Measles and its neurological complications
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Because its symptoms are typical, acute measles can be diagnosed clinically by experienced physicians. Criteria for clinical diagnosis of measles, as defined by the CDC, are listed in Table 18.1. Laboratory confirmation is possible by demonstration of MV-specific IgM antibodies and/or by demonstration of a seroconversion or rise of IgG antibodies, which are frequently negative in blood samples obtained during the acute phase, and/or measles virus RNA detection by reverse transcriptase polymerase chain reaction (RT-PCR) from throat swabs or urine. Confirmation of acute measles by serological tests or RT-PCR should be obtained regularly in countries with low measles incidence. Diagnostic tests, in particular RT-PCR, are also indicated in immunosuppressed patients in whom the rash may be missing or be atypical.
Viruses and Antiviral Agents
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Measles is extremely contagious, and causes coryza, conjunctivitis, fever, and a typical maculopapular rash that appears 1–3 days after the onset of other symptoms. The infective stage extends from around 2–4 days prior to the appearance of a rash to 2–5 days after. In the early phase of the disease the infection is primarily spread via contact with nasal or oral excretions, and in the later stages via contact with the rash itself. Measles infection is associated with a number of serious complications including encephalitis and pneumonia, leading to death in approximately 1 in 5000 cases.8 The group most at risk of developing such complications are infants less than 12 months old. In around 1 in 1000 cases, measles causes permanent bilateral deafness. Like mumps there is no cure for measles, and treatment is focused on ameliorating symptoms. However, the MMR vaccine given to children between the ages of 12 and 15 months elicits a highly effective and lifelong protection.
Multivariate Analysis and Interaction
Johan Giesecke in Modern Infectious Disease Epidemiology, 2017
Most of the examples given so far have only looked at one exposure and one outcome: type of food eaten versus risk for gastroenteritis in Chapter 4, HIV status and risk of tuberculosis in Chapter 6, or length of relationship versus risk for chlamydia infection in Chapter 8. In many instances there may be several factors that are potentially associated with risk for disease. There are two different possibilities here: We want to describe the independent contributions to risk for disease from several factors. Risk for infection with measles in a cohort of children could depend on family size, age, vaccination status, type of schooling, and so on. Each of these factors could well play an independent role for the number of measles cases in the cohort during 1 year, and we may want to analyse them all.Or, we just want to study the risk associated with one single factor. In the measles example, we could, for example, be interested in the association between age at vaccination and subsequent risk of measles infection. All the other variables, such as family size and so on, would then just be potential confounders, and we would want to get rid of their influences in our calculation of an RR or OR.
Can a Measles Epidemic Be Avoided in 2022?
Published in Comprehensive Child and Adolescent Nursing, 2022
Edward Alan Glasper
In contemporary societies, the combined Measles, Mumps, and Rubella (MMR) vaccine can prevent measles. In the United Kingdom, for example, this vaccine is given as part of the routine National Health Service childhood vaccination program. Uptake of the vaccine within many societies remained high up until 1998 when Andrew Wakefield, an English doctor, published a peer-reviewed research paper in the prestigious medical journal The Lancet that claimed an association between the vaccine and autism and bowel disease. The paper was later retracted by the journal when it was suggested that the author had committed academic fraud. Although the study was discredited, the publicity surrounding the subject had a profound effect on vaccine uptake by concerned parents. The controversy linked to the Wakefield publication had a damaging impact on overall compliance to childhood immunization protocols, and vaccination rates fell from 90% to 54% after the article was published. This resulted in a subsequent public health crisis in the United Kingdom as population protection against these childhood diseases fell dramatically. This was because many parents became convinced that their children risked neurological damage if they were vaccinated without fully understanding the more dangerous risks of not vaccinating their children (Levin et al., 2022).
Intralesional measles–mumps–rubella is associated with a higher complete response in cutaneous warts: a systematic review and meta-analysis of randomized controlled trial including GRADE qualification
Published in Journal of Dermatological Treatment, 2021
Rachel Vania, Raymond Pranata, Sukmawati Tansil Tan
A Cochrane pooled review found for the efficacy of topical 5-fluorouracil, intralesional interferons and photodynamic therapy (5). However, they are potentially hazardous or toxic treatments and result in more pain than the lesion itself; therefore, careful consideration on the benefit-to-risk ratio is advised (1,3,6). The reported locally destructive treatment encompassing caustic agents (ablation, cryotherapy, salicylic acid) to antiproliferative agents have reported variable range of clearance rate, but ultimately results in scarring (7,8). Meanwhile, a systemic immunotherapeutic maneuvers such as intralesional antigens and vaccines have gained interest for a higher efficacy with tolerable side effects (8–13). Several trials have shown the successful application of mumps–measles–rubella (MMR) vaccine resulting in complete clearance of warts (14), defined as eradication of the treated area. It is hypothesized that the vaccine increases the ability of the immune system to recognize and destroy the antigen and infected cells, while establishing efficacy and safety (7,14). In this systematic review and meta-analysis, we aimed to collect the latest evidence on the efficacy of MMR vaccine as immunotherapy for cutaneous warts.
Abstracts book
Published in Acta Clinica Belgica, 2020
Patrick Van De Voorde
Measles is an infectious disease that could be responsible for serious respiratory and neurological complications. Mimicry with the virus causes ADEM, an inflammatory demyelinating disease of the central nervous system. Its clinical presentation is sudden fever, convulsions and cerebellar, pyramidal or medullary signs. The PCR on CSF is the key to diagnostic exam. Blood tests and the CSF basic analysis are not specific of the disease. The MRI is the gold standard for the study of brain damages. The treatment of ADEM is empirical and consists of high-dose corticotherapy. The second-line therapy consists of intravenous immunoglobulin and the third-line therapy is plasmapheresis. In addition, high dose of vitamin A reduces mortality and ocular lesions. Antiviral treatment is rarely used and its effectiveness is uncertain. The evolution is unpredictable.
Related Knowledge Centers
- Vaccine-Preventable Disease
- Infection
- Measles Morbillivirus
- Fever
- Rhinitis
- Conjunctivitis
- Koplik'S Spots
- Diarrhea
- Otitis Media
- Pneumonia