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  • Measles symptoms in adults

    Measles is an acute infectious disease of a viral nature, occurring mainly in children, but also affecting the adult population. The susceptibility to measles is very high, so all who are not sick and not vaccinated against it can get sick at any age. This disease occurs with fever, generalized defeat of the mucous membranes of the respiratory tract, oral cavity, oropharynx, eye, a kind of rash and frequent complications mainly from the respiratory organs. How to use folk remedies for this disease look here.

    Etiology. Pathogen of measles - the virus Polinosa morbillarum belongs to the genus Morbillivirus, family. Paramyxoviridae, morphologically typical for paramyxoviruses, large sizes( 120-250 nm), irregular spherical shape. The shell contains 3 layers - the protein membrane, the lipid layer and the outer glycolipid projections. Single-stranded RNA is not segmented, contains RNA-dependent RNA polymerase. Has hemagglutination and hemolyzing activity. Neuraminidase is not detected. Hemolyses and hemagglutinates red blood cells of monkeys, but does not agglutinate erythrocytes of hens, guinea pigs, mice. Pathogen for monkeys. Breeding in tissue cultures, causes characteristic cytopathic changes with the formation of syncytium of giant multinucleate cells of unusual form( stellate, fusiform).Multiple passages produce attenuated non-pathogenic strains with high antigenic activity, used as vaccine.

    The virus induces( including vaccine strains) the formation of antibodies: virus neutralizing, complement-binding, hemagglutinating, antihemolysing. Immunity is life-long, because there is one persistent type of virus.

    The virus is destroyed by heating at 56 ° C for 60 minutes, but it is preserved by freezing and lyophilization, 1 M MgS04 has a stabilizing effect( can withstand 50 ° C for up to 1 hour).

    It is sensitive to disinfectants, ultraviolet irradiation. Direct sunlight and daylight, drying have a harmful effect.

    Epidemiology. Specific prevention of measles in Russia, carried out for more than 30 years, as well as epidemiological surveillance of infection led to a sharp decrease in the incidence of measles in the country( 620 times compared with the pre-vaccination period) and almost complete elimination of mortality. This was a prerequisite for the implementation of the WHO measles elimination program by 2010. The activities envisaged by the program included three stages:

    • at the first stage( 2002-2004) - achieving a general stabilization of the incidence at the sporadic level;

    • at the second( 2005-2007) - creation of conditions for prevention of cases of measles and its complete eradication in the country;

    • on the third( 2008-2010) - certification of territories free of measles.

    In recent years, a sharp decline in the incidence of measles has been noted, in 2009 it was 0.07 per 100,000( measles 101 people, including 29 children under the age of 17).The incidence of measles is distributed unevenly across regions of the country, it is more often registered in the North Caucasus and Far Eastern federal districts. This is due to migration processes and a violation of the vaccination system.

    The source of the infection is a person who is sick with typical and atypical forms of measles. It is dangerous for others from 9-10 days after contact, in some cases - from the 7th day. The maximum isolation of the pathogen from the patient occurs in the prodromal period. From the 5th day of rashes the patient ceases to be contagious, with the development of complications, the infectious period extends to 10 days.

    The measles pathogen is transmitted by airborne droplets. The susceptibility to measles in the wild is universal. After the introduction of vaccination, the index of contagiosity decreased to 0.1-0.2.Currently, the incidence is mainly registered in adults: from 2457 cases in 2004, the share of children under the age of 14 accounted for 816 people. Cases of measles are registered both among unvaccinated and vaccinated children. Unvaccinated people are more often ill at the age of 1-2 years. Children of the first months of life suffer from measles rarely because of the presence of innate immunity. The vaccinated are more often ill in the older age. More than half of the 7-14-year-old children who became ill in 2004 were unvaccinated against measles or had no vaccination history. The absolute majority of children( 95.3%) who fell ill after the revaccination against measles, also belonged to this age group. In this regard, the plan for measures to eliminate measles includes the immunization of adolescents and adults under 35 who did not have this infection and who do not have information about vaccinations.

    After the transmitted measles, a stable, practically lifelong immunity is formed. Repeated cases of measles are very rare.

