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Measles, also known as rubeola, results from an infection with a virus belonging to the paramyxovirus family and affects the respiratory system. Measles is extremely contagious and has a high incidence among children.
How Common Is Measles?
The latest WHO data, from 2017, relating to measles cases and deaths, show an estimated 6.7 million instances in that particular year, with around 110,000 measles-related deaths based on the 173,330 reported cases. (1)
Studies report a 300% global hike in reported measles cases in 2019, in comparison with the number of reported cases in the first quarter of 2018.
The incidence of measles is high in underdeveloped and developing countries. People visiting such countries may act as carriers of the virus and spread it to the non-immunized individuals in their respective countries.
Types of Measles Infections
Measles caused by the rubeola virus is the most common, but there are three more types of measles infection:
1. Atypical measles syndrome
Individuals vaccinated with the original killed measles vaccine may develop atypical measles syndrome (AMS) on exposure to measles due to incomplete immunity. Symptoms of AMS include headache, high fever, cough, abdominal pain, edema, and rash.
2. Modified measles
Modified measles is seen in people who receive immune globulin as postexposure prophylaxis. It can also occur in infants with residual maternal measles antibody. Modified measles is characterized by a short-lived rash, mild prodrome, and prolonged incubation periods.
3. Hemorrhagic measles
Hemorrhagic measles produces symptoms such as delirium, seizures, high fever (105°F), respiratory distress, and hemorrhage.
Spread of Measles
Measles develops when the rubeola virus finds its way into the mucosal layer of the respiratory tract. The virus is transmitted through airborne respiratory droplets released by an infected individual through the mouth or nose during coughing, sneezing, or even talking. (2)
Measles may also spread in the following ways:
- Physical contact with an infected individual
- Contact with a surface contaminated by mucosal secretions of an infected individual
- Through saliva by sharing foods and drinks
- From mother to baby during the gestation period, labor, or feeding
Symptoms of Measles
It takes 1–2 weeks for a person with measles to show symptoms after the virus enters his/her body. It usually begins with a sudden rise in body temperature (around or above 104°F) to make the environment inhospitable for the invading virus.
This high fever is followed by the formation of a red rash on the face after 3–5 days. The rash gradually spreads to the neck, toward other parts of the body. (3)
These classic signs of measles may be accompanied by any of the following symptoms:
- Dry cough
- Body pains
- Soreness in the throat
- Runny nose
- Watering and swelling in the eyes
- Discomfort and fatigue
- Loss of appetite
- Headache
- Diarrhea
- Light sensitivity
- Inflammation in lymph nodes
- Koplik’s spots (red spots with bluish-white centers in the mouth)
Treatment for Measles
The clinical treatments for measles focus on managing its symptoms. Given it’s a viral infection, antibiotics are useless in treating it. The viral infection resolves on its own after running its full course, usually for 2 weeks.
The primary purpose of measles medication is to make your condition less uncomfortable and to prevent complications. If complications occur, the symptoms and physical problems may take longer to improve or may even be permanent.
The doctor may recommend ibuprofen or acetaminophen to reduce the fever and alleviate the pain. Moreover, daily supplementation of vitamin A may be advised since a deficiency of this vital nutrient can increase the severity of the infection to a dangerous level.
To ensure and aid proper recovery, keep the following things in mind:
- Avoid giving aspirin to children. Aspirin intake can cause Reye’s syndrome in children.
- Keep checking on your ward’s condition.
- Get immediate medical help to avoid complications.
- Avoid contact with people to prevent the spread of the disease.
- Medical attention is necessary during pregnancy. Contracting measles during pregnancy increases the risk of pneumonia and hospitalization and may also pose some risks to the baby.
Diagnosing Measles
Measles can be easily identified through its distinctive symptoms and a physical examination. The doctor may also evaluate your medical history and order a urine test.
Blood tests can help confirm the diagnosis. These include the measles virus sandwich-capture immunoglobulin (IgM) antibody assay, which detects the presence of antibodies generated against the measles virus in the blood by analyzing blood samples collected within 3 days to 1 month after the appearance of the rash.
