During epidemics, the spread of measles can be limited with immunization programs to protect susceptible individuals. Measles may have a high fatality rate in underdeveloped populations, therefore, vaccines, if available, should be given early in an epidemic to limit the spread. If there is a shortage of vaccines, give young children the highest priority.
Meningococcal meningitis is a bacterial disease that has a sudden onset with symptoms of fever, severe headache, nausea and usually vomiting, stiff neck, and often a pinpoint red rash. Coma and delirium occur frequently. Occasional cases experience purplish patches caused by extravasation of blood into the skin, and shock at the onset of illness. It can be fatal without treatment. The diagnosis is established by the identification of bacterial organisms in a gram stain of spinal fluid or blood.
Meningococcal meningitis occurs in both tropical and temperate areas. Sporatic cases usually occur throughout the year in urban and rural areas with the greatest numbers occurring during the winter and spring. Epidemics may occur at irregular intervals. This is usually a disease of small children, but it can occur in young adults. In adults, it is more common in those recently introduced to crowded living conditions.
The infectious agent is the bacterium Neisseria meningilidis. The reservoir is man. Transmission is by direct contact, which includes droplets and discharges from the nose and throat of infected persons or asymptomatic carriers. About 25 percent of a population may be carriers with no actual disease cases. In military units during outbreaks, more than one-half of the unit may be asymptomatic carriers. The incubation period is normally for 3 to 4 days. Meningococcal meningitis is communicable as long as the organism is present in discharges from the nose and mouth.
Penicillin in adequate doses given parenterally remains the drug of choice.
Preventive measures are primarily based on the immunization of personnel who live in crowded conditions, e.g., military recruits.
For patients, respiratory isolation is required until 24 hours after chemotherapy is begun. There should be surveillance of household or other intimate contacts for early symptoms of meningitis, especially fever, so that early treatment can be started. Household or other intimate contacts may benefit from oral chemotherapy. Routine cultures of contacts are not recommended because the results are not sensitive enough and are not completed promptly enough to effect the decision to give prophylaxis. During community outbreaks, emphasis is placed on surveillance, early diagnosis, and treatment.
Mumps is a viral disease with symptoms of fever, swelling, and tenderness of one or more of the salivary glands (usually the parotid gland(s)). Fifteen to 20 percent of adult males experience infection of the testicle. About 5 percent of females experience ovary infections; however, reproductive sterility is a rare sequels. Aseptic meningitis occurs frequently as a symptom of central nervous involvement. Females during the first trimester of pregnancy may experience an increase in the rate of spontaneous abortions. Deaths are rare.
The infectious agent is the mumps virus. The reservoir is man. Mumps is transmitted by direct contact with saliva or by droplet spread with saliva from an infected person. The incubation period is about 18 days. Mumps are most infectious about 38 hours prior to the onset of illness and probably communicable from 6 days prior to swelling and tenderness of the salivary glands until 9 days later. Asymptomatic cases may be communicable. Susceptibility is general. After a clinical case or asymptomatic infection, immunity is generally lifelong.
There is no specific treatment.
Preventive measures are based on a vaccine available as a single vaccine or combined with rubella and measles.
Patients isolated should be using respiratory precautions in a private room for 9 days after the onset of swelling and tenderness of salivary glands or until the swelling has subsided.
Pediculosis is an infestation of lice on the body and/or clothing. Lice and eggs (nits) are usually found in body hair or the inside seams of clothing. An infestation results in extreme itching and abraded skin (from bites and scratching). Secondary skin infections and inflammation of the regional lymph nodes may occur. Crab lice normally infest the pubic area. However, they may infest other hairy areas, including facial hair and eyebrows. Pediculosis occurs worldwide.