    Pathogenesis. The entrance gate for measles virus is the mucosa of the upper respiratory tract and, possibly, the eye conjunctiva.

    In the submucosal layer and in regional lymph nodes primary replication of the virus takes place. Since the third day of the incubation period, viremia develops, but the amount of the virus is still minimal. Viralemia reaches significant values ​​at the onset of the prodromal period. Hematogenous virus spreads throughout the body. In the central nervous system, skin, lungs, intestines, tonsils, bone marrow, spleen, liver, secondary replication of the virus takes place. Here, inflammatory infiltrates are formed, consisting of lymphoid and reticular elements, multinucleated cells.

    As a result of secondary replication of the virus, viremia increases, which leads to a secondary, deeper lesion of the epithelium of the upper respiratory tract and gastrointestinal tract. There is a characteristic rash.

    Measles rash is a nest infectious dermatitis. The trigger mechanism for the development of a rash is the reaction between the epidermal cells where the virus is fixed and the immunocompetent lymphocytes.

    In the upper layers of the dermis there is a perivascular inflammation with a pronounced exudative component, which corresponds to the stage of a bright patchy-papular rash.

    Then there is a diapedesis of erythrocytes in the skin followed by the decay of hemosiderin. This is clinically manifested by pigmentation.

    As a result of the spread of the inflammatory process to the Malpighia and the granular layers of the skin, epidermal destruction occurs, which in turn leads to a puffy peeling.

    Since the end of the incubation period, an immune reconstitution has begun. The measles virus has a suppressor effect on T-lymphocytes. A T-cell immune deficiency develops, which persists for 25-30 days, counting from the onset of the rash. Parallel with this, there is accumulation of specific virus neutralizing antibodies, and from the 4th day after the onset of the rash the measles virus disappears from the body. There comes a recovery.

    I. By form:

    1. Typical.

    2. Atypical:

    • mitigated;

    • abortive;

    • Erased;

    • hemorrhagic;

    • in the treatment of antibiotics and glucocorticoid hormones.

    II.By gravity:

    1. Light.

    2. Medium-heavy.

    3. Heavy:

    a) without hemorrhagic syndrome;B) with hemorrhagic syndrome.

    III.Downstream:

    1. Acute.

    2. Smooth( without complications).

    3. With complications.

    4. Mixt infection.

    Clinical picture. In the course of measles, the following are allocated:

    • The incubation period is 9-17 days.

    • Catarrhal period - 3-5 days.

    • The period of rashes is 3 days.

    • Pigmentation period - 1-1,5 weeks.

    For the catarrhal period is characterized by a combination of symptoms of intoxication and catarrhal inflammation of the mucous membranes of the upper respiratory tract and conjunctiva.

    Qatar of the upper respiratory tract is characterized by the presence of abundant mucous discharge from the nose, coarse cough. The conjunctiva is hyperemic, there is photophobia, lacrimation. The face is pasty.

    Intoxication is moderately pronounced. Body temperature is 38-38,5 ° C, by the end of the prodromal period it decreases for a day or more.

    2-3 days before the appearance of exanthema( ie, on the 2-3 day from the onset of the disease) of the enantheme appears.

    Enanthem is a rash on the mucous membranes.

    There are two types of measles of the enanthem:

    1) Specific - Belsky-Filatova-Koplik spots - whitish very small papules surrounded by a narrow zone of hyperemia that are not removed by a swab. In appearance, resemble semolina. They are located on the mucous membrane of the cheeks near the molars, but may be on the mucous membrane of the lips, gums, and sometimes conjunctiva. As they wither, they acquire a reddish color, the mucous membrane becomes rough. Disappear with the advent of exanthema. This pathognomonic sign of measles;

    2) nonspecific - it is represented by small red spots located on a soft, hard sky, tongue. Appears on the 2-3rd day of the disease, persists until the end of the rash.

    The period of rashes starts on the 4th-5th day of the disease and is characterized by the appearance of a rash against the background of the most pronounced symptoms, intoxication and catarrhal phenomena.

