Case study on measles disease

Jennifer S. Rota, Carole J. Rota, Sara Mercader, William J. These physicians were suspected of having been infected with measles after treating patients who subsequently received a diagnosis of measles.

The clinical presentation was nonclassical in regard to progression, duration, and severity. It is hypothesized that the 2 physicians mounted vigorous secondary immune responses typified by high avidity measles immunoglobulin G antibody and remarkably high neutralizing titers in response to intense and prolonged exposure to a primary measles case patient.

Both of the physicians continued to see patients, because neither considered that they could have measles. Despite surveillance for cases among contacts, including unvaccinated persons, no additional cases were identified. In the United States, limited measles outbreaks continue to occur after importation of measles, and the cost of conducting follow-up investigations and case containment can be substantial [ 1 ].

Prior to a diagnosis of measles, a patient may be seen in multiple health care facilities, resulting in numerous exposures of patients and health care workers. In hospitals, there are often immunocompromised patients and other persons for whom infection with measles can have severe consequences.

The laboratory plays a critical role in case classification when rash and fever develop in persons who have possibly been exposed to measles. To complicate matters, nonclassic cases of measles in vaccinated persons may be identified, which must be investigated.

Often the symptoms are mild and resolve rapidly and, outside of the context of an outbreak or known exposure to a measles case patient, the nonclassic presentation might not raise suspicion of measles [2—4]. However, the consequences of possible spread from such cases, and particularly from cases among health care workers, puts tremendous pressure and demands on those who are responsible for outbreak control.

The laboratory findings from the 2 suspected cases were consistent with a secondary immune response SIR to measles. The relevance of immunoglobulin Ig M detection for case confirmation in such circumstances and the implications for outbreak investigations are discussed.

The absence of spread cases from the 2 physicians suggests that such cases, although not asymptomatic, have a very low potential for infecting others, compared with cases in fully symptomatic individuals. A year-old female emergency department physician in Pennsylvania with mild symptoms was suspected of being infected with measles in the course of an outbreak investigation in which the initial case of measles was not immediately recognized. The physician had a history of having received 3 doses of MMR vaccine, 2 of which were documented, with the most recent dose being administered in The reason given for the additional dose was failure to show immunity to rubella.

The physician had evaluated a year-old child in the emergency department on 10 March who was suspected to have Kawasaki disease.

The child had arrived from India on 8 March and had developed a rash on 9 March. A review of medical records led the investigators to reconsider the rash illness in the year-old child as a possible measles case following the laboratory confirmation of measles by IgM testing on 30 March in 3 family members who had been in the same emergency department on 10 March for an unrelated complaint.Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

This finding expands our knowledge on timing and mapping of novel coronavirus transmission pathways.

Coronavirus disease COVID symptoms can encompass a Kawasaki disease—like multisystem inflammatory syndrome and skin manifestations that accompany common viral infections such as chickenpox and measles 12.

However, some evidence suggests that severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 had been circulating unnoticed for several weeks in Lombardy before the first official detection 3. Phylogenetic studies highlighted an early circulation of SARS-CoV-2 in Italy and suggest multiple introductions of the virus from China and Germany, followed by an autochthonous transmission 45.

Furthermore, environmental surveillance has unequivocally demonstrated the presence of the virus, at concentrations comparable to those obtained from samples collected at later stages of the pandemic, in the untreated wastewater of the Milan area as early as mid-December 6. We therefore retrospectively explored a possible etiologic involvement of SARS-CoV-2 in these non—measles-linked rash cases.

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We analyzed oropharyngeal swabs specimens collected during September —February from 39 consenting patients mean age All laboratory procedures were conducted in a university research laboratory, accredited according to World Health Organization standards, dedicated exclusively to the surveillance of measles and rubella, and therefore designated as free from SARS-CoV Positive and negative controls also were included in each PCR test and performed as expected.

One oropharyngeal swab specimen tested positive. The amplicon was sequenced by using Sanger technology, resulting in a sequence of bp. The specimen was confirmed as positive by repeated amplification and sequencing, and all other specimens were repeatedly negative. MW] was identified in a specimen collected from a 4-year-old boy who lived in the surrounding area of Milan and had no reported travel history.

On November 21, the child had cough and rhinitis; about a week later November 30he was taken to the emergency department with respiratory symptoms and vomiting.

On December 1, he had onset of a measles-like rash; on December 5 14 days after symptom onsetthe oropharyngeal swab specimen was obtained for clinical diagnosis of suspected measles. These findings, in agreement with other evidence of early COVID spread in Europe, advance the beginning of the outbreak to late autumn 68 — However, earlier strains also might have been occasionally imported to Italy and other countries in Europe during this period, manifesting with sporadic cases or small self-limiting clusters.

These importations could have been different from the strain that became widespread in Italy during the first months of Unfortunately, the swab specimen, which was collected for measles diagnosis, was not optimal for SARS-CoV-2 detection because it was an oropharyngeal rather than a nasopharyngeal swab specimen and it was collected 14 days after the onset of symptoms, when viral shedding is reduced.

