measles

Definition

Measles is an infection, caused by a virus, which causes an illness displaying a characteristic skin rash. Measles is also sometimes called rubeola, 5-day measles, or hard measles.

Description

Measles infections appear all over the world. Prior to the current effective immunization program, large-scale measles outbreaks occurred on a two to three-year cycle, usually in the winter and spring. Smaller outbreaks occurred during the off-years. Babies up to about eight months of age are usually protected from contracting measles, due to immune cells they receive from their mothers in the uterus. Once someone has had measles infection, he or she can never get it again.

— Rosalyn Carson-DeWitt, MD

1. 1. An acute, contagious viral disease, usually occurring in childhood and characterized by eruption of red spots on the skin, fever, and catarrhal symptoms. Also called rubeola.
   2. Black measles.
   3. Any of several other diseases, especially German measles, that cause similar but milder symptoms.
2. A disease of cattle and swine caused by tapeworm larvae.
3. A plant disease, usually caused by fungi, that produces minute spots on leaves and stems.

[Middle English maseles, mesels, pl. of masel, measles-spot, of Middle Low German origin.]

For more information on measles, visit Britannica.com.

An acute, highly infectious viral disease with cough, fever, and maculopapular rash. It is of worldwide endemicity.

The virus enters the body via the respiratory system, multiplies there, and circulates in the blood. Cough, sneezing, conjunctivitis, photophobia, and fever occur, with Koplik's spots (small red spots containing a bluish-white speck in the center) in the mouth.

A rash appears after 14 days' incubation and persists 5–10 days. Serious complications may occur in 1 out of 15 persons; these are mostly respiratory (bronchitis, pneumonia), but neurological complications are also found. Encephalomyelitis occurs rarely. Permanent disabilities may ensue for a significant number of persons. Measles is one of the leading causes of death among children in the world, particularly in the developing countries.

In unvaccinated populations, immunizing infections occur in early childhood during epidemics which recur after 2–3 years' accumulation of susceptible children. Transmission is by coughing or sneezing. Measles is infectious from the onset of symptoms until a few days after the rash has appeared. Second attacks of measles are very rare. Treatment is symptomatic.

Killed virus vaccine should not be used, as certain vaccinees become sensitized and develop local reactions when revaccinated with live attenuated virus, or develop a severe illness upon contracting natural measles. Live attenuated virus vaccine effectively prevents measles; vaccine-induced antibodies persist for years. See also Biologicals; Hypersensitivity; Skin test.

An infectious disease caused by a virus. There are two types: rubeola and rubella (German measles). Both have oral manifestations.

Koplik’s spots with measles. (Sapp/Eversole/Wysocki, 2004, courtesy Dr. Robert J. Achterberg)

Definition

Measles is a viral infection that causes an illness displaying a characteristic skin rash known as an exanthem. Measles is also sometimes called rubeola, five-day measles, or hard measles.

Description

Measles infections appear all over the world. Incidence of the disease in the United States is down to a record low and only 86 confirmed cases were reported in the year 2000. Of these, 62% were definitely linked to foreigners or international travel. Prior to the current effective immunization program, large-scale measles outbreaks occurred on a two to three year cycle, usually in the winter and spring. Smaller outbreaks occurred during the off-years. Babies up to about eight months of age are usually protected from contracting measles, due to antibodies they receive from their mothers in the uterus. Once someone has had measles, he or she can never get it again.

Causes & Symptoms

Measles is caused by a type of virus called a paramyxovirus. It is an extremely contagious infection, spread through the tiny droplets that may spray into the air when a person carrying the virus sneezes or coughs. About 85% of those people exposed to the virus will become infected with it. About 95% of those people infected with the virus will develop the illness. Once someone is infected with the virus, it takes about seven to 18 days before he or she actually becomes ill. The most contagious time period is the three to five days before symptoms begin through about four days after the characteristic measles rash has begun to appear.

The first signs of measles infection are fever, extremely runny nose, red, runny eyes, and a cough. A few days later, a rash appears in the mouth, particularly on the mucous membrane that lines the insides of the cheek. This rash consists of tiny white dots (like grains of salt or sand) on a reddish bump. These are called Koplik's spots, and are unique to measles infection. The throat becomes red, swollen, and sore.

A couple of days after the appearance of the Koplik's spots, the measles rash begins. It appears in a characteristic progression, from the head, face, and neck, to the trunk, then abdomen, and next out along the arms and legs. The rash starts out as flat, red patches, but eventually develops some bumps. The rash may be somewhat itchy. When the rash begins to appear, the fever usually climbs higher, sometimes reaching as high as 105°F (40.5°C). There may be nausea, vomiting, diarrhea, and multiple swollen lymph nodes. The cough is usually more problematic at this point, and the patient feels awful. The rash usually lasts about five days. As it fades, it turns a brownish color, and eventually the affected skin becomes dry and flaky.

Many patients (about 5–15%) develop other complications. Bacterial infections, such as ear infections, sinus infections, and pneumonia are common, especially in children. Other viral infections may also strike the patient, including croup, bronchitis, laryngitis, or viral pneumonia. Inflammation of the liver, appendix, intestine, or lymph nodes within the abdomen may cause other complications. Rarely, inflammation of the heart or kidneys, a drop in platelet count (causing episodes of difficult-to-control bleeding), or reactivation of an old tuberculosis infection can occur.

An extremely serious complication of measles infection is the inflammation and subsequent swelling of the brain. Called encephalitis, this can occur up to several weeks after the basic measles symptoms have resolved. About one out of every 1,000 patients develops this complication, and about 10–15% of these patients die. Symptoms include fever, headache, sleepiness, seizures, and coma. Long-term problems following recovery from measles encephalitis may include seizures and mental retardation.

