Measles

There are many viruses today that at one time were a deadly disease, however because of advances in technology and vaccinations, we no longer give them a second thought. Prior to the discovery of a vaccination, the United States reported a total of over 50,000 cases of measles outbreaks each year with 450-500 cases resulting in death. (NCIRD) Since the disbursement of an effective vaccination, the measles has been almost eradicated in the United States; however it is still abundant in other countries around the world. (The college of physicians of Philadelphia) Is this something we think of when we are traveling?

Is it possible for people to visit or immigrate to the United States carrying the disease with them? The measles virus can be dated as far back as 900 CE however many scientists believe it has always been with us. (David) The measles was frequently mistaken for smallpox and at the time it was believed that they were the same disease with varying but similar signs and symptoms. In 900ac Rhazes, an Arab physician, described measles in his medical notes differentiating smallpox and measles as two separate diseases, but were still thought to originate from the same cause.

Since measles is an illness affecting mainly children over six months old, it was believed to be a “poison” passed to the child from the mother. Once a child developed the disease, he was believed to be rid of the “poison”. (Axton) The next known record of measles was in 1544, in “The Boke of Chyldren” a book written by Thomas Phaer. Phaer states that the two diseases were by one cause but passed not by the mother to the child, but from one infected person to another. Jr) With this new understanding of the disease it became common practice for parents of an effected child to hang a red curtain in the house to warn others of the presence of the illness. Parents commonly brought their children to these houses to expose them to the illness much like the “pox parties” associated with the chicken pox virus. It wasn’t until 1657 that the first official epidemic was recorded by John Hull in Boston, Massachusetts. Although the disease ran rampant very few deaths from the disease were recorded with this outbreak. Axton) Finally, in 1670, English doctor Thomas Sydenham described in detail his sons’ encounter of the measles, successfully distinguishing a clear difference in the measles and small pox. (Axton) Over the next century, measles epidemics began to appear all over the world and the number of deaths due to the disease increased significantly. (The college of physicians of Philadelphia) In 1757, Scottish physician Francis home attempted to transmit the virus from host children to healthy children verifying the theory of the disease originating from an infectious agent residing within the blood stream.

A true understanding of the measles virus came in 1846 when Peter Ludwig Panum was sent to the Faeroe Isles to investigate the outbreak of seventeen isolated islands. In his investigation Panum was able to track the virus from village to village isolating it back to a seaman from Copenhagen who appeared to be the source of the illness. Panum’s investigation developed a detailed timeline establishing an incubation period, contagious period, possible transmission method, and that people who had acquired the disease as a child seemed to be immune. (Axton) In 1954, Dr.

Thomas Peebles was the first to isolate the measles virus furthering the ability to test and study the virus in its pure form. The isolation of the virus, along with the advances in growth and attenuation understanding made by Dr. Hektoen in 1910, paved the way for the development of an effective vaccine against the measles virus, made by lab director John Enders in 1963. (The college of physicians of Philadelphia) Measles is the term for the disease caused by the Rubeola virus. In the genus Morbilivirus it is part of the larger classification Paramyxoviridae family. Manzo and Karunanidhi) The taxonomy of this virus stops at the family level due to the fact that it does not contain all of the characteristics of the microbes in the remaining levels and therefore cannot truly be categorized as such. (Crouch) The Rubeola virus has a helical nucleocapsid surrounded by a protein envelope and lipid bilayer membrane. The capsid contains non-segmented, negative single-stranded RNA, and proteins. The capsid envelope is covered in glycoprotein H and F spikes that are used to attach and fuse its self to the host. Plemper, Brindley and Iorio) The virus’s crystal like structure helps it gain entry to the host, and provides a larger surface area for attachment. (Casasnovas, Larvie and Stehle) Rubeola contains V and C proteins which are believed to be the virus’s defense mechanism against the hosts’ antiviral immune response, although this is still a very new theory and is currently being tested. (Messling and Cattaneo) Measles is typically diagnosed by signs and symptoms that are presenting and then confirmed with a blood test.

