Measles: A-to-Z Guide from Diagnosis to Treatment to Prevention

We’re now in the beginning of the 21st century, and about one million children still die of measles each year around the world.

Measles has been a major cause of suffering and death at least since the societies of ancient China, Persia, and Rome. Before the measles vaccine became generally available in 1965, there were 3 to 9 million cases of measles in the United States each year. It was a common cause of pneumonia, blindness, seizures, brain damage, and death.
Thanks to widespread vaccination against measles, most adults in the United States have never seen a friend or loved one battle this infection. Unfortunately, measles outbreaks are now becoming all too common. Consider this:

In January 2008, an unvaccinated school-aged boy returned to California from Europe, where he had unknowingly become infected with measles. He infected his unvaccinated siblings with measles and he exposed classmates at his school, where 11% of the children were unvaccinated for measles. In the end, over a dozen cases of measles could be attributed to this one source and hundreds were exposed to this potentially fatal disease.

Sadly, this is not a rare occurrence; there were at least 8 outbreaks of measles in the United States in 2013, involving 159 cases of the disease. The CDC also notes that cases of measles seem to be on the rise since it was declared eliminated in 2000.(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm)

What is it?

Measles is a specific virus that causes a specific disease. It was the first of the non-pox rash illnesses of childhood to be identified (first disease). It remains a major worldwide problem.

In most children, the illness is self-limited. Nevertheless, complications are common. Some are as simple as ear infections, croup, or appendicitis. Others are crippling or lethal.

Who gets it?

In developing countries, measles is still widespread, infecting almost all unimmunized children by the age of 4. The mortality rate in unimmunized children remains about 10 percent and blindness is common if the child is unimmunized and malnourished.

The number of cases in the United States is reported to be less than 1000 per year and serious complications are far less common. Whenever immunization rates fall, the measles rates rise.

Measles tends to be a winter and spring disease. There is no difference in illness rates between boys and girls, but complications are more common in boys.

Measles causes disease in humans and other primates.

What are the symptoms?

During roughly the first 10 days following exposure, a child has dramatic viral and immunologic activity taking place inside her body, with virtually no outward sign of illness.

Next, typically, comes the prodromal period in which she has symptoms of a cold (tiredness, runny nose, cough, and perhaps red eyes) but with a high fever (~39.5 C or 103 F). These symptoms gradually increase over about 4 days.

During these 4 days, she has white spots in her mouth. These are called Koplik spots and are the hallmark of measles. They usually start on the inside of the cheek opposite the lower molars, then spread within 12 hours to cover most of the inside of the cheeks and lower lip. Many things can cause white spots in the mouth; Koplik spots always appear on a bright red, granular background.

The typical measles rash begins about 14 days after exposure (or 4 days after appearing ill). The fever is still at its height when the rash appears (in contrast to an infection called Roseola).

The measles rash starts as spots, which then begin to blend together. The rash begins around the ears and on the forehead at the hairline. Over three days, it spreads sequentially to cover the face, neck, trunk, arms, buttocks, and legs. Over this same three-day period, the Koplik spots disappear and the fever begins to fall.

Is it contagious?

Measles is a highly contagious disease and is spread from person to person through the air. People with measles are contagious throughout the illness, but especially during the prodromal period before the rash.

It can also spread by direct contact and droplets.

How long does it last?

Measles symptoms usually last about 12 days. The rash disappears over about three or four days after it reaches its peak in the same order in which it started. As the rash fades, it looks coppery, then brownish, with fine white flakes.

Complications such as encephalitis, subacute sclerosing panencephalitis (SSPE), blindness, other forms of brain damage, pneumonia, or heart damage may last considerably longer. They may be lifelong or even life-ending. Encephalitis is thought to occur in about 1 out of every 1000 cases of measles (AAP RedBook 2006).

How is it diagnosed?

The diagnosis is usually based on the presence of Koplik spots, the presence of the fever with the three C’s — cough, conjunctivitis, and coryza (cough, red eyes, and a very runny nose), and the sequential progression of the rash.

The diagnosis may be confirmed by a series of blood tests.

How is measles treated? For uncomplicated measles, there is no specific treatment.

Some studies suggest that vitamin A lessens the severity of measles. The cough is often severe and some older children benefit from cough medicines. Particularly during the period of the fever, plenty of fluids should be given.

Avoid exposure to other ill children in the first weeks following measles, since some of the normal defenses are temporarily damaged.

How can it be prevented?

The measles vaccine is an effective vaccine in preventing measles. After 2 doses of the measles vaccine, over 99 percent of recipients will be immune to measles. The initial dose of the measles vaccine is usually administered after a child is 12 months of age. The second dose is recommended at the age of kindergarten entry (i.e. age 4-6 years), but may be given any time 1 month after the first dose. In areas where measles is very common, the vaccine can be given as young as 6 months of age, but protection is suboptimal. In these children, repeat vaccination at 12-15 months and 4-6 years is recommended. When the vaccine is not completely effective, it at least minimizes the length, and particularly the severity, of the disease.

For those who have suppressed immune systems (such as with cancer or immunodeficiency), exposure to measles may necessitate prophylaxis with IV immunoglobulins (disease-fighting antibodies).

Related concepts:

Rubeola, First Disease