A very rare complication of measles can occur up to 10 years or more following the initial infection. Called subacute sclerosing panencephalitis, this is a slowly progressing, smoldering, swelling, and destruction of the entire brain. It is most common among people who had measles infection prior to the age of two years. Symptoms include changes in personality, decreased intelligence with accompanying school problems, decreased coordination, and involuntary jerks and movements of the body. As the disease progresses, the patient becomes increasingly dependent, ultimately becoming bedridden and unaware of his or her surroundings. Blindness may develop, and the temperature may spike (rise rapidly) and fall unpredictably as the brain structures responsible for temperature regulation are affected. Death is inevitable.

Measles during pregnancy is a serious disease, leading to increased risk of a miscarriage or stillbirth. In addition, the mother's illness may progress to pneumonia.

Diagnosis

Measles is almost always diagnosed based on its characteristic symptoms, including Koplik's spots, and a rash that spreads from central body structures out towards the arms and legs. If there is any doubt as to the diagnosis, then a specimen of body fluids (mucus or urine) can be collected and combined with fluorescent-tagged measles virus antibodies. Antibodies are produced by the body's immune cells that can recognize and bind to markers (antigens) on the outside of specific organisms, in this case the measles virus. Once the fluorescent antibodies have attached themselves to the measles antigens in the specimen, the specimen can be viewed under a special microscope to verify the presence of the measles virus.

Treatment

There are a variety of general measures that can be taken to treat measles and help the patient feel more comfortable. These include:

• humidifying the air to ease cough
• drinking plenty of fluids to prevent dehydration
• keeping the room lights dim to relieve sensitivity to light
• getting plenty of rest
• eating nutritious and easily digestible food

Herbals and Chinese Medicine

There are specific acupuncture and acupressure therapies for measles. The following herbals can also help relieve the symptoms associated with measles:

• Chamomile tea for restlessness.
• Echinacea plus goldenseal to clear infection, boost the immune system, and soothe skin and mucous membranes.
• A tea of lemon balm leaf, chamomile flower, peppermint leaf, licorice root, and elder flower to reduce fever and chills and increase perspiration.
• Ginger tea to reduce fever.
• Shiitake mushrooms to boost the immune system.
• Witch hazel (Hamamelis virginiana), chickweed (Stellaria media), or oatmeal baths to reduce itching.
• Eyebright (Euphrasia officinalis) eyewash to soothe eyes.
• Garlic to fight infection and boost the immune system.
• Flos lonicerae (10 g) and Radix glycyrrhizae (3 g) decoction to wash the mouth, eyes, and nose.

Supplements

Some studies have shown that children with measles encephalitis or pneumonia benefit from relatively large doses of vitamin A. Vitamin A may also heal mucous membranes. Bioflavinoids and vitamin C boost the immune system. Zinc promotes healing and is an immune system stimulant. Zinc can cause nausea and vomiting, and chronic use can cause low levels of copper and iron-deficiency anemia.

Homeopathy

Homeopathic remedies cater to the patient's specific symptoms. Remedies for common measles symptoms are listed. The patient can take 30x or 9c of the following remedies four times daily for two days:

• Apis mellifica: for swollen throat, breathing difficulty, and painful cough.
• Arsenicum album: for restlessness, feeling worse after midnight, and thirst.
• Belladonna: for high fever, red eyes, flushed face, headache, and swallowing difficulty.
• Gelsemium: for fever, droopy eyes, cough, feeling cold, and runny nose.
• Pulsatilla: for eye problems (tears, drainage, light sensitivity), dark red rash, thick yellow nasal discharge, and dry cough.

Allopathic Treatment

There are no medications available to cure measles. Treatment is primarily aimed at helping the patient to be as comfortable as possible, and watching carefully so that antibiotics can be started promptly if a bacterial infection develops. Fever and discomfort can be treated with acetaminophen (Tylenol) or ibuprofen (Advil, Motrin, Nuprin). Children with measles should never be given aspirin, as this increases the risk of the fatal disease Reye's syndrome.

Expected Results

The prognosis for an otherwise healthy, well-nourished child who contracts measles is usually quite good. In developing countries, however, death rates may reach 15–25%, as malnutrition, especially protein deficiency, for six months prior to the onset of measles increases the risk of death. Adolescents and adults usually have a more difficult course. Women who contract the disease while pregnant may give birth to a baby with a hearing impairment. Although only one in 1,000 patients with measles will develop encephalitis, 10–15% of those who do will die, and about another 25% will be left with permanent brain damage.

Prevention

Measles is a highly preventable infection. A very effective vaccine exists, made of live measles viruses that have been treated so they cannot cause infection. The important markers on the viruses are intact and cause the immune system to produce antibodies. In the event of a future infection with measles virus the antibodies will quickly recognize the organism and eliminate it. Measles vaccines are usually given at about 15 months of age. Prior to that age, the baby's immune system is not mature enough to initiate a reaction strong enough to ensure long-term protection from the virus. A repeat injection should be given at about 10 or 11 years of age. Outbreaks on college campuses have occurred among nonimmunized or incorrectly immunized students.

Measles vaccine should not be given to a pregnant woman, however, in spite of the seriousness of gestational measles. The reason for not giving this particular vaccine during pregnancy is the risk of transmitting measles to the unborn child.

Surprisingly, new cases of measles began being reported in some countries—including Great Britain—in 2001 because of parents' fears about vaccine safety. The combined vaccine for measles, mumps, and rubella (MMR) was claimed to cause autism or bowel disorders in some children. However, the World Health Organization (WHO) says there is no scientific merit to these claims. The United Nations expressed concern that unwarranted fear of the vaccine would begin spreading the disease in developing countries, and ultimately in developed countries as well. Parents in Britain began demanding the measles vaccine as a separate dose and scientists were exploring that option as an alternative to the combined MMR vaccine. Unfortunately, several children died during an outbreak of measles in Dublin because they had not received the vaccine. Child mortality due to measles is considered largely preventable, and making the MMR vaccine widely available in developing countries is part of WHO's strategy to reduce child mortality by two-thirds by the year 2015.

