Measles

Measles is a highly contagious viral infection that typically causes a skin rash and fevers, mostly in young children. It has the potential to cause serious complications, including death. However, due to vaccination programs, the number of measles infections and deaths have dramatically reduced. Unfortunately, measles still kills over 100,000 people a year, mainly in developing countries where vaccination rates are below 85%.

Causes

Measles is caused by the measles virus, also known as the rubella virus (not to be confused with rubella, a different disease altogether).

The virus is highly contagious, meaning that an unvaccinated person who has not been infected with the measles virus before has a high chance of being infected if they are in the presence of an infected person or share household or office items with an infected person. The virus can remain infectious outside of the body for two hours.

When an infected person sneezes or coughs, the virus spreads via millions of tiny droplets, each containing many viruses that are spread into the air. If a droplet enters your nose or mouth, you may then be infected. The droplets can also collect on surfaces and objects, so you can also catch the virus by touching an infected surface and then touching your nose or mouth area.

An infected person can spread the measles virus in the air via sneezes or coughs. 

Signs and symptoms

The symptoms of measles usually appear about 7-12 days after the infection.

Early symptoms

Early symptoms of measles resemble cold symptoms. They can include:

• Mild to moderate fever;
• Dry, hacking cough;
• Sore throat;
• Sneezing;
• Runny nose;
• Reddish, watery eyes that are sensitive to light, and;
• Malaise - a feeling of weakness and discomfort.

Later symptoms

• Koplik's spots - small white spots inside the mouth appear about 2-3 days after the start of the early symptoms and normally disappear after a day or so;
• A reddish, blotchy rash appears about 3-5 days after the start of the early symptoms. The rash usually starts on the face and behind the ears and gradually spreads downwards to the whole of the body, and;
• Along with the rash, fever can increase in severity to above 104°F (40°C).

The symptoms of measles normally last about 7-10 days, then go away naturally unless there are complications. An infected person is contagious from around five days before the appearance of the rash.

A reddish, blotchy rash is one of the later symptoms of measles. 

Methods for diagnosis

Measles can be diagnosed based upon the symptoms and signs, especially the distinctive rash. Blood tests (checking for the presence of the virus and for antibodies against it) can confirm the diagnosis. A viral culture can be done to find the specific type of virus, which is important for tracking outbreaks in the community.

Types of treatment

There is no specific treatment for measles. Treating a measles patient focuses on relieving some of the symptoms while the patient's immune system handles the disease. Some measures that can be taken to ease symptoms are:

• Rest;
• Medicines to reduce fever and coughing and ease throat soreness;
• Drinking plenty of fluids to prevent dehydration, especially if diarrhea occurs (see below);
• Relieving eye dryness by dabbing them gently with moist cotton wool, and;
• Reducing eye strain by minimizing exposure to light.

There is extensive evidence to suggest that malnutrition in children, especially vitamin A deficiency, results in more severe disease and increased risk of death. Treating an associated vitamin A deficiency with vitamin A supplements can result in better outcomes and reduced risk of death.

For a person who has measles or is at a high risk of infection, a doctor may recommend treatment with immunoglobulin G - antibodies against measles.

Potential complications

Complications of measles appear in 30-40% of cases. Some of the complications of measles include:

Diarrhea

Diarrhea can appear in 8% of measles cases.

Pneumonia

A bacterial or viral infection of the lungs, pneumonia appears in about 6% of all measles cases and is responsible for most measles-related deaths, particularly among children.

Stomatitis

Stomatitis is the formation of mouth sores. These can make eating and drinking painful and uncomfortable.

Earache

Middle ear infection appears in 7% of all measles cases and can cause acute earache and discomfort.

Keratoconjunctivitis

This is an inflammation of the eyes (specifically the cornea and conjunctiva) that can lead to blindness.

Pregnancy complications

If a woman is infected with measles during pregnancy, serious complications can arise for both the mother and the baby. Increased fetal and maternal death, maternal pneumonia and encephalitis (see below), preterm birth, miscarriage and lower birth weight are among some of the many potential complications.

Encephalitis

This is inflammation of the brain. A rare but serious complication of measles, it occurs in about one out of 1,000 cases. It is more common in adults and carries a high risk of death or significant brain damage.

Late-onset complications

In rare cases, some complications of measles can appear months or years after infection. Measles inclusion body encephalitis (MIBE) and sub acute sclerosing panencephalitis (SSPE) are two serious late-onset complications. They affect the central nervous system and can be fatal.

Prognosis

If no complications ensue, measles clears up on its own after 7-10 days.

Prevention

Two doses of the measles vaccine are routinely recommended in children to reduce their risk of developing measles. The first dose is usually given at 12 months of age, as part of the measles, mumps, rubella (MMR) vaccine, and the second dose is given at 18 months as part of the measles, mumps, rubella, varicella (MMRV) combined vaccine. It can also be given to children over nine months old shortly after they have been exposed to the measles virus, but before symptoms of the disease begin to appear. Babies younger than nine months may be offered immunoglobulin G if exposed to the virus, depending on their individual situation.

In the case of an outbreak of measles in a community, infected and unvaccinated children may be asked to stay home and not come to day care or school until the situation improves.

Precaution

In recent years, some developed countries have seen a drop in vaccination rates. As a result, measles is making something of a comeback in the developed world, with tens of thousands of new cases reported annually in Europe and hundreds a year in the United States. Recent US cases are mostly due to unvaccinated people bringing measles with them from travel abroad.