II. INTRODUCTION Brief Description of the Disease What is measles?

Measles, also known as Rubeola or morbilli, is a highly infectious illness caused by a virus - a viral infection caused by the rubeola virus. Measles is an endemic disease; meaning it is continually present in a community and many people develop resistance. If measles enters an area where the people have never been exposed the result can be devastating. History of Measles One of the earliest written descriptions of measles as a disease was provided by an Arab physician in the 9th century who described differences between measles and smallpox in his medical notes. A Scottish physician, Francis Home, demonstrated in 1757 that measles was caused by an infectious agent present in the blood of patients. In 1954 the virus that causes measles was isolated in Boston, Massachusetts, by John F. Enders and Thomas C. Peebles. Before measles vaccine, nearly all children got measles by the time they were 15 years of age. Each year in the United States about 450-500 people died because of measles, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness. Today there are only about 60 cases a year reported in the United States, and most of these originate outside the country.

Etymology of measles (origin of the word) The English word "measles" is thought to come from the Middle Dutch word masel, meaning "blemish".

Some say the word is connected to the Middle English word meseles, the plural of mesel, meaning "infested with tapeworms". The British slang word measly, which appeared in the mid 1860s meaning "meager and contemptible" was an adaptation of the modern word "measles" which had become established before that time. Signs and Symptoms Measles symptoms invariably include fever, together with at least one of the three C's (cough, coryza, conjunctivitis).

Symptoms will appear about 9-11 days after infection, and may include the following:

Coryza - runny nose. Dry hacking cough. Conjunctivitis - swollen eyelids, inflamed eyes. Watery eyes. Photophobia - sensitivity to light. Sneezing. Fever - this may be mild to severe and can reach 105F (40.6C) for a number of days. Fever may drop, and then rise again when the rash appears.

Koplik's spots - very small grayish-white spots with bluish-white centers in the mouth, insides of cheeks, and throat.

Aches generally all over the body. Rash - 3 to 4 days after initial symptoms a reddish-brown spotty rash appears. The rash can last for over a week. It usually starts behind the ears and spreads all over the head and neck. After a couple of days it spreads to the rest of the body, including the legs. As the little spots grow many of them will join together.

How is measles diagnosed? A primary care physician will be able to diagnose measles fairly easily if the signs and symptoms are present. A blood test will confirm the presence of the rubeola virus. In most countries measles is a notifiable disease. This means that doctors have to notify the authorities of any suspected cases. If the patient is a child the doctor will also notify the school. A child with measles should not return to school until at least five days after the rash has appeared.

What is the treatment for measles? There is no specific measles treatment. If there are no complications the doctor will recommend plenty of rest and normal measures to control the fever and prevent dehydration (drink fluids). Symptoms will usually go away within 7 to 10 days.

If a child has measles, the following measures may help:

Fever - if the temperature is high try to keep the child cool, but make sure he/she is not cold. Tylenol (paracetamol, acetaminophen) or ibuprofen are effective in controlling fever, as well as aches and pain. Children under 16 should not be given aspirin. Check with your doctor about acetaminophen dosage - too much can harm the child, especially the liver.

Smoking - do not let anyone smoke near the child with measles. Photophobia - as the child may be painfully sensitive to light, keeping the lights dim or the room darkened may help. Sunglasses may also help.

Conjunctivitis - if there is crustiness around the eyes gently clean with damp cotton wool. Cough - cough medicines will not relieve the cough. Making the room more humid by placing a bowl of water may help the cough. If the child is over twelve a glass of warm water with a teaspoon of lemon juice and two teaspoons of honey may help. Do not give honey to babies.

Dehydration - make sure the child is hydrated. If the child has a fever he/she can become dehydrated more quickly. Encourage the child to drink plenty of fluids.

Isolation - while children are contagious they should be kept away from school and should not return to activities that involve human interaction. Non-immunized people who have never had measles should be kept out of the house.

Vitamin A supplements - studies have shown that Vitamin A supplements significantly help prevent complications caused by measles. Supplements are recommended for children with vitamin A deficiency and children under the age of two who have severe measles. Vitamin A deficiency is virtually non-existent in developed countries, but fairly common in much of the developing world.