The ELISA test will present with a positive result if the IgM antibody is present in the affected person, in which case viral cultures will be taken and further tested for absolute verification. During this process the infected person should be isolated and treatment for the disease will be initiated. (Cowan) Measles is selective to human hosts, it is one of a few viruses that cannot attach to and live in animal hosts. (Donnelly) The virus is transmitted by droplet contact and enters the host by way of the respiratory tract, by coughing, sneezing, or breathing, attaching its self in the mucosal lining.

It then migrates to the lymphatic system where it rapidly multiplies and then enters the blood stream. (Cowan) In the blood stream, the virus causes the cells to merge together creating one large cell with many nuclei. Once the cells are merged they are unable to form the intended functions resulting in failure of immunity response and multiple system breakdown. (Plemper, Brindley and Iorio) Rubeola is considered one of the most infectious virus’s know today due to its increased ability to attach to the host, rapid reproduction, and ability to enter the blood stream and spread to all organs of the host. Vyas) The prevention of measles begins with ensuring you child receives the MMR vaccination around 12-15 months of age, and then again at 4-6 years of age. The MMR vaccination protects against the virus for approximately 20 years therefore another vaccination may be needed again later in life. (David) Increasing the availability of medical care and vaccination has almost eradicated the Rubeola virus in the United States. Decreasing population density, improving sanitation, and insuring adequate nutrition will lower the susceptibility of a population to contracting the virus. Schoenstadt) Once the virus is contracted there is no anti-viral known at this time to cure it. Treatment is based upon symptoms presented and typically includes body temperature maintenance, fluid and electrolyte replacements, nutritional supplements, and cough suppression. An antibiotic may be ordered to prevent subsequent bacterial infections from arising until the immune response returns to full function. (Hooker) Once exposed to an infected person, the virus incubates for 8 – 12 days before the onset of symptoms. cdphe) Rubeola presents initially with a sore throat, headache, dry cough, conjunctivitis, lymphadenitis, Koplik spots, and fever. (Cowan) This period is called the Prodrome and can last up to 7 days. (cdphe) During this time the newly infected host can still transmit the virus. By day 21 after exposure a reddish-brown, maculopapular rash appears along the hairline and continues to spread down the body. The rash typically lasts for 5-6 days and during this time fever may increase above 104O F. The rash will fade into a more patch appearance and go from red to brown in color as the virus progresses. Cowan) Once the rash is no longer present, a host may still contain the virus but is typically no longer infectious and may be taken off isolation precautions. Although it is uncommon, some hosts will develop a decrease in oxygen saturation and the skin may appear pale or dusky. Children may develop additional respiratory infections such as laryngitis, sinus/ear infections, and bronchopneumonia from the decreased immune response. Encephalitis is more commonly seen in adults as a secondary infection however these cases are still rare. Hooker) The most devastating complication from the measles is a degeneration of sections of the brain known as subacute sclerosing panencephalitis. This result from a flaw in the virus that fails to form a capsid and invades that host unable to be contained by the cells defenses, freely passing through cell membranes destroying neurons and accessory cells. SSPE is the only permanent damage seen by the Rubeola virus and is extremely rare. Onset of infection during pregnancy may result in miscarriage and small infant size. Cowan) Once the infection reaches day 3 of rash presentation, quarantine precautions are typically instituted and can remain in affect up to 21 days post exposure. Although clinical diagnosis is usually sufficient to diagnose the presence of a Rubeola infection cultures may be obtained to confirm an accurate diagnosis has been made, and create a record for tracking a potential epidemic. An IgM culture result may present with a false negative for the first 72 hours after the rash presentation, therefore follow-up cultures should be obtained and tested after this period.

An acute serum IgM culture may present as positive up to 30 days after exposer, and a convalescent serum IgG culture may remain for 10-30 days. A PCR (nasal or urine) culture should be collected within the first 3 days following rash presentation for best results, delay greater than 10 days will result in low viral levels. MMR vaccination should be administered within 72 hours of symptoms presentation especially for persons that are pregnant or immune-compromised, as long as they are over 6 months of age. (cdphe) Rubeola thrives in densely populated communities, where nutrition and medical care are poor.

