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Section 3. Summaries of Infectious Diseases
Measles
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
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CLINICAL MANIFESTATIONS
Measles is an acute viral disease characterized by fever, cough, coryza, conjunctivitis, an erythematous maculopapular rash, and a pathognomonic enanthema (Koplik spots). Complications including otitis media, bronchopneumonia, laryngotracheobronchitis (croup), and diarrhea occur commonly in young children. Acute encephalitis, which often results in permanent brain damage, occurs in approximately 1 of every 1000 cases. Death, predominantly resulting from respiratory and neurologic complications, occurs in 1 to 3 of every 1000 cases reported in the United States. Case fatality rates are increased in children younger than 5 years of age and immunocompromised children, including children with leukemia, human immunodeficiency virus (HIV) infection, and severe malnutrition. Sometimes the characteristic rash does not develop in immunocompromised patients.
Subacute sclerosing panencephalitis (SSPE) is a rare degenerative central nervous system disease characterized by behavioral and intellectual deterioration and seizures that occurs 7 to 10 years after wild-type measles virus infection. Widespread measles immunization has led to the virtual disappearance of SSPE in the United States.
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ETIOLOGY
Measles virus is an RNA virus with 1 serotype, classified as a member of the genus Morbillivirus in the Paramyxoviridae family.
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EPIDEMIOLOGY
The only natural hosts of measles virus are humans. Measles is transmitted by direct contact with infectious droplets or, less commonly, by airborne spread. Measles is one of the most highly communicable of all infectious diseases. In temperate areas, the peak incidence of infection usually occurs during late winter and spring. In the prevaccine era, most cases of measles in the United States occurred in preschool and young school-aged children, and few people remained susceptible by 20 years of age. The childhood and adolescent immunization program in the United States has resulted in a greater
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