Measles (also known as morbilli, English measles, or rubeola -- not to be confused with rubella) is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus.
The virus lives in the mucus of the nose and throat of people with this infection. Physical contact, coughing and sneezing can spread the infection. In addition, infected droplets of mucus can remain active and contagious for around two hours. This means that the virus can live outside the body - for example, on surfaces and door handles.
CAUSES
Measles is caused by the measles virus, a single-stranded, negative-sense, enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae. Humans are the natural hosts of the virus; no animal reservoirs are known to exist. This highly contagious virus is spread by coughing and sneezing via close personal contact or direct contact with secretions.
Risk factors for measles virus infection include the following:
-Children with immunodeficiency due to HIV or AIDS, leukemia,alkylating agents, or corticosteroid therapy, regardless of immunization status
-Travel to areas where measles is endemic or contact with travelers to endemic areas.
-Infants who lose passive antibody before the age of routine immunization.
Risk factors for severe measles and its complications include the following:
-Malnutrition
-Underlying immunodeficiency.
-Pregnancy.
-Vitamin A deficiency.
IS MEASLES INFECTIOUS
Yes - it is very infectious. It is passed on by coughing and sneezing the virus into the air. It takes between 7 and 18 days (most commonly 10-12 days) to develop symptoms after being infected. (This is the incubation period.) You are infectious and can pass it on to others from four days before to four days after the onset of the rash. Therefore, children with measles should not mix with others and should stay off school.
What if I come into contact with someone with measles?
Some people have not been immunized against measles. Also, some people are more prone to complications if they get measles. In particular, people with a poor immune system (for example, those on chemotherapy, or who have HIV, etc), pregnant women and young babies under the age of 12 months. If you or your child come into contact with someone with measles, you should see your doctor as soon as possible. And most importantly, if you or your child are in a group more prone to complications. You may be advised to have a test to check on your immunity to measles. And, if necessary, offered immediate immunization
or a protecting injection of antibody (immunoglobulin). See the guidelines cited at the end from the Health Protection Authority for details.
DIAGNOSIS
Your doctor will usually be able to diagnose measles from the combination of your symptoms, especially the characteristic rash and the small spots inside your mouth. However, a simple blood or saliva test is usually done to confirm the diagnosis.
SYMPTOMS
Once you are infected with the virus, the virus multiples in the back of your throat and in your lungs. It then spreads throughout your body. The following are the most common symptoms of measles:
-A high temperature, sore eyes (conjunctivitis), and a runny nose usually occur first.
-Small white spots usually develop inside the mouth a day or so later. These can persist for several days.
-A harsh dry cough is usual.
-Going off food, tiredness, and aches and pains are usual.
-Diarrhoea and/or vomiting is common.
-A red blotchy rash normally develops about 3-4 days after the first symptoms. It usually starts on the head and neck, and spreads down the body. It takes 2-3 days to cover most of the body. The rash often turns a brownish colour and gradually fades over a few days.
-Children are usually quite unwell and miserable for 3-5 days. After this, the fever tends to ease, and then the rash fades. The other symptoms gradually ease and go.
-Most children are better within 7-10 days. An irritating cough may persist for several days after other symptoms have gone. The immune system makes antibodies during the infection. These fight off the virus and then provide lifelong immunity. It is therefore rare to have more than one bout of measles.
Some people mistake rashes caused by other viruses for measles. Measles is not just a mild red rash that soon goes. The measles virus causes an unpleasant, and sometimes serious, illness. The rash is just one part of this illness.
TREATMENT
There is no specific treatment for measles. Most patients with uncomplicated measles will recover with rest and supportive treatment. It is, however, important to seek medical advice if the patient becomes more unwell, as they may be developing complications.
Some patients will develop pneumonia as a sequelae to the measles. Other complications include ear infections, bronchitis, and encephalitis. Acute measles encephalitis has a mortality rate of 15%. While there is no specific treatment for measles encephalitis, antibiotics are required for bacterial pneumonia, sinusitis, and bronchitis that can follow measles.
All other treatment addresses symptoms, with ibuprofen, or acetaminophen (paracetamol) to reduce fever and pain and, if required, a fast-acting bronchodilator for cough. As for aspirin, some research has suggested a correlation between children who take aspirin and the development of Reye's syndrome. Some research has shown aspirin may not be the only medication associated with Reye's, and even antiemetics have been implicated,with the point being the link between aspirin use in children and Reye's syndrome development is weak at best, if not actually nonexistent. Nevertheless, most health authorities still caution against the use of aspirin for any fevers in children under 16.The use of vitamin A in treatment has been investigated. A systematic review of trials into its use found no significant reduction in overall mortality, but it did reduce mortality in children aged under two years.