In addition, thawing might have partially degraded the RNA, preventing the sequencing of longer genomic regions that could have been helpful in determining the origin of the strain. This finding is of epidemiologic importance because it expands our knowledge on timing and mapping of the SARS-CoV-2 transmission pathways. Full exploitation of existing virologic surveillance systems to promptly identify emerging pathogens is therefore a priority to more precisely clarify the course of outbreaks in a population.

Amendola and Dr. Their primary research interests include the epidemiology and prevention of viral infectious diseases. The authors wish to thank Marino Faccini and the staff of local health authorities involved in outbreak investigation. Emerg Infect Dis. Table of Contents — Volume 27, Number 2—February Please use the form below to submit correspondence to the authors or contact them at the following address:.

case study on measles disease

Section Navigation. Facebook Twitter LinkedIn Syndicate.Measles is caused by a virus known simply as the measles virus and is spread mainly through droplet contact. Measles virus is one of the most highly transmissible pathogenic microorganisms known to humankind Young and Rall, It is estimated that 30 to 40 million cases of measles cases occur annually worldwide, resulting in aboutdeaths per year Cowan, Despite the enormous progress made in deciphering the basis of measles virus pathogenesis and in the creation of effective attenuated vaccines, how the virus causes disease, including rare, but serious, central nervous system CNS complications, remains poorly understood.

Furthermore, little is known about its routes of transmission and its survival in the environment Young and Rall, Measles is also known as rubeola and should not be confused with the maculopapular rash disease rubella Cowan, Widespread vaccination has made measles in the United States nearly unheard of, with only a few cases reported per year Cowan, A recent outbreak of measles linked to one or more Disney theme parks has reinvigorated discussion of measles vaccination.

By April 10,confirmed measles cases were reported in the outbreak in California, with 40 cases in California having traveled to the parks in December. An additional 16 cases linked to this outbreak have been reported elsewhere in the U. In Quebec, a total of cases of the same genotype B3 were reported in a non-immunizing religious community by March 28, and the importation to Canada was linked to travel to Disneyland. Cases from this outbreak also were observed in Mexico.

This outbreak, larger than those typically seen in recent years in North America, may raise questions regarding the continuing success of measles control and its routes of transmission Clemmons et al. The objective of this case study is to model the transmission effect of measles in the theme park outbreak. Measles virus is a member of the Paramyxoviridae family, within the Morbillivirus genus.

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Its genome consists of approximately 16, bases of non-segmented, single-stranded negative-sense RNA, meaning that the viral genome is transcribed immediately upon entry into the cell.

Virions are spherical and enveloped and the envelope is derived from the host cell as the viral particle buds from the plasma membrane Kayser et al, ; Young and Rall, No other organism is responsible for measles except the measles virus Kayser et al, Similar viruses within the Morbillivirus family are capable of causing disease in other animals, such as dogs, cats, cattle, seals, dolphins, and turtles Kayser et al, Non-human primates can also be a host, and measles is a threat to their conservation.

The pathogenesis of measles has not been fully explained.

case study on measles disease

It is assumed that the virus, following primary replication in lymphoid tissues, is distributed hematogenously in two episodes Kayser et al. The virus implants in the respiratory mucosa and infects the tracheal and bronchial cells. From there it travels to the lymphatic system, where it multiplies and enters the bloodstream Cowan, Viremia carries the virus to the skin and to various organs.

The measles virus induces the cell membranes of adjacent host cells to fuse into large syncytia, giant cells with many nuclei. These cells no longer perform their proper function. The virus seems proficient at disabling many aspects of the host immune response, especially cell-mediated immunity and delayed-type hypersensitivity Cowan, The host may be left vulnerable for many weeks after infection.EARLIER this year, we reported how the mother of a Manchester tot who was treated in hospital for five days after catching measles was appealing to other parents to give their children the jab.

Rachael Whittle, from Longsight, Manchester, was so worried by research linking the measles, mumps and rubella MMR jab to autism and the bowel disorder Crohn's disease that she put off giving Lola-Mae the jab, but she became so sick with the disease she had to be admitted to St Mary's Hospital, Manchester.

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Cut through the noise with the top M. I felt so guilty and scared. I thought a lot about the MMR jab over the last few years. By Manchester Evening News. Rachel Whittle with daughter Lola-Mae. Our Privacy Notice explains more about how we use your data, and your rights. You can unsubscribe at any time. Thank you for subscribing We have more newsletters Show me See our privacy notice. Follow MENNewsdesk. More On Longsight Manchester. News all Most Read Most Recent.

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Vaccines: Cameron Case Study

Emergency services called to reports of an 'explosion' on street in Hale Barns Hale Barns Two fire engines, a hazardous materials team and police went to Alan Drive.