What are the complications of measles? Complications from measles are fairly common, and are more likely to get worse for patients who have weak immune systems, such as those with HIV/AIDS or leukemia, those with vitamin deficiency, and very young children. Adults over the age of 20 are more likely to have complications than healthy children over the age of 5.

About 20% of people who develop measles have some kind of complication, which may include:

Diarrhea. Vomiting. Eye infection. Laryngitis and bronchitis - laryngitis is inflammation of the voice box. Bronchitis is inflammation of the inner walls that line the main air passageways. About 4% of people with measles have difficulties breathing.

Otitis media - inner ear infection and inflammation. Febrile convulsion - fits caused by fever. Occurs in 1 in 200 cases. May be alarming, but children usually make a full recovery.

Pneumonia - patients with weakened immune system who develop measles are vulnerable to an especially dangerous type of pneumonia (Streptococcus pneumoniae) which can be fatal.

The following less common complications are also possible:

Hepatitis - liver complications in childhood measles is rare and temporary. However, it can be severe in children receiving hepatotoxic drugs (medications which may be toxic to the liver). Acetaminophen (Tylenol, paracetamol) can harm the liver if the dose is too high. Check acetaminophen dosage with your doctor if you wish to use it to treat fever.

Encephalitis - approximately 1 in every 1,000 patients with measles develops encephalitis. This is an inflammation of the brain which may cause vomiting, and convulsions. Coma and even death is possible, but rare. Encephalitis may occur soon after measles, or several years later.

Thrombocytopenia - low platelet count. The blood's ability to clot is affected. The patient may bruise easily.

Squint - eye nerves and eye muscles may be affected.

The complications listed below are very rare, but possible:

Neuritis - infection of the optic nerve, which can lead to blindness. Heart complications Subacute sclerosing panencephalitis (SSPE) - Occurs in 1 in every 100,000 cases. SSPE is a brain disease which can occur several months or years after measles infection and causes convulsions, motor abnormalities, mental retardation and death.

Other nervous system complications - toxic encephalopathy, retrobulbar neuritis, transverse myelitis, and ascending mielitis.

Pregnancy Measles during pregnancy can cause miscarriage, premature labor, or low birth weights.

Public health significance & occurrence

The use of measles vaccine in infant immunization programs globally has led to a significant reduction in measles cases and deaths. In addition to providing direct protection to the vaccine recipient immunization against measles results in the indirect protection of unimmunized persons (herd immunity) if high enough coverage is achieved. Measles vaccine has several major effects on measles epidemiology. These include achieving an increase of the mean age of infection and an increase in the time between epidemics.

Despite the availability of an effective measles vaccine for almost 40 years the disease still causes a considerable burden in many countries. This is primarily because of underutilization of the vaccine. In 2001 it was estimated that there were 30 million measles cases and 777,000 deaths. Most deaths occurred in developing countries, principally in Africa and Asia. Thirteen countries reported that routine measles vaccine coverage was below 50%. Large measles outbreaks continue to occur. These occur especially in areas of developing countries with low vaccine coverage and among children living in countries where there are unstable social conditions. These outbreaks frequently have high case-fatality rates.

The importance of understanding the epidemiology of this disease is underlined by its ability to change rapidly in the face of increasing immunization coverage. Much is still to be learned about its epidemiology and the best strategies for administering measles vaccines. However, it is clear that tremendous progress can be made in preventing death and disease from measles with existing knowledge about the disease, and by using the presently available vaccines and applying well-tried methods of treating cases. Research in the coming decade may provide

more effective vaccines for use in immunization programmes. An understanding of the basic epidemiology of measles is a prerequisite for effective control measures.

III. Descriptive Epidemiology Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year. It remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 122,000 people died from measles in 2012 mostly children under the age of five. Measles is caused by a virus in the paramyxovirus family. The measles virus normally grows in the cells that line the back of the throat and lungs. Measles is a human disease and is not known to occur in animals. Accelerated immunization activities have had a major impact on reducing measles deaths. Since 2000, more than one billion children in high risk countries were vaccinated against the disease through mass vaccination campaigns about 145 million of them in 2012. Global measles deaths have decreased by 78% from an estimated 562,400 to 122,000. Measles kills more children than any other vaccine-preventable disease. Before the widespread use of vaccine, 90% of children had contracted measles by the age of 10 years. An effective vaccine has been available since the 1960s, and all countries offer measles-containing vaccine (MCV) in their immunization programmes. Measles infection has its greatest incidence in children below 2 years of age in the developing countries.

