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MEASLES IN CHILDREN WITH COMORBIDITIES: CLINICAL PRESENTATION,
RISKS, AND MANAGEMENT
Bayxanova Nasiba Tursunbayevna
Department of infectious diseases
Andijan State Medical Institute
Uzbekistan, Andijan
Abstract:
Measles is a highly contagious, vaccine-preventable disease caused by the measles
virus. Although healthy children typically experience an acute, self-limiting illness, measles can
be more severe or prolonged in those with underlying comorbidities. This article examines how
different comorbid conditions—ranging from malnutrition and immunodeficiency to chronic
respiratory and cardiac diseases—influence the clinical course, complications, and management
strategies for measles in pediatric patients [1]. Emphasis is placed on preventive measures,
including comprehensive immunization and supportive therapies such as vitamin A
supplementation [2].
Keywords:
Measles, Children, Comorbidities, Immunosuppression, Malnutrition, Chronic
Diseases, Vitamin A, Vaccination, Secondary Infections, Public Health.
Introduction
Measles, also known as rubeola, remains a significant global health concern, particularly in
regions with low vaccination coverage. The World Health Organization (WHO) estimates that
measles was responsible for over 140,000 deaths globally in 2018, primarily among children
under five years of age [3]. While many children recover uneventfully with proper treatment,
those with existing comorbidities—such as immunosuppression, malnutrition, congenital heart
disease, or chronic respiratory conditions—are at elevated risk for severe outcomes,
complications, and mortality [4].
The purpose of this article is to discuss the pathophysiology of measles in children with various
comorbid conditions, highlighting clinical features, management strategies, and preventive
measures. Recognizing high-risk groups is essential for early intervention and reducing measles-
related morbidity and mortality.
Epidemiology and Transmission
Global Distribution: Measles occurs worldwide, but outbreaks are more frequent in areas with
suboptimal vaccination coverage.
Transmission: The virus spreads via respiratory droplets when an infected individual coughs or
sneezes. It remains infectious on surfaces or in the air for up to two hours, contributing to its high
contagion rate [5].
Incubation Period: Typically 10–14 days from exposure to onset of fever.
Vaccination campaigns have dramatically reduced measles incidence, but persistent gaps in
immunization coverage leave children with comorbidities vulnerable to severe infections [6].
Pathophysiology and Impact of Comorbidities
Measles Virus and Immune Response - Once inhaled, the measles virus infects the respiratory
tract and eventually spreads systemically via lymphatic and blood circulation. The virus causes a
characteristic immune suppression that may last for weeks to months, increasing susceptibility to
secondary infections (e.g., pneumonia, diarrhea).
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Common Comorbidities in Children with Measles
Malnutrition:
Mechanism of Increased Severity: Protein-energy malnutrition weakens immune responses,
hindering effective viral clearance.
Clinical Implications: Malnourished children frequently present with protracted fevers, severe
diarrhea, and higher rates of measles-associated mortality.
Immunodeficiency (e.g., HIV, Congenital Immunodeficiencies):
Mechanism: Decreased ability to mount an effective immune response leads to prolonged viral
replication and severe disease.
Clinical Implications: Increased risk of complications such as pneumonia, encephalitis, and
persistent measles infection.
Respiratory Diseases (e.g., Asthma, Cystic Fibrosis):
Mechanism: Pre-existing inflammation or structural lung changes can worsen measles-related
respiratory symptoms [7].
Clinical Implications: Higher likelihood of pneumonia, respiratory failure, and extended hospital
stays.
Cardiac Diseases (e.g., Congenital Heart Defects):
Mechanism: Poor cardiovascular reserve can exacerbate the systemic inflammatory response to
measles.
Clinical Implications: Children may experience hemodynamic instability, requiring closer
monitoring and supportive care.
Other Chronic Conditions (e.g., Diabetes Mellitus):
Mechanism: Altered immune response and metabolic demands complicate the management of
acute viral illnesses [8].
Clinical Implications: Increased risk of secondary infections, and glycemic control may be
harder to maintain during acute illness.
Clinical Presentation in Children with Comorbidities
Typical Measles Symptoms - Prodromal Phase (2–4 days): High fever, cough, coryza (runny
nose), conjunctivitis, and Koplik’s spots (tiny white spots on the buccal mucosa).
Exanthem (Rash) Phase: A maculopapular rash typically starting on the face and spreading
downward [9].
Modified or Severe Presentations
Children with comorbidities may exhibit:
Prolonged Fever: Due to a delayed or inadequate immune response.
Worsening Underlying Disease: Acute decompensation of chronic conditions (e.g., an asthmatic
child experiencing a severe flare-up).
Enhanced Complications: Pneumonia, acute encephalitis, otitis media, and diarrhea.
Higher Mortality Rates: Particularly in severely immunocompromised or malnourished children.
Diagnosis
Clinical Examination: The hallmark features of measles (prodrome, Koplik’s spots, classic rash)
are often diagnostic, but may be atypical in children with comorbidities.
Serologic Tests: Detection of measles-specific IgM antibodies in serum confirms recent infection
[10].
Molecular Methods (RT-PCR): Useful for early detection and for confirming cases during
outbreaks.
Chest Imaging: May be necessary if respiratory complications are suspected (e.g., pneumonia).
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Assessment of Comorbidities: Evaluation of the underlying condition (e.g., immune status,
nutritional level, cardiac function) to guide treatment strategies.
Management
Supportive Care
Hydration and Nutrition: Adequate fluid intake and nutritional support, including correction of
electrolyte imbalances.
Antipyretics: For fever management (e.g., acetaminophen).
Respiratory Support: Oxygen supplementation and, if needed, mechanical ventilation for severe
respiratory distress.
Vitamin A Supplementation - Vitamin A has been shown to reduce morbidity and mortality in
measles, especially among malnourished children. The WHO recommends high-dose vitamin A
supplementation immediately upon measles diagnosis and repeated the next day or as indicated
[11].
Antibiotics for Secondary Infections
Bacterial superinfections (e.g., pneumonia, otitis media) can worsen outcomes. Empirical
antibiotic therapy may be warranted, particularly if a child’s immunocompromised or comorbid
status places them at high risk for complications.
Management of Underlying Conditions
Immunocompromised Children: May require immunoglobulin therapy if exposed to measles.
Children with Chronic Respiratory/Cardiac Disease: Close monitoring, possibly in an intensive
care setting for prompt intervention if decompensation occurs.
Malnourished Children: Enhanced nutritional rehabilitation and frequent follow-up to ensure
recovery.
Prevention Strategies
Vaccination:
Measles-Containing Vaccines (MCVs): The most effective preventive measure. WHO
recommends two-dose schedules for robust immunity.
Catch-Up Campaigns: Target unvaccinated or under-vaccinated children, especially in high-risk
populations [12].
Isolation and Infection Control:
During Outbreaks: Early identification and isolation of measles cases help reduce transmission.
Hospital Settings: Strict airborne precautions to prevent nosocomial outbreaks, particularly in
wards housing immunocompromised patients.
Post-Exposure Prophylaxis:
Immunoglobulin (IG) Administration: For high-risk, non-immune individuals (e.g.,
immunocompromised children) exposed to measles.
Prompt Vaccination: If appropriate and no contraindications exist.
Addressing Social Determinants of Health:
Nutrition Programs: Reduce malnutrition to strengthen immune defenses.
Access to Healthcare: Regular follow-ups for chronic conditions and timely immunizations [13].
Prognosis and Future Perspectives
Children with comorbidities who develop measles are at increased risk of complications and
have a potentially worse prognosis. However, prompt diagnosis, appropriate supportive care, and
targeted therapy of underlying conditions can significantly improve outcomes [14]. Future efforts
should focus on: Enhancing Global Vaccination Coverage to eliminate measles transmission.
Strengthening Healthcare Systems to identify and treat high-risk children early. Developing
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Comprehensive Management Protocols that integrate treatment for measles with optimal control
of comorbidities [15].
Conclusion
Measles remains a formidable disease for children with various comorbidities due to the
increased likelihood of severe complications. Early recognition, aggressive supportive care,
vitamin A supplementation, and management of secondary infections are cornerstones of therapy.
Above all, universal vaccination and vigilant public health measures are essential to preventing
measles outbreaks and protecting vulnerable pediatric populations.
References:
1.
Perry RT, Halsey NA. The clinical significance of measles: a review. J Infect Dis.
2004;189(Suppl 1):S4–S16.
2.
Sharifjonovich, A.N.M., 2023. CLINICAL EFFECTIVENESS OF THE DRUG
VIFERON IN PREGNANT WOMEN WITH ACUTE RESPIRATORY INFECTION. Ethiopian
International Journal of Multidisciplinary Research, 10(11), pp.302-304.
3.
Sharifjonovich, A.N.M., 2024, October. MODERN APPROACHES TO THE
ETIOLOGY, PATHOGEN. In Russian-Uzbekistan Conference (Vol. 1, No. 1).
4.
Marufjon, K., 2024. HELMINTHIASIS. Web of Medicine: Journal of Medicine, Practice
and Nursing, 2(3), pp.65-67.
5.
Marufjon, K., 2024. INFECTIOUS MONONUCLEOSIS: CLINICAL PRESENTATION,
DIAGNOSIS, AND TREATMENT METHODS. Web of Medicine: Journal of Medicine,
Practice and Nursing, 2(12), pp.310-313.
6.
Nematovna, O.J., 2025. THE USE OF HEPATOPROTECTORS IN THE TREATMENT
OF VIRAL HEPATITIS B. Ethiopian International Journal of Multidisciplinary Research,
12(02), pp.298-301.
7.
Nematovna, O.J., 2024, November. PHYSIOLOGICAL AND PATHOGENETIC BASIS
OF THE ORIGIN OF ALLERGY TO COW'S MILK PROTEINS IN CHILDREN. In Russian-
Uzbekistan Conference (Vol. 1, No. 1).
8.
Sayibovna, Tuxtanazarova Nargiza. "PREVENTION OF THE SPREAD OF
POLIOMYELITIS INFECTION, PATHOGENESIS AND STATISTICS ON THE WORLD."
Ethiopian International Journal of Multidisciplinary Research 10, no. 10 (2023): 30-34.
9.
Bakhodirovna, Mirzakarimova Dildora, and Abdukodirov Sherzodjon Taxirovich.
"CHARACTERISTICS OF RHINOVIRUS INFECTION." International journal of medical
sciences 4, no. 08 (2024): 55-59.
10.
Bayxanova, N., 2022. MONITORING OF OPPORTUNIST INFECTIONS IN
PATIENTS WITH HIV INFECTION. Экономика и социум, (2-2 (93)), pp.70-72.
11.
Байханова, Н. and Абдукодиров, Ш.Т., 2021. ВЗАИМОСВЯЗЬ ВИРУСНОЙ
ИНФЕКЦИИ
В
РАЗВИТИИ
АНТИФОСФОЛИПИДНОГО
СИНДРОМА
ПРИ
СИНДРОМЕ ПОТЕРИ ПЛОДА. Экономика и социум, (4-1 (83)), pp.691-693.
12.
Каюмов, А.М., 2024, November. ОСОБЕННОСТИ ТЕЧЕНИЯ КОРИ У ПРИВИТЫХ.
In Russian-Uzbekistan Conference (Vol. 1, No. 1).
13.
Каюмов, А.М., 2024, November. ОСОБЕННОСТИ ТЕЧЕНИЯ КОРОНАВИРУСНОЙ
ИНФЕКЦИИ НА ФОНЕ САХАРНОГО ДИАБЕТА. In Russian-Uzbekistan Conference (Vol.
1, No. 1).
14.
Mutalibovich, Q.A., 2024. ENTEROVIRAL INFECTIONS: MODERN FEATURES.
Ethiopian International Journal of Multidisciplinary Research, 11(02), pp.199-200.
Volume 4, issue 2, 2025
90
15.
Pulatov, M.E. and Sobirov, M.A., 2024, November. THE FREQUENCY OF
DETECTION OF ACTIVE CHRONIC HEPATITIS B AMONG HBsAg CARRIERS. In
Russian-Uzbekistan Conference (Vol. 1, No. 1).
