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Measles

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What is 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%. [1] [2]

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. 

Risk factors

Anyone can catch measles if they have not been vaccinated or previously infected. Children between 1-4 years of age are most at risk of catching measles.

Breastfed newborn babies are often protected against infection by antibodies they receive from their mother during pregnancy and through breastmilk. However, this protection gradually decreases throughout the first year of life.

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:

Later symptoms

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:

There is extensive evidence to suggest that malnutrition in children, especially vitamin A deficiency, results in more severe disease and increased risk of death. [3] 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. [2] [ 4] 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. [2] 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. [2]

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. [4] [5] Recent US cases are mostly due to unvaccinated people bringing measles with them from travel abroad.

References

  1. Global health observatory data repository. World Health Organisation. Accessed 3 July 2014 from link here
  2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.
  3. Hussey G.D. and Klein M. (1990) A randomized controlled trial of vitamin A in children with severe measles. New England Journal of Medicine 323:160–164.
  4. Measles cases and outbreaks. Centers for disease control and prevention. Accessed 3 July 2014 from link here
  5. Muscat M. Bang H. Wohlfahrt J. et al. (2009) Measles in Europe: an epidemiological assessment. The Lancet 373:383–389.
  6. White S.J. Boldt K.L. Holditch S.J. et al. (2012) Measles mumps and rubella. Clinical Obstetrics and Gynecology 55:550–559.
  7. Jakab Z Salisbury DM. Back to basics: the miracle and tragedy of measles vaccine. The Lancet. 2013 May 3;381(9876):14334. [Accessed 3rd July 2014].
  8. CDC - Measles: Cases and Outbreaks [Internet]. [cited 2014 Jul 3]. Available from: link here [Accessed 3rd July 2014].
  9. CDC - Measles: Homepage [Internet]. [cited 2014 Jun 27]. Available from: link here [Accessed 3rd July 2014].
  10. Agency HP. Confirmed cases of Measles Mumps and Rubella 1996-2013 [Internet]. [cited 2014 Jul 3]. Available from: link here [Accessed 3rd July 2014].
  11. Cáceres VM Strebel PM Sutter RW. Factors Determining Prevalence of Maternal Antibody to Measles Virus throughout Infancy: A Review. Clin Infect Dis. 2000 Jul 1;31(1):1109. [Accessed 3rd July 2014].
  12. Moss WJ Griffin DE. Measles. The Lancet. 2012 Jan 20;379(9811):15364. [Accessed 3rd July 2014].
  13. Department AG. Measles Elimination Achieved in Australia [Internet]. Australian Government Department; [cited 2014 Jul 3]. Available from: link here [Accessed 3rd July 2014].
  14. Choices NHS. Measles - NHS Choices [Internet]. 2014 [cited 2014 Jun 27]. Available from: link here [Accessed 3rd July 2014].
  15. Measles (rubeola) - Blue Book - Department of Health Victoria Australia [Internet]. [cited 2014 Jun 27]. Available from: link here [Accessed 3rd July 2014 and 12th August 2014].
  16. Sanderson K. Measles doesnt work in the way we thought. Nature News [Internet]. 2008 Jun 20 [cited 2014 Jul 3]; Available from: link here [Accessed 3rd July 2014].
  17. Measles Makes a Comeback | Viruses101 | Learn Science at Scitable [Internet]. [cited 2014 Jun 26]. Available from: link here [Accessed 3rd July 2014].
  18. Griffin DE Lin W-H Pan C-H. Measles virus immune control and persistence. FEMS Microbiology Reviews. 2012 May;36(3):64962. [Accessed 3rd July 2014].
  19. Measles mumps and rubella - Department of Health Victoria Australia [Internet]. [cited 2014 Jul 3]. Available from: link here [Accessed 3rd July 2014].
  20. White SJ Boldt KL Holditch SJ Poland GA Jacobson RM. Measles Mumps and Rubella. Clin Obstet Gynecol. 2012 Jun;55(2):5509. [Accessed 3rd July 2014].
  21. Number of deaths: WORLD - By cause [Internet]. [cited 2014 Jul 3]. Available from: link here [Accessed 3rd July 2014].
  22. PathInfo: Pathogen Information [Internet]. [cited 2014 Jun 27]. Available from: link here [Accessed 3rd July 2014].
  23. WHO | Measles [Internet]. WHO. [cited 2014 Jul 3]. Available from: link here [Accessed 3rd July 2014].
  24. The Cochrane Collaboration editor. Cochrane Database of Systematic Reviews: Reviews [Internet]. Chichester UK: John Wiley & Sons Ltd; 1996 [cited 2014 Jul 4]. Available from: link here [Accessed 3rd July 2014].
  25. The Cochrane Collaboration editor. Cochrane Database of Systematic Reviews: Reviews [Internet]. Chichester UK: John Wiley & Sons Ltd; 1996 [cited 2014 Jul 4]. Available from: link here [Accessed 3rd July 2014].
  26. Up to Date Clinical Presentation and link here measles measles?source=search_result&search=measles+in+pregnancy&selectedTitle=1%7E150 [accessed 12th August 2014].

