Measles

Symptoms of Measles

Measles typically presents in stages, with symptoms developing about 10–14 days after exposure to the virus. The disease usually lasts for about 2 weeks, and symptoms generally progress through several phases:

1. Prodromal Phase (Before the Rash):

   • Fever: Often starts mild and increases over several days.
   • Cough: A dry, persistent cough.
   • Runny nose (rhinorrhea).
   • Conjunctivitis: Red, watery eyes, also known as “pink eye”.
   • Sore throat.
   • Malaise: A general feeling of being unwell.
   • Koplik spots: Small, bluish-white spots with red halos that appear inside the mouth, usually on the inner lining of the cheeks, and are considered a hallmark sign of measles. These spots often appear 2–3 days before the rash.

2. Rash Phase:

   • Rash Appearance: The measles rash typically starts around day 3 to 5 after the initial symptoms. It usually begins at the hairline or behind the ears, then spreads down to the face, neck, and eventually to the rest of the body, including the arms, trunk, and legs.
   • Characteristics of the Rash: The rash consists of flat, red spots that may merge together. The rash is often described as “maculopapular” (flat and raised).
   • As the rash develops, the fever often peaks and becomes higher. The rash lasts for about 4–7 days before beginning to fade, starting from the face and moving downward.

3. Recovery Phase:

   • After the rash resolves, the fever subsides, and the skin begins to peel. Most children and adults will recover fully within 2 to 3 weeks.
   • A persistent cough can last for weeks even after other symptoms have resolved.

Transmission of Measles

Measles is an extremely contagious viral infection. The virus is spread through respiratory droplets when an infected person coughs, sneezes, or talks. The virus can remain in the air and on surfaces for up to two hours after the infected person has left the area.

• People are contagious from about four days before to four days after the rash appears, which means they can spread the virus before they even know they are infected.
• Measles is highly contagious—about 90% of non-immune people who are exposed to the virus will become infected.

Complications of Measles

Although measles is often considered a “mild” illness in children, it can lead to serious complications, especially in young children, pregnant women, and immunocompromised individuals. Some of the complications include:

1. Ear Infections (Otitis Media):

   • Bacterial ear infections are common in children with measles and can lead to hearing loss.

2. Pneumonia:

   • Measles-related pneumonia is a major cause of measles-related deaths. The virus can infect the lungs directly, or a secondary bacterial infection can cause pneumonia.

3. Encephalitis:

   • Encephalitis (inflammation of the brain) is a rare but serious complication that can lead to permanent brain damage, seizures, and even death. It occurs in about 1 in 1,000 cases of measles.

4. Diarrhea:

   • Measles can cause gastrointestinal symptoms like diarrhea, which can lead to dehydration, especially in young children.

5. Pregnancy Complications:

   • Pregnant women who contract measles may have an increased risk of premature birth or miscarriage.

6. Subacute Sclerosing Panencephalitis (SSPE):

   • SSPE is a rare but fatal complication that can occur years after a measles infection, usually 7–10 years after the initial illness. It causes progressive neurological deterioration and is almost always fatal.

7. Death:

   • Measles can be fatal, particularly in young children, those with weakened immune systems, and individuals who develop complications like pneumonia or encephalitis.

Diagnosis of Measles

Measles is usually diagnosed based on clinical symptoms, particularly the characteristic rash and Koplik spots. If necessary, laboratory tests can confirm the diagnosis, including:

1. Measles IgM Antibody Test: The presence of IgM antibodies in the blood indicates a recent infection.
2. Measles RNA PCR Test: Polymerase chain reaction (PCR) testing can detect the genetic material of the measles virus.
3. Viral Culture: A sample from the throat or urine can be cultured to confirm the presence of the measles virus.

Treatment of Measles

There is no specific antiviral treatment for measles. The focus of treatment is supportive care to manage symptoms and prevent complications.

1. Symptomatic Relief:

   • Fever: Medications such as acetaminophen (Tylenol) or ibuprofen can help reduce fever and discomfort.
   • Hydration: It is important to stay hydrated, especially if fever or diarrhea is present.
   • Rest: Plenty of rest is essential to recovery.
   • Vitamin A: Supplementing with vitamin A has been shown to reduce the risk of complications, particularly in children under 2 years old. It helps to reduce the severity of the illness and improve recovery.

2. Treatment for Complications:

   • Antibiotics: If bacterial infections (e.g., ear infections, pneumonia) develop as a complication, antibiotics may be required.
   • Hospitalization: Severe cases, particularly those with pneumonia, encephalitis, or other complications, may require hospitalization for supportive care, such as oxygen therapy, intravenous fluids, and more intensive monitoring.

Prevention of Measles

The most effective way to prevent measles is vaccination. The measles-mumps-rubella (MMR) vaccine is a combination vaccine that protects against three diseases: measles, mumps, and rubella.

1. Measles Vaccine (MMR):

   • The MMR vaccine is highly effective in preventing measles. The recommended vaccination schedule is:
     • First dose: At age 12–15 months.
     • Second dose: At age 4–6 years.
   • The vaccine is 99% effective at preventing measles after two doses.
   • Individuals who have not been vaccinated or previously infected with measles are at risk for contracting the disease, and outbreaks can occur in communities with low vaccination rates.

2. Herd Immunity:

   • High vaccination coverage in the population (usually above 95%) helps protect individuals who cannot be vaccinated (e.g., infants, pregnant women, and immunocompromised individuals) through herd immunity. When most people are immune to a disease, it is much harder for the virus to spread.

3. Post-exposure Prophylaxis:

   • If someone is exposed to measles and is at high risk (e.g., pregnant women or infants), post-exposure prophylaxis with immune globulin (IG) may be given to reduce the severity of the disease or prevent infection. This is most effective when given within 72 hours of exposure.

4. Isolation:

   • Individuals with measles should be isolated from others, especially vulnerable populations, until they are no longer contagious (about four days after the rash appears).

Conclusion

Measles is a serious, highly contagious viral infection that can cause severe complications, including pneumonia, encephalitis, and even death. It is primarily a childhood illness, but adults who are unvaccinated or have not had measles are also at risk. The disease is preventable through vaccination with the MMR vaccine, which has dramatically reduced the incidence of measles worldwide. If someone contracts measles, treatment focuses on symptom relief, and antiviral medications are not used. Early vaccination and maintaining high vaccination coverage are key to preventing outbreaks and protecting vulnerable populations.