During epidemics, the spread of measles can
be limited with immunization programs to pro-
tect 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
of contacts are not recommended because the
results are not sensitive enough and are not com-
pleted promptly enough to effect the decision to
During community outbreaks, emphasis is
placed on surveillance, early diagnosis, and
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 extravasa-
tion 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
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 oc-
cur 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 in-
troduced 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 per-
cent of a population may be carriers with no
actual disease cases. In military units during out-
breaks, more than one-half of the unit may be
asymptomatic carriers. The incubation period is
normally for 3 to 4 days. Meningococcal men-
ingitis 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 in-
timate 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
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, re-
productive sterility is a rare sequels. Aseptic men-
ingitis 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
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 com-
municable. 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). Secon-
dary 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.