Measles is a very contagious infection caused by the rubeola virus. It is an airborne disease whose symptoms typically appear about 10-12 days after exposure to an infected person.
The initial symptoms of this disease include fever, runny nose, cough, inflamed, red eyes, and tiny white spots inside the mouth.
Measles is transmitted easily through sneezes and coughs of an infected person. It may also be transmitted via direct contact with mouth and nasal secretions.
The majority of people who are not immune to the infection and share a living space with an infected person will be infected. Measles is a public health concern due to its rapid rate of infection and its target population being children.
Although the measles vaccine is available and very effective, it remains a leading cause of death among children.
According to the World Health Organization (WHO), despite the global death rate caused by measles decreasing by up to 84 percent globally in recent years – from 550, 100 deaths in 2000 to 89,780 in 2016 – the disease remains ubiquitous in many developing countries, especially in Asia and Africa. Seven million people were estimated to be infected by measles in 2016 alone.
The vaccine for measles has been in use since the middle of the 20th century. It is safe, inexpensive, and effective in preventing the disease. It is usually used in combination with other childhood vaccines.
The application of vaccines to susceptible populations – that is, children – which was recommended by the World Health Organization has drastically reduced the number of deaths worldwide.
WHO also recommends the immunization of adults who have not been vaccinated against measles. Like all viral infections, there is no specific treatment for measles, although support and care for the infected person can improve healing.
Causes of Measles
Measles is caused by the rubeola virus, a single-stranded RNA virus of the family Paramyxoviridae.
It is very contagious and can spread by the coughing and sneezing of an infected person or through direct contact with their secretions. It is capable of surviving in airspace and nearby surfaces for up to two hours.
The contagion rate of measles is so high that if a single person has it, they can infect up to 90 percent of no-immune people nearby. Humans are the only natural host of the rubeola virus.
There have not been any known cases of infection in animals. The following risk factors have been associated with the disease. These are:
- Immunodeficiency caused by HIV or AIDS.
- Traveling to areas with a high incidence of measles cases.
- Immunosuppression following stem cell transplant or the receipt of an organ.
- Alkylating agents.
- Corticosteroid therapy.
Signs and Symptoms of Measles
The symptoms of measles typically appear about 10 to 14 days after exposure to the virus. The symptoms include;
- Fever
- Cough
- Runny nose
- Puffy red eyes (conjunctivitis)
- Tiny white spots with a bluish-white tinge around the center located in the mouth on the inner lining of the cheek – also known as Koplik’s spots
- Presence of red rash on the skin, which consists of large, flat patches that flow into each other.
The infection occurs sequentially over a period of two to three weeks.
Stage One
This is the incubation stage of the virus that occurs in the first 10 to 14 days after you have been infected. There is no visible sign or symptom of the virus at this time.
Stage Two
The symptoms typically begin with a moderate fever, often followed by a persistent dry cough, runny nose, sore throat, and red eyes. This stage lasts for two or three days.
Stage Three
Rashes consisting of small red dots which are sometimes slightly raised, begin to show, The spots and bumps in tight bunches give the skin a patchy red appearance. The face is the first to show this particular symptom.
Over the next few days, the rash spreads to the arms and torso, then over the thighs, and lower limbs. While this occurs, the fever rises sharply, sometimes going as high as 41℃. The rash recedes gradually, first fading rapidly from the face and last from the thighs and feet.
Stage Four
An infected person can spread the virus to others for about eight days. This contagious period starts from four days before the rash appears and ends when the rash has been present for four days.
Complications
The following complications may arise from measles infection. They include:
- Vomiting
- Eye infection
- Diarrhea
- Ear infection that could lead to permanent hearing loss
- Seizures
- Difficulty breathing
- Respiratory tract infection like bronchitis and laryngitis
Individuals with a weakened immune system who have measles are more susceptible to bacterial pneumonia. This can be life-threatening if not treated.
The following complications, although not common, are also possible:
- Low platelet count or thrombocytopenia which affects the blood’s ability to clot
- Liver complications such as hepatitis which can occur in adults and children taking a specific medication.
- Inflammation of the brain – also known as encephalitis – a life-threatening condition that could occur after a case of measles.
- Impairment of the nerves and muscles around the eyes.
Rare complications of measles are;
- Heart complications
- Nervous system complications such as toxic encephalopathy, transverse myelitis, and retrobulbar neuritis
Measles infection during pregnancy can lead to early delivery, low birth weight, or even miscarriage.
Diagnosis
The medical diagnosis of measles infection requires a history of fever within at least three days with symptoms such as cough, runny nose, or the inflammation of the eyes. Koplik’s spots, once observed, can also be used to diagnose the infection.
However, it is recommended that laboratory testing should be performed to confirm the diagnosis. This testing can be done by isolating the rubeola virus from respiratory specimens. Saliva can be used for people who are unable to draw blood.
Positive contact with other persons who have been known to be infected by the disease lends credence to the diagnosis.
Treatment of Measles
Like all diseases caused by viruses, there is no specific treatment for measles. Unlike infections caused by bacteria, viral infections are not sensitive to antibiotics.
The symptoms of measles typically disappear after two or three weeks.
However, there is some medication available for people who may have recently been exposed to the virus. These can help alleviate the severity of the infection. They include:
- Measles vaccine administered within 72 hours of exposure
- Immunoglobulin- immune proteins – taken within six days of exposure.
The following may be recommended to aid recovery:
- Rest to boost the immune system
- Lots of fluids
- Ibruprofen to reduce fever
- Vitamin A supplements
- Humidifier to ease sore throat and cough
Prevention
People who have had measles are generally resistant and cannot be infected again. However, for those who have not had it, there are ways to prevent getting ill with the disease:
By Vaccination
Vaccination is the most effective method of preventing measles. Two doses of the vaccine are enough to prevent the infection. The vaccines available are the MMR vaccine and the MMRV vaccine.
The MMR vaccine prevents against not just measles but also rubella and mumps. The MMRV protects against measles, rubella, mumps, and also against chickenpox.
Children are able to receive their first dose of the vaccine at 12 months and the second dose between the ages 4 to 6. It is recommended that adults who have never been immunized visit their doctor for the vaccine.
Other preventive methods include;
- Practicing good hygiene by washing hands before eating, after bathroom use, and before touching face, mouth, or nose.
- Avoid sharing personal items with infected persons. These include eating utensils, toothbrushes, and drinking glasses.
- Avoid coming in contact with people that have been infected.
