Review Question - QID 105435

A young, unvaccinated child with cough, coryza, and conjunctivitis (the three Cs), high fever, and an erythematous maculopapular rash that originated on the head and spread down the body most likely has measles. Vitamin A has has been shown to reduce mortality in children less than 2 years of age with measles.

Although rare in developed countries, several measles outbreaks have occurred among unvaccinated populations in the US and Europe in recent years. This paramyxovirus, transmitted via respiratory droplets, has a 10-12 day incubation period, followed by the classic 3 C's and low grade fever prodrome, and then the ensuing rash and high fever. One of the more serious sequela is subacute sclerosing panencephalitis. Mortality is low in healthy children but can be up to 30% in those who are malnourished or immunocompromised.

Kripke discusses the necessity of physicians counseling parents on vaccine safety and side effects. Widespread, but unfounded, concerns that vaccines cause adverse health effects (including autism) have led to many parents declining vaccines. With regard to the measles, mumps, and rubella (MMR) vaccine, parents are sometimes concerned about thimersol, a safe preservative containing mercury, but this has not been used in the MMR vaccine since 2003.

Huiming et al. review the evidence for using Vitamin A in the treatment of measles in children. Children with Vitamin A deficiency are known to have more severe cases of measles, so the WHO recommends 200,000 U of Vitamin A for 2 days. Although the authors found no overall reduction in mortality with Vitamin A treatment, they did find a significant reduction in risk of mortality in children under the age of 2.

Figure A shows a boy with the maculopapular, erythematous rash seen in measles. Illustration A depicts Koplik spots, small red lesions on the buccal mucosa with white or blueish central spots, which are pathognomonic for measles. They appear in the first 2-3 days of the illness, prior to the rash, and then fade.
Illustration B shows that despite a decline in vaccination in the US, the vast majority of the vulnerable, unvaccinated population resides in the developing world.

Incorrect Answers:
Answer 1: Vitamin A reduces mortality from measles in children <2 years of age, so it would be incorrect to only give supportive care.
Answer 2: Penicillin is the treatment of choice for scarlet fever.
Answer 3: Diphenhydramine is often used to treat hives.
Answer 5: Acyclovir treats herpes simplex, which would be rare to see covering the entire body.