OVERVIEW

Measles is one of six killer diseases (tuberculosis, tetanus, whooping cough, polio, diphtheria) as stated by the World Health Organization. It is an extremely contagious viral and airborne disease. This implies that, a person can be infected by coming in contact with an infected person’s airway fluids (through coughing and sneezing).

For several years, there has been a major breakthrough in the prevention of measles outbreak worldwide. The introduction of the measles vaccination has lowered mortality rate by 80%. Despite the far-reaching access to vaccination, measles still remains a fundamental cause of death in children across the world. 

According to the World Health Organization (WHO), approximately 110, 000 people died from measles in 2017. Most of these people were children under the age of 5.

TRANSMISSION

Measles virus (rubeola) can be transmitted when an infected person sneezes or coughs close to a person who is not infected.  The virus surfaces in the trachea of the host inciting a coughing and sneezing reflex. Hence, the virus occupies the air and infects the next host. It takes 7-18 days for an infected person to become seriously ill.

The virus can stay alive and functional in the air or on infected surfaces for up to 2 hours. Also, an infected person can only transmit the virus from 4 days before the onset of a rash to 4 days after the rash appears. 85% of people that come in contact with the virus get infected. Whereas 95% of those who get infected get seriously ill.

WHO IS AT RISK?

Measles is chiefly a childhood disease. However, due to uneven economic development across the globe, some children are more liable to the disease than others. Also, people of certain race (Africans and Asians) are at a high chance of getting infected. People who are at a higher risk include:

  • Unvaccinated children or under-vaccinated children
  • Immunocompromised people
  • Unvaccinated pregnant women
  • People from developing countries
  • Undernourished children
  • People with an older ineffective version of the measles vaccine.

According to studies, Individuals who are younger or malnourished are more likely to get infected even if they have been vaccinated.

Signs And Symptoms

The early signs and symptoms of measles mostly begin 10-12 days after an individual has contracted the virus. The early sign to look out for are: 

  • High fever: this is usually the first sign of measles.
  • Runny nose (Coryza)
  • Red and watery eyes (Conjunctivitis)
  • Cough
  • White spots inside the cheeks (Koplik’s spot)

The late signs usually include the appearance of a rash mostly on the face and the upper part of the neck. It eventually spreads to the hands and feet. When the rash starts to manifest, the fever worsens causing symptoms such as

  • Nausea
  • Vomiting
  • Diarrhea
  • Multiple enlarged lymph nodes.

Complications

Most people with the measles infection experience complications which often lead to death. The infected individual becomes susceptible to bacterial and viral infections. This causes conditions such as: 

  • Respiratory infections, especially pneumonia (the common cause of measles related deaths). According to Centers for Disease Control and Prevention (CDC), 1 out of every 20 children with measles gets pneumonia.
  • Sinus infections
  • Ear infections
  • Inflammation of the liver, appendix, intestines and sometimes the lymph nodes within the abdomen
  • Severe diarrhea leading to dehydration

A much serious complication of measles is the swelling of the brain (encephalitis) and blindness. 1 out every 1000 children with measles will develop encephalitis that can lead to convulsions as stated by the CDC.

Diagnosis

The diagnosis of measles is based on its distinctive signs and symptoms. A clear sign of measles a doctor will look out for is the appearance of a red rash on the body and Koplik spots within the cheeks. 

For more clarification, certain specific tests are conducted to rule out any doubts. A throat swab specimen and blood specimen is collected for further studies to verify the presence of the measles virus. 

Also, a serology test can be done to detect specific antibodies (IgM, IgG) in blood serum within the first few days of the rash’s onset. This provides conclusive evidence of the measles virus.

Treatement 

Unfortunately, there is no specific treatment for the measles virus. However, medications are administered to treat the underlying symptoms, as well as complications. These include:

  • Antibiotics to treat bacterial infections and ear infections
  • Fever medication like acetaminophen to reduce the fever that comes with measles. It must be noted that doctors are not encouraged to prescribe aspirin to children with measles. Aspirin has been shown to cause a rare but serious condition in children known as the Reye’s syndrome.
  • Vitamin A supplement especially in undernourished children. It is given in two doses within a 24-hour interval. This replenishes the decreased level of vitamin A caused by nutrition deficiency. It also helps to stop eye damages and blindness. According to WHO, vitamin A supplements have proven to decrease the number of measles related deaths by 50%.

Prevention

Measles is a vaccine-preventable disease. Measles can be prevented with the MMR vaccine. It is a vaccine which protects against measles, mumps and rubella, hence the name MMR. 

The measles vaccines are often administered in two doses. The first dose is given at about 12-15 months of age. Whiles the second dose is given at the age of 4-6. Even so, most children have been reported to receive only one dose of the measles vaccine. In such a situation, the child is considered to be under-vaccinated.  Children who are under-vaccinated are very likely to get infected. Two doses are approved to prevent an individual from getting infected, as well as ensure immunity against the measles virus. 

It is estimated that 85% of children received only one dose of the measles vaccines in 2017, out of which 15% did not develop total immunity against the measles virus. Only 67% of children received their second vaccines as stated by the World Health Organization. 

An alternate MMRV vaccine is also available which prevents against measles, mumps, rubella and varicella (chicken pox). 

There have been concerns about the MMR vaccines and their connection with autism in children. These concerns have been addressed by credible organizations such as the Food and Drug Administration (FDA) as well as the Centers for Disease Control and Prevention (CDC). They found no link between the MMR vaccine and autism in children.

KEY POINTS

  • According to CDC, 1 out of every 20 children with measles get pneumonia.
  • Measles may cause premature births in pregnant women.
  • Unvaccinated or under-vaccinated children are at a high risk of severe health complications such as pneumonia, blindness, brain damage and deafness.
  • MMR vaccine is not associated with autism in children.
  • Two doses of the MMR vaccine are recommended for complete immunity against the measles virus.