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Question: Measles

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You are seeing a child with fever and rash x 1 day. Cognizant that we are in the middle of a measles outbreak, which of the following reassures you that this is unlikely to be measles?

Which makes measles in a child with fever and rash unlikely?

pemsou5_wp • May 7, 2019

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  1. Kelly May 7, 2019 - 10:37 am Reply

    E) The child is well-appearing, has no other symptoms, and the rash started on the trunk
    Measles has currently hit a 25-year high, with more than 700 cases reported according to the CDC. Symptoms include fever (can be very high), cough, coryza (runny nose), conjunctivitis, and a rash that starts on the face and spreads downwards (cephalocaudal) and outwards (centrifugal) – like a paint bucket tipped over on the head. Koplik spots (enanthem), small red spots with white to blue-greyish centers on the oral mucosa mucosa are pathognomic but fleeting, often present only before the rash (exanthem). It is very contagious from 4 days before to 4 days after rash appearance, with a 90% attack rate, and the incubation period is 8-12 days. Kids do not receive immunization until age 12-15 months, so remain susceptible prior to that. A single immunization is only 93% effective, and immunization is repeated at 4-5 years. Peak age affected is 6-12 months due to protective maternal antibody transplacental passage at < 6 months. WHO recommends Vitamin A for all children with acute measles, even if from a developed country.

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