PREVENTION
In developed countries, most children are immunized against measles by the age of 18 months, generally as part of a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than this because sufficient of the anti measles immunoglobulins (antibodies) acquired via the placenta from the mother during pregnancy may persist to prevent the vaccine viruses from being effective. A second dose is usually given to children between the ages of four and five, to increase rates of immunity. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune.[citation needed] Adverse reactions to vaccination are rare, with fever and pain at the injection site being the most common. Life threatening adverse reactions occur in less than one per million vaccinations (<0.0001%).
In developing countries where measles is highly endemic, WHO doctors recommend two doses of vaccine be given at six and nine months of age. The vaccine should be given whether the child is HIV-infected or not. The vaccine is less effective in HIV-infected infants than in the general population, but early treatment with antiretroviral drugs can increase its effectiveness.Measles vaccination programs are often used to deliver other child health interventions, as well, such as bed nets to protect against malaria, anti parasite medicine and vitamin A supplements, and so contribute to the reduction of child deaths from other causes. Unvaccinated populations are at risk for the disease. Traditionally low vaccination rates in northern Nigeria dropped further in the early 2000s when radical preachers promoted a rumor that polio vaccines were a Western plot to sterilize Muslims and infect them with HIV. The number of cases of measles rose significantly, and hundreds of children died.This could also have had to do with the aforementioned other health-promoting measures often given with the vaccine.
PROGNOSIS
The vast majority of patients survive measles, though in some cases complications may occur, which may include bronchitis, and – in about 1 in 100,000 cases – pan-encephalitis, which is usually fatal.The patient may spread the disease to an immunocompromised patient, for whom the risk of death is much higher, due to complications such as giant cell pneumonia. Acute measles encephalitis is another serious risk of measles virus infection. It typically occurs two days to one week after the breakout of the measles exanthem and begins with very high fever, severe headache, convulsions and altered men tation. A patient may become comatose, and death or brain injury may occur.
The virus lives in the mucus of the nose and throat of people with this infection. Physical contact, coughing and sneezing can spread the infection. In addition, infected droplets of mucus can remain active and contagious for around two hours. This means that the virus can live outside the body - for example, on surfaces and door handles.
CAUSES
Measles is caused by the measles virus, a single-stranded, negative-sense, enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae. Humans are the natural hosts of the virus; no animal reservoirs are known to exist. This highly contagious virus is spread by coughing and sneezing via close personal contact or direct contact with secretions.
Risk factors for measles virus infection include the following:-Children with immunodeficiency due to HIV or AIDS, leukemia,alkylating agents, or corticosteroid therapy, regardless of immunization status
-Travel to areas where measles is endemic or contact with travelers to endemic areas.
-Infants who lose passive antibody before the age of routine immunization.
Risk factors for severe measles and its complications include the following:
-Malnutrition
-Underlying immunodeficiency.
-Pregnancy.
-Vitamin A deficiency.
IS MEASLES INFECTIOUS
Yes - it is very infectious. It is passed on by coughing and sneezing the virus into the air. It takes between 7 and 18 days (most commonly 10-12 days) to develop symptoms after being infected. (This is the incubation period.) You are infectious and can pass it on to others from four days before to four days after the onset of the rash. Therefore, children with measles should not mix with others and should stay off school.
What if I come into contact with someone with measles?
Some people have not been immunized against measles. Also, some people are more prone to complications if they get measles. In particular, people with a poor immune system (for example, those on chemotherapy, or who have HIV, etc), pregnant women and young babies under the age of 12 months. If you or your child come into contact with someone with measles, you should see your doctor as soon as possible. And most importantly, if you or your child are in a group more prone to complications. You may be advised to have a test to check on your immunity to measles. And, if necessary, offered immediate immunization
or a protecting injection of antibody (immunoglobulin). See the guidelines cited at the end from the Health Protection Authority for details.
Your doctor will usually be able to diagnose measles from the combination of your symptoms, especially the characteristic rash and the small spots inside your mouth. However, a simple blood or saliva test is usually done to confirm the diagnosis.