    The rash first appears in the form of pale pink spots on the upper-lateral sections of the neck, behind the ears, along the hair growth line and on the cheeks closer to the auricle. Within 24 hours, it quickly spreads to the entire face, neck, arms and upper chest. The rash acquires a patchy-papular character, has a bright pink color and a tendency to merge.

    Within the next 24 hours, the rash spreads to the back, abdomen and limbs. On the third day she appears on her feet and at the same time begins to grow pale on her face. This spread of rash is called step-by-step.

    The severity of the disease is directly dependent on the severity of the rashes and their tendency to merge. In severe cases, the rash acquires a hemorrhagic character.

    Simultaneously with the appearance of exanthema, a new rise in body temperature is noted, symptoms of intoxication and inflammation of the mucosa of the upper respiratory tract and eyes become worse.

    An increase in the lymph nodes of the cervical group. The spleen may slightly increase. The defeat of the mesenteric lymph nodes and the appendix is ​​the cause of abdominal pain.

    Gradually, the condition of patients with measles is improved, intoxication disappears, body temperature is normalized, catarrhal phenomena diminish, which usually disappear by the 9-10th day of the disease. On the skin at this time, spots of a brownish color are defined - pigmentation. Pigmentation persists for 1 to 1.5 weeks.

    On the site of the rash, it is determined puffy peeling.

    Because of the development of measles energy at this time, complications are possible.

    A mild form of measles develops usually in children 5-7 years of age. It accounts for 30-40% of all cases of measles.

    The mild form of measles is characterized by mild symptoms of intoxication, short-term( 3-4 days) body temperature increase to 38-38,5 ° С, moderately pronounced inflammation of the mucous membranes of the upper respiratory tract and conjunctiva.

    Spotted or spotty-papular rash usually appears on the 4th-5th day, it is pink in color, has a weak tendency to merge. The period of rashes is usually shortened to 2 days, there is no rash on the legs. With this form, pigmentation is weak, complications are absent.

    The medium-heavy form of measles develops in most unvaccinated children.

    It is characterized by mild symptoms of intoxication in the catarrhal period with an increase in the period of rashes.

    Inflammatory changes in the mucous membranes of the upper respiratory tract and eyes are expressed. The rash is copious, spotty-papular, bright pink, fused, localized on the face, trunk, extremities. After it remains a distinct pigmentation.

    With moderate forms of measles, complications may develop.

    Severe form of measles develops in young children, hypotrophic, with background IDS.It occurs in 3-5% of patients.

    Severe form of measles is characterized by pronounced symptoms of intoxication, the appearance of neurological symptoms due to hypoxic brain edema, which is manifested by a violation of consciousness, seizures, delirium, repeated vomiting.

    Temperature rises to 39-40 ° C and above, persists for 7-10 days and longer.

    Inflammation of the mucous membranes of the upper respiratory tract and eyes is pronounced.

    The rash is profuse, can acquire hemorrhagic character. For severe forms of measles is characterized by the development of early and late complications due to pronounced measles anergy.

    Recovery is delayed up to 3-4 weeks.

    Mitigated measles develops in children who have received in the incubation period immune globulin or blood products.

    Mitigated measles is characterized by an elongation of the incubation period( up to 21 days), a shortening( up to 1-2 days) and a weak expression of the catarrhal period. Specific enanthema( spots Belsky-Filatova-Koplik) may be absent. The disease is accompanied by subfebrile body temperature and mild symptoms of intoxication. Exanthema appears on the 2-3rd day, it is uninvolved, the stage of its appearance is disrupted, there is no inclination to merge. Pigmentation is poorly expressed, it is short-lived.

    The disease is characterized by mild course, without the development of complications.

    After mitigated measles, persistent immunity develops.

    The abortive form of measles usually develops in children 5-7 years old, who received vaccination on a decree( 12-15 months).Clinical diagnosis of this form of measles is difficult.

    The abortive form of measles begins acutely - with catarrhal phenomena and fever to subfebrile digits. Symptoms of intoxication and inflammatory changes in the upper respiratory tract are poorly expressed, the symptom of Velsky-Filatov-Koplik is often absent. On the 2nd-3rd day a pale-pink, spotty-papular rash appears that is localized on the face, and the next day it can spread to the trunk. Rash on the extremities is absent.