Top Stories. Shocking figures reveal up to 50, children a week have been absent from Greater Manchester schools during Covid Education Attendance rates for local authority areas have been revealed for the first time. Emergency services called to reports of an explosion on street in Hale Barns Hale Barns Two fire engines, a hazardous materials team and police went to Alan Drive. Police swoop on McDonald's car park after reports of a knife-point robbery Tameside Pictures from the scene showed several police vehicles and officers near the fast-food restaurant in the town centre.

They bumped fists and the deal was done Warden slapped ticket on NHS worker's car directly below free parking pass Bury Si Gracey has now finally been issued with a refund after his initial appeal was rejected.A case-control study is a type of observational study commonly used to look at factors associated with diseases or outcomes.

The case-control study starts with a group of cases, which are the individuals who have the outcome of interest. The researcher then tries to construct a second group of individuals called the controls, who are similar to the case individuals but do not have the outcome of interest. If the exposure is found more commonly in the cases than the controls, the researcher can hypothesize that the exposure may be linked to the outcome of interest.

For example, a researcher may want to look at the rare cancer Kaposi's sarcoma.

case study on measles disease

The researcher would find a group of individuals with Kaposi's sarcoma the cases and compare them to a group of patients who are similar to the cases in most ways but do not have Kaposi's sarcoma controls.

The researcher could then ask about various exposures to see if any exposure is more common in those with Kaposi's sarcoma the cases than those without Kaposi's sarcoma the controls. The researcher might find that those with Kaposi's sarcoma are more likely to have HIV, and thus conclude that HIV may be a risk factor for the development of Kaposi's sarcoma.

There are many advantages to case-control studies. First, the case-control approach allows for the study of rare diseases. If a disease occurs very infrequently, one would have to follow a large group of people for a long period of time to accrue enough incident cases to study. Such use of resources may be impractical, so a case-control study can be useful for identifying current cases and evaluating historical associated factors.

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For example, if a disease developed in 1 in people per year 0. If the disease is much rarer, say 1 in 1, per year 0. As it may be impractical to follow 1, for ten years or to wait years for recruitment, a case-control study allows for a more feasible approach.

Second, the case-control study design makes it possible to look at multiple risk factors at a once. In the example above about Kaposi's sarcoma, the researcher could ask both the cases and controls about exposures to HIV, asbestos, smoking, lead, sunburns, aniline dye, alcohol, herpes, human papillomavirus, or any number of possible exposures to identify those most likely associated with Kaposi's sarcoma.

Case-control studies can also be very helpful when disease outbreaks occur, and potential links and exposures need to be identified.

This study mechanism can be commonly seen in food-related disease outbreaks associated with contaminated products, or when rare diseases start to increase in frequency, as has been seen with measles in recent years.

Because of these advantages, case-control studies are commonly used as one of the first studies to build evidence of an association between exposure and an event or disease. In a case-control study, the investigator can include unequal numbers of cases with controls such as or to increase the power of the study.

The most commonly cited disadvantage in case-control studies is the potential for recall bias. Recall bias in a case-control study is the increased likelihood that those with the outcome will recall and report exposures compared to those without the outcome. In other words, even if both groups had exactly the same exposures, the participants in the cases group may report the exposure more often than the controls do. Recall bias may lead to concluding that there are associations between the exposure and disease that do not, in fact, exist.

It is due to subjects' imperfect memories of past exposures. If people with Kaposi's sarcoma are asked about exposure and history e. Case-control studies, due to their typically retrospective nature, can be used to establish a correlation between exposures and outcomes, but cannot establish causation. These studies simply attempt to find correlations between past events and the current state.

When designing a case-control study, the researcher must find an appropriate control group. Ideally, the case group those with the outcome and the control group those without the outcome will have almost the same characteristics, such as age, gender, overall health status, and other factors.

The two groups should have similar histories and live in similar environments. If, for example, our cases of Kaposi's sarcoma came from across the country but our controls were only chosen from a small community in northern latitudes where people rarely go outside or get sunburns, asking about sunburn may not be a valid exposure to investigate.

Similarly, if all of the cases of Kaposi's sarcoma were found to come from a small community outside a battery factory with high levels of lead in the environment, then controls from across the country with minimal lead exposure would not provide an appropriate control group.

The investigator must put a great deal of effort into creating a proper control group to bolster the strength of the case-control study as well as enhance their ability to find true and valid potential correlations between exposures and disease states.

Similarly, the researcher must recognize the potential for failing to identify confounding variables or exposures, introducing the possibility of confounding bias, which occurs when a variable that is not being accounted for that has a relationship with both the exposure and outcome.

Case Control Studies

This can cause us to accidentally be studying something we are not accounting for but that may be systematically different between the groups. Excerpt A case-control study is a type of observational study commonly used to look at factors associated with diseases or outcomes. Advantages There are many advantages to case-control studies.

Disadvantages and Limitations The most commonly cited disadvantage in case-control studies is the potential for recall bias.This may not literally be one thousand. Treat your music promotion like a boot-strapped blog. Your side project of writing and your eventual day job as a game designer will provide incredible perspective on making art.

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Measles Outbreak Case Study

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Measles case study

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