectives of Measles Surveillance
• Detect and investigate suspected measles outbreaks
• Improve case management of measles cases
• Identify high-risk populations/areas for measles
• Strengthening measles immunization coverage in these areas
• Monitor progress in reduction in measles mortality and morbidity
Operational criteria for conducting extensive outbreak investigation
• > 5 suspect cases of measles in a block in a week(OR)
• > 1 death due to measles in a block in a week(OR)
• > 5 suspect cases in an area bordering several blocks
• Outbreak Flag:
– 5 or more suspected measles cases are reported from one block or contiguous blocks in a week, OR
– 1 or more suspected measles deaths are reported from one block in a week
• Collate information at District level from
– weekly reports,
– AFP Informer network
– Other sources like IDSP/ICMR Measles network etc.
Sample Collection and Transport Kit
• 5ml syringe and needle or Vacutainer tube with 22 gauge needle and adapter
• 5ml externally threaded screw cap vials
• Tourniquet, sterile swabs & band aid
• Gloves
• Uricol disposable bottles
• Specimen labels
• Zip lock plastic bags
• Autoclavable disposal bags
• Cold box with ice packs
• Measles lab request form
Blood sample collection
• Apply tourniquet 2 - 3’’ above elbow, swab the cubital fossa.
• Draw 3-5 ml of blood by venipuncture using syringe
• Discard Needle into disposable bags / needle destroyer. Be careful of needle stick injury
• Push the blood gently into sterile labeled tube. (do not push blood through the needle). Discard the barrel of syringe into auto clavable disposal bags
• Leave the tube at RT for 30mins for clot formation.
• Clotted Blood can be stored at 4-8deg C for up to 24 hours. Do not freeze whole blood
• Fill up lab request: Three dates are important: Dates of last measles vaccination, of rash onset, & collection of sample
Factors responsible for increased rate/severity of complications & deaths in measles
• Young age
• Malnutrition
• Vitamin A deficiency
• Overcrowding
• Immune deficiency (~HIV)
MEASLES REPORTING
• Gross under reporting
v Perception of disease
v Workers perception vs. immunization
v Outbreak response immunization
REPORTING GUIDELINES
Ø All Block PHC will be a reporting unit
Ø All the additional PHCs will send weekly report to the Block PHC every Monday (Form VPD-H002) (2 copies)
Ø All the Block PHCs will send consolidated weekly report VPD-H002 (2 copies) based on additional PHC reports including block PHC area to DDHS office by Tuesday noon
Ø Weekly Hospital report VPD-H002