Resources

Books

Gershon, Anne. "Measles (Rubeola)." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.

Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley and Sons, Inc., 1995.

"Viral Infections: Measles." Section 19, Chapter 265 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Ying, Zhou Zhong, and Jin Hui De. "Childhood Infections." In Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingston, 1997.

Periodicals

Borton, Dorothy. "Keeping Measles at Bay: Use These Four Techniques to Stop the Spread." Nursing 27, no. 12 (December 1997): 26.

Chiba, M. E., M. Saito, N. Suzuki, et al. "Measles Infection in Pregnancy." Journal of Infection 47 (July 2003): 40–44.

Hussey, Greg. "Managing Measles: Integrated Case Management Reduces Disease Severity." British Medical Journal 314, no. 7077 (February 1, 1997): 316+.

Jones, G., R. W. Steketee, R. E. Black, et al. "How Many Child Deaths Can We Prevent This Year?" Lancet 362 (July 5, 2003): 65–71.

McBrien, J., J. Murphy, D. Gill, et al. "Measles Outbreak in Dublin, 2000." Pediatric Infectious Disease Journal 22 (July 2003): 580–584.

"Measles—United States, 2000. (From the Centers for Disease Control and Prevention)." Journal of the American Medical Association 287, no. 9 (March 6, 2002): 1105–1112.

"Progress Toward Global Measles Control and Elimination, 1990-1996." Journal of the American Medical Association 278, no. 17 (November 5, 1997): 1396+.

Scott, L. A., and M. S. Stone. "Viral exanthems." Dermatology Online Journal 9 (August 2003): 4.

Sur, D. K., D. H. Wallis, and T. X. O'Connell. "Vaccinations in Pregnancy." American Family Physician 68 (July 15, 2003): 299–304.

"WHO: Vaccine Fears Could Lead to Unnecessary Deaths." Medical Letter on the CDC & FDA (March 17, 2002): 11.

Organizations

American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove Village, IL 60007. (847) 434-4000. .

Centers for Disease Control and Prevention. 1600 Clifton Rd., Atlanta, GA 30333. (404) 639-3311. .

Other

Zand, Janet. "Measles." HealthWorld Online [cited October 2002]. .

[Article by: Belinda Rowland; Teressa G. Odle; Rebecca J. Frey, PhD]

Definition

Measles is an infection caused by a virus, which causes an illness displaying a characteristic skin rash known as an exanthem. Measles is also sometimes called rubeola, five-day measles, or hard measles.

Description

Measles is a very contagious disease primarily characterized by cough, runny nose, red eyes (conjunctivitis), and a characteristic rash on the skin and inside of the cheeks. The most common complications are ear infection and diarrhea, although more serious complications can include pneumonia, meningitis, or encephalitis. Measles is fatal (due to complications) in about two out of every 1,000 cases.

Demographics

Measles infections appear all over the world. Prior the effective immunization program used in the early 2000s, large-scale measles outbreaks occurred on a two to three-year cycle, usually in the winter and spring. Smaller outbreaks occurred during the off years. Babies up to about eight months of age are usually protected from contracting measles, due to immune cells they receive from their mothers in the uterus. Once someone has had measles infection, he or she can never get it again.

Causes and Symptoms

Measles is caused by a type of virus called a paramyxovirus. It is an extremely contagious infection, spread through the tiny droplets that may spray into the air when an individual carrying the virus sneezes or coughs. About 85 percent of those people exposed to the virus will become infected with it. About 95 percent of those people infected with the virus will develop the illness called measles. Once someone is infected with the virus, it takes about seven to 18 days before he or she actually becomes ill. The most contagious time period is the three to five days before symptoms begin through about four days after the characteristic measles rash has begun to appear.

The first signs of measles infection are fever; extremely runny nose; red, runny eyes; and a cough. A few days later, a rash appears in the mouth, particularly on the mucous membrane that lines the cheeks. This rash consists of tiny white dots (like grains of salt or sand) on a reddish bump. These are called Koplik's spots and are unique to measles infection. The throat becomes red, swollen, and sore.

A couple of days after the appearance of the Koplik's spots, the measles rash begins. It appears in a characteristic progression, from the head, face, and neck, to the trunk, then abdomen, and next out along the arms and legs. The rash starts out as flat, red patches but eventually develops some bumps. The rash may be somewhat itchy. When the rash begins to appear, the fever usually climbs higher, sometimes reaching as high as 105°F (40.5°C). There may be nausea, vomiting, diarrhea, and multiple swollen lymph nodes. The cough is usually more problematic at this point, and the patient feels awful. The rash usually lasts about five days. As it fades, it turns a brownish color and eventually the affected skin becomes dry and flaky.

Many patients (about 5–15%) develop other complications. Bacterial infections, such as ear infections, sinus infections, and pneumonia are common, especially in children. Other viral infections may also strike the patient, including croup, bronchitis, laryngitis, or viral pneumonia. Inflammation of the liver, appendix, intestine, or lymph nodes within the abdomen may cause other complications. Rarely, inflammations of the heart or kidneys, a drop in platelet count (causing episodes of difficult-to-control bleeding), or reactivation of an old tuberculosis infection can occur.

An extremely serious complication of measles infection is swelling of the brain. Called encephalitis, this condition can occur up to several weeks after the basic measles symptoms have resolved. About one out of every thousand patients develops this complication, and about 10 to 15 percent of these patients die. Symptoms include fever, headache, sleepiness, seizures, and coma. Long-term problems following recovery from measles encephalitis may include seizures and mental retardation.

