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87-679: Measles (probably from Middle Dutch or Middle High German masel(e) ("blemish, blood blister ")) is a highly contagious, vaccine-preventable infectious disease caused by measles virus . Other names include morbilli , rubeola , red measles , and English measles . Both rubella , also known as German measles , and roseola are different diseases caused by unrelated viruses. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever , often greater than 40 °C (104 °F), cough, runny nose , and inflamed eyes . Small white spots known as Koplik's spots may form inside

174-416: A stem cell transplant , alkylating agents , or corticosteroid therapy , regardless of immunization status; travel to areas where measles commonly occurs or contact with travelers from such an area; and the loss of passive, inherited antibodies before the age of routine immunization. Once the measles virus gets onto the mucosa , it infects the epithelial cells in the trachea or bronchi. Measles virus uses

261-580: A billion people. Vaccination rates have been high enough to make measles relatively uncommon. Adverse reactions to vaccination are rare, with fever and pain at the injection site being the most common. Life-threatening adverse reactions occur in less than one per million vaccinations (<0.0001%). In developing countries where measles is common , the World Health Organization (WHO) recommends two doses of vaccine be given, at six and nine months of age. The vaccine should be given whether

348-418: A certain ruler also created a sphere of linguistic influence, with the language within the area becoming more homogeneous. Following, more or less, the political divisions of the time, several large dialect groups can be distinguished. However, the borders between them were not strong, and a dialect continuum existed between them, with spoken varieties near the edges of each dialect area showing more features of

435-447: A correlation between children who take aspirin and the development of Reye syndrome . The use of vitamin A during treatment is recommended to decrease the risk of blindness; however, it does not prevent or cure the disease. A systematic review of trials into its use found no reduction in overall mortality, but two doses (200,000 IU ) of vitamin A was shown to reduce mortality for measles in children younger than two years of age. It

522-434: A decrease in immunization. Symptoms typically begin 10–14 days after exposure. The classic symptoms include a four-day fever (the four Ds) and the three Cs— cough , coryza (head cold, fever, sneezing), and conjunctivitis (red eyes)—along with a maculopapular rash . Fever is common and typically lasts for about one week; the fever seen with measles is often as high as 40 °C (104 °F). Koplik's spots seen inside

609-749: A form of modified measles. Modified measles is characterized by a prolonged incubation period , milder, and less characteristic symptoms (sparse and discrete rash of short duration). Complications of measles are relatively common, ranging from mild ones such as diarrhea to serious ones such as pneumonia (either direct viral pneumonia or secondary bacterial pneumonia ), laryngotracheobronchitis (croup) (either direct viral laryngotracheobronchitis or secondary bacterial bronchitis), otitis media , acute brain inflammation , corneal ulceration (leading to corneal scarring ), and in about 1 in 600 unvaccinated infants under 15 months while more rarely in older children and adults, subacute sclerosing panencephalitis , which

696-519: A labial or velar consonant. Some former class 1 weak verbs retained so-called Rückumlaut . These verbs had undergone umlaut in the present tense, but the umlaut-triggering vowel was syncopated in the past tense already in Old Dutch, preventing umlaut from taking hold there. Thus, senden had the first- and third-person singular past tense sande . These verbs tended to be reinterpreted as strong verbs in later Middle Dutch; sande itself gave rise to

783-687: A measles outbreak in the German capital of Berlin resulted in at least 782 cases. In 2017, numbers continued to increase in Europe to 21,315 cases, with 35 deaths. In preliminary figures for 2018, reported cases in the region increased 3-fold to 82,596 in 47 countries, with 72 deaths; Ukraine had the most cases (53,218), with the highest incidence rates being in Ukraine (1209 cases per million), Serbia (579), Georgia (564) and Albania (500). The previous year (2017) saw an estimated measles vaccine coverage of 95% for

870-407: A newly made virus. Within days, the measles virus spreads through local tissue and is picked up by dendritic cells and alveolar macrophages , and carried from that local tissue in the lungs to the local lymph nodes. From there it continues to spread, eventually getting into the blood and spreading to more lung tissue, as well as other organs like the intestines and the brain. Functional impairment of

957-412: A protein on its surface called hemagglutinin (H protein), to bind to a target receptor on the host cell, which could be CD46 , which is expressed on all nucleated human cells, CD150 , aka signaling lymphocyte activation molecule or SLAM, which is found on immune cells like B or T cells, and antigen-presenting cells, or nectin-4 , a cellular adhesion molecule. Once bound, the fusion, or F protein helps

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1044-438: A result of large doses of niacin or no-flush niacin (2000 – 2500 mg), used for the management of low HDL cholesterol. This type of rash can also be a symptom of Sea bather's eruption . This stinging, pruritic, maculopapular rash affects swimmers in some Atlantic locales (e.g., Florida, Caribbean, Long Island). It is caused by hypersensitivity to stings from the larvae of the sea anemone (e.g., Edwardsiella lineate ) or

1131-469: A second dose of the MMR vaccine is given, it will provide immunity in 99% of children. There is no evidence that the measles vaccine virus can be transmitted to other persons. There is no specific antiviral treatment if measles develops. Instead the medications are generally aimed at treating superinfections, maintaining good hydration with adequate fluids, and pain relief. Some groups, like young children and

1218-433: A word could be found spelled differently in different occurrences within the same text. There was the matter of personal taste, and many writers thought it was more aesthetic to follow French or Latin practice, leading to sometimes rather unusual spellings. The spelling was generally phonetic, and words were written based on how they were spoken rather than based on underlying phonemes or morphology. Final-obstruent devoicing

1305-403: A year, primarily in the developing areas of Africa and Asia. It is one of the leading vaccine-preventable disease causes of death. In 1980, 2.6 million people died from measles, and in 1990, 545,000 died due to the disease; by 2014, global vaccination programs had reduced the number of deaths from measles to 73,000. Despite these trends, rates of disease and deaths increased from 2017 to 2019 due to

1392-477: Is also described as erythematous , or red. This type of rash is common in several diseases and medical conditions, including scarlet fever , measles , Ebola virus disease , rubella , HIV , secondary syphilis (Congenital syphilis, which is asymptomatic, the newborn may present this type of rash), erythrovirus ( parvovirus B19 ), chikungunya (alphavirus), zika , smallpox (which has been eradicated), varicella (when vaccinated persons exhibit symptoms from

1479-608: Is also recommended for children. Among cases reported in the U.S. between 1985 and 1992, death occurred in only 0.2% of cases, but may be up to 10% in people with malnutrition . Most of those who die from the infection are less than five years old. The measles vaccine is effective at preventing the disease, is exceptionally safe, and is often delivered in combination with other vaccines. Vaccination resulted in an 80% decrease in deaths from measles between 2000 and 2017, with about 85% of children worldwide having received their first dose as of 2017. Measles affects about 20 million people

1566-428: Is caused by the measles virus , a single-stranded, negative-sense , enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae . The virus is highly contagious and is spread by coughing and sneezing via close personal contact or direct contact with secretions. Measles is the most contagious virus known. It remains infective for up to two hours in that airspace or nearby surfaces. Measles

1653-600: Is classically described as a generalized red maculopapular rash that begins several days after the fever starts. It starts on the back of the ears and, after a few hours, spreads to the head and neck before spreading to cover most of the body. The measles rash appears two to four days after the initial symptoms and lasts for up to eight days. The rash is said to "stain", changing color from red to dark brown, before disappearing. Overall, measles usually resolves after about three weeks. People who have been vaccinated against measles but have incomplete protective immunity may experience

1740-434: Is extremely infectious and its continued circulation in a community depends on the generation of susceptible hosts by birth of children. In communities that generate insufficient new hosts the disease will die out. This concept was first recognized in measles by Bartlett in 1957, who referred to the minimum number supporting measles as the critical community size (CCS). Analysis of outbreaks in island communities suggested that

1827-486: Is important for public health efforts. Measles is not known to occur in other animals. Once a person has become infected, no specific treatment is available, although supportive care may improve outcomes. Such care may include oral rehydration solution (slightly sweet and salty fluids), healthy food, and medications to control the fever. Antibiotics should be prescribed if secondary bacterial infections such as ear infections or pneumonia occur. Vitamin A supplementation

