TOTALLY GEEKED!

According to the Centers for Disease Control and Prevention (CDC), the current measles outbreak has reached 14 states. Originating at an amusement park in California, this spike in cases has been attributed to unvaccinated children. Because the disease had been all but eradicated in the United States, many are unfamiliar with the serious consequences of the condition. Test your knowledge of the complications, workup, and treatment of measles with this quick quiz.

A single dose of measles vaccine administered to a child older than 12 months produces protective immunity in what percentage of individuals?

75%

80%

90%

95%

A single dose of measles vaccine administered to a child older than 12 months produces protective immunity in what percentage of individuals?

Maternal antibodies play a significant role in protection against infection in infants younger than 6 months and may interfere with live-attenuated measles vaccination. However, now that most mothers have been vaccinated as opposed to having had the measles disease, their antibody titers are lower than in the past; therefore, what is vertically transferred to their children is lower than what was documented in the past, meaning that vaccination at age 6 months appears effective. A single dose of measles vaccine administered to a child older than 6-12 months induces protective immunity in 95% of recipients.

Because measles virus is highly contagious, a 5% susceptible population is sufficient to sustain periodic outbreaks in otherwise highly vaccinated populations. A second dose of vaccine, now recommended for all school-aged children in the United States, induces immunity in about 95% of the 5% who do not respond to the first dose. Slight genotypic variation in recently circulating strains has not affected the protective efficacy of live-attenuated measles vaccines.

For more information on the efficacy of the measles vaccine, read here.

Which of the following is usually the first sign of measles observed by parents or physicians?

Photophobia

Rash

High fever (>104° F) and Koplik spots

Periorbital edema

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A single dose of measles vaccine administered to a child older than 12 months produces protective immunity in what percentage of individuals?

Maternal antibodies play a significant role in protection against infection in infants younger than 6 months and may interfere with live-attenuated measles vaccination. However, now that most mothers have been vaccinated as opposed to having had the measles disease, their antibody titers are lower than in the past; therefore, what is vertically transferred to their children is lower than what was documented in the past, meaning that vaccination at age 6 months appears effective. A single dose of measles vaccine administered to a child older than 6-12 months induces protective immunity in 95% of recipients.

Because measles virus is highly contagious, a 5% susceptible population is sufficient to sustain periodic outbreaks in otherwise highly vaccinated populations. A second dose of vaccine, now recommended for all school-aged children in the United States, induces immunity in about 95% of the 5% who do not respond to the first dose. Slight genotypic variation in recently circulating strains has not affected the protective efficacy of live-attenuated measles vaccines.

For more information on the efficacy of the measles vaccine, read here.

Which of the following is usually the first sign of measles observed by parents or physicians?

Photophobia

Rash

High fever (>104° F) and Koplik spots

Periorbital edema

Which of the following is usually the first sign of measles observed by parents or physicians?

The first sign of measles observed by parents is usually a high fever (often >104° F [40° C]) that typically lasts 4-7 days. Koplik spots appear the day before the rash and persist for the first 2 days of the rash, which may be seen by parents and is documented by physicians. The prodromal phase is marked by malaise, fever, anorexia, and the classic triad of conjunctivitis, cough, and coryza (the "3 C's"). Other possible associated symptoms include photophobia, periorbital edema, and myalgias.

For more on the presentation of measles, read here.

Which of the following is NOT a common complication of measles?

Otitis media

Pericarditis

Croup

Sinusitis

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Which of the following is usually the first sign of measles observed by parents or physicians?

The first sign of measles observed by parents is usually a high fever (often >104° F [40° C]) that typically lasts 4-7 days. Koplik spots appear the day before the rash and persist for the first 2 days of the rash, which may be seen by parents and is documented by physicians. The prodromal phase is marked by malaise, fever, anorexia, and the classic triad of conjunctivitis, cough, and coryza (the "3 C's"). Other possible associated symptoms include photophobia, periorbital edema, and myalgias.

For more on the presentation of measles, read here.

Which of the following is NOT a common complication of measles?

Otitis media

Pericarditis

Croup

Sinusitis

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Which of the following is NOT a common complication of measles?

Common infectious complications include otitis media, interstitial pneumonitis, bronchopneumonia, laryngotracheobronchitis (ie, croup), exacerbation of tuberculosis, transient loss of hypersensitivity reaction to tuberculin skin test, encephalomyelitis, diarrhea, sinusitis, stomatitis, subclinical hepatitis, lymphadenitis, and keratitis, which can lead to blindness. In fact, measles remains a common cause of blindness in many developing countries.

Rare complications include hemorrhagic measles, purpura fulminans, hepatitis, disseminated intravascular coagulation, subacute sclerosing panencephalitis, thrombocytopenia, appendicitis, ileocolitis, pericarditis, myocarditis, acute pancreatitis, and hypocalcemia. Transient hepatitis may occur during an acute infection.

For more information on complications of measles, read here.

Which of the following is the quickest method of confirming acute measles?

Viral culture

Urinalysis

Tissue analysis

Antibody assay

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Which of the following is the quickest method of confirming acute measles?

The measles virus sandwich-capture immunoglobulin M (IgM) antibody assay, offered through many local health departments and through the CDC, is the quickest method of confirming acute measles. Because IgM may not be detectable during the first 2 days of rash, obtain blood for measles-specific IgM on the third day of the rash or on any subsequent day up to 1 month after onset, to avoid a false-negative IgM result.

For more on the workup of measles, read here.

Which of the following supplementations has been associated with reductions in morbidity and mortality in patients with measles?

Calcium

Vitamin D

Vitamin A

Dehydroepiandrosterone

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Which of the following supplementations has been associated with reductions in morbidity and mortality in patients with measles?

Vitamin A supplements have been associated with reductions of approximately 50% in morbidity and mortality and appear to help prevent eye damage and blindness. Because vitamin A deficiency is associated with severe disease from measles, the World Health Organization recommends that all children diagnosed with measles receive vitamin A supplementation, regardless of their country of residence, based on their age.

For more on the treatment of measles, read here.

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