A very rare complication of measles can occur up to ten years following the initial infection. Called subacute sclerosing panencephalitis, this is a slowly progressing, smoldering swelling and destruction of the entire brain. It is most common among people who had measles infection prior to the age of two years. Symptoms include changes in personality, decreased intelligence with accompanying school problems, decreased coordination, involuntary jerks and movements of the body. The disease progresses so that the individual becomes increasingly dependent, ultimately becoming bedridden and unaware of his or her surroundings. Blindness may develop, and the temperature may spike (rise rapidly) and fall unpredictably as the brain structures responsible for temperature regulation are affected. Death is inevitable.

Measles during pregnancy is a serious disease, leading to increased risk of a miscarriage or stillbirth. In addition, the mother's illness may progress to pneumonia.

Diagnosis

Measles infection is almost always diagnosed based on its characteristic symptoms, including Koplik's spots, and a rash which spreads from central body structures out towards the arms and legs. If there is any doubt as to the diagnosis, then a specimen of body fluids (mucus, urine) can be collected and combined with fluorescent-tagged measles virus antibodies. Antibodies are produced by the body's immune cells that can recognize and bind to markers (antigens) on the outside of specific organisms, in this case the measles virus. Once the fluorescent antibodies have attached themselves to the measles antigens in the specimen, the specimen can be viewed under a special microscope to verify the presence of measles virus.

Treatment

As of 2004 there are no treatments available to stop measles infection. Treatment is primarily aimed at helping the patient to be as comfortable as possible and watching carefully so that antibiotics can be started promptly if a bacterial infection develops. Fever and discomfort can be treated with acetaminophen. Children with measles should never be given aspirin, as aspirin is correlated with the fatal disease Reye's syndrome. A cool-mist vaporizer may help decrease the cough. Patients should be given a lot of liquids to drink, in order to avoid dehydration from the fever.

Some studies have shown that children with measles encephalitis benefit from relatively large doses of vitamin A.

Prognosis

The prognosis for an otherwise healthy, well-nourished child who contracts measles is usually quite good. In developing countries, however, death rates may reach 15 to 25 percent. Adolescents and adults usually have a more difficult course. Women who contract the disease while pregnant may give birth to a baby with hearing impairment. Although only one in 1,000 patients with measles will develop encephalitis, 10 to 15 percent of those who do will die, and about another 25 percent will be left with permanent brain damage.

Prevention

Measles is a highly preventable infection. A very effective vaccine exists, made of live measles viruses that have been treated so that they cannot cause actual infection. The important markers on the viruses are intact, however, which causes an individual's immune system to react. Immune cells called antibodies are produced, which in the event of a future infection with measles virus quickly recognize the organism and kill it off. Measles vaccines are usually given to children at about 15 months of age; prior to that age, the baby's immune system is not mature enough to initiate a reaction strong enough to insure long-term protection from the virus. A repeat injection should be given at about ten or 11 years of age. Outbreaks on college campuses have occurred among students who were not immunized or who were incorrectly immunized.

Measles vaccine should not be given to pregnant women, however, in spite of the seriousness of gestational measles. The reason for not giving this particular vaccine during pregnancy is the risk of transmitting measles to the unborn child.

Parental Concerns

New cases of measles began being reported in some countries—including Great Britain—in 2001 because of parents' fears about vaccine safety. The combined vaccine for measles, mumps, and rubella (MMR) was claimed to cause autism or bowel disorders in some children. However, the World Health Organization (WHO) position is there is no scientific merit to these claims. The United Nations expressed concern that unwarranted fear of the vaccine would begin spreading the disease in developing countries and ultimately in developed countries as well. Parents in Britain began demanding the measles vaccine as a separate dose, and scientists were exploring that option as an alternative to the combined MMR vaccine. Unfortunately, several children died during an outbreak of measles in Dublin because they had not received the vaccine. Child mortality due to measles is considered largely preventable, and making the MMR vaccine widely available in developing countries is part of WHO strategy to reduce child mortality by two-thirds by the year 2015.

Resources

Books

Katz, Samuel L. "Measles (Rubeola)." In Principles andPractice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

Maldonado, Yvonne. "Measles." In Nelson Textbook ofPediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

Periodicals

Kerr, C. "Good response rate for MMRV vaccine." LancetInfectious Disease 3 (December 2003): 748.

Stalkup, J. R. "A review of measles virus." DermatologyClinics 20 (April 2002): 209–215.

Organizations

American Academy of Pediatrics (AAP). 141 Northwest Point Blvd., Elk Grove Village, IL 60007. Web site: www.aap.org.

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. Web site: www.cdc.gov.

[Article by: Rosalyn Carson-DeWitt, MD Rebecca J. Frey, PhD]

Measles is a viral respiratory illness characterized by high fever and generalized rash. Symptoms start ten to twelve days after airborne exposure and include fever, malaise, conjunctivitis, runny nose, and cough. About fourteen days after exposure, a maculopapular rash appears at the hairline, extends to the face and upper neck, and, over the next three days, spreads down the body to the hands and feet. Although measles is usually not severe in developed countries, it can lead to serious complications including diarrhea (8% of cases), ear infections (7%), pneumonia (6%), encephalitis (0.1%), subacute sclerosing panencephalitis (SSPE)(0.001%), and death (0.2%). Measles is much more serious in developing countries, causing about one million deaths annually during the 1990s. The case fatality rate can be as high as 25 percent, with deaths often caused by secondary infections such as diarrhea or pneumonia. Measles is also a common cause of blindness in the developing world.

Measles is one of the most contagious diseases in the world. The virus, a paramyxovirus containing a single strand of RNA, is normally spread through respiratory droplets and can be transmitted from four days before to four days after rash onset. Before vaccines were introduced, nearly everyone was infected by age ten to twelve years. Immunity is lifelong following infection.