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1914-448: Is not ideal, as saliva contains many other fluids and proteins which may make it difficult to collect samples and detect measles antibodies. Saliva also contains 800 times fewer antibodies than blood samples do, which makes salivary testing additionally difficult. Positive contact with other people known to have measles adds evidence to the diagnosis. Mothers who are immune to measles pass antibodies to their children while they are still in

2001-779: Is progressive and eventually lethal. In addition, measles can suppress the immune system for weeks to months, and this can contribute to bacterial superinfections such as otitis media and bacterial pneumonia. Two months after recovery there is a 11–73% decrease in the number of antibodies against other bacteria and viruses. The death rate in the 1920s was around 30% for measles pneumonia. People who are at high risk for complications are infants and children aged less than 5 years; adults aged over 20 years; pregnant women; people with compromised immune systems, such as from leukemia , HIV infection or innate immunodeficiency; and those who are malnourished or have vitamin A deficiency . Complications are usually more severe in adults. Between 1987 and 2000,

2088-461: Is recommended that children be immunized against measles at 12 months, generally as part of a three-part MMR vaccine (measles, mumps , and rubella ). The vaccine is generally not given before this age because such infants respond inadequately to the vaccine due to an immature immune system. A second dose of the vaccine is usually given to children between the ages of four and five, to increase rates of immunity. Measles vaccines have been given to over

2175-474: Is so contagious that if one person has it, 90% of non-immune people who have close contact with them (e.g., household members) will also become infected. Humans are the only natural hosts of the virus, and no other animal reservoirs are known to exist, although mountain gorillas are believed to be susceptible to the disease. Risk factors for measles virus infection include immunodeficiency caused by HIV/AIDS , immunosuppression following receipt of an organ or

2262-442: Is the most common fatal complication of measles infection and accounts for 56–86% of measles-related deaths. Possible consequences of measles virus infection include laryngotracheobronchitis , sensorineural hearing loss , and—in about 1 in 10,000 to 1 in 300,000 cases— panencephalitis , which is usually fatal. Acute measles encephalitis is another serious risk of measles virus infection. It typically occurs two days to one week after

2349-439: Is unclear if zinc supplementation in children with measles affects outcomes as it has not been sufficiently studied. There are no adequate studies on whether Chinese medicinal herbs are effective. Most people survive measles, though in some cases, complications may occur. About 1 in 4 individuals will be hospitalized and 1–2 in 1,000 will die. Complications are more likely in children under age 5 and adults over age 20. Pneumonia

2436-568: Is unclear. The following can be said: The vowels /eɛ̯/ , /øœ̯/ and /oɔ̯/ , termed "sharp-long" and denoted with a circumflex ê ô , developed from Old Dutch long vowels. The opening diphthong pronunciation was probably widespread, and perhaps once universal, as it is nowadays still found in both West Flemish and in Limburgish, at opposite ends of the Middle Dutch language area. In the general area in between, including standard Dutch,

2523-962: The American Red Cross , the United States CDC , the United Nations Foundation , UNICEF and the WHO. Globally, measles fell 60% from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Estimates for 2008 indicate deaths fell further to 164,000 globally, with 77% of the remaining measles deaths in 2008 occurring within the Southeast Asian region. There were 142,300 measles related deaths globally in 2018, of which most cases were reported from African and eastern Mediterranean regions. These estimates were slightly higher than that of 2017, when 124,000 deaths were reported due to measles infection globally. In 2000,

2610-466: The reverse transcription polymerase chain reaction assay. This method is particularly useful to confirm cases when the IgM antibodies results are inconclusive. For people unable to have their blood drawn , saliva can be collected for salivary measles-specific IgA testing. Salivary tests used to diagnose measles involve collecting a saliva sample and testing for the presence of measles antibodies. This method

2697-593: The 13th century. Its characteristics are: Hollandic was spoken in the County of Holland . It was less influential during most of the Middle Ages but became more so in the 16th century during the "Hollandic expansion", during which the Eighty Years' War took place in the south. It shows the following properties: Limburgish was spoken by the people in the provinces of modern Dutch and Belgian Limburg . It

Measles - Misplaced Pages Continue

2784-464: The CCS for measles is around 250,000. To achieve herd immunity , more than 95% of the community must be vaccinated due to the ease with which measles is transmitted from person to person. In 2011, the WHO estimated that 158,000 deaths were caused by measles. This is down from 630,000 deaths in 1990. As of 2018, measles remains a leading cause of vaccine-preventable deaths in the world. In developed countries