10 Most frequently asked questions (FAQs)

What is 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.
What are the symptoms of measles?
Early symptoms of measles resemble cold symptoms. They can include mild to moderate fever; coughing; a sore throat; sneezing; a runny nose; reddish, watery eyes that are sensitive to light, and; malaise (a general feeling of unwellness). Two to three days after the early symptoms appear, Koplik's spots (small white spots inside the mouth) appear, and normally disappear after a day or so. A rash appears three to five days after the start of the early symptoms, starting behind the ears and spreading downwards to the rest of the body. Along with the rash, fever can increase in severity to above 40 degrees Celsius. Symptoms of measles normally last about seven to 10 days.
Who gets measles?
Any person who is not immune can get measles. The disease is most common among children aged one to five years.
How is measles diagnosed?
Your doctor will diagnose measles by the clinical signs, particularly the rash, and confirm it with blood tests.
How is measles treated?
There is no specific treatment for measles. Once the disease is established in the body, treatment involves supportive measures and watching out for complications.
Is measles contagious?
Measles is a highly contagious condition.
How is measles spread?
When an infected person sneezes or coughs, millions of tiny droplets, each containing many viruses, are spread into the air. The droplets can infect by entering your nose or mouth. The droplets can also collect on surfaces and objects. You can catch the virus by touching an infected surface and then touching your nose or mouth area.
Can measles be prevented?
A measles vaccine is available and routinely provided for children above 12 months of age.
Is measles serious?
Normally, measles is not serious. However, complications of measles can appear in up to two in every five (40%) of cases and may be serious, even fatal.
What happens if measles occurs during pregnancy?
Pregnant women infected with measles are at increased risk of miscarriage, premature birth, low birth weight and stillbirth.

Related topics

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Vision loss, sometimes called vision impairment, can occur for many reasons. In some cases, it can be as simple as needing glasses or contact lenses, but in other cases it can be serious and irreversible.

Mumps

Mumps is an infectious viral disease. It is mostly a childhood disease and, although usually a mild illness, mumps can have serious consequences. A mumps vaccine is available and given as part of a combined vaccine during routine childhood vaccination.

Pink eye

Conjunctivitis, also called ‘pink eye’, is an inflammation of the outer layer of the eye and the inside of the eyelids. It can be caused by viral or bacterial infections, irritants or allergies. It may require medicated eye drops or ointments.

Hay fever

Hay fever is an allergic reaction usually triggered by pollen from grasses, trees and weeds during spring and summer. It can also be due to other airborne particles, such as mould, dust mites or animal hair. Treatment options are available to help manage symptoms.

About this article

Title: Measles

Author: Dr Idan Ben-Barak PhD, MSc, BSc (Med)

First Published: 19 Sep 2014

Last reviewed: 17 Jan 2022

Category: Information on Measles

Average rating: 4.9 out of 5 (1554 votes)

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