Epidemiology Occurrence Measles occurs throughout the world. However, interruption of indigenous transmission of measles has been achieved in the United States and other parts of the Western Hemisphere. Reservoir Measles is a human disease. There is no known animal reservoir, and an asymptomatic carrier state has not been documented. Transmission Measles transmission is primarily person to person via large respiratory droplets. Airborne transmission via aerosolized droplet nuclei has been documented in closed areas (e.g., office examination room) for up to 2 hours after a person with measles occupied the area. Temporal Pattern In temperate areas, measles disease occurs primarily in late winter and spring. Communicability Measles is highly communicable, with greater than 90% secondary attack rates among susceptible persons. Measles may be transmitted from 4 days before to 4 days after rash onset. Maximum communicability occurs from onset of prodrome through the first 34 days of rash.

IV. Rates

Global measles mortality fell 74% in one decade.

Global measles mortality (death rate) fell by 74% from 2000 to 2010, researchers from the World Health Organization (WHO) reported in The Lancet (April 2012 issue). WHO had aimed for a 90% reduction. In the year 2000, there were 535,300 reported deaths from measles worldwide, compared to 139,300 in 2010. The authors explained that measles remains a major cause of death in India because only 74% of children are vaccinated, a lower rate than in Africa (76%). The following table attempts to extrapolate the above incidence rate for Measles to the populations of various countries and regions. As discussed above, these incidence extrapolations for Measles are only estimates and may have very limited relevance to the actual incidence of Measles in any region:

Country/Region

Extrapolated Incidence Population Estimated Used

Measles in North America (Extrapolated Statistics) USA Canada Mexico 107 293,655,405
2 1

11 WARNING! (Details) 32,507,874

38 WARNING! (Details) 104,959,594

Measles in Central America (Extrapolated Statistics) Belize Guatemala Nicaragua 0 WARNING! (Details) 5 WARNING! (Details) 1 WARNING! (Details) 272,945
2

14,280,596 5,359,759
2

Measles in Caribbean (Extrapolated Statistics) Puerto Rico 1 WARNING! (Details) 3,897,960

2

Measles in South America (Extrapolated Statistics) Brazil Chile Colombia Paraguay Peru Venezuela 67 WARNING! (Details) 184,101,109 5 WARNING! (Details) 15,823,957
2 2

15 WARNING! (Details) 42,310,775 2 WARNING! (Details) 6,191,368

2

10 WARNING! (Details) 27,544,305 9 WARNING! (Details) 25,017,387

Measles in Northern Europe (Extrapolated Statistics) Denmark Finland Iceland Sweden 1 WARNING! (Details) 1 WARNING! (Details) 0 WARNING! (Details) 3 WARNING! (Details) 5,413,392 5,214,512 293,966
2 2

8,986,400

Measles in Western Europe (Extrapolated Statistics) Britain (United Kingdom) 22 WARNING! (Details) 60,270,708 for UK Belgium France Ireland Luxembourg Monaco 3 WARNING! (Details) 10,348,276
2 2

22 WARNING! (Details) 60,424,213 1 WARNING! (Details) 0 WARNING! (Details) 0 WARNING! (Details) 3,969,558 462,690 32,270
2 2 2

Netherlands (Holland) United Kingdom Wales

5 WARNING! (Details)

16,318,199

22 WARNING! (Details) 60,270,708 1 WARNING! (Details) 2,918,000

2

Measles in Central Europe (Extrapolated Statistics) Austria Czech Republic Germany Hungary Liechtenstein Poland Slovakia Slovenia Switzerland 3 WARNING! (Details) 0 WARNING! (Details) 8,174,762
2

1,0246,178

30 WARNING! (Details) 82,424,609 3 WARNING! (Details) 0 WARNING! (Details) 10,032,375 33,436

2

14 WARNING! (Details) 38,626,349 1 WARNING! (Details) 0 WARNING! (Details) 2 WARNING! (Details) 5,423,567 2,011,473 7,450,867
2

Measles in Eastern Europe (Extrapolated Statistics) Belarus Estonia Latvia Lithuania Russia Ukraine 3 WARNING! (Details) 0 WARNING! (Details) 0 WARNING! (Details) 1 WARNING! (Details) 10,310,520 1,341,664 2,306,306 3,607,899
2 2