    With the appearance of a rash, the condition returns to normal, the body temperature decreases, the catarrhal symptoms disappear.

    The disease ends with a quick recovery( 3-4 days), pigmentation is pale, short-term( 1-3 days), complications are not characteristic.

    After the abortive form of measles, persistent specific immunity develops.

    Complications. Due to the development of anergy, complications in measles are often recorded. Usually they occur in young children, in immunocompromised patients, with severe measles.

    Complications can be early( occur in the prodromal period and / and against the background of rashes) and late( develop during the pigmentation period).

    Complications are actually measles( caused directly by measles virus) and secondary( due to attachment of bacterial flora).

    Complications of measles are very diverse. More often the respiratory system and LOP organs are affected, laryngitis develops( laryngeal stenosis is possible), purulent nasopharyngitis, purulent tracheobronchitis, pneumonia, pleurisy, otitis, mastoiditis, tonsillitis, sinusitis. In second place in frequency there is a lesion of the gastrointestinal tract. Develop stomatitis, enterocolitis. In addition, keratitis, keratoconjunctivitis, pyoderma can occur. The most serious are complications from the nervous system: encephalitis, meningoencephalitis, myelitis. These complications develop more often in the elderly.

    Differential diagnostics. In the prodromal period of measles, the leading syndrome is "upper respiratory tract catarrh".

    List of diseases accompanied by catarrh of the upper respiratory tract:

    1. Measles.

    2. Rubella.

    3. Adenoviral infection.

    4. Influenza.

    5. Paragripp.

    6. Rhinovirus infection.

    7. RS-infection.

    8. Enterovirus infection.

    9. Herpesviral infection( catarrhal form of herpes simplex infection).

    10. Mycoplasma infection.

    11. Legionellosis( Pontiac fever).

    12. Chlamydia.

    13. Pertussis.

    14. Paracottis.

    15. Meningococcal nasopharyngitis.

    16. Rhinopharyngitis of streptococcal, staphylococcal etiology.

    17. Respiratory allergosis.

    18. Burns of the upper respiratory tract.

    Reference diagnostic signs of measles in the catarrhal period:

    • combination of symptoms of intoxication and catarrhal phenomena;

    • presence of conjunctivitis, scleritis;

    • intensification of catarrhal phenomena within 3-4 days;

    • appearance of a specific enanthema - Belsky-Filatova-Koplik spots on the 2nd-3rd day from the onset of the disease;

    • appearance of a nonspecific enanthema on a hard and soft sky on the 2nd-3rd day from the onset of the disease.

    When a symptom of Belsky-Filatov-Koplik is detected, the diagnosis of measles is indisputable.

    In the midst of the disease, the leading syndrome is a spotty papular rash. A list of diseases accompanied by a spotted-papular rash:

    I. Infectious:

    1. Measles.

    2. Rubella.

    3. Varicella( prodromal rash).

    4. Pseudotuberculosis.

    5. Infectious mononucleosis.

    6. Cytomegalovirus infection, acquired form.

    7. Toxoplasmosis acute, acquired.

    8. Enteroviral exanthema.

    9. Leptospirosis.

    10. Trichinosis.

    11. Infectious erythema of Rosenberg.

    12. Syphilis.

    II.Non-infectious:

    1. Response to measles vaccination.

    2. Allergic dermatitis.

    3. Pink lichen.

    Reference diagnostic criteria for measles in the rash period.

    • Appearance of rash on the 4-5th day from the onset of the disease.

    • Presence of the previous catarrhal period.

    • Staged spread of the rash within 3 days.

    • The rash tends to merge.

    • Presence of spots of Belsky-Filatov-Koplik on the first day of rashes.

    • Presence of symptoms of intoxication, increased body temperature, pronounced catarrhal phenomena and conjunctival damage.

    • Appearance of pigmentation after rash.

    Algorithm of diagnostic search is presented for the syndrome "spotty-papular rash".

    Rubella differs from measles by the simultaneous appearance of a rash on the 1st and 2nd day of the disease, its smaller size, lack of a tendency to merge, pigmentation, lack of or weak expression of catarrhal syndrome and intoxication, lack of Belsky-Filatov-Koplik spots, the presence of lymphadenopathya predominant increase in the lymph nodes - occipital and cervical).

