Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Measles


Related Terms

  • Hard Measles
  • Nine-day Measles
  • Red Measles
  • Rubeola

Differential Diagnosis

Specialists

  • Dermatologist
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Neurologist

Comorbid Conditions

  • Compromised immune system
  • Malnutrition

Factors Influencing Duration

Severity of the illness is related to an increased recovery period. Adults tend to experience severe symptoms and thus may recover more slowly. Complications such as pneumonia or thrombocytopenia may lengthen recovery, and encephalitis can result in permanent disability. Individuals with a compromised immune system may experience severe complications and prolonged disability.

Medical Codes

ICD-9-CM:
055.0 - Postmeasles Encephalitis
055.1 - Postmeasles Pneumonia
055.2 - Postmeasles Otitis Media
055.71 - Measles keratoconjunctivitis; Measles keratitis
055.79 - Measles with Other Specified Complications, Other
055.8 - Measles with Unspecified Complication
055.9 - Rubeola; Measles without Mention of Complications

Overview

Measles (rubeola) is an extremely contagious viral infection caused by the measles virus (member of the genus Morbillivirus, family Paramyxoviridae). The hallmark symptoms are fever, cough, and rash. Measles is spread from person to person through airborne droplets that enter the air as the infected individual coughs or sneezes. After infection, the virus incubates for 7 to 14 days before symptoms emerge. The individual is contagious 2 to 4 days before the rash appears and remains contagious until the rash disappears. Although measles is primarily a disease of children, adults who are infected have a more severe disease. Infection results in life-long immunity.

Incidence and Prevalence: Measles was once common, occurring in epidemics every 2 to 3 years. Widespread immunization over the past 30 years has resulted in effectively eliminating endemic measles from the US (Chen). Although there are occasional outbreaks, they appear to be associated with measles imported into the US from abroad. Worldwide, the yearly number of measles cases in underdeveloped countries is estimated at about 30 million children, of which about 1 million die (Chen).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Immunization is extremely effective at preventing the disease. Those at greatest risk are individuals who have not been immunized, especially if they travel to developing countries with incomplete immunization programs.

Source: Medical Disability Advisor



Diagnosis

History: The incubation period is usually 7 to 14 days (Chen). Upon questioning, the individual or the individual's parent may be able to confirm prior exposure to an infected individual. The first symptoms to appear generally include high fever, a hacking dry cough, profuse nasal discharge (coryza), and red eyes (conjunctivitis). After 3 to 5 days, a mildly itchy, red rash appears. Usually starting on the face (at the hairline) or the sides of the neck and behind the ears, the rash spreads downward, covering the whole body. Patches of rash sometimes join to produce larger blotchy areas, especially above the shoulders. Individuals may also report diarrhea, muscle soreness (myalgia), a vague feeling of bodily discomfort (malaise), abnormal sensitivity to light (photophobia), vomiting, and abdominal pain. The rash begins to fade and the symptoms subside after 3 to 5 days.

Physical exam: The exam usually reveals rash, tiny bluish-white spots inside the mouth (Koplik spots), and fever.

Tests: The law requires that suspected cases of measles must be reported to local and state health departments. A blood sample should be drawn to test for IgM and IgG antibodies measured by the enzyme immunoassay (EIA). Although commercial antibody tests are available, this is the only test that the US Centers for Disease Control and Prevention (CDC) will accept for confirmation.

Source: Medical Disability Advisor



Treatment

Treatment is supportive and consists of bed rest and increased fluid intake. Other treatments are aimed at reducing symptoms. Individuals with photophobia may be kept in a darkened room. Paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce fever and pain; aspirin should be avoided in young children because of its association with Reye's syndrome. Antibiotics are not indicated unless needed to treat a secondary bacterial infection. Pregnant women exposed to measles are at higher risk of stillbirth, and immunocompromised individuals are at high risk of complications from measles; these individuals should therefore be given injections of immunoglobulin into the muscle after exposure to prevent the disease or to lessen its symptoms and duration. Measles vaccination may be given for the same purposes to non-immune individuals within 72 hours of a known exposure to the measles virus (post-exposure vaccination). In the US, most individuals are immunized with measles, mumps, and rubella (MMR) vaccine before the age of 2. Adverse reactions to vaccination are required by law to be reported to the CDC.

Source: Medical Disability Advisor



Prognosis

The vast majority of individuals will recover completely. Among the rare cases of encephalitis, about half will suffer permanent brain damage, and approximately 10% will die (Chen). Immunocompromised individuals are at much higher risk of mortality than otherwise healthy individuals.