A live attenuated vaccine was licensed in 1963, and further attenuated vaccines are now used around the world. The vaccine is about 95 percent effective in the United States when administered at the recommended age of twelve to fifteen months, and immunity is considered lifelong. It is usually given in conjunction with the mumps and rubella vaccines. Children in developing countries are vaccinated at nine months of age because of the higher risk of infection in infancy.

Routine treatment of measles includes supportive care such as oral rehydration therapy for diarrhea and respiratory care for patients with pneumonia. Antibiotics are used to treat secondary bacterial infections. Although antiviral medications have been used to treat complex measles infections, there are few studies to confirm their effectiveness. High-dose vitamin A therapy reduces mortality and prevents blindness and is recommended by the World Health Organization for children in developing countries.

Global measles eradication has been a goal since the development of an effective vaccine. Humans are the only reservoir for the measles virus, which can survive only hours in the environment. Endemic measles can be eliminated from large geographic areas using intensive vaccination programs, as seen in the United States in the late 1990s. However, measles is so infectious that immunization rates of at least 90 to 95 percent must be attained to interrupt transmission. In addition, the billions of doses required to achieve eradication highlight the need for injection safety and the potential development of needle-free vaccination methods. Finally, the HIV (human immunodeficiency virus) epidemic presents several barriers to measles eradication. HIV-infected persons have a lower response to measles vaccination, develop more severe cases of the disease, and, theoretically, may be infectious for longer periods of time. There is hope that these challenges will be surmounted and measles will be eradicated, following smallpox into the history books.

(SEE ALSO: Communicable Disease Control; Disease Prevention; Eradication of Disease; Immunizations)

Bibliography

Atkinson, W.; Wolfe, C.; Humizter, S.; and Nelson, R., eds. (2000). "Measles." In Epidemiology and Prevention of Vaccine-Preventable Diseases: The Pink Book. Atlanta, GA.: U.S. Department of Health and Human Services.

Redd, S. C.; Markowitz, L. E.; and Katz, S. L. (1999). "Measles Vaccine." In Vaccines, eds. S. A. Plotkin and W. A. Orenstein. Philadelphia, PA: W. B. Sanders.

— SONIA KLEMPERER-JOHNSON; MARK PAPANIA

An acute and contagious disease caused by a virus and characterized by the outbreak of small red spots on the skin. Measles occurs most often in school-age children. (Compare German measles.)

1. a highly contagious disease of humans characterized by a maculopapular skin rash and caused by a morbillivirus; called also rubeola.
2. a term used in veterinary science to identify animal diseases that have a speckled appearance thought to resemble the skin rash of measles in humans. The resemblance in most diseases is superficial and highly speculative.

• beef m. — see cysticercus bovis.
• pork m. — see cysticercus cellulosae.
• sheep m. — see cysticercus ovis.
• m. vaccine — a preparation containing attenuated human measles virus that is used to immunize dogs against canine distemper virus, based on the close antigenic relationship between the two viruses. It is only administered to young puppies, in which the persistence of maternal antibodies against canine distemper virus is likely to interfere with an immune response to canine distemper vaccine. It must always be followed by the administration of canine distemper vaccine by 4 months of age.

Measles
Classification and external resources
ICD-10	B05..-
ICD-9	055
DiseasesDB	7890
MedlinePlus	001569
eMedicine	derm/259 emerg/389 ped/1388
MeSH	D008457

Measles virus
Measles virus
Virus classification
Group:	Group V ((-)ssRNA)
Order:	Mononegavirales
Family:	Paramyxoviridae
Genus:	Morbillivirus
Type species
Measles virus

Measles is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses. Symptoms include fever, cough, runny nose, red eyes and a generalized, maculopapular, erythematous rash.

Measles is spread through respiration (contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing a house with an infected person will catch it. The infection has an average incubation period of 14 days (range 6–19 days) and infectivity lasts from 2–4 days prior, until 2–5 days following the onset of the rash (i.e. 4–9 days infectivity in total).^[1]

An alternative name for measles in English-speaking countries is rubeola, which is sometimes confused with rubella (German measles); the diseases are unrelated.^[2][3] In some other European languages, rubella and rubeola are synonyms, and rubeola is not an alternative name for measles.^[4]

Contents 1 Signs and symptoms 1.1 Complications 2 Cause 3 Diagnosis 4 Prevention 5 Treatment 6 Epidemiology 7 History and culture 7.1 History 7.2 Recent outbreaks 7.3 The Americas 8 Additional images 9 See also 10 References 11 External links

Signs and symptoms

This patient presented on the third pre-eruptive day with “Koplik spots” indicative of the beginning onset of measles.

The classical symptoms of measles include four day fevers, the three Cs—cough, coryza (runny nose) and conjunctivitis (red eyes). The fever may reach up to 40° Celsius (104° Fahrenheit). Koplik's spots seen inside the mouth are pathognomonic (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.

The characteristic measles rash is classically described as a generalized, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing itching. The rash is said to "stain", changing colour from red to dark brown, before disappearing.^{[citation needed]}

Complications

Complications with measles are relatively common, ranging from relatively mild and less serious diarrhea, to pneumonia and encephalitis (subacute sclerosing panencephalitis), corneal ulceration leading to corneal scarring.^[5] Complications are usually more severe amongst adults who catch the virus.

The fatality rate from measles for otherwise healthy people in developed countries is 3 deaths per thousand cases, or .3%.^[6] In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates have been as high as 28%.^[6] In immunocompromised patients (e.g. people with AIDS) the fatality rate is approximately 30 percent.^[7]

Cause

The measles virus is a highly contagious airborne pathogen which spreads primarily via the respiratory system. The virus is transmitted in respiratory secretions, and can be passed from person to person via aerosol droplets containing virus particles, such as those produced by a coughing patient. Once transmission occurs, the virus infects and replicates in the lymphatic system, urinary tract, conjunctivae, blood vessels and central nervous system of its new host.^[8] The role of epithelial cells is uncertain, but the virus must infect them to spread to a new individual.^[9]

Patients with the measles should be placed on droplet precautions.

