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1、Measles,Xie min Department of Pediatrics , Xiangya Hospital,,Introduction,Xiangya Hospital,In the 9th century, the first scientific description by Persian In 1529, a measles outbreak in Cuba In 1531, measles killed half the population of Honduras In 1875, measles killed over 40,000 Fijians During th
2、e 1850s, measles killed a fifth of Hawaiis people In the 19th century, measles decimated the Andamanese In 1954, measles virus was isolated from a USA boy In 1963 ,measles vaccines became available In 1968,an improved measles vaccine became available,,Measles death,Xiangya Hospital,Globally, in 1999
3、, about 873,000deaths Africa, in 1999, about 506,000 deaths India，about 100,000 children die as a result of measles each year In 2000, 1.7 million vaccine-preventable childhood deaths occurred, of which 777,000 were attributed to measles.,Globally, in 2004, about 454,000 measles deaths,Worldwide mea
4、sles remains the fifth leading cause of mortality among children aged 5 years,,Recent outbreaks,Xiangya Hospital,On February 19, 2009, 505 measles cases were reported in the North of Vietnam Approximately 1000 measles cases were reported in Israel between August 2007 and May 2008 In 2007, a large me
5、asles outbreak in Japan In 2008, 1,217 cases were diagnosed in the United Kingdom,,Measles,Xiangya Hospital,Measles is a commom and highly contagious disease with high morbidity and mortality It is caused by infection with measles virus and characterised by fever ,cough,coryza,conjunctivitis, Koplik
6、s spot and erythematous maculopapular,,Measles virus,Xiangya Hospital,Member of the family of Paramyxoviruses ssRNA enveloped virus, a separate genus, the morbillivirus one serotype only and there are very little differences between different isolates,,临床症状,基本病变主要见于皮肤 淋巴组织 呼吸道 肠道粘膜,病变部位单核细胞浸润 增生形成多核
7、巨细胞,局部上皮细胞 淋巴组织中繁殖,Xiangya Hospital,Pathogenesis,麻疹病毒,单核巨噬细胞,鼻咽,病毒血症,Syncytial formation caused by measles virus in cell culture,,Xiangya Hospital,Epidemiology,source of Infection,contagious airborne,Humans are the only known natural hosts of measles,Fluids from an infected persons nose and mouth,ve
8、ry dangerous in immunocompromised children,Infected case,route of transmission,潜伏期,前驱期,出疹期,恢复期,Clinical features,typical measles,6-18天 症状无 特异性,发热 结膜充血 卡他症状 Kopliks斑,发热后3-4天出疹 中毒症状加重 出疹顺序： 耳后、 发际、额、面 部、 颈、躯干、四肢、 手掌、足底 红色斑丘疹 疹间皮肤正常,出疹3-4天后热退 皮疹消退 色素沉着 糠麸样脱屑,Koplik spots the pathognomonic sign of measl
9、es in the prodromal phase tiny grey-white dots surrounded by erythema on the buccal mucosa,rarely on the palate and lower lip disappear rapidly after rash appearance,潜伏期,前驱期,出疹期,恢复期,Clinical features,typical measles,6-18天 症状无 特异性,发热 结膜充血 卡他症状 Kopliks斑,发热后3-4天出疹 中毒症状加重 出疹顺序： 耳后、 发际、额、面 部、 颈、躯干、四肢、 手掌
10、、足底 红色斑丘疹 疹间皮肤正常,出疹3-4天后热退 皮疹消退 色素沉着 糠麸样脱屑,轻型麻疹,重型麻疹,异性麻疹,主要见于营养不良、免疫力低下患儿 死亡率高,主要见于接种过疫苗再 次感染麻疹野病毒株,Clinical features,atypical measles,多见于有部分免疫力患儿,,Xiangya Hospital,Complications,pneumonia/ laryngitis/otitis media diarrhea myocarditis measles encephalitis Subacute sclerosing panencephalitis (SSPE)
11、tuberculosis exacerbating malnutrition vitamin A deficiency (corneal ulceration),J Ayub Med Coll Abbottabad,2008,20(2):14-6,Pakistan,136 measles children with complications malnourished patients 71.35% the commonest complications the commonest cause of death encephalitis (57.1%),pneumonia (39.7%) di
12、arrhoea (38.2%),J Coll Physicians Surg Pak. 2005,15(9):547-51,Turkey,143 measles children with complications malnourished patients 72.7% the commonest complications pneumonia (39.7%),J Med Assoc Thai. 2004 Apr;87(4):386-8,四川省宜宾市翠屏区妇幼保健院儿科,20032007 年收治 147 例麻疹 109例有并发症 71.35% 肺炎 97例 心肌炎 49例 脑炎 8例,重庆医
13、学,2008, 37（ 24）,重庆医大儿童医院,中华儿科杂志, 2001,39(11),,Xiangya Hospital,Laboratory diagnosis,Microscopy,multinucleate giant cells with inclusion bodies,Serology,measles-specific IgM IgG rise by 4 fold between acute and convalescent phase,virus isolation,MV antigens,success rate is high in the prodrome phase,
14、,Xiangya Hospital,Diagnosis,The symptoms of acute measles are so distinctive that laboratory diagnosis is seldom required. However, as the vaccination program progresses, atypical forms of measles have emerged and laboratory diagnosis may be required.,Differentiation diagnosis,药物疹,皮疹痒感，多形性 摩擦及受压部位多,
15、原发病症状,发热多为原发病 引起，有服药史,肠道病毒 感染,埃可病毒 柯萨奇病毒,发热、咽痛、腹泻 全身或颈枕淋巴结大,斑疹或斑丘疹 很少融合，1-3天退,发热时或热退后 出疹,,Xiangya Hospital,Management,Treatment is symptomatic,一般治疗：卧床休息，保持室内空气流通，避免强光刺激，给易消化有营养的食物，保持皮肤粘膜清洁。,对症：高热：用小剂量退热剂，烦躁用镇静剂， 剧咳：止咳祛痰。 VitA：20万40万单位/日，连用2天 继发感染：抗生素,治疗并发症,,active immunization,passive immunization,separate case,block the route of transmission,Prevention,Xiangya Hospital,With no animal reservoir, it must be possible to eradicate measles through
