Measles

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What is Measles (Rubeola)?

Measles (Rubeola) is an airborne viral infection that is highly contagious and is caused by the measles virus or measles morbillivirus. It usually affects children but anyone who is not vaccinated can get infected by it.

Alternate names

  • Morbilli
  • Red measles
  • English measles

Is Measles a Medical emergency?

Measles is not a medical emergency.

Causes

Measles is caused when a person is exposed to the rubeola virus. The measles virus replicates and survives only in the human hosts. The infection is spread by coughing, sneezing, close personal contact, or direct contact with the secretions. The virus droplets remain active and contagious in the air or on surfaces for a few hours. When a non-vaccinated individual inhales the droplets, or touches the surfaces with the droplets and then their eyes, nose, or mouth, the infection is passed on, and the virus starts to multiply in the respiratory passages of the new host. After 2 -4 days the virus enters the lymphatic system, and then enters the various organs before the appearance of the rubella rash. Infection with the virus causes a generalized suppression of the immune system.

Risk factors

The risk factors of rubeola include:

  • Not being vaccinated for morbilli
  • Children with a weak immune system due to HIV/AIDS, leukemia, corticosteroid therapy irrespective of the vaccination status.
  • Traveling to regions where the infection is endemic.
  • Vitamin A deficiency
  • Malnutrition
  • Pregnancy

Symptoms & signs

The symptoms and signs of measles include the following and usually develop 7-14 days after the virus enters the body.

  • Fever
  • Cold or runny nose
  • Conjunctivitis - Inflamed and watery eyes
  • Cough - Which is usually dry and the last symptom to appear.
  • Throat pain
  • Tiny white spots with a blue dotted center on the inside of the mouth (they are temporary and often missed).
  • Measles Rash - It starts on the forehead and behind the ears and then spreads to cover the entire body. Morbilli rash is red with tiny bumps that seem to join or merge.

Investigations

Investigations are usually not required for the diagnosis of morbilli, but the following tests may be done:

  • Laboratory tests
  • Measles IgM antibodies
  • Polymerase chain reaction - For isolation of the measles RNA from the throat, nasal, or urine specimens.

The following tests may be done if complications are suspected:

  • Chest X-ray - If bacterial pneumonia is suspected
  • Lumbar puncture - If encephalitis is suspected

Diagnosis

Diagnosis is established based on medical history, clinical evaluation, and results of the investigations if any. The diagnosis is considered positive if there is a history of fever for 3 days with the presence of cough, coryza (cold), or conjunctivitis, and rash. The presence of the koplik’s spots is also diagnostic. Confirmation can be done with the laboratory investigations.

Course & Stages

Rubeola goes through the following stages:

  • Stage I: Infection and Incubation, is the first 7-14 days from the time an individual is infected. There are no signs or symptoms at this stage.
  • Stage II: A non-specific illness with mild to moderate fever, cold, dry cough, conjunctivitis and sore throat, general weakness, and muscle pain. Koplik’s spots are seen at this stage. This stage lasts for about 2 - 4 days.
  • Stage III: Acute illness and rash, this stage presents with high fever and a rash that starts on the forehead and behind the earthen spreads to the trunk, arms, abdomen, thighs, legs, and feet. The rash starts as red spots with tiny bumps in clusters that appear to merge.

Contagious Period: The period when the disease can spread starts about 2-4 days before the start of the rash until about 4 days after the rash starts. Immunocompromised individuals may be contagious throughout the disease and in some, the typical rash may not be present. The entire course of the disease after the initial incubation phase is about 7 - 12 days.

Treatment options

There is no treatment for measles once it has started. Treatment only includes supportive care to manage dehydration, and other symptoms.

Medical management

The medical management of measles includes:

  • Post-exposure vaccination: In individuals who have not been vaccinated before, giving a vaccination within 72 hours after exposure helps to lessen the severity of rubeola.
  • Immune serum globulins: These are given to pregnant women, infants, and immunocompromised individuals within 6 days after exposure to the rubeola virus, as they help to prevent or lessen the severity of the infection.
  • Antipyretics: To provide relief from fever. Aspirin should not be given
  • Antibiotics: If secondary infections like pneumonia or ear infections develop
  • Vitamin A supplementation: It is done for children who have low levels of vitamin A which results in more severe disease

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

Once rubeola starts watching for complications is all that needs to be done. The following measures may also be taken:

  • Getting ample rest
  • Drinking fluids regularly

Prevention

Vaccination is available for the prevention of measles. The vaccine is available as an MMR II vaccine that helps to prevent measles, mumps, and rubella. The first dose of the vaccine is given at the age of 9-12 months and the second or the booster dose is given at the age of 16-24 months.

If previous immunization was not done at the appropriate age two doses 4 weeks apart may be given to older children and teenagers. In adults who have no immunization history and who are at risk of being exposed to the measles virus, two doses 4 weeks apart may be given.

Apart from this, maintaining good personal hygiene, and washing hands at regular and appropriate intervals can help to minimize the risk of measles as well as other infections. If there is an existing measles infection then isolation and vaccination can help to control the spread of the disease. 

Complications

The complications of measles usually occur because the virus suppresses the host’s immune system. Complications of measles are more likely to occur in immunocompromised individuals, children less than the age of 5 years, adults older than 20 years, malnutrition, vitamin deficiency, and inadequate vaccination.

Some of the complications of measles include:

  • Bacterial pneumonia
  • Interstitial pneumonitis
  • Pleural effusion
  • Laryngotracheobronchitis (croup)
  • Flaring up of tuberculosis
  • Middle ear infections
  • Sinusitis
  • Encephalitis, SSPE (subacute sclerosing panencephalitis)
  • Keratitis - It can lead to blindness
  • Myocarditis and pericarditis
  • Liver and spleen enlargement, hepatitis
  • Appendicitis, ileocolitis, acute pancreatitis
  • Thrombocytopenia, Disseminated intravascular coagulation (DIC)

Prognosis

The prognosis of measles is good and fatal complications are rare. Complications can develop and measles is still one of the main causes of childhood blindness and childhood mortality. Death and complications are more in young children and in individuals who have weak or compromised immune systems.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek medical advice if there are signs and symptoms of measles, or if there is a recent history of exposure to someone with measles.

Indications for hospitalization if required

Hospitalization is not required for measles unless severe complications develop and they need medical intervention.

Suggested clinical specialist/ Departments to consult for this condition

Measles will be attended to by specialists from the Department of Pediatrics or Infectious Diseases.

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