We know WHERE . . .
150,000
100,000
50,000
0
AFR SEAR EMR WPR EUR AMR
900000
800000
700000
600000
500000
400000
300000
200000
100000
0
1999 2000 2001 2002 2003 2004 2005
Deaths from Measles
Africa 126 000 [93 000 - 164 000]
Americas <1 000 [-]
Eastern Mediterranean 39 000 [26 000 - 53 000]
European <1 000 [-]
South-East Asia 174 000 [126 000 - 233 000]
Western Pacific 5000 [3000 - 8000]
TOTAL 345 000 [247 000 - 458 000]
Measles Mortality Reduction in EMRO Region,
1999-2004 EMRO
120,000
100,000
Estimated Deaths
80,000
60,000
40,000
20,000
Oman
Sudan Yemen
Djibouti
Somalia
Percent reduction in estimated measles
deaths by WHO region between 1999 and
2002
0
-5 AFR SEAR WPR EMR EUR Global
-10
% reduction
-15
-20
-25
-30
-35
-40
Region
Measles Case Counts and
Coverage Saudi Arabia 1983-2004
12000 100
11000 98
10000 96
Percent coverage
9000
8000 94
7000
Cases
92
6000 90
5000
4000 88
3000 86
2000 84
1000
0 82
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
There was a marked reduction in the epidemic
peak from 500/100 000 in the 1970s to < 80/100
000 in the 1990s.
Incidence among children 6–8 months of age fell
from > 400/100 000 before the implementation of
the new policy to < 100/ 100 000 in 1997.
Similarly, among children aged 9–11 months, the
number of cases fell from > 200/100 000 before
the implementation of the new policy to <100/100
000 in 1997.
2005 373cases
Measles Pathogenesis
Respiratory transmission of virus
Replication in nasopharynx and regional
lymph nodes
Primary viremia 2-3 days after exposure
Secondary viremia 5-7 days after exposure
with spread to tissues
Measles Clinical Features
Incubation period 10-12 days
Prodrome
Stepwise increase in fever to
103°F or higher
Cough, coryza, conjunctivitis , malaise,
sneezing, rhinitis, congestion
Koplik spots
Koplik's spots, are
pathognomonic in
measles, appear on
the buccal and
lower labial
mucosa opposite
the lower molars
as White spots
inside the mouth
Measles Clinical Features
Rash
2-4 days after prodrome, 14 days after
exposure
Maculopapular, becomes confluent
Begins on face and head
Persists 5-6 days
Fades in order of appearance
Child has a
rash caused
by measles
Measles
rash
covering
child's
arms and
stomach
Measles Complications
Condition
Percent reported
Diarrhea 8
Otitis media 7
Pneumonia 6
Encephalitis 0.1
Hospitalization 18
Death 0.2
Based on 1985-1992 surveillance data
Measles Complications by Age Group
30 Pneumonia Hospitalization
25
20
Percent
15
10
0
<5 5-19 20+
Age group (yrs)
Measles Clinical Case Definition
No animal reservoir
Transmission
The virus spreads by the respiratory
route via aerosol droplets and
respiratory secretions which can remain
infectious for several hours.
3. Surveillance
Bahrain