Traumatic Brain Injury

• Universal Newborn Hearing Screening

• Poison Control Centers Program

The bureau is part of the Health Resources and Services Administration of the U.S. Department of Health and Human Services. (For contact information, see Appendix I.)

mathematics disorder A disorder in which mathematical ability, as measured by standardized tests, is substantially below what is expected given the child's chronological age, intelligence, and education level. The disorder significantly interferes with academic achievement and with activities of daily living that require mathematical ability.

measles A childhood viral illness causing a widespread red rash and fever considered to be the most contagious disease in the world. one infected person in a crowded room is able to transmit the illness to almost every unvaccinated person in the room. The medical name for measles is "rubeola," and it is sometimes called "red measles" to distinguish it from the much milder disease known as rubella (german measles). While measles was once commonly found throughout the world and was not normally considered to be dangerous, complications can be fatal.

In populations that have never been exposed to it, measles can be a killer; 800 children died of measles during an epidemic in the Charlestown area of Boston in 1772. It is so remarkably virulent that in 1951, a single person with measles landed in Greenland and within six weeks, all but five of the 4,300 never-before-exposed Greenland natives came down with the disease.

Although measles has been known to be a viral disease since 1911, it was not until 1954 that two Harvard researchers isolated the actual measles virus in the lab. When a vaccine was finally licensed in 1963, experts thought the disease would be eradicated by 1982. When this did not occur, the target date was revised to 1990. But instead of disappearing, measles cases began to rise again from only 1,500 cases in 1983 to 28,000 cases in 1990 in the United States. Half of those reported cases occurred in children under age five. Because many high schools and colleges experienced measles outbreaks in the late 1980s and early 1990s, most schools now require older students to be re-immunized.

Since 1991 measles cases have again been decreasing; there were 963 cases in 1994 and just 301 in 1995 (the lowest number for a single year since the disease became reportable in 1912). However, it is still a killer in developing countries, where more than one million deaths a year are recorded, especially among malnourished children with impaired immunity.

one case of measles confers lifelong immunity; the vaccine also confers lifelong immunity after two doses; anyone who received two doses of vaccine during childhood will not get measles.

Cause

The measles virus is spread by airborne droplets from nasal secretions. The incubation period is between nine and 11 days, and the patient is infectious from shortly after the beginning of this period until up to a week after symptoms have developed. Infants under six months of age rarely contract measles because they still harbor some immunity from their mothers.

The virus survives best in low humidity; it can survive in the air for several hours. It is so infectious that it is capable of traveling down a hall on air currents and into other rooms where healthy people are located, infecting them. It is also possible to contract the disease from touching bedding or towels touched by an infected person, or by directly touching secretions from a person's nose, mouth, eyes, or cough. The patient is most infectious right before the rash beings.

A milder form of the disease can occur among those who do not develop adequate immunity from just one dose of vaccine, who were immunized too early, or who had received an older, less effective variety of the vaccine. As their immunity wears off, these people become susceptible to measles.

Symptoms

About 10 days after the virus enters the body, symptoms of a high fever (up to 105°F) and general sick feeling begin. This is followed the next day by red, sore eyes, a stuffy nose, and cough. on the second day of fever, a rash of tiny white dots on a red base appears inside the mouth. After three or four days, a bright red splotchy rash will begin on the head and neck, spreading down to cover the entire body. The spots may be so numerous that they appear together as a large, reddened area. The rash begins to fade within three days and will disappear by six days. The fever will begin to drop on the second day of the rash, and the runny nose and sore eyes also lessen as the fever falls. The cough, however, may last for up to two weeks. Everyone with measles feels terrible, but babies and young children usually fare the worst, feeling much sicker than they would with a cold, the flu, or chicken pox.

A physician should be called immediately if any of the following signs appear:

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