It is typically contracted by children over the age of six months, but can appear in any non-immunized person without regard to age. Although there have been many cases of the measles that resulted in death, these are typically caused by the inability to maintain body temperature, hydration, and adequate nutrition. (NCIRD) The effects of measles vary depending on the geographic location of the epidemic. In places such as the United States where living conditions are not conducive to the virus, nutrition, adequate water supply, and vaccines are readily available, the disease is more contained and does not carry a high impact on the population. Vyas) In 2000, the Rubeola virus was officially declared to be eradicated from the United States having only an estimated 50 reported cases per year. (NCIRD)Conditions more resembling that of modern day Africa and India where medical care, clean water supply, and adequate nutrition sources are unavailable and living conditions are congested, the virus runs rampant and more deaths are apparent. (Hooker) In many places entire villages are isolated where the virus plagues entire populations. Currently, there are still an estimated 20 million cases of Rubeola outbreaks totaling only 200,000 deaths a year worldwide. NCIRD) Works Cited Axton, J. H. M. “The natural history of Measles. ” Department of Pediatrics and child health, University of Rhodesia (1979): 139 – 154. electronic document. Casasnovas, Jose M, Mykol Larvie and Thilo Stehle. “Crystal structure of two CD46 domains reveals an. ” The EMBO Journal 18. 11 (1999): 2911 – 2922. 15 july 2012. cdphe. Colorado Department of Public Health and Environment. n. d. web. 28 June 2012. <http://www. cdphe. state. co. us/dc/epidemiology/Measles/MeasTimeline. pdf>. Cowan, M. K. “Microbiology: A Systems Approach. ” 3rd.

New York: McGraw-Hill Publishing Co. , 2012. 530 – 531. Print. Crouch, Melissa. adjunct Professor Elizabeth Foy. July 2012. In Person. David, Joseph K. et al. “Measles (Rubeola) In Previously Immunized Children. “ Pediatrics 46. 3 (1970): 397. Academic Search Premier. Web. 19 June 2012. Donnelly, Margaret T. Missouri Department of Health and Senior Services. n. d. web. 08 July 2012. Hooker, Edmond. “Measles (Rubeola). ” MedicineNet. com 20 June (2012): 1-10. National Library of Medicine, National Institutes of Health. Google. Web. 25 June 2012. <http://www. edicinenet. com/measles_rubeola/article. htm>. Jr, T. E. C. “THE BOKE OF CHILDREN (1544) BY THOMAS PHAIRE, THE FIRST PEDIATRIC TEXT PUBLISHED IN ENGLISH. ” Pediatrics 68. 2 (1981): 182. web. 05 july 2012. Manzo , Uri and Karthi Karunanidhi. PARAMYXOVIRUS. Stanford University . 27 November 2005. 25 June 2012. <http://www. stanford. edu/group/virus/paramyxo/2005/index. htm>. Messling, Veronika Von and Roberto Cattaneo. “Determinants of Viral Tropism: A Morbillivirus V Protein Exerts Host Defense Evasion Function in T Lymphocytes. ” Molecular Therapy (2005): S328. eb. 25 June 2012. <http://www. nature. com/mt/journal/v11/n1s/pdf/mt2005964a. pdf>. NCIRD. Centers for Disease Control and Prevention. 13 April 2012. electronic document. 05 July 2012. <http://wwwnc. cdc. gov/travel/yellowbook/2010/chapter2/measles. aspx>. Plemper, Richard K, Melinda A Brindley and Ronald M Iorio. “Structural and Mechanistic Studies of Measles Virus Illuminate Paramyxovirus Entry. ” Plos Pathogens 7. 6 (2011). web. 25 June 2012. <http://www. plospathogens. org/article/info%3Adoi%2F10. 1371%2Fjournal. ppat. 1002058>.

Schoenstadt, Arthur. emedTV. 31 January 2007. website. 25 June 2012. <http://measles. emedtv. com/measles/history-of-measles. html>. The college of physicians of Philadelphia. The history of vaccines. 2012. website. 12 july 2012. <http://www. historyofvaccines. org/content/timelines/measles>. Vyas, Jatin M. , and David Zieve. “Measles. ” A. D. A. M. Medical Encyclopedia. 2012. N. pag. National Library of Medicine, National Institutes of Health. Web. 25 June 2012. <file:///E:/Micro/research%20paper/Measles%20-%20PubMed%20Health. htm>.

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