Source: Medical Disability Advisor



Complications

Measles is usually uncomplicated and not serious. Individuals who are malnourished or immunocompromised are the most likely candidates for complications. Severe lung and neurologic complications occur in up to 80% of immunocompromised individuals with cancer or AIDS, and death related to these complications occurs in 40% to 70% of the afflicted. Infection with the measles virus may also suppress the immune response, which could cause reactivation of inactive (latent) infection such as tuberculosis. The most common complications are chest infections (pneumonia) and middle ear infections (otitis media), which usually occur 2 to 3 days after the rash appears. Individuals infected with measles are particularly susceptible to additional infection with bacteria called Streptococci. Blood platelet levels may drop to abnormally low levels (thrombocytopenia), resulting in a tendency to bruise and bleed easily, but this is rare.

Hemorrhagic measles, also called black measles, is a severe form of measles characterized by a dark-colored rash that is due to increased blood flow to the skin. Other complications may include inflammation of portions of the eye known as the conjunctiva and cornea (keratoconjunctivitis) that may lead to blindness, or a temporary inflammation of the liver (hepatitis). Young adults who were inadequately immunized may develop a hypersensitivity/allergic reaction to the measles virus; this reaction is called atypical measles syndrome and can be severe. Inflammation of the brain (encephalitis) occurs in 1 in 2,000 measles cases, and about 10% of those cases are fatal (Chen); the seizures and coma that follow may lead to mental deterioration, imbalance when walking (ataxia), or death. Seizures are common with measles, however, and are not necessarily related to encephalitis.

Rarely (about 1 in a million), a progressive brain disorder (subacute sclerosing panencephalitis) may develop months to years after the acute illness. Subacute sclerosing panencephalitis (characterized by seizures, muscle jerking, and mental deterioration) is not treatable and is usually fatal.

Measles during pregnancy results in stillbirth in about one-fifth of cases; other complications include preterm labor and birth, low birth weight, pneumonitis, and hepatitis.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Bed rest is an important aspect of recovery. Because the recovery period can be long, extended sick leave may be required. Return to work prior to complete recovery is not advised. Adult recovery time is almost always longer than recovery time in children.

Risk: In the infectious phase, individuals should stay home to avoid spread of the disease. Risk of measles infection may be eradicated by immunization against the disease. In an immunocompromised individual, working with heavy public contact, with indigent or incarcerated populations, or in health care settings may place the individual at increased risk of further or recurrent infection. A n individual with symptom onset within the last 24 to 48 hours may be at a more infectious state and should avoid working in settings with immunocompromised individuals. Some risk can be mitigated by frequent hand washing, gloves, or masks.

Capacity: Capacity will be initially reduced upon return to work until the individual fully regains his or her strength after prolonged bed rest. Once recovery is complete, work activities may become therapeutic to help resolve deconditioning and restore the individual to full strength.

Tolerance: Tolerance of symptoms during recovery is dependent on the severity of the disease and whether the individual developed photophobia and a high fever during the worst period of illness. Once the infection has resolved and the individual returns to work, tolerance is typically not an issue.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual have past immunization against measles?
  • Had individual traveled outside the US to areas where measles is endemic?
  • Was there a recent history of exposure to the measles virus?
  • Did individual present with symptoms of fever, cough, and a skin rash?
  • Has diagnosis of measles been confirmed (usually by a blood test)?
  • Have other diseases with similar symptoms been ruled out (e.g., rubella, secondary syphilis, scarlet fever, Kawasaki's disease, Rocky Mountain spotted fever, secondary syphilis, and drug reactions)?

Regarding treatment:

  • Was conservative treatment with bed rest, fluids, and antipyretics effective in reducing symptoms?
  • Was immunoglobulin administered to exposed individuals who have high-risk of severe measles (pregnant or immunocompromised)?

Regarding prognosis:

  • Did individual suffer complications of measles infection that may be delaying or preventing recovery (e.g., pneumonia, thrombocytopenia, or encephalitis)?
  • Is individual obeying the doctor's orders (especially those related to rest and fluid intake)?
  • Does individual have conditions such as pregnancy or immune suppression that could prolong recovery?

Source: Medical Disability Advisor



References

Cited

Chen, Selina S. P. "Measles." eMedicine. Eds. Russell W. Steele, et al. 6 Jun. 2014. Medscape. 27 Sep. 2014 <http://emedicine.medscape.com/article/966220-overview>.

Source: Medical Disability Advisor






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