Introduction
The word measles has prominently been used to define a variety of illnesses that mainly affect children and are characterized by high fever, skin rashes, and are highly contagious. Among the most common diseases causing this form of sickness are Measles Rubeola (measles) commonly referred as normal measles and roseola which is caused by Roseolovirus, a variety of viruses (O’Connor et al., 2017) . Measles Rubeola is perhaps the most common, highly contagious, and the most severe of these illnesses. Indeed, the complication rate of measles is over 30% which results either in fatal or life changing circumstances. The instant research paper focuses on the general biological factors relating to measures rubeola, its advent, effects, and control.
Description of the Microorganism
The measles virus, commonly abbreviated as MeV is a single-stranded virus of the genus Morbillivirus. Its genetic information is stored in the RNA as opposed to DNA. The virus comprises of a helical nucleocapsid with a diameter of between 100-300 nm (Harvala et al., 2015) . It is surrounded by matrix proteins lined envelopes which carry transmembrane hemagglutinin and glycoproteins. Currently, the only host known to harbor this virus is human beings. Research has identified 8 clades and 23 subtypes of measles. As recommended for viruses, electronic microscopy of the blood or saliva of a victim is the standard method used to identify it (Harvala et al., 2015) .
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Virulence Factors
Upon attack on the host, the two envelopes; transmembrane hemagglutinin and glycoproteins are responsible for cell binding and invasion. Within 24 hours of the end of the 8-12 days incubation period, the first noticeable effect is fever, which averages at 38.3 0 degrees Celsius. This fever will be closely followed by an acute cough and coryza which continues and degenerates for about 2-3 days as the effects on the respiratory system exacerbate (Harvala et al., 2015) . Conjunctivitis in the eyes and koplik spots on the skin will also appear contemporaneously with the cough and coryza. By the fourth day, the head, neck and behind the ears will develop a maculopapular rash, which will spread then fade if no complications have occurred. This is a sign that the illness is abating (Harvala et al., 2015) .
Immunity
The exponentially high propensity for measles transmission is, however, mitigated by the human capacity for immunity against it. Measles is among the diseases against which herd immunity can be developed leading to its elimination within the said community. According to the Center for Disease Control and Prevention (CDC), absolute immunity for measles can be acquired either by individuals who have had a prior measles infection or those who have received two doses of the standard measures vaccine (Phadke et al., 2016) . This implies that the measles virus produces a permanent immune response within the body. Further, everyone born before 1957 in America is considered naturally immune to measles, but if 95% of the population gets immunized in any of the two ways, herd immunity will be developed. Through this, few possible hosts will remain for the survival of the virus within the community, and it will thus peter away (Phadke et al., 2016) .
Infectious Disease Information
Everyone who has not developed immunity to measles is susceptible to the disease. All mucus based body fluids and excretions such as semen, saliva, and nasal mucus can be used to transmit the measles virus. The advent and growth of a measles infection are extremely systematic and affect the respiratory epithelium of the nasopharynx. Some of the complications that may arise from a bout of measles include brain inflammation, pneumonia or bronchitis. The brain inflammation has a mortality rate of 15% (O’Connor et al., 2017) . The organs affected by measles include the entire respiratory system, the skin and in the case of complications, the brain. Measles can also be considered as an opportunistic pathogen as it is known to prey on those whose immunities are diminished for example by HIV/AIDS (O’Connor et al., 2017) .
Epidemiology
Measles Host
High Birthrate Low Immunity Low Birthrate Vaccination/Immunity
High Infection Rates Low Infection Rates
The spread of measles is more of a community than an individual issue due to its high infection rates. The fact that once immunity has been developed in a person remains for life means that survival and spread of measles in a community are dependent on the availability of new host, mostly through birth as shown by the yellow arrow and the blue arrow above. Being an opportunistic infection, low immunity either through lack of vaccination, poor nutrition or immunity disorders can increase propensity as shown by the red arrows (O’Connor et al., 2017) .
Presentations
Anthony is a 5-year-old African American from Forest Park who is currently residing with his 45 year of grandmother since his mother passed on two years ago due to HIV/AIDS-related complications. Whereas Anthony has never been tested, the fact that his mother never attended specialized prenatal and postnatal care creates a high likelihood that he is infected with the HIV. His mother was a staunch Christian from a denomination that considers vaccination to be evil thus Anthony has never undergone measles vaccination. Unbeknownst to his grandmother, one of the children he had played with in church over a week ago was suffering from measles. Three days ago, Anthony developed a cough and started sweating profusely with a high fever more so at night. Last night, he was found to have rashes on his face and neck with a semblance of the same seeming to develop between his fingers.