    In infectious mononucleosis, in contrast to measles, there are tonsillitis( often with overlap), systemic lymphadenopathic enlargement, enlargement of the liver, spleen, no conjunctivitis, Belsky-Filatov-Koplik stains, stage distribution of the rash, pigmentation.

    Leptospirosis differs from measles by the presence of muscle pains, the simultaneous appearance of rash on the 3rd to 6th day of the disease, the presence of hepato- and splenomegaly, frequent kidney damage, the presence of jaundice( facultative symptom), the absence of catarrh of the upper respiratory tract, the Belsky-Filatov-Koplik spots, frequent polymorphism of the rash( along with patchy-papular, there is a small-pointed, hemorrhagic).

    Enterovirus infection, in contrast to measles, is often accompanied by multiorgan lesions( encephalic syndrome, myocarditis, splenomegaly, myalgia, etc.).Exanthema with this disease appears simultaneously, disappears without a trace. With enteroviral exanthema there are no spots of Belsky-Filatova-Koplik;catarrhal symptoms and conjunctivitis may be weak or absent.

    Varicella and measles must be differentiated only if a prothrombin rash of a spotty-papular character occurs with chicken pox. A prodromal rash appears among the full health or the background of subfebrile. A typical bubble rash appears after a few hours( or at the end of the first day).At this time, the assumption of measles can be removed.

    Exanthema is typical for the moderate and severe course of trichinosis. In addition to the patchy-papular rash, urticaria and hemorrhagic eruptions are often noted.

    In trichinellosis, in contrast to measles, the rash appears simultaneously, there are no Belsky-Filatov-Koplik stains; it is characterized by the presence of intense muscle pains, puffiness and edema of the face, expressed by eosinophilia.

    Trichinosis is diagnosed on the basis of epidemiological data - eating for 1-6 weeks before the appearance of the first clinical signs of a disease of raw or insufficiently thermally processed pork, meat of other animals.

    With pseudotuberculosis, the rash may be spotty-papular. However, unlike measles, its appearance is not preceded by pronounced catarrh of the upper respiratory tract, there is no conjunctivitis, the spots of Belsky-Filatov-Koplik, the rash appears simultaneously, it can have a primary localization in the region of hands, feet, head, disappears without pigmentation. Often when pseudotuberculosis is observed polymorphism of clinical manifestations( arthralgia, abdominal pain, enlargement of the liver, diarrhea).

    With the acquired form of CMVI, in contrast to measles, there is a systemic increase in lymph nodes, an increase in the liver and spleen, there may be sialadenitis, angina, there are no conjunctivitis, Belsky-Filatov-Koplik stains, stage distribution of the rash, pigmentation.

    In acute, acquired toxoplasmosis, in contrast to measles, there is an increase in the liver, spleen, there are no catarrh of the upper respiratory tract and conjunctivitis, there are no spots of Belsky-Filatov-Koplik, the rash appears momentarily and disappears without a trace.

    With Rosenberg infectious erythema, the rash appears on the 4th-6th day of the disease, at fever height( 38-39 ° C), at the onset of the disease it is represented by spots and papules( separate elements) that resemble measles. But in contrast to measles, with infectious erythema of Rosenberg, the rash has a predominant localization on the limbs( extensor surfaces of the joints) and is almost completely absent on the trunk and face, it manifests itself simultaneously, and in the following days, increasing in size, turns into erythematous fields, there are no Velski spots-Filatov-Koplika, catarrh of the upper respiratory tract. At the peak of the disease, the liver and spleen often increase. The rash persists for 5-6 days, then on the place of the rash appears pancreatic or lamellar ecdysis.

    In secondary syphilis, the main element of the exanthema is a spot, but at the same time single roseola and papules are detected;individual spots can merge.

    In contrast to measles, rash with syphilis appears simultaneously at normal body temperature and a satisfactory general condition of the patient, persists up to 2-3 weeks without dynamics, then disappears completely, with the disease there are no spots of Velsky-Filatov-Koplik.

    Specific laboratory tests are used to confirm the diagnosis of syphilis.

