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Vitamin A and Measles

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Consequences of deficiency in pre-clinical stage: Increased risk of mortality ... Clinical stage: Shows common symptoms like xerophthalmia,etc ... – PowerPoint PPT presentation

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Title: Vitamin A and Measles


1
Vitamin A and Measles
  • NSCI 5373
  • Mugdha Jog

2
Vitamin A deficiency
  • Primary Vit A deficiency prolonged dietary
    deprivation, South and East Asia
  • Secondary Vit A deficiency interference with
    absorption, storage, transport of Vit A
  • Defective absorption and storage cystic
    fibrosis, celiac disease, pancreatic disease,
    giardiasis, cirrhosis
  • Defective storage and transport PEM

3
Signs and symptoms
  • Increased susceptibility to infections
  • Growth retardation in children
  • Keratomalacia
  • Xeropthalmia
  • Night blindness
  • Xerosis of cornea and conjuctiva
  • Bitots spots

4
Diagnosis
  • Sub-clinical stage No evidence history of
    inadequate intake
  • Consequences of deficiency in pre-clinical stage
    Increased risk of mortality from common childhood
    infections like diarrhea and measles

5
Diagnosis contd
  • Clinical stage Shows common symptoms like
    xerophthalmia,etc
  • Plasma retinol levels good indicator
  • Mild 20-30 micro.gm/dl
  • Moderate 10-19 micro.gm/dl
  • Severe lt 10 micro.gm/dl

6
Diagnosis contd
  • Plasma RBP levels indicator
  • Children less than or up to 10yrs 20-30
    micro.gm/ml
  • Adult females 42micro.gm/ml
  • Adult males 47micro.gm/ml
  • Both plasma retinol and plasma RBP fall in
    deficient populations

7
WHO Figures
  • In 1995, 28 million children lt5yrs of age with
    clinical VAD
  • 251 million with sub-clinical VAD
  • Under 5 mortality over 70 per 1,000 live births
  • Xerophthalmia afflicts 2-3 million children each
    yr, of which 250,000 go permanently blind

8
Recommendations
  • Infants less than 1 yrs age100,000 IU
  • Children between 1-4 yrs of age200,000 IU (
    66,000 micrograms Vitamin A palmitate in oil
    taken orally once every 3-6 months ).

9
Dietary Sources
  • Dark green leafy vegetables
  • Yellow orange fruits mango, papaya
  • Liver, eggs, milk
  • Red palm oil, cod liver oil
  • Vitamin A fortified products Bread, sugar, MSG,
    Margarine, biscuits, rice

10
Measles
  • Highly contagious air borne viral illness
  • Infected children worldwide in pre-vaccination
    era
  • Still frequent and often fatal in developing
    countries

11
Measles Pathogenesis
  • Primary infection site- respiratory epithelium
  • Replication in nasopharynx and regional lymph
    nodes
  • Viremia- spreads to other tissues and organs

12
Measles Clinical Features
  • Incubation Period 10-12 days
  • Prodrome Fever, runny nose, cough,
    conjunctivitis
  • Kopliks spots

13
Clinical Features contd
  • Rash 14 days after exposure
  • Maculopapular eruptions
  • Begins on head and face, proceeds downwards and
    outwards
  • Persists 5-6 days
  • Fades in order of appearance

14
Other Complications
  • Diarrhea (8), Otitis media (7), Pneumonia (6),
    Encephalitis (0.1), Death (0.2)
  • Hospitalization rate (18)
  • 30 cases have one or more of above
  • Risk of death higher among children lt 5yrs

15
Treatment
  • Medications
  • ORT
  • Vitamin A supplementation
  • Immunization

16
Immunization
  • Live attenuated vaccine
  • WHO recommends
    1St vaccine between 9 to 12 months of birth
    2nd vaccine a month after the first one

17
Measles in U.S
  • Measles resurgence in U.S between 1989-1991
  • 55,000 cases
  • 45 under 5 yrs 35 between 5-19 yrs
  • 123 deaths ( 49 under 5yrs)
  • 11,000 hospitalizations
  • Reason Low vaccine coverage

18
Global Strategies
  • WHO and UNICEF Global Measles Strategic Plan.
  • By 2005, reduce global measles deaths by 50
  • Achieve and maintain interruption of indigenous
    measles transmission with elimination goals
    America(2000) Europe(2007) Eastern
    Mediterranean(2010)
  • Global review and assessment of plan in 2005

19
Plan Strategies
  • 1st dose by 9 months
  • 2nd opportunity for vaccine
  • Monitor coverage and conduct surveillance
  • Improve measles case management
  • Additional campaigns
    Provide vitamin A supplements Include
    Mumps and RubellaMMR

20
Progress
  • Global vaccine coverage at 70
  • 40 global decline in cases from 1990 to 1999
  • South America - measles mortality reduced by 99
  • 7 countries in south Africa Measles mortality
    reduced by 99 just from 1996 to 1998

21
Conclusion
  • Measles still accounts for 46 of the 1.7 million
    deaths due to vaccine-preventable diseases
  • 30 to 40 million cases and 777,000 measles deaths
    still occur every year
  • It costs less than 1 to immunize a child with
    the measles vaccine
  • Children DONT HAVE to die from measles!!

22
  • Questions ?
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