Vaccinations Against Measles
The World Health Organization (WHO) recommends that measles vaccines should be administered to all individuals irrespective of their age group.
Vaccines against measles are available as singular products or as combination vaccines, which include: (4)
- Measles-rubella vaccine (MR)
- Measles-mumps-rubella vaccine (MMR)
- Measles-mumps-rubella-varicella (MMRV) (5)
Immunization of the majority of the population consequently lowers the risk of the spread of measles. Thus, as a preventive measure, the vaccination must be administered to everyone since no treatment is available.
If you belong to any of the following categories, mention your condition to your health care personnel before getting the vaccine:
- HIV/AIDS patient
- Cancer patient
- Using immunomodulatory medications
- Has a history of any blood disorder or low platelet count
- Vaccinated in the last month
- Recently received a blood transfusion
Patients suffering from any kind of ailment should not get vaccinated until they have fully recovered.
Vaccination Guidelines
Unvaccinated adults can contract the infection quickly. Consult your doctor for an MMR vaccine if you have never contracted measles and fall under any of the following categories:
- Born after 1957
- Non-immunized
- Uncertain about being vaccinated
Risk Factors for Contracting Measles
Some individuals may be at a higher risk of contracting a measles infection. The risk factors include:
- Low vitamin A level
- Improper nourishment
- Compromised immune system due to immunodeficiency syndromes such as AIDS
- International travel
- Pregnancy
- Non-immunization
Complications Associated With Measles
The most common complications associated with measles include:
- Ear infection in children, which may cause hearing problems if not treated
- Febrile seizures due to raised body temperature
- Inflammation of the voice box, also known as laryngitis
- Croup, pneumonia, bronchitis, or other respiratory system infections
Measles may also cause severe complications, which include:
- Hepatitis or liver infection
- Squint (improper alignment of eyes)
- Encephalitis (inflammation in the brain)
- Neurological diseases
Measles infection during pregnancy poses a high risk for both the fetus and mother. The complications may include:
- Premature delivery
- Miscarriage
- Still-born child
- Underweight child
- Pneumonia
When to See a Doctor
Immediate medical attention should be given to children if they suffer from any of the following:
- Persistent fever (more than 4 days)
- Development of rash
- Severe cough
- Pain in the ears
Individuals suffering from measles should get further medical care if they develop any of the following symptoms:
- Difficulty in breathing
- Drowsiness
- Stiff neck
- Back pain
- Coughing up yellow or green mucus
Expert Answers (Q&A)
Answered by Dr. Brandi Lewis, MD (Pediatrician)
The rash from measles is typically not itchy. Measles has no treatment, but your doctor may prescribe vitamin A and an antiviral medicine to help speed up recovery.
Measles in pregnancy is associated with premature labor and fetal death. Unfortunately, a high number of pregnant women without protection to measles have been documented.
Pregnant women often fail to recollect whether they have been vaccinated against measles or not and, therefore should ideally get tested to know for sure.
Measles has an infection rate of 90% if exposed to high-risk individuals. (6) It is spread both by contact and by respiratory secretions. Therefore, the infection can easily be passed on from an infected mother to her infant while breastfeeding, and vice versa.
Vaccines can be taken at any time but it is important to vaccinate according to the recommended immunization schedules. Failure to do so can lead to disease outbreaks.
One dose of the MMR vaccine may be enough to protect some adults. It is recommended that school-age children and high-risk adults receive two doses.
If you are unsure if you fall into the category of high-risk individuals or if you are concerned that you may not be protected, you should speak with your doctor.
Final Word
Measles is a highly contagious viral infection that is a major threat to children, pregnant women, unvaccinated individuals, and people with weak immune systems. Since there is no definite cure for measles, prevention through vaccination is key.
If you do contract the infection, you can take medications along with proper home care for symptomatic relief, quick recovery, and prevention of undue complications. Medical attention is vital for pregnant women or those with persistent fever, who are usually kept under observation.
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