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Measles

Condition Overview:

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, 5-day measles, or hard measles.

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.

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.

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.

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 this has caused the fatal disease Reye's syndrome in the past. 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.

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%. 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 1 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.

Measles