    Post-vaccination rash. Since measles vaccine is used for live immunization, in 10-15% of recipients in the period from 6th to 15th day, a general post-vaccination reaction may occur, which manifests itself as a subfebrile condition, a slight deterioration in the general condition, the emergence of ungainly spotted-papular rash, rapidly disappearing without a trace. Occasionally, there may be a slight catarrh of the upper respiratory tract.

    In contrast to measles, allergic exanthema appears without the previous catarrhal period, the rashes do not have the stage of spreading, pigmentation is rare, there is no conjunctivitis, photophobia, Belsky-Filatov-Koplik spots. Often along with a patchy-papular rash, there are urtic elements accompanied by itching.

    Allergic dermatitis usually develops in children with an allergic phenotype after contact with a potential allergen( medicines, foods, etc.).

    In contrast to measles, a rash with pink lichen appears at normal body temperature and a satisfactory general condition, its intensity increases for 2-3 weeks, it spots up to 1.5 cm in diameter, having peeling in the center. With pink deprivation, there are no catarrh of the upper respiratory tract and the spots of Velsky-Filatov-Koplik.

    Laboratory diagnostics. Virological methods are based on virus isolation in tissue culture( human amnion or kidney cells).The virus can be isolated from the blood and the nasopharynx 2-3 days before the onset of symptoms and a day after the onset of the rash.

    Express methods( immunofluorescence) are aimed at the indication of the virus, practically do not apply due to the short-term presence of the virus in the child's body.

    Serological methods are aimed at detecting antibodies to the virus and its antigenic components. Specific viral neutralizing, hemagglutinating and complement-binding antibodies, which are detected by appropriate methods, are developed early and reach the maximum level simultaneously with the appearance of the rash. When using RIGA and RTGA, the blood for the first examination is taken in the catarrhal period or in the first 3 days after the onset of the rash. Repeated examinations are performed after 10-14 days. For diagnostic increase in titer take no less than 4-fold increase. In the case of an initial blood test on the 5th-6th day after the rash and then repeated, even at intervals of more than 14 days, in the vast majority of cases, a significant increase in antibody titers is not detected.

    With the help of ELISA, a single study is carried out, the detection of antibodies to the measles virus IgM is indicative of acute measles infection, and IgG antibodies indicate a previous disease and the remaining immunity to measles infection. Confirmation of the diagnosis of measles by serological methods is mandatory.

    Treatment. Treatment of measles patients should be comprehensive, with an individual approach to the selection of medications and taking into account age, condition of premorbid background, severity of the disease. Basic principles of treatment of patients with measles:

    1. Etiotropic therapy.

    2. Pathogenetic treatment.

    3. Symptomatic treatment.

    4. Care, diet.

    Most patients with measles are treated on an outpatient basis.

    For hospitalization, the following indications exist:

    I. Clinical:

    • severe measles;

    • development of severe complications;

    • Serious concomitant pathology.

    II.Age:

    • children aged the first two years of life.

    III.Epidemiological:

    • children from closed children's institutions;

    • under adverse housing conditions.

    For etiotrope purposes, antiviral drugs are prescribed, which are used for moderate to severe measles.

    Virazids( inosine pranobex, arbidol), interferon preparations( viferon, kipferon, leukinferon, reaferon, reaferon-EU lipin), interferon inducers( anaferon, cycloferon, amixin, neovir, etc.), immunoglobulins for intravenous use( immunovinin,pentaglobin, sandhoglobin, etc.).

    The choice of the drug is determined by the severity of the course of the disease and the condition of the premorbid background of the patient.

    The following indications are used to designate antibacterial drugs:

    • development of bacterial complications;

    • severe measles;

    • development of measles in young children with an unfavorable premorbid background;

    • Serious concomitant pathology.

    In these situations, the appointment of cephalosporins of the second generation( ketacef, etc.) or macrolides( rovamycin, trigger, fromelide, etc.) is advisable in age dosages.

    All patients need detoxification therapy( in case of mild and moderate flow - oral, with a heavy current - intravenous drip infusions, in conjunction with the use of enterosorbents), the appointment of desensitizing agents.