SYMPTOMS
Once you are infected with the virus, the virus multiples in the back of your throat and in your lungs. It then spreads throughout your body. The following are the most common symptoms of measles:
-A high temperature, sore eyes (conjunctivitis), and a runny nose usually occur first.
-Small white spots usually develop inside the mouth a day or so later. These can persist for several days.
-A harsh dry cough is usual.
-Going off food, tiredness, and aches and pains are usual.
-Diarrhoea and/or vomiting is common.
-A red blotchy rash normally develops about 3-4 days after the first symptoms. It usually starts on the head and neck, and spreads down the body. It takes 2-3 days to cover most of the body. The rash often turns a brownish colour and gradually fades over a few days.
-Children are usually quite unwell and miserable for 3-5 days. After this, the fever tends to ease, and then the rash fades. The other symptoms gradually ease and go.
-Most children are better within 7-10 days. An irritating cough may persist for several days after other symptoms have gone. The immune system makes antibodies during the infection. These fight off the virus and then provide lifelong immunity. It is therefore rare to have more than one bout of measles.
Some people mistake rashes caused by other viruses for measles. Measles is not just a mild red rash that soon goes. The measles virus causes an unpleasant, and sometimes serious, illness. The rash is just one part of this illness.
TREATMENT
There is no specific treatment for measles. Most patients with uncomplicated measles will recover with rest and supportive treatment. It is, however, important to seek medical advice if the patient becomes more unwell, as they may be developing complications.
Some patients will develop pneumonia as a sequelae to the measles. Other complications include ear infections, bronchitis, and encephalitis. Acute measles encephalitis has a mortality rate of 15%. While there is no specific treatment for measles encephalitis, antibiotics are required for bacterial pneumonia, sinusitis, and bronchitis that can follow measles.
All other treatment addresses symptoms, with ibuprofen, or acetaminophen (paracetamol) to reduce fever and pain and, if required, a fast-acting bronchodilator for cough. As for aspirin, some research has suggested a correlation between children who take aspirin and the development of Reye's syndrome. Some research has shown aspirin may not be the only medication associated with Reye's, and even antiemetics have been implicated,with the point being the link between aspirin use in children and Reye's syndrome development is weak at best, if not actually nonexistent. Nevertheless, most health authorities still caution against the use of aspirin for any fevers in children under 16.The use of vitamin A in treatment has been investigated. A systematic review of trials into its use found no significant reduction in overall mortality, but it did reduce mortality in children aged under two years.
PREVENTION
In developed countries, most children are immunized against measles by the age of 18 months, generally as part of a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than this because sufficient of the anti measles immunoglobulins (antibodies) acquired via the placenta from the mother during pregnancy may persist to prevent the vaccine viruses from being effective. A second dose is usually given to children between the ages of four and five, to increase rates of immunity. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune.[citation needed] Adverse reactions to vaccination are rare, with fever and pain at the injection site being the most common. Life threatening adverse reactions occur in less than one per million vaccinations (<0.0001%).
In developing countries where measles is highly endemic, WHO doctors recommend two doses of vaccine be given at six and nine months of age. The vaccine should be given whether the child is HIV-infected or not. The vaccine is less effective in HIV-infected infants than in the general population, but early treatment with antiretroviral drugs can increase its effectiveness.Measles vaccination programs are often used to deliver other child health interventions, as well, such as bed nets to protect against malaria, anti parasite medicine and vitamin A supplements, and so contribute to the reduction of child deaths from other causes. Unvaccinated populations are at risk for the disease. Traditionally low vaccination rates in northern Nigeria dropped further in the early 2000s when radical preachers promoted a rumor that polio vaccines were a Western plot to sterilize Muslims and infect them with HIV. The number of cases of measles rose significantly, and hundreds of children died.This could also have had to do with the aforementioned other health-promoting measures often given with the vaccine.
PROGNOSIS
The vast majority of patients survive measles, though in some cases complications may occur, which may include bronchitis, and – in about 1 in 100,000 cases – pan-encephalitis, which is usually fatal.The patient may spread the disease to an immunocompromised patient, for whom the risk of death is much higher, due to complications such as giant cell pneumonia. Acute measles encephalitis is another serious risk of measles virus infection. It typically occurs two days to one week after the breakout of the measles exanthem and begins with very high fever, severe headache, convulsions and altered men tation. A patient may become comatose, and death or brain injury may occur.
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