52 WARNING! (Details) 143,974,059 17 WARNING! (Details) 47,732,079

2

Measles in the Southwestern Europe (Extrapolated Statistics) Azerbaijan Portugal Spain Georgia 2 WARNING! (Details) 3 WARNING! (Details) 7,868,385
2

10,524,145

14 WARNING! (Details) 40,280,780 1 WARNING! (Details) 4,693,892

2

Measles in the Southern Europe (Extrapolated Statistics) Italy Greece 21 WARNING! (Details) 58,057,477 3 WARNING! (Details) 10,647,529
2

Measles in the Southeastern Europe (Extrapolated Statistics) Albania 1 WARNING! (Details) 3,544,808
2

Bosnia and Herzegovina 0 WARNING! (Details) Bulgaria Croatia Macedonia Romania 2 WARNING! (Details) 1 WARNING! (Details) 0 WARNING! (Details) 8 WARNING! (Details)

407,608

7,517,973 4,496,869 2,040,085

22,355,551 10,825,900

Serbia and Montenegro 3 WARNING! (Details)

Measles in Northern Asia (Extrapolated Statistics) Mongolia 1 WARNING! (Details) 2,751,314

2

Measles in Central Asia (Extrapolated Statistics) Kazakhstan Tajikistan Uzbekistan 5 WARNING! (Details) 2 WARNING! (Details) 9 WARNING! (Details) 15,143,704 7,011,556
2

26,410,416

Measles in Eastern Asia (Extrapolated Statistics) China Hong Kong s.a.r. Japan Macau s.a.r. North Korea South Korea Taiwan 477 WARNING! (Details) 1,298,847,624 2 WARNING! (Details) 6,855,125
2 2

46 WARNING! (Details) 127,333,002 0 WARNING! (Details) 8 WARNING! (Details) 445,286

2

22,697,553

17 WARNING! (Details) 48,233,760 8 WARNING! (Details) 22,749,838

Measles in Southwestern Asia (Extrapolated Statistics) Turkey 25 WARNING! (Details) 68,893,918

2

Measles in Southern Asia (Extrapolated Statistics) Afghanistan Bangladesh Bhutan India Pakistan Sri Lanka 10 WARNING! (Details) 28,513,677
2

51 WARNING! (Details) 141,340,476 0 WARNING! (Details) 2,185,569

2

391 WARNING! (Details) 1,065,070,607 58 WARNING! (Details) 159,196,336 7 WARNING! (Details) 19,905,165
2 2

Measles in Southeastern Asia (Extrapolated Statistics)

East Timor Indonesia Laos Malaysia Philippines Singapore Thailand Vietnam

0 WARNING! (Details) 1,019,252

87 WARNING! (Details) 238,452,952 2 WARNING! (Details) 6,068,117

2

8 WARNING! (Details) 23,522,482 31 WARNING! (Details) 86,241,697 1 WARNING! (Details) 4,353,893

2

23 WARNING! (Details) 64,865,523 30 WARNING! (Details) 82,662,800

Measles in the Middle East (Extrapolated Statistics) Gaza strip Iran Iraq Israel Jordan Kuwait Lebanon Saudi Arabia Syria United Arab Emirates West Bank Yemen 0 WARNING! (Details) 1,324,991
2

24 WARNING! (Details) 67,503,205 9 WARNING! (Details) 2 WARNING! (Details) 2 WARNING! (Details) 0 WARNING! (Details) 1 WARNING! (Details) 9 WARNING! (Details) 6 WARNING! (Details) 0 WARNING! (Details) 0 WARNING! (Details) 7 WARNING! (Details) 25,374,691 6,199,008 5,611,202 2,257,549 3,777,218
2

25,795,938 18,016,874 2,523,915 2,311,204

2

20,024,867

Measles in Northern Africa (Extrapolated Statistics) Egypt Libya Sudan 27 WARNING! (Details) 76,117,421 2 WARNING! (Details) 5,631,585
2 2

14 WARNING! (Details) 39,148,162

Measles in Western Africa (Extrapolated Statistics) Congo Brazzaville Ghana Liberia Niger 1 WARNING! (Details) 7 WARNING! (Details) 1 WARNING! (Details) 4 WARNING! (Details) 2,998,040
2

20,757,032 3,390,635
2

11,360,538

Nigeria Senegal Sierra leone

6 WARNING! (Details) 3 WARNING! (Details) 2 WARNING! (Details)

12,5750,356 10,852,147 5,883,889

2 2

Measles in Central Africa (Extrapolated Statistics) Central African Republic 1 WARNING! (Details) Chad Congo kinshasa Rwanda 3 WARNING! (Details) 3,742,482 9,538,544
2

21 WARNING! (Details) 58,317,030 3 WARNING! (Details) 8,238,673

2

Measles in Eastern Africa (Extrapolated Statistics) Ethiopia Kenya Somalia Tanzania Uganda 26 WARNING! (Details) 71,336,571 12 WARNING! (Details) 32,982,109 3 WARNING! (Details) 8,304,601
2 2

13 WARNING! (Details) 36,070,799 9 WARNING! (Details) 26,390,258

Measles in Southern Africa (Extrapolated Statistics) Angola Botswana South Africa Swaziland Zambia Zimbabwe 4 WARNING! (Details) 0 WARNING! (Details) 10,978,552 1,639,231
2 2

16 WARNING! (Details) 44,448,470 0 WARNING! (Details) 4 WARNING! (Details) 1 WARNING! (Details) 1,169,241
2

11,025,690 1,2671,860

Measles in Oceania (Extrapolated Statistics) Australia New Zealand Papua New Guinea 7 WARNING! (Details) 1 WARNING! (Details) 1 WARNING! (Details) 19,913,144 3,993,817 5,420,280
2 2

** EXTRAPOLATED Prevalence of Measles Worldwide**

V. Causes and Risk Factors Who is at risk? Unvaccinated young children are at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected. Measles is still common in many developing countries particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures. Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection. What causes measles? Measles is caused by infection with the rubeola virus, a paramyxovirus of the genus Morbillivirus. The virus lives in the mucus of the nose and throat of an infected child or adult. The infected person is contagious for four days before the rash appears, and continues so for about four to five days afterwards. You can become infected through:

Physical contact with an infected person. Being nearby infected people if they cough or sneeze.

Touching a surface that has infected droplets of mucus (the virus remains active for two hours) and then putting your fingers into your mouth, rubbing your nose or eyes.

VI. Conclusion Measles is a highly infectious disease which has a major impact on child survival, particularly in developing countries. Worldwide, measles is a significant cause of morbidity and mortality. Precise incidence estimates are difficult to obtain because of heterogeneous surveillance systems and probable under-reporting. In 2000, measles was estimated to cause approximately 31 to 39.9 million illnesses worldwide with an estimated 733,000 to 777,000 deaths, making it the fifth most common cause of death in children under 5 years of age. The World Health Assembly adopted the WHO/UNICEF Global Immunization Vision and Strategy, which included a goal of 90 percent reduction in global measles mortality between 2000 and 2010. The WHO identified 47 priority countries to focus measles mortality reduction efforts; these nations jointly account for approximately 98 percent of measles deaths. The strategy in these nations includes the following measures: (1) measles immunization with a goal of >90 percent national coverage and >80 percent per-district coverage with two doses of vaccine; (2) surveillance activities, including case investigation and laboratory testing in all suspected cases; and (3) clinical management of measles cases, including administration of vitamin A.

Prevention Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for 50 years. It is safe,

effective and inexpensive. It costs less than one US dollar to immunize a child against measles. The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form. In 2012, about 84% of the world's children received one dose of measles vaccine by their first birthday through routine health services up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose.

WHO response The fourth Millennium Development Goal (MDG 4) aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015. Recognizing the potential of measles vaccination to reduce child mortality, and given that measles vaccination coverage can be considered a marker of access to child health services, routine measles vaccination coverage has been selected as an indicator of progress towards achieving MDG 4. Overwhelming evidence demonstrates the benefit of providing universal access to measles and rubella-containing vaccines. Globally, an estimated 562 400 children died of measles in 2000. By 2012, the global push to improve vaccine coverage resulted in a 78% reduction in deaths. Since 2000, with support from the Measles & Rubella Initiative (M&R Initiative) over 1 billion children have been reached through mass vaccination campaigns about 145 million of them in 2012.

The M&R Initiative is a collaborative effort of WHO, UNICEF, the American Red Cross, the United States Centers for Disease Control and Prevention, and the United Nations Foundation to support countries to achieve measles and rubella control goals. In 2012, the MR Initiative launched a new Global Measles and Rubella Strategic Plan which covers the period 2012-2020. The Plan includes new global goals for 2015 and 2020:

By the end of 2015

To reduce global measles deaths by at least 95% compared with 2000 levels. To achieve regional measles and rubella/congenital rubella syndrome (CRS) elimination goals.

By the end of 2020

To achieve measles and rubella elimination in at least five WHO regions.

The strategy focuses on the implementation of five core components: 1. achieve and maintain high vaccination coverage with two doses of measles- and rubella-containing vaccines; 2. monitor the disease using effective surveillance, and evaluate programmatic efforts to ensure progress and the positive impact of vaccination activities; 3. develop and maintain outbreak preparedness, rapid response to outbreaks and the effective treatment of cases; 4. communicate and engage to build public confidence and demand for immunization;

5. perform the research and development needed to support cost-effective action and improve vaccination and diagnostic tools.

Implementation of the Strategic Plan can protect and improve the lives of children and their mothers throughout the world, rapidly and sustainably. The Plan provides clear strategies for country immunization managers, working with domestic and international partners, to achieve the 2015 and 2020 measles and rubella control and elimination goals. It builds on years of experience in implementing immunization programmes and incorporates lessons from accelerated measles control and polio eradication initiatives. Outbreak measures

Outbreaks in the community setting occur sporadically as a result of imported measles cases exposing local susceptible people. The epidemiology of outbreaks has changed with the introduction of childhood vaccination, with young adults now at highest risk. Outbreaks in schools may still occur if there are significant numbers of unvaccinated students.

The Department of Health conducts detailed investigations of clusters of cases.

Special settings Schools Although outbreaks mainly affect unvaccinated children, highly vaccinated school populations have also been affected.

Cases are excluded from school and child care for at least four days after rash onset.

Immunized contacts are not excluded. Unimmunized contacts should be excluded until 14 days after the first day of appearance of the rash in the last case.

If unimmunized contacts are vaccinated within 72 hours of their first contact with the first case or if they receive immunoglobulin within seven days of the contact they may return to school.

During an outbreak, children and their siblings who are aged between one and four years should receive their routine second dose of MMR early (but not less than four weeks after their first dose). They are then considered to have completed their MMR vaccination schedule and so do not need a further dose at four years of age.

Child care If there is a case of measles in a child care setting where infants between six to twelve months of age are present, they should be excluded from attendance for 14 days to interrupt local transmission: Infants can return if they receive MMR vaccination (9 12 months) within 72 hours of their first contact or if they receive immunoglobulin (612 months) within seven days.

It is not necessary for infants under six months to be excluded unless the mother is a case, or where the mother is aware she has no protective immunity.

VII. Bibliography 1. CDC. Measles, mumps, and rubellavaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1998;47(No. RR-8):157. 2. American Academy of Pediatrics. Measles. In: Pickering L, Baker C, Kimberlin D, Long S, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009:44455. 3. World Health Organization. Global eradication of measles. http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_18-en.pdf (Accessed on November 08, 2010). 4. World Health Organization. World Health Statistics, 2010. http://www.who.int/whosis/whostat/2010/en/index.html (Accessed on November 08, 2010). 5. http://www.medicalnewstoday.com/articles/37135.php 6. http://www.cdc.gov/measles/about/overview.html 7. http://www.who.int/mediacentre/factsheets/fs286/en/ 8. http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html 9. http://www.health.ny.gov/diseases/communicable/measles/fact_sheet.htm 10. http://ideas.health.vic.gov.au/bluebook/measles.asp 11. http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-measles.htm 12. http://www.wpro.who.int/immunization/documents/measles_country_profile_apr2012_PHL. pdf 13. http://www.rightdiagnosis.com/m/measles/stats-country.htm

Saint Marys University School of Health Sciences GRADUATE SCHOOL DEPARTMENT Bayombong, Nueva Vizcaya

MSN-AHN 209

Submitted to: Mrs. Alicia Z. Jubay

Submitted by: Emily Faye L. Turingan, RN Alma Vanessa M. Zapatero, RN