    Patients should receive antipyretic, expectorant and mucolytic drugs( mucaltin, bromhexine, mucosolvine, ambroxol).

    Measles patients need a diet( mostly milk-and-vegetable) throughout the fever period. They must comply with bed rest. Of great importance is the careful care of the skin, the mouth( rinsing after eating), eyes( washing eyes with boiled water or a weak solution of potassium permanganate).

    When complications develop, their treatment is conducted in accordance with the nature of the complications.

    In connection with the development of measles energy, patients need a follow-up visit within a month. In this period it is expedient to designate adaptogens( ginseng, eleutherococcus, etc.), immunomodulators, the choice of which is determined by the nature of immunological disorders.

    Prevention. To reduce the incidence of measles, non-specific and specific prevention methods are currently being used.

    Nonspecific prevention measures include early detection and isolation of the source of infection and activities among the contact. Isolate patients for a period from the onset of the disease to the 5th day after the onset of rashes, in the presence of pneumonia, this period is recommended to extend to 10 days. The room where the patient was located should be ventilated within 30-45 minutes.

    Children who have been exposed to measles and who have not received gamma globulin prophylaxis are isolated for 17 days, and those who receive it - for 21 days.

    According to the existing regulations, children who have been in contact with children who have survived measles in the past or were vaccinated with living measles vaccine( HCV), as well as schoolchildren over the second class, adolescents and adults are not subject to quarantine and no preventive measures are taken among them.

    Specific prevention of measles is divided into active( HCV) and passive, or gamma globulin prophylaxis.

    Measles prophylaxis in Russia is carried out with HCV, which is prepared from the vaccine strain of the virus L-16( Leningrad-16),

    In addition, in our country, the application of Ruvax( Pasteur Merye Connaught, France) andcombined vaccine against measles, mumps and rubella: MMR-II, Prioriks.

    Due to the high sensitivity of the vaccines to the temperature regime, all these vaccines are stored at a temperature of 2-8 ° C in a dark place. Moreover, this temperature regime should be observed at all stages of transportation: from the manufacturer of the vaccine to the patient.

    LCD, "Ruvax", MMR-II, Priori inoculate children aged 12-15 months who did not have measles, and with MMR-II, Prioriks - mumps and rubella.

    The second inoculation is carried out at the age of 6 years before the school.

    All vaccines are administered in a volume of 0.5 ml subcutaneously or intramuscularly under the shoulder blade or in the shoulder region( at the border of the lower and middle third of the shoulder from the outside).

    In most children, vaccination is not accompanied by any reactions.

    In 5-15% of children in the period from 5 to 15 days there may be specific reactions in the form of a rise in body temperature, catarrhal phenomena, korepodobnoj rashes. The vaccine reaction usually lasts no more than 2-3 days.

    Regardless of the severity of the reaction, the child is not contagious to others.

    Measles vaccine is slightly reactogenic, complications in vaccinated are very rare. However, in some cases, allergic reactions are possible( exanthema, Quincke's edema, lymphadenopathy, etc.) both in the first days after vaccination, and in later periods.

    At the height of the temperature reaction to measles vaccination, predisposed children may develop febrile convulsions lasting 1-2 minutes( single or repeated).The prognosis is usually favorable, residual effects are rare, persistent CNS lesions are very rare( 1: 1 000 000).

    In Russia, measles vaccination in an overwhelming number of children occurs easily, without complications.

    There are the following contraindications to vaccination of ASH:

    • immunodeficiency states( primary and consequent immunosuppression), leukemias, lymphomas, malignant formations;

    • severe forms of allergic reactions to aminoglycosides, egg white;

    • pregnancy( due to theoretical risk of teratogenic effects on the fetus).

    In the presence of acute or exacerbation of chronic diseases, the vaccine is postponed until the symptoms of acute disease and chronic remission are eliminated.

    Under the current regulations, gamma-globulin prophylaxis is carried out not by measles and ungrafted children aged 3 months to 2 years, and also regardless of age, weakened and sick.

    The optimal timing of the introduction of immunoglobulin - 3-5 day after contact with the patient. The dose depends on the purpose of the drug. To prevent the disease, not less than 3 ml.