Measles: Causes, Symptoms, Diagnosis, Prevention and More

 What do you know about measles?

Not sure?

Well, if you are traveling out of the US, or you often interact with people who have returned to the US from measles-prone countries (especially underdeveloped countries), then you need to understand what measles , what it can do to your family, and how you can deal with it if it affects your baby or yourself.

What is measles?

Measles is an extremely contagious disease that is characterized by a flat rash and catarrhal inflammation of the eyes and respiratory system.

Measles normally infects children, but it can also afflict persons of any age who have previously not been infected by the disease.

Types of measles

Measles is classified depending on the severity of the disease. Mild, moderate, and severe measles are distinguished.

Besides, measles can run an atypical course: it can be classified as abortive (rudimentary) or malignant. The abortive measles is seen in people who are vaccinated. The symptoms are mild; many of them are absent.

Mitigated or modified measles occurs in children immunized prophylactically with immunoglobulin. The runny nose period is either absent or mild.

Malignant hemorrhagic measles is the severest form of measles. Its symptoms include high fever and bleeding. It usually ends by death of the patient. This form is exceptionally rare now.

Measles prevalence

According to the World Health Organization (WHO) there were about 140,000 measles deaths globally in the year 2018.  

Measles cases are on the rise in the United States. Although measles was eliminated in the US in 2000, outbreaks occur when US citizens who have not been vaccinated pick up the infection during their travels abroad and infect Americans in under-immunized close-knit communities.

Who is at risk?

Anybody who has not been vaccinated is at risk of developing measles. Babies between the ages of three months and one year who are not being breastfed are at a high risk of getting the disease. Furthermore, pregnant women and adults who have a weak immune system also have a high risk of contracting measles.

What organism causes measles?

Measles is caused by a medium –sized virus of the paramyxovirus family known as paramyxoviridae. This very small virus (about 1400 A in diameter) induces apparent infection in only human being s and monkeys.  

The virus can remain infectious in the air and contaminated surfaces (at room temperature 37° C) for about two hours.

The virus is rapidly killed when it is exposed to high temperatures, ultra-violet radiation (sunlight), or disinfectants.

The journey of the virus in the infected person

The portal of entry into a healthy person is the lining of the upper airways. There, the virus multiplies and causes inflammation. The virus then enters the blood to cause toxaemia (blood- poisoning) and to affect various organs and tissues.

How measles is spread

When an infected person coughs or sneezes, he releases the virus in droplets of mucus from his respiratory system into the air. The virus can be carried by air to adjacent rooms and flats within a house.

The viruses eventually settle on objects in the environment and when an uninfected person touches the infected objects, he gets infected.   

Complications

Children who are 5 years or younger, and adults who are 20 years and older, are the groups of people who are most at risk for developing measles complications.

Some of the non-severe complications are abdominal pain and diarrhea (in about 8% of cases), as well as ear infections (in about 7% of cases).

Encephalitis (or swelling of the brain) occurs in about 1 in 1000 people who develop measles. Encephalitis occurs in mild measles, as well as severe measles. This swelling normally appears one to 14 days after one is infected. This complication is associated with a recurring fever, headache, vomiting, and a stiff neck. Convulsions occasionally follow these symptoms. About 15% of people who develop encephalitis will die.

Symptoms of measles

When the virus enters the body, it usually incubates for a period of between 9 and 11 days, but can last to 17 days. In people who have been immunized with immunoglobulin, it can incubate for as long as 21 days.

The onset of measles is usually gradual. Initially, the infected person’s temperature rises to 38-39° C. This is accompanied by a headache, malaise, and pain in the muscles.

Within hours, the infected person may suffer burning pain in the eyes. Sneezing, a barking cough, and nasal discharge are also common. Less commonly, the voice of the infected person may become hoarse.

Tiny white spots, also known as Koplik spots, may appear in the inner walls of the cheeks about four days after the person is infected.

Two to four days after the Koplik spots appear, a rash follows. The rash first appears behind the ears or on the face and spread downward to cover the trunk and, eventually, it spreads to cover the hands and legs. The rash fades about 5 days after its onset and leaves a powdery substance on the skin.

Measles Diagnosis

Irritability, development of a bleary-eye, and breathing open-mouthed between sneezing and coughing are signs that suggest that a baby has measles.

When you see these signs, as well as the symptoms of measles enumerated above, consult your doctor immediately.

When the doctor examines the baby and suspects measles, he will order you to do a specific diagnosis. A specific diagnosis involves tests to isolate the measles virus from throat washings, blood, and urine.

Measles Prognosis

Uncomplicated measles is rarely fatal and complete recovery from the disease is the rule. Fatalities are almost always the result of bacterial infections occurring in children below the age of 5 who become infected after passive childhood immunity disappears around 2.5 months.

Antibiotics are effective against the usual secondary invaders (bacteria such as Pneumococcus, Streptococcus hemolyticus, Staphylococcus aureus, and Hemophilus influenza) have reduced the case fatality rate of measles.

Case fatality rates are high in the elderly and people who have tuberculosis.  Congestive cardiac failure is a common cause of death in patients over 50 years old.

Measles Prevention

There are two ways of preventing measles: getting vaccinated and observing proper hygiene.

Getting vaccinated

Highly effective vaccines, the measles-mumps-rubella (MMR) vaccine and the measles-mumps-rubella-varicella (MMRV) vaccine, induce immunity in people who are vaccinated. Children should be vaccinated between 12 and 15 months, and again when they are 4 to 6 year old.  

However, people taking steroid medications, people with leukemia (cancer of the blood) and other systemic malignant diseases, and someone with tuberculosis should not take a vaccination shot.

Practicing good personal hygiene

Observing good hygienic practices, such as washing your hands immediately you come home, and before you touch anything or eat, can also help.

Furthermore, avoiding sharing items such as sponges, spoons, cups, and toothbrushes with other people, can reduce your risk of getting infected.

How to treat measles in babies fast

No viral infection, including measles, can be treated. All you can do is treat the symptoms of the disease. So for a baby who cannot be immunized (0-12 months), give him a pain killer such as acetaminophen or ibuprofen when he develops a fever. 

Furthermore, in the absence of complications, make sure your baby gets enough bed rest in a dark room. Additionally, give the person warm baths every other day.

Give the baby plain water and fresh fruit juices (that contain vitamin C, a vitamin known to boost the immune system).

Since the measles virus is unstable in the environment, making sure the room of the baby is well aerated and disinfecting the room should be enough to kill the virus.

The baby’s diet should be easy to digest and assimilate and rich in vitamins, especially vitamin A to boost the immune system.

How to stop itching from measles

Generally, the rash that develops on the body does not itch. In a few cases, itching may occur. If the infected person itches, put cold wet towels or cloth on the rash to reduce itching. Applying calamine lotion can also give relief.

References

Loeb, C. (1971). Textbook of Medicine. Thirteenth edition.  W.B  Saunders Company.

Volovskaya, M.L. (1990). Epidemiology and Fundamentals of Infectious Diseases. Moscow Mir Publishers.