Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
            demiological determinants 
3. Environmental factors
• Epidemics of measles are common during winter and early spring
(Jan. to April).
• Population density and movement do affect epidemicity.
• The lower the socio-economic conditions, the lower the average age
at which children are attacked.
Dr
. Abdulsalam Al-Akel 
29
Who is at risk?
a. Poverty and poor:
• The overwhelming majority (more than 95%) of measles deaths occur 
in countries with low per capita incomes and weak health 
infrastructures.
b. Conflict:
• Measles outbreaks can be particularly deadly in countries 
experiencing or recovering from a natural disaster or conflict. 
Dr
. Abdulsalam Al-Akel 
30
Who is at risk?
c. Health System:
• Damaged health infrastructure and health services interrupts routine 
immunization.
d. Overcrowding in residential camps greatly increases the risk of 
infection.
Dr
. Abdulsalam Al-Akel 
31
Who is at risk?
1. Unvaccinated young children are at highest risk of measles and its 
complications, including death. 
2. Unvaccinated pregnant women. 
3. Any non-immune person can become infected.
• Any one not been vaccinated
• Any one who was vaccinated but did not develop immunity,
4. Infection still common and often fatal in developing countries - 
particularly in parts of Africa and Asia.
Dr
. Abdulsalam Al-Akel 
32
Transmission
• Measles is one of the world’s most contagious diseases. 
• Transmission occurs directly from person to person mainly by droplet
infection and droplet nuclei (spread by coughing and sneezing).
• Close personal contact or direct contact with infected nasal or throat 
secretions.
• The virus remains active and contagious in the air or on infected 
surfaces for up to 2 hours. 
Dr
. Abdulsalam Al-Akel 
33
Transmission
• It can be transmitted by an infected person from 4 days prior to the onset 
of the rash to 4 days after the rash erupts.
• The portal of entry is the respiratory tract.
• Infection through conjunctiva is likely.
• Recipients of measles vaccine are not contagious to others.
• Measles outbreaks can result in epidemics that cause many deaths.
• These deaths, especially occurring, among young, malnourished children. 
Dr
. Abdulsalam Al-Akel 
34
Measles Clinical Features
Incubation period is commonly:
• 10 days from exposure to onset of fever
• 14 days to appearance of rash.
Dr
. Abdulsalam Al-Akel 
35
Measles Clinical Features
There are three stages in the natural history of measles:
1. PRODROMAL STAGE (or pre-eruptive stage)
• It begins 10 days after infection and lasts until day 14 (last 2 to 4 
days).
•
Stepwise increase in fever to 103°F–105°F.
•
Cough, coryza with sneezing and nasal discharge
•
Redness of the eyes, lacrimation, and conjunctivitis
•
Koplik spots (on mucous membranes).
Dr
. Abdulsalam Al-Akel 
36
Measles Clinical Features
Koplik' s spots (table salt like crystals)
•
appear on the buccal mucosa opposite the first and second
lower molars
•
one day or two before the appearance of the rash.
•
small, bluish-white 

            Quiz: