Measles also called rubeola is a highly contagious infection caused by the measles virus.
In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year. The disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 134,200 people died from measles in 2015 – mostly children under the age of 5.
During 2000-2015, measles vaccination prevented an estimated 20.3 million deaths. Global measles deaths have decreased by 79% from an estimated 651,600 in 2000 to 134,200 in 2015.
What are the Symptoms of Measles?
Symptoms of measles generally appear within 14 days of exposure to the virus. Symptoms include:
Coryza - runny nose.
Dry hacking cough.
Conjunctivitis - swollen eyelids, inflamed eyes.
Photophobia - sensitivity to light.
Fever - this may be mild to severe and can reach 40.6 degrees Centigrade for a number of days. Fever may drop and then rise again when the rash appears.
Koplik's spots - very small grayish-white spots with bluish-white centers in the mouth, insides of cheeks, and throat.
Generalized body aches.
Rash - 3 to 4 days after initial symptoms, a reddish-brown spotty rash appears. The rash can last for over a week. It usually starts behind the ears and spreads all over the head and neck. After a couple of days, it spreads to the rest of the body, including the legs. As the little spots grow, many of them will join together.
Although the majority of childhood rashes are not measles, a child should be taken to the doctor if:
A parent suspects it could be measles
Symptoms do not improve, or get worse
The fever rises to above 38 degrees Centigrade
When other symptoms have resolved except for fever
Complications from measles are fairly common and are more likely to be worse for patients who have weak immune systems, such as those with HIV/AIDS or leukaemia, those with vitamin deficiency, and very young children.
Adults over the age of 20 are more likely to have complications than healthy children over the age of 5.
Complications can include:
Laryngitis and bronchitis - laryngitis is inflammation of the voice box; bronchitis is inflammation of the inner walls of airways. About 4 percent of people with measles have difficulties breathing.
Otitis media - inner ear infection and inflammation.
Febrile seizure - Occurs in 1 in 200 cases. They may be alarming, but children usually make a full recovery.
Pneumonia - patients with a weakened immune system who develop measles are vulnerable to developing bacterial pneumonia (Streptococcus pneumoniae), which can be fatal if not treated.
The following less common complications are also possible:
Hepatitis - liver complications in childhood measles are rare and temporary. However, it can be severe in children receiving hepatotoxic drugs (medications which may be toxic to the liver). Acetaminophen (Tylenol, paracetamol) can harm the liver if the dose is too high.
Encephalitis - approximately 1 in every 1,000 patients with measles develops encephalitis. This is an inflammation of the brain which can cause vomiting and convulsions. Coma and even death is possible but rare. Encephalitis may occur soon after measles, or several years later.
Thrombocytopenia - low platelet count. The blood's ability to clot is affected. The patient may bruise easily.
Squint - eye nerves and eye muscles may be affected.
The complications listed below are very rare, but possible:
Neuritis - infection of the optic nerve, which can lead to blindness.
Subacute sclerosing panencephalitis (SSPE) - Occurs in 2 in every 100,000 cases. SSPE is a brain disease which can occur months or years after measles infection and causes convulsions, motor abnormalities, mental retardation, and death.
Other nervous system complications - toxic encephalopathy, retrobulbar neuritis, transverse myelitis, and ascending myelitis.
Who is at Risk?
Unvaccinated young children are at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.
Measles is still common in many developing countries – particularly in parts of Africa and Asia. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capital incomes and weak health infrastructures.
Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.
Measles is an airborne disease which spreads easily through the coughs and sneezes of those infected. It may also be spread through contact with saliva or nasal secretions, including semen through sex. Nine out of ten people who are not immune and share living space with an infected person will catch it. People are infectious to others from four days before to four days after the start of the rash. People usually do not get the disease more than once. Testing for the virus in suspected cases is important for public health efforts.
A doctor will be able to diagnose measles fairly easily if the signs and symptoms are present. A blood test will confirm the presence of the rubeola virus.
In most countries, measles is a notifiable disease. This means that doctors have to notify the authorities of any suspected cases. If the patient is a child, the doctor will also notify the school.
A child with measles should not return to school until at least 5 days after the rash has appeared.
How does a Measles Infection Develop?
As soon as the virus enters the body, it multiplies in the back of the throat, lungs, and the lymphatic system. It later infects and replicates in the urinary tract, eyes, blood vessels, and central nervous system.
Experts say it takes 1-3 weeks for the virus to establish itself. However, people show symptoms 9-11 days after acquiring the infection.
A person who has had measles before does not become infected again; cases of re-infection are very rare. However, anyone who has never been infected or vaccinated that breathes in infected droplets or is in close physical contact with an infected person is likely to become ill.
Approximately 90 percent of people who are not immune will develop measles if they share a house with an infected person.
There is no prescription medication to treat measles. The virus and symptoms typically disappear within two to three weeks. However, your doctor may recommend:
acetaminophen to relieve fever and muscle aches
rest to help boost your immune system
plenty of fluids (six to eight glasses of water a day)
humidifier to ease a cough and sore throat
vitamin A supplements
Prevention of Measles
People who have already had measles are immune and will not get it again. Cases of re-infection are extremely rare.
If someone in your household has measles, take these precautions to protect vulnerable family and friends:
Isolation. Because measles is highly contagious from about four days before to four days after the rash breaks out, people with measles shouldn't return to activities in which they interact with other people during this period.
It may also be necessary to keep non-immunised people (siblings, for example) away from the infected person.
Vaccinate. For people who are not immune, there is the measles vaccine. Be sure that anyone who's at risk of getting the measles who hasn't been fully vaccinated receives the measles vaccine as soon as possible.
The measles vaccine should not be given to these at-risk groups:
kids with untreated tuberculosis, leukemia, or other cancers
people whose immune systems are weakened for any reason
kids who have a history of severe allergic reaction to gelatin or to the antibiotic neomycin, as they could have serious reactions to the vaccine
Because certain people cannot receive the measles vaccine for health reasons, it's all the more important to make sure that children who can get the vaccine get it on schedule. At-risk children depend on "herd immunity." This means a high percentage of people have been immunized against a disease, which prevents the disease from spreading in a population and helps prevent outbreaks.