麻疹2013课件

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 the 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, 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 measles 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 measles 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, Kopliks 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,very 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 measles 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、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) 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%) diarrhoea (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,,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,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 a controlled vaccination campaign,prevention,active immunization,Diagram,506,000,Globally,Africa,126,000,1999,2005,873,000,345,000,vaccinationthe most effective way,Measles deaths are down,Most children are immunized,In developed countries,The distribution of cases shifted to older age groups (especially the 10-14 year group).,Some parents rejecting vaccination,到2008年，欧洲区的53个国家都在全国范围实行常规的两剂次含麻疹成分疫苗（MCV）免疫策略；51个（96%）国家在全国范围内采用麻疹-腮腺炎-风疹联合疫苗（MMR）；欧洲区MCV1估算接种率从2000-2004年的90-91%提高到2005-2007年的93-94%。2007年，MCV1接种率95%的国家有36个(68%)，MCV2接种率95%的国家有26个(49%)。10个国家（8个在西欧地区）的MCV1接种率95%,At what age should the first MMR/MMRV shot be given?,The first dose of MMR or MMRV should be given on or after the first birthday; the recommended range is from 12-15 months. A dose given before 12 months of age may not be counted, so the childs medical appointment should be scheduled with this in mind,When should children get the second MMR/MMRV shot?,The second dose is usually given when the child is 4-6 years old, or before he or she enters kindergarten or first grade. However, the second dose can be given anytime as long as it is at least four weeks after the first dose. MMRV can only be given through age 12 years.,The first dose of MMR vaccine produces immunity to measles in 95-98% of children vaccinated. The reason for the second dose is to protect those persons who did not become immune after one dose. After two doses of measles vaccine, 99% of persons become immune to the disease,Indigenous measles were declared to have been eliminated in North, Central, and South America The last endemic case in the region was reported on November 12, 2002. Outbreaks are still occurring following importations of measles viruses from other world regions,In developing countries,Routine vaccination coverage for measles remains low,(50-75%) in 6-month-old-children as opposed to 95% for 12-month-old children,The first measles vaccine is usually Given less than 12 months of age and the success rate is low,An estimated 197,000 deaths from measles occurred in 2007; of these, 136,000 (69%) occurred in the WHO South-East Asian Region,Measles tends to occur in infants and younger children,,Xiangya Hospital,Measles vaccine,Measles vaccine 1963 An improved measles vaccine 1968 Measles-mumps-rubella (MMR) vaccine 1971 Measles-mumps-rubella-varicella (MMRV) vaccine 2005,Who should NOT receive measles vaccine?,Anyone who experiences a severe allergic reaction following the first dose of vaccine Anyone knowing they are allergic to an MMR component Women known to be pregnant should not receive the MMR vaccine, and pregnancy should be avoided for four weeks following vaccination with MMR Severely immunocompromised persons should not be given MMR vaccine Persons with AIDS or HIV infection with signs of serious immunosuppression persons with HIV infection without symptoms can and should be vaccinated against measles.,What side effects have been reported with this vaccine?,Fever is the most common side effect 5%-15% mild rash 5% adult women receiving MMR develop temporary joint pain 25% MMR vaccine may cause thrombocytopenia 1/30,000-40,000 inflammation of the brain 1/1,000,000,Does the MMR vaccine cause autism? There is no scientific evidence that measles, MMR, or any other vaccine causes autism.,Adverse Event Following Immunisation (AEFI) The incidence of AEFI was estimated at 1.91 cases per 10(5) vaccinated children. Children from 5 to 59 months represented 57.33%, 20% of AEFI were serious. The AEFI had occurred in the first three days after vaccination (69.33%). The cutaneomucous allergies were represented more than half of AEFI (53.33%), followed by feverish syndromes (24%). The causes were the vaccine reactions (67%), coincidences (29%) and errors of program (4%). The outcome was favourable in 97.33% of cases with 2 cases of death. Good safety of vaccine against measles,Bull Soc Pathol Exot. 2009 ,102(1):21-25,,Xiangya Hospital,中国,麻疹减毒活疫苗 初种年龄 生后8月 复种年龄 7岁 强化免疫接种,159 例婴儿麻疹流行特征,年龄最小 2 个月 8 月龄婴儿占57.13 %,何炳福,浙江预防医学.2009,21(2):19-20,165例婴儿麻疹的临床及流行病学分析,年龄最小28天 8 月龄婴儿占25.11%,苏桂华,地方病通报.2009,24(1):89-90,8个月内婴儿