2871-401: The Middle Dutch period. The consonants of Middle Dutch differed little from those of Old Dutch. The most prominent change is the loss of dental fricatives. In addition the sound [z] was phonemicised during this period, judging from loanwords that retain [s] to this day. For descriptions of the sounds and definitions of the terms, follow the links on the headings. Notes: Most notable in

2958-408: The Middle Dutch period. A new second person plural pronoun was created by contraction of gij/jij and lui ('people') forming gullie/jullie (literally, 'you people'). Note: There are several other forms. Definite Article ( die , dat = the) Middle Dutch mostly retained the Old Dutch verb system. Like all Germanic languages, it distinguished strong , weak and preterite-present verbs as

3045-467: The Middle Dutch vowel system, when compared to Old Dutch, is the appearance of phonemic rounded front vowels, and the merger of all unstressed short vowels. Long vowels and diphthongs cannot be clearly distinguished in Middle Dutch, as many long vowels had or developed a diphthongal quality, while existing diphthongs could also develop into monophthongs. Sometimes, this occurred only in restricted dialects, other developments were widespread. Many details of

3132-624: The Old Dutch long ā , and "soft-long" ā being the result of lengthening. These two vowels were distinguished only in Limburgish and Low Rhenish at the eastern end, and in western Flemish and coastal Hollandic on the western end. The relative backness of the two vowels was opposite in the two areas that distinguished them. The closing diphthong /ɛi̯/ remained from the corresponding Old Dutch diphthong. It occurred primarily in umlauting environments, with /eɛ̯/ appearing otherwise. Some dialects, particularly further west, had /eɛ̯/ in all environments (thus cleene next to cleine ). Limburgish preserved

3219-465: The WHO established the Global Measles and Rubella Laboratory Network (GMRLN) to provide laboratory surveillance for measles, rubella , and congenital rubella syndrome . Data from 2016 to 2018 show that the most frequently detected measles virus genotypes are decreasing, suggesting that increasing global population immunity has decreased the number of chains of transmission. Cases reported in

3306-471: The WHO. In November 2024, the WHO and CDC reported that that measles cases increased by 20% last year, primarily due to insufficient vaccine coverage in the world’s poorest and conflict-affected regions. Nearly half of the major outbreaks occurred in Africa, where deaths rose by 37%, the agencies noted. In 2023, approximately 10.3 million cases of the highly contagious disease were reported, up from 8.65 million

3393-630: The age of 5 years. In February 2024, the World Health Organization said more than half of the world was at risk of a measles outbreak due to Covid-19 pandemic-related disruptions in that month. All the world regions have reported such outbreaks with the exception of the Americas , though these could still be expected to become hotspots in the future. Death rates during the outbreaks tend to be higher among poorer countries but middle income nations are also heavily impacted, according to

3480-443: The brain may occur. Measles is an airborne disease which spreads easily from one person to the next through the coughs and sneezes of infected people. It may also be spread through direct contact with mouth or nasal secretions . It is extremely contagious: nine out of ten people who are not immune and share living space with an infected person will be infected. Furthermore, measles's reproductive number estimates vary beyond

3567-759: The case fatality rate across the United States was three deaths per 1,000 cases attributable to measles, or 0.3%. In underdeveloped nations with high rates of malnutrition and poor healthcare , fatality rates have been as high as 28%. In immunocompromised persons (e.g., people with AIDS ) the fatality rate is approximately 30%. Even in previously healthy children, measles can cause serious illness requiring hospitalization. One out of every 1,000 measles cases progresses to acute encephalitis , which often results in permanent brain damage. One to three out of every 1,000 children who become infected with measles will die from respiratory and neurological complications. Measles

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3654-472: The child is HIV-infected or not. The vaccine is less effective in HIV-infected infants than in the general population, but early treatment with antiretroviral drugs can increase its effectiveness. Measles vaccination programs are often used to deliver other child health interventions as well, such as bed nets to protect against malaria , antiparasite medicine and vitamin A supplements, and so contribute to

3741-413: The dative singular, a remnant of the late Old Dutch inflection. In some rare occasions, the genitive singular was also endingless. Some nouns ended in -e in the singular also; these were primarily former ja-stems, which were masculine or neuter. A few were former i-stems with short stems. Nouns of this type tended to be drawn into the weak inflection by analogy. The following table shows the inflection of