Prevention
In the USA, measles is prevented through a vaccination program superintended by the CDC. The measles vaccine is usually combined with that of mumps and rubella creating a composition abbreviated as MMR (Measles, Mumps, & Rubella). Two doses are necessary to build immunity to all the three diseases. The first dose is given at the age of 12 to 15 months with the second administered at 4-6 years. The second dose can be given earlier, but in the very least after 28 days of the initial dose (Phadke et al., 2016) . Children below 12 months can be vaccinated if they are traveling out of America but will still have to undergo the full vaccination regimen after return. Albeit the vaccination is not per se compulsory, it is considered one of the primary requirements for admission of children in elementary school. The vaccine type is attenuated vaccine which works by enabling the body’s immune system to learn about the measles virus and therefore develop immunity. Upon proper vaccination, lifelong immunity is developed (Phadke et al., 2016) .
Treatment
Upon the advent of measles, no form of treatment can stop or extenuate its cycle. In most cases, therefore, measles treatment is symptomatic as well as enhancement of comfort for the patient. These include medication to control pain and fever. Ibuprofen or paracetamol is recommended for this purpose with aspirin being discouraged for children below 16 years due to possible adverse side effects. With proper rest and ingestion of fluids, patients who do not develop complications will recover (O’Connor et al., 2017) . Complications are treated depending on their nature. Pneumonia and bronchitis are bacterial infections and are, therefore, treated using antibiotic regimens. Brain inflammation, on the other hand, has no known treatment and results in about 15% mortality rate at random for measles patients who develop it. Secondary treatment regimens include Vitamin A to avoid propensity for blindness due to the rashes and the use of Zinc supplementation in affected children to extenuate damage (O’Connor et al., 2017) . However, the two treatment regimens lack scientific evidence for the actual effects.
Clinical Relevance
The fact that no known treatment regimen is currently available for measles also means that no drug resistance capabilities may have been developed. The only known approach to the control of measles is vaccination, which has been known to be very effective leading to the elimination of the disease in some regions. Sowers et al. (2016), however, reports a rare problem in the USA indicating that 9% of adult measles infections was on individuals who had been fully vaccinated. The study establishes a way of determining the efficacy of vaccination. The absence of both vaccination and natural immunity through infection can, however, be catastrophic. A good example is the 1529 infection in the island of Cuba that wiped out over 65% of the population.
Conclusion
Measles is one of the diseases that used to ravage the world population with abandon before the advent of vaccination. However, being an endemic disease, communities within whom measles was a common occurrence with time developed a level of immunity that avoided massive mortality rates. A new infection in a fresh community would, however, be devastating. The combination of natural immunity and vaccination has gone a long way in controlling measles across the globe even in developing countries. By introducing the attenuated vaccine, the body develops as high immunity as if the individual had contracted the disease. However, upon the advent of infection in the body, nothing can be done to extenuate the development of the disease. Most of the patients heal naturally and only need medication to control symptoms, a few will develop bacterial complications such as pneumonia or bronchitis, which can be controlled using antibiotics. The other complication is brain inflammation, which may lead to brain damage and a 15% mortality rate.
References
Harvala, H., Wiman, Å., Wallensten, A., Zakikhany, K., Englund, H., & Brytting, M. (2015). Role of Sequencing the measles virus Hemagglutinin gene and Hypervariable region in the measles outbreak investigations in Sweden during 2013–2014. Journal of Infectious Diseases , 213 (4), 592–599. doi:10.1093/infdis/jiv434
O’Connor, P., Jankovic, D., Muscat, M., Ben Mamou, M., Reef, S., Papania, M., … Datta, S. (2017). Measles and rubella elimination in the WHO region for Europe: Progress and challenges. Clinical Microbiology and Infection . doi:10.1016/j.cmi.2017.01.003
Phadke, V. K., Bednarczyk, R. A., Salmon, D. A., & Omer, S. B. (2016). Association between vaccine refusal and vaccine-preventable diseases in the United States. JAMA , 315 (11), 1149- 1158. doi:10.1001/jama.2016.1353
Sowers, S. B., Rota, J. S., Hickman, C. J., Mercader, S., Redd, S., McNall, R. J., … Bellini, W. J. (2016). High concentrations of measles Neutralizing antibodies and high-avidity measles IgG accurately identify measles Reinfection cases. Clinical and Vaccine Immunology , 23 (8), 707–716. doi:10.1128/cvi.00268-16
