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[MEASLES INVESTIGATION] 2014

Introduction
Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread
vaccination, measles caused an estimated 2.6 million deaths each year.
It remains one of the leading causes of death among young children globally, despite the availability
of a safe and effective vaccine. Approximately 122 000 people died from measles in 2012 mostly
children under the age of five.
Measles is caused by a virus in the paramyxovirus family. The measles virus normally grows in the
cells that line the back of the throat and lungs. Measles is a human disease and is not known to
occur in animals.
Accelerated immunization activities have had a major impact on reducing measles deaths. Since
2000, more than one billion children in high risk countries were vaccinated against the disease
through mass vaccination campaigns about 145 million of them in 2012. Global measles deaths
have decreased by 78% from an estimated 562 400 to 122 000.
Signs and symptoms
The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to
the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes, and small white
spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on
the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands
and feet. The rash lasts for 5 to 6 days, and then fades. On average, the rash occurs 14 days after
exposure to the virus (within a range of seven to 18 days).
Severe measles is more likely among poorly nourished young children, especially those with
insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other
diseases.
Most measles-related deaths are caused by complications associated with the disease.
Complications are more common in children under the age of five, or adults over the age of 20. The
most serious complications include blindness, encephalitis (an infection that causes brain swelling),
severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as
pneumonia. As high as 10% of measles cases result in death among populations with high levels of
malnutrition and a lack of adequate health care. Women infected while pregnant are also at risk of
severe complications and the pregnancy may end in miscarriage or preterm delivery. People who
recover from measles are immune for the rest of their lives.
Who is at risk?
Unvaccinated young children are at highest risk of measles and its complications, including death.
Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been
vaccinated or was vaccinated but did not develop immunity) can become infected.
Measles is still common in many developing countries particularly in parts of Africa and Asia.
More than 20 million people are affected by measles each year. The overwhelming majority (more
than 95%) of measles deaths occur in countries with low per capita incomes and weak health
infrastructures.
Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural
disaster or conflict. Damage to health infrastructure and health services interrupts routine
immunization, and overcrowding in residential camps greatly increases the risk of infection.
Transmission
The highly contagious virus is spread by coughing and sneezing, close personal contact or direct
contact with infected nasal or throat secretions.
The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can
be transmitted by an infected person from four days prior to the onset of the rash to four days after
the rash erupts.
[MEASLES INVESTIGATION] 2014

Measles outbreaks can result in epidemics that cause many deaths, especially among young,
malnourished children. In countries where measles has been largely eliminated, cases imported
from other countries remain an important source of infection.






General Objective
To apply the knowledge on how to handle and control certain vaccine disease cases so that it
will under control.

Specific Objective
To investigate how measles can infect the patient.
To take sample according to standard operating procedure for measles test.
To do control measure to avoid it spread.

Administrative Data

Date : 6
th
July 2011
Time : 8.30 am 12.00 pm
Place :
[MEASLES INVESTIGATION] 2014

Activity : HIV screening to the prisoners
Person Incharge : Mdm Uma a/p (U29)
Staff Involve : Medical Assistant, Assistant of Public Health
Case source :
Investigate by : Mdm Uma A/P , AEHO U29
Place of investigation : House of patient at



Apparatus and Materials

1. Glove
2. Mask
3. National Measles Registry Investigation form
4. Pen
5. Log book of AIDS Screening
6. Laboratory Test form
7. Serum container
8. Sticker name
9. Label
10. Clinical Waste plastic bag and dustbin
11. Syringe with needle stick

Case Notification

1. All cases of suspected measles shall be notified to District Health Office.
2. Notification by phone shall be made within 24 hours of diagnosis to enable the investigation and
control action are made quickly and followed by written notification.
[MEASLES INVESTIGATION] 2014

3. Medical practitioners who fail to give notice (notification) within the period prescribed for
suspected cases of measles can be liable to a fine for an offense under subsection 10(2) of the
Prevention and Control of Infectious Diseases, 1988.
4. Information of case notification need to be entered in Infectious Diseases Information System
(e-Notification System) and is registered in the Measles Investigation Information System (SM2)

Case Investigation

1. Investigation of all cases shall be conducted within 48 hours of receipt of the notification.
2. Investigation of all cases should include the history of immunization and measles immunization
coverage in the locality of cases. The following information must be obtained and inserted into
the SM2.
a. Date of occurrence of the rash
b. Specimen collection date
c. Measles vaccination status
d. Date of last measles immunization
e. Date of birth and age
f. District information
3. Information of all cases investigation shall be updated within 24 hours of the investigation.

Laboratory Tests

8. All testing for screening, diagnosis and confirmation of measles virus isolation MUST be sent to
National Public Health Laboratory, Sungai Buloh (MKAK)
9. All cases of suspected measles specimens MUST be appropriate to the onset of the rash to run
lab tests. User type specimens and tests carried out as shown in the table below.

The onset of the rash
(Date of specimen
taken the date of
rash onset)
Specimen Type
Test type
Virus
isolation
Serology
test
1 5 days
Blood
Urine/throat swab /

[MEASLES INVESTIGATION] 2014

nasopharyngeal
6 28 days Blood

10. Specimens should be taken for second time if:
a. Results of Measles / Rubella IgM equivocal. It is for verification purposes.
b. Results of Measles / Rubella IgM negative for blood specimen taken with the onset
of a rash of less than 5 days.
11. For the suspected Measles outbreak, only a maximum of 10 cases to be taken specimens for
each locality. For outbreaks of less than 10 cases, specimens shall be taken in accordance with
the number of cases.


Case Classification

1. cases with fever and rash are used as case definition for suspected measles cases. The case
definition is also used for the purpose of elimination of measles and rubella.
2. All suspected measles cases classified as confirmed cases of measles (positive laboratory tests
and clinical case epidemiological link) or discard.
a. Cases classified as positive laboratory test if laboratory tests show positive measles
IgM.
b. Cases classified as epidemiological relationship (epidemiological link) if the case of
positive laboratory tests.
c. Cases classified as clinical cases if the case is not verified or confirmed laboratory
tests relate epidemiology and meet the case definition.
d. Case discard if laboratory tests were negative Measles IgM, positive rubella IgM or
related measles vaccine. (blood specimens tested positive for measles in the perios
of 1 to 6 weeks from the date of the MMR or Measles.

5 Years Previous Case Data

Comparison of Measles Case since 2010 until April 2014
Report on Measles Cases until April 2014
Measles Cases According to Group of Age

Case Profile
Patient Name : Armezarizan Bin Arbaan
[MEASLES INVESTIGATION] 2014

IC number : 810913-10-5937
Prisoner ID : 41-10-00030
Age : 29 years old
Gender : Male
Race : Malay
Religion : Islam
Marital status : Single
First exposure : Student
Academic level : Secondary school
Risk factor : Patient had involved in drug abused since he was 18 years old by
Intravenous Drug User (IVDU) which is heroin and had shared the needle
with 15 people. He also had sex with his girlfriend without using
condom when he was 25 years old.
Laboratory report : From screening that have been done on 7
th
February 2011, HIV Rapid Test
had been done and the result shown that it is reactive.
Treatment
Conclusion
Appendix