Humans are the only known natural host of measles, although the virus can infect some non-human primate species.

Diagnosis

Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three C's (cough, coryza, conjunctivitis). Observation of Koplik's spots is also diagnostic of measles.

Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens. In children, where phlebotomy is inappropriate, saliva can be collected for salivary measles specific IgA test. Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis. The contact with any infected person in any way, including semen through sex, saliva, or mucus can cause infection.

Prevention

Rates of measles vaccination worldwide

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 children younger than 18 months usually retain anti-measles immunoglobulins (antibodies) transmitted from the mother during pregnancy. A second dose is usually given to children between the ages of four and five, in order 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.

In developing countries where measles is highly endemic, the WHO recommend that two doses of vaccine be given at six months and at nine months of age. The vaccine should be given whether the child is HIV-infected or not.^[10] The vaccine is less effective in HIV-infected infants, but the risk of adverse reactions is low.

Unvaccinated populations are at risk for the disease. After vaccination rates dropped in northern Nigeria in the early 2000s due to religious and political objections, the number of cases rose significantly, and hundreds of children died.^[11] A 2005 measles outbreak in Indiana was attributed to children whose parents refused vaccination.^[12] In 1998 the MMR vaccine controversy in the United Kingdom regarding a potential link between the combined MMR vaccine (vaccinating children from mumps, measles and rubella) and autism prompted a reemergence of the "measles party", where parents deliberately expose their child to measles in the hope of building up the child's immunity without an injection. This practice poses many health risks to the child, and has been discouraged by the public health authorities.^[13] Scientific evidence provides no support for the hypothesis that MMR plays a role in causing autism.^[14] However, the MMR scare in Britain caused uptake of the vaccine to plunge, and measles cases came back: 2007 saw 971 cases in England and Wales, the biggest rise in occurrence in measles cases since records began in 1995.^[15]

The joint press release by members of the Measles Initiative brings to light another benefit of the fight against measles: "Measles vaccination campaigns are contributing to the reduction of child deaths from other causes. They have become a channel for the delivery of other life-saving interventions, such as bed nets to protect against malaria, de-worming medicine and vitamin A supplements. Combining measles immunization with other health interventions is a contribution to the achievement of Millennium Development Goal Number 4: a two-thirds reduction in child deaths between 1990 and 2015."^[16]

Treatment

Please help improve this article by expanding it. Further information might be found on the talk page. (May 2009)

There is no cure for measles. Most patients with uncomplicated measles will recover with rest and supportive treatment.

Some patients will develop pneumonia as a sequel to the measles.

Epidemiology

Disability-adjusted life year for measles per 100,000 inhabitants.

     no data      ≤ 10      10-25      25-50      50-75      75-100      100-250      250-500      500-750      750-1000      1000-1500      1500-2000      ≥ 2000

According to the World Health Organization (WHO), measles is a leading cause of vaccine-preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by a vaccination campaign led by partners in the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the World Health Organization (WHO). Globally, measles fell 60% from an estimated 873,000 deaths in 1999 to 345,000 in 2005.^[16] Estimates for 2007 indicate deaths have fallen further to 197,000 globally, with most of the global decline seen in the Eastern Mediterranean and African regions (90% and 89% reduction from 2000 respectively).^[17]

History and culture

History

The Antonine Plague, 165-180 AD, also known as the Plague of Galen, who described it, was probably smallpox or measles. Disease killed as much as one-third of the population in some areas, and decimated the Roman army.^[18] The first scientific description of measles and its distinction from smallpox and chickenpox is credited to the Persian physician, Muhammad ibn Zakariya ar-Razi (860-932), known to the West as "Rhazes", who published a book entitled The Book of Smallpox and Measles (in Arabic: Kitab fi al-jadari wa-al-hasbah).^[19]

Measles is an endemic disease, meaning that it has been continually present in a community, and many people develop resistance. In populations that have not been exposed to measles, exposure to a new disease can be devastating. In 1529, a measles outbreak in Cuba killed two-thirds of the natives who had previously survived smallpox. Two years later measles was responsible for the deaths of half the population of Honduras, and had ravaged Mexico, Central America, and the Inca civilization.^[20]

In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide.^[21] During the 1850s, measles killed a fifth of Hawaii's people.^[22] In 1875, measles killed over 40,000 Fijians, approximately one-third of the population.^[23] In the 19th century, the disease decimated the Andamanese population.^[24] In 1954, the virus causing the disease was isolated from an 11-year old boy from the United States, David Edmonston, and adapted and propagated on chick embryo tissue culture.^[25] To date, 21 strains of the measles virus have been identified.^[26] Licensed vaccines to prevent the disease became available in 1963.

Recent outbreaks

Main article: Measles outbreaks in the 2000s

On February 19, 2009, 505 measles cases were reported in twelve provinces in the North of Vietnam, with Hanoi accounting for 160 cases^[27]. A high rate of complications including meningitis & encephalitis has worried health workers^[28] and the U.S. CDC recommended that all travelers be immune to measles^[29].

On The 1st April 2009, an outbreak has happened in two schools in North Wales. Ysgol John Bright and Ysgol Ffordd Dyffryn in Wales have had the outbreak and are making sure every pupil has had the MMR vaccine.