3828-499: The diphthong wherever it was preserved in High German. The closing diphthong /ɔu̯/ has two different origins. In the vast majority of the Middle Dutch area, it developed through l-vocalization from older /ol/ and /al/ followed by a dental consonant. In the eastern area, Limburg in particular, it was a remnant of the older diphthong as in High German, which had developed into /oɔ̯/ elsewhere. L-vocalization occurred only in

3915-492: The disease was declared eliminated from the Americas in 2016. However, there were cases again in 2017, 2018, 2019, and 2020 in this region. In the United States, measles affected approximately 3,000 people per million in the 1960s before the vaccine was available. With consistent widespread childhood vaccination, this figure fell to 13 cases per million by the 1980s, and to about 1 case per million by 2000. Middle Dutch Several phonological changes occurred leading up to

4002-430: The distinction was mostly lost. Class 3, which retained a clear distinction that did not rely on vowel length, was levelled in favour of the o of the plural. In classes with a lengthened vowel in the present, the singular imperative often appears with a short vowel instead, e.g. les , drach . An alternative form, with final -e by analogy with the weak verbs, also occurs. The eastern dialects occasionally show i in

4089-436: The exact phonetics are uncertain, and seemed to have differed by dialect. The overall system is clear, however, as almost all the vowels remain distinct in modern Limburgish: /iː/ , /iə̯/ , /eɛ̯/ , /eː/ and /aː/ appear in modern Limburgish as /iː/ , /eː/ , /iə̯/ , /æː/ and /aː/ respectively. The vowels /ie̯/ , /yø̯/ and /uo̯/ developed from Old Dutch opening diphthongs, but their exact character in Middle Dutch

4176-536: The first dose and 90% for the second dose in the region, the latter figure being the highest-ever estimated second-dose coverage. In 2019, the United Kingdom, Albania, the Czech Republic, and Greece lost their measles-free status due to ongoing and prolonged spread of the disease in these countries. In the first 6 months of 2019, 90,000 cases occurred in Europe. As a result of widespread vaccination,

4263-465: The first three months of 2019, were 300% higher than in the first three months of 2018, with outbreaks in every region of the world, even in countries with high overall vaccination coverage where it spread among clusters of unvaccinated people. The numbers of reported cases as of mid-November is over 413,000 globally, with an additional 250,000 cases in DRC (as reported through their national system), similar to

4350-454: The former ja-stems, had an -e even in the strong and copular form, e.g. die vrouwe is clein e "the lady is small". Middle Dutch pronouns differed little from their modern counterparts. The main differences were in the second person with the development of a T-V distinction . The second-person plural pronoun ghi slowly gained use as a respectful second-person singular form. The original singular pronoun du gradually fell out of use during

4437-428: The frequently cited range of 12 to 18. The NIH quote this 2017 paper saying: "[a] review in 2017 identified feasible measles R 0 values of 3.7–203.3". People are infectious to others from four days before to four days after the start of the rash. While often regarded as a childhood illness, it can affect people of any age. Most people do not get the disease more than once. Testing for the measles virus in suspected cases

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4524-515: The immune system, which can cause deaths from other diseases. Suppression of the immune system by measles lasts about two years and has been epidemiologically implicated in up to 90% of childhood deaths in third world countries, and historically may have caused rather more deaths in the United States, the UK and Denmark than were directly caused by measles. Although the measles vaccine contains an attenuated strain, it does not deplete immune memory. Measles

4611-616: The increasing trends of infection reported in the earlier months of 2019, compared to 2018. In 2019, the total number of cases worldwide climbed to 869,770. The number of cases reported for 2020 is lower compare to 2019. According to the WHO, the COVID-19 pandemic hindered vaccination campaigns in at least 68 countries, including in countries that were experiencing outbreaks, which caused increased risk of additional cases. In 2022, there were an estimated 136,000 measles deaths globally, mostly among unvaccinated or under vaccinated children under

4698-791: The infected dendritic cells by the measles virus is thought to contribute to measles-induced immunosuppression. Typically, clinical diagnosis begins with the onset of fever and malaise about 10 days after exposure to the measles virus, followed by the emergence of cough , coryza , and conjunctivitis that worsen in severity over 4 days of appearing. Observation of Koplik's spots is also diagnostic. Other possible condition that can result in these symptoms include parvovirus , dengue fever , Kawasaki disease , and scarlet fever . Laboratory confirmation is, however, strongly recommended. Laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or detection of measles virus RNA from throat, nasal or urine specimen by using

4785-524: The language. The general practice was to write long vowels with a single letter in an open syllable and with two letters in a closed syllable. Which two letters were used varied among texts. Some texts, especially those in the east, do not do so and write long vowels with a single letter in all cases (as is the predominant rule in modern German). Middle Dutch nouns inflected for number as well as case . The weakening of unstressed syllables merged many different Old Dutch classes of nominal declension. The result

4872-481: The masculine noun dach "day", feminine dâet "deed" and neuter brôot "bread". Weak nouns were characterised by the ending -en throughout the plural. The singular ended in -e . The following table shows the inflection of the masculine noun bōge "bow, arc". Middle Dutch adjectives inflected according to the gender, case and number of the noun they modified. The Germanic distinction between strong and weak, or indefinite and definite inflection,

4959-419: The measles rash breaks out and begins with very high fever, severe headache, convulsions and altered mentation. A person with measles encephalitis may become comatose , and death or brain injury may occur. For people having had measles, it is rare to ever have a symptomatic reinfection. The measles virus can deplete previously acquired immune memory by killing cells that make antibodies, and thus weakens

5046-602: The measles vaccine and autism ; this incorrect concern has reduced the rate of vaccination and increased the number of cases of measles where immunization rates became too low to maintain herd immunity . Additionally, there have been false claims that measles infection protects against cancer. Administration of the MMR vaccine may prevent measles after exposure to the virus (post-exposure prophylaxis). Post-exposure prophylaxis guidelines are specific to jurisdiction and population. Passive immunization against measles by an intramuscular injection of antibodies could be effective up to

5133-414: The modern zond , mirroring strong class 3. Maculopapular rash A maculopapular rash is a type of rash characterized by a flat, red area on the skin that is covered with small confluent bumps. It may only appear red in lighter-skinned people. The term "maculopapular" is a compound: macules are small, flat discolored spots on the surface of the skin; and papules are small, raised bumps. It

5220-469: The modern period in Limburgish, and the distinction between /ol/ and /al/ was preserved, being reflected as ów and aa respectively. Phonological changes that occurred during Middle Dutch: Middle Dutch was not a single homogeneous language. The language differed by area, with different areas having a different pronunciation and often using different vocabulary. The dialect areas were affected by political boundaries. The sphere of political influence of

5307-504: The modified form), heat rash , and sometimes in Dengue fever . It is also a common manifestation of a skin reaction to the antibiotic amoxicillin or chemotherapy drugs. Cutaneous infiltration of leukemic cells may also have this appearance. Maculopapular rash is seen in graft-versus-host disease (GVHD) developed after a hematopoietic stem cell transplant (bone marrow transplant), which can be seen within one week or several weeks after

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5394-462: The mortality rate is lower, for example in England and Wales from 2007 to 2017 death occurred between two and three cases out of 10,000. In children one to three cases out of every 1,000 die in the United States (0.1–0.2%). In populations with high levels of malnutrition and a lack of adequate healthcare, mortality can be as high as 10%. In cases with complications, the rate may rise to 20–30%. In 2012,

5481-401: The mouth are diagnostic for measles, but are temporary and therefore rarely seen. Koplik spots are small white spots that are commonly seen on the inside of the cheeks opposite the molars. They appear as "grains of salt on a reddish background." Recognizing these spots before a person reaches their maximum infectiousness can help reduce the spread of the disease. The characteristic measles rash

5568-444: The mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea (in 8% of cases), middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression . Less commonly seizures , blindness , or inflammation of

5655-472: The neighbouring areas. Middle Dutch has four major dialects groups: Flemish, Brabantic and Hollandic are known as West Franconian, while Limburgic is known as East Franconian (not to be confused with the High German dialect East Franconian ). In a finer classification there are: Brabantian was spoken primarily in the Duchy of Brabant . It was an influential dialect during most of the Middle Ages, during

5742-479: The number of deaths due to measles was 78% lower than in 2000 due to increased rates of immunization among UN member states . Even in countries where vaccination has been introduced, rates may remain high. Measles is a leading cause of vaccine-preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by a vaccination campaign led by partners in the Measles Initiative :

5829-428: The past participle. In classes 6 and 7, there was no distinction between the two different vowels of the past tense. In classes 4 and 5, the difference was primarily one of length, since ā and â were not distinguished in most dialects. The difference between ê and ē , and between ô and ō , found in classes 1 and 2, was a bit more robust, but also eventually waned in the development to modern Dutch. Consequently,

5916-701: The previous year. In England and Wales, though deaths from measles were uncommon, they averaged about 500 per year in the 1940s. Deaths diminished with the improvement of medical care in the 1950s but the incidence of the disease did not retreat until vaccination was introduced in the late 1960s. Wider coverage was achieved in the 1980s with the measles, mumps and rubella , MMR vaccine . In 2013–14, there were almost 10,000 cases in 30 European countries. Most cases occurred in unvaccinated individuals and over 90% of cases occurred in Germany, Italy, Netherlands, Romania, and United Kingdom. Between October 2014 and March 2015,

6003-549: The reduction of child deaths from other causes. The Advisory Committee on Immunization Practices (ACIP) recommends that all adult international travelers who do not have positive evidence of previous measles immunity receive two doses of MMR vaccine before traveling, although birth before 1957 is presumptive evidence of immunity. Those born in the United States before 1957 are likely to have been naturally infected with measles virus and generally need not be considered susceptible. There have been false claims of an association between

6090-411: The second- and third-person singular present indicative forms, instead of e . This is a remnant of older i-mutation in these forms. Umlaut is also sometimes found in the past subjunctive in the east. Middle Dutch retained weak verbs as the only productive class of verbs. While Old Dutch still had two different classes of weak verbs (and remnants of a third), this distinction was lost in Middle Dutch with

6177-401: The seventh day after exposure. Compared to no treatment, the risk of measles infection is reduced by 83%, and the risk of death by measles is reduced by 76%. However, the effectiveness of passive immunization in comparison to active measles vaccine is not clear. The MMR vaccine is 95% effective for preventing measles after one dose if the vaccine is given to a child who is 12 months or older; if

6264-412: The severely malnourished, are also given vitamin A , which acts as an immunomodulator that boosts the antibody responses to measles and decreases the risk of serious complications. Treatment is supportive , with ibuprofen or paracetamol (acetaminophen) to reduce fever and pain and, if required, a fast-acting medication to dilate the airways for cough. As for aspirin , some research has suggested

6351-483: The so-called "Brabantian expansion" in which the influence of Brabant was extended outwards into other areas. Compared to the other dialects, Brabantian was a kind of "middle ground" between the coastal areas on one hand, and the Rhineland and Limburg on the other. Brabantian Middle Dutch has the following characteristics compared to other dialects: Flemish, consisting today of West and East Flemish and Zeelandic ,

6438-533: The subjunctive became distinguished from the indicative only in the singular but was identical to it in the plural, and also in the past tense of weak verbs. That led to a gradual decline in the use of the subjunctive, and it has been all but lost entirely in modern Dutch. The seven classes of strong verb common to the Germanic languages were retained. The four principal parts were the present tense, first- and third-person singular past tense, remaining past tense, and

6525-406: The three main inflectional classes. Verbs were inflected in present and past tense, and in three moods: indicative, subjunctive and imperative. The weakening of unstressed vowels affected the distinction between the indicative and subjunctive moods, which had largely been determined by the vowel of the inflectional suffix in Old Dutch. In Middle Dutch, with all unstressed vowels merging into one,

6612-426: The transplant. In the case of GVHD, the maculopapular lesions may progress to a condition similar to toxic epidermal necrolysis . In addition, this is the type of rash that some patients presenting with Ebola virus hemorrhagic (EBO-Z) fever will reveal but can be hard to see on dark skin people. It is also seen in patients with Marburg hemorrhagic fever , a filovirus not unlike Ebola. This type of rash can be as

6699-435: The underlying phonemic value. However, by and large, spelling was phonetic, which is logical as people usually read texts out loud. Modern dictionaries tend to represent words in a normalised spelling to form a compromise between the variable spellings on one hand and to represent the sounds of the language consistently. Thus, normalised spellings attempt to be a general or "average" spelling but still being accurate and true to

6786-408: The virus fuse with the membrane and ultimately get inside the cell. As the virus is a single-stranded negative-sense RNA virus , it includes the enzyme RNA-dependent RNA polymerase (RdRp) which is used to transcribe its genome into a positive-sense mRNA strand. After entering a cell, it is ready to be translated into viral proteins, wrapped in the cell's lipid envelope, and sent out of the cell as

6873-608: The vowels merged with the "soft-long" vowels during the early modern Dutch period. The vowels /eː/ , /œː/ and /oː/ , termed "soft-long" and denoted with a macron ē ō , developed through the lengthening of Old Dutch short vowels in open syllables, but also frequently before /r/ . They were simple monophthongs in all Middle Dutch dialects, with the exception of western Flanders where /eː/ later developed into /ei̯/ . They might have been close-mid but also perhaps open-mid [ɛː] , [œː] and [ɔː] , as in modern Limburgish. There were two open vowels, with "sharp-long" â developed from

6960-465: The weakening of unstressed syllables. The past tense was formed with a suffix -ed- , which generally lost its e through syncope and thus came to be directly attached to the preceding stem. This triggered voicing assimilation, so that t appeared whenever the preceding stem ended in a voiceless consonant. This phenomenon remains in modern Dutch. Unsyncopated forms, which retain the fuller suffix -ed- , are sometimes found, especially with stems ending in

7047-437: The womb, especially if the mother acquired immunity through infection rather than vaccination. Such antibodies will usually give newborn infants some immunity against measles, but these antibodies are gradually lost over the course of the first nine months of life. Infants under one year of age whose maternal anti-measles antibodies have disappeared become susceptible to infection with the measles virus. In developed countries, it

7134-585: Was a general distinction between strong and weak nouns. Eventually even these started to become confused, with the strong and weak endings slowly beginning to merge into a single declension class by the beginning of the modern Dutch period. The strong nouns generally originated from the Old Dutch a-stem, i-stem and u-stem inflections. They mostly had a nominative singular with no ending, and a nominative plural in -e or, for some neuter nouns, with no ending. Most strong nouns were masculine or neuter. Feminines in this class were former i-stems, and could lack an ending in

7221-399: Was fairly minimal in Middle Dutch, appearing only in the masculine and neuter nominative singular. These forms received an -e ending when a definite word (demonstrative, article) preceded, and had no ending otherwise. Adjectives were uninflected when connected through a copula. Thus, even for feminine nouns, no ending appeared: die vrouwe is goet "the lady is good". Some adjectives, namely

7308-471: Was not clearly tied to one political area, instead being divided among various areas, including the Duchy of Limburg (which was south of modern Limburg). It was also the most divergent of the dialects. Kleverlandish ("Kleverlands") was spoken around the area of the Duchy of Cleves , around the Lower Rhine . It represented a transitional dialect between Limburgish and Middle Low German . Middle Dutch

7395-527: Was reflected in the spelling, and clitic pronouns and articles were frequently joined to the preceding or following word. Scribes wrote in their own dialect, and their spelling reflected the pronunciation of that particular scribe or of some prestige dialect by which the scribe was influenced. The modern Dutch word maagd (" maiden ") for example was sometimes written as maghet or maegt , but also meget , magt , maget , magd , and mecht . Some spellings, such as magd , reflect an early tendency to write

7482-490: Was spoken in the County of Flanders , northern parts of the County of Artois and areas around the towns of Calais and Boulogne-sur-Mer . Though due to their intermediary position between West Flemish and Brabantian , the East Flemish dialects have also been grouped with the latter. Flemish had been influential during the earlier Middle Ages (the "Flemish expansion") but lost prestige to the neighbouring Brabantian in

7569-515: Was written in the Latin alphabet , which was not designed for writing Middle Dutch so different scribes used different methods of representing the sounds of their language in writing. The traditions of neighbouring scribes and their languages led to a multitude of ways to write Middle Dutch. Consequently, spelling was not standardised but was highly variable and could differ by both time and place as various "trends" in spelling waxed and waned. Furthermore,

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