In 2007, a large measles outbreak in Japan caused a number of universities and other institutions to close in an attempt to contain the disease.^[30][31]

Approximately 1000 cases of the disease were reported in Israel between August 2007 and May 2008 (in sharp contrast to just some dozen cases the year before).^{[citation needed]} Many children in ultra-Orthodox Jewish communities were affected due to low vaccination coverage.^[32][33] As of 2008 the disease is endemic in the United Kingdom with 1,217 cases diagnosed in 2008 ^[34] and epidemics have been reported in Austria, Italy and Switzerland. Low vaccination rates are responsible.^[35]

The Americas

Indigenous measles were declared to have been eliminated in North, Central, and South America; the last endemic case in the region was reported on November 12, 2002, with only Northern Argentina and rural Canada, particularly in the provinces of Ontario, Quebec, and Alberta having minor endemic status.^[36] Outbreaks are still occurring, however, following importations of measles viruses from other world regions. In June 2006, an outbreak in Boston resulted after a resident became infected in India,^[37] and in October 2007, a Michigan girl who had been vaccinated contracted the disease in Sweden.^[38]

Between January 1 and April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported in the United States to the Centers for Disease Control and Prevention,^[39][40] the most reported by this date for any year since 2001. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status.^[41]

By July 9, 2008, a total of 127 cases were reported in 15 states (including 22 in Arizona^[42]), making it the largest U.S. outbreak since 1997 (when 138 cases were reported).^[43] Most of the cases were acquired outside of the United States and afflicted individuals who had not been vaccinated.

By July 30, 2008, the number of cases had grown to 131. Of these, about half involved children whose parents rejected vaccination. The 131 cases occurred in 7 different outbreaks. There were no deaths, and 15 hospitalizations. 11 of the cases had received at least one dose of the measles vaccine. 122 of the cases involved children who were unvaccinated or whose vaccination status was unknown. Some of these were under the age of one year old and below the age when vaccination is recommended, but in 63 cases the vaccinations had been refused for religious or philosophical reasons.

Additional images

Intra oral rash of measles

Measles in African Child

This child shows a classic day-4 rash with measles.

Histopathology of measles pneumonia. Giant cell

See also

• Infectious disease
• List of epidemics
• MMR vaccine
• Roseola ("baby measles")
• Rubella (German measles)

References

1. ^ "Measles". http://www.patient.co.uk/showdoc/40000391/. 
2. ^ Merriam-webster:Rubeola Accessed 2009-09-20.
3. ^ T. E. C. Jr. Letters to the editor Pediatrics Vol. 49 No. 1 January 1972, pp. 150-151.
4. ^ Webster's Online Dictionary: German measles Accessed 2009-09-20
5. ^ http://web.archive.org/web/20080227154121/http://www.iceh.org.uk/files/tsno4/resources/no04.doc
6. ^ ^{a b} Perry, Robert T.; Halsey, Neal A. (May 1, 2004). "The Clinical Significance of Measles: A Review". The Journal of Infectious Diseases (Infectious Diseases Society of America) 189 (S1): 1547–1783. doi:10.1086/377712. http://www.journals.uchicago.edu/doi/full/10.1086/377712. Retrieved January 14, 2009. 
7. ^ Sension, MG; Quinn TC, Markowitz LE, Linnan MJ, Jones TS, Francis HL, Nzilambi N, Duma MN, Ryder RW (December 1988). "Measles in hospitalized African children with human immunodeficiency virus". American Journal of Diseases of Children 142 (12): 1271–1272. http://www.popline.org/docs/0832/055280.html. Retrieved January 14, 2009. 
8. ^ Skalka, Anna M.; Johnson, Flint; Enquist, L. W.; Racaniello, Vincent R. (2003). Principles of Virology: Molecular Biology, Pathogenesis, and Control of Animal Viruses (2nd ed.). American Society Microbiology. ISBN 1-55581-259-7. 
9. ^ Leonard VH, Sinn PL, Hodge G, et al. (2008). "Measles virus blind to its epithelial cell receptor remains virulent in rhesus monkeys but cannot cros the airway epithelium and is not shed". J. Clin. Invest. 118 (7): 2448–2458. doi:10.1172/JCI35454. PMID 18568079. 
10. ^ Helfand RF, Witte D, Fowlkes A, et al. (2008). "Evaluation of the immune response to a 2-dose measles vaccination schedule administered at 6 and 9 months of age to HIV-infected and HIV-uninfected children in Malawi". J Infect Dis 198: 1457–1465. doi:10.1086/592756. 
11. ^ "Measles kills more than 500 children so far in 2005". IRIN. 2005-03-21. http://www.irinnews.org/Report.aspx?ReportId=53506. Retrieved 2007-08-13. 
12. ^ Parker A, Staggs W, Dayan G et al. (2006). "Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States". N Engl J Med 355 (5): 447–55. doi:10.1056/NEJMoa060775. PMID 16885548. 
13. ^ Dillner L (2001-07-26). "The return of the measles party". Guardian. http://lifeandhealth.guardian.co.uk/health/story/0,,1610704,00.html. Retrieved 2007-08-13. 
14. ^ Rutter M (2005). "Incidence of autism spectrum disorders: changes over time and their meaning". Acta Paediatr 94 (1): 2–15. doi:10.1080/08035250410023124. PMID 15858952. 
15. ^ Torjesen I (2008-04-17). "Disease: a warning from history". Health Serv J: 22–4. PMID 18533314. http://www.hsj.co.uk/insideknowledge/features/2008/03/ingrid_torjesen_on_the_diseases_we_thought_had_gone_away.html. 
16. ^ ^{a b} UNICEF Joint Press Release
17. ^ State of the world's vaccinations and immunizations, 3rd edition, 2009 http://www.who.int/immunization/sowvi/en/index.html
18. ^ Plague in the Ancient World
19. ^ Harminder S. Dua, Ahmad Muneer Otri, Arun D. Singh (2008), "Abu Bakr Razi", British Journal of Ophthalmology (BMJ Group) 92: 1324 
20. ^ http://www.mariner.org/exploration/index.php?page=faq. Retrieved October 15, 2006.
21. ^ Torrey EF and Yolken RH. 2005. Their bugs are worse than their bite. Washington Post, April 3, p. B01.
22. ^ Migration and Disease. Digital History.
23. ^ Fiji School of Medicine
24. ^ Measles hits rare Andaman tribe. BBC News. May 16, 2006.
25. ^ "Live attenuated measles vaccine". EPI Newsl 2 (1): 6. 1980. PMID 12314356. 
26. ^ Rima BK, Earle JA, Yeo RP, et al. (1995). "Temporal and geographical distribution of measles virus genotypes". J. Gen. Virol. 76 (5): 1173–80. doi:10.1099/0022-1317-76-5-1173. PMID 7730801. http://vir.sgmjournals.org/cgi/pmidlookup?view=long&pmid=7730801. 
27. ^ "Measles spreads to 12 provinces". Look At Vietnam. 20 February 2009. http://www.lookatvietnam.com/2009/02/measles-spreads-to-12-provinces.html. 
28. ^ "Measles outbreak hits North Vietnam". Saigon Gia Phong. 4 February 2009. http://www.saigon-gpdaily.com.vn/Health/2009/2/68224/. 
29. ^ AmCham Vietnam | Public Notice: Measles immunization recommendation
30. ^ "The Public Health Agency of Canada Travel Advisory". http://www.phac-aspc.gc.ca/tmp-pmv/2007/measjap070601_e.html. Retrieved 2008-05-02. 
31. ^ Norrie, Justin (May 27, 2007). "Japanese measles epidemic brings campuses to standstill". The Sydney Morning Herald. http://www.smh.com.au/news/world/japanese-measles-epidemic-brings-campuses-to-standstill/2007/05/27/1180205052602.html. Retrieved 2008-07-10. 
32. ^ Stein-Zamir, C.; G. Zentner, N. Abramson, H. Shoob, Y. Aboudy, L. Shulman and E. Mendelson (February 2008). "Measles outbreaks affecting children in Jewish ultra-orthodox communities in Jerusalem". Epidemiology and Infection 136 (2): 207–214. doi:10.1017/S095026880700845X. PMID 17433131. 
33. ^ Rotem, Tamar (August 11, 2007). "Current measles outbreak hit ultra-Orthodox the hardest". Haaretz. http://www.haaretz.com/hasen/spages/921836.html. Retrieved 2008-07-10. 
34. ^ Batty, David (Friday 9 January 2009 15.38 GMT). "Record number of measles cases sparks fear of epidemic". guardian.co.uk. http://www.guardian.co.uk/society/2009/jan/09/measles-record-numbers. Retrieved January 15th, 2009. 
35. ^ Eurosurveillance - View Article
36. ^ NORTH YORK: Measles outbreak may bring new strategy, May 2008
37. ^ "Measles outbreak shows a global threat - The Boston Globe". http://www.boston.com/yourlife/health/diseases/articles/2006/06/10/measles_outbreak_shows_a_global_threat/. Retrieved 2007-12-05. 
38. ^ Jesse, David (October 4, 2007). "Measles outbreak may have spread". The Ann Arbor News. http://blog.mlive.com/study_hall/2007/10/measles_outbreak_may_have_spre.html. Retrieved 2008-07-10. 
39. ^ "cdc.gov". http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e501a1.htm?s_cid=mm57e501a1_e. Retrieved 2008-05-02. 
40. ^ JS Online: Measles outbreak brewing, city health officials say
41. ^ "cdc.gov MeaslesUpdate". http://www.cdc.gov/Features/MeaslesUpdate/. Retrieved 2008-05-02. 
42. ^ Rotstein, Arthur (July 9, 2008). "Response curtailed measles outbreak". The Associated Press. http://www.tucsoncitizen.com/daily/local/90471.php. Retrieved 2008-07-10. 
43. ^ Dunham, Will (July 9, 2008). "Measles outbreak hits 127 people in 15 states". Reuters. http://www.reuters.com/article/newsOne/idUSN0943743120080709. Retrieved 2008-07-10. 

External links

Wikimedia Commons has media related to: Measles

• WHO.int - 'Initiative for Vaccine Research (IVR): Measles', World Health Organization (WHO)
• Measles FAQ from Centers for Disease Control and Prevention in the United States
• Case of an adult male with measles (facial photo)
• Clinical pictures of measles

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Dansk (Danish)
n. - mæslinger
n. pl. - tinter, bændelorm (hos dyr)

Nederlands (Dutch)
mazelen, bepaalde varkensziekte

Français (French)
n. - (Méd) rougeole, rougeole (des porcins)
n. pl. - larve (de la rougeole chez les porcins)

Deutsch (German)
n. pl. - Masern, Larven der Taenia-Würmer
n. - Masern, Finnen

Ελληνική (Greek)
n. pl. - (παθολ.) ιλαρά

Italiano (Italian)
morbillo

Português (Portuguese)
n. pl. - sarampo (m)

Русский (Russian)
корь

Español (Spanish)
n. - sarampión, triquinosis, hidatidosis
n. pl. - larvas que provocan la triquinosis e hidatidosis

Svenska (Swedish)
n. pl. - mässling (en), dynt (vet.med.)

中文（简体）(Chinese (Simplified))
麻疹, 包虫病, 风疹

中文（繁體）(Chinese (Traditional))
n. pl. - 麻疹, 包蟲病, 風疹
n. - 麻疹, 包蟲病, 風疹

한국어 (Korean)
n. pl. - 홍역
n. - 빨간 반점

日本語 (Japanese)
n. - 麻疹, 風疹, 包虫の幼虫, 包虫症

العربيه (Arabic)
‏(الجمع) حصبه‏

עברית (Hebrew)
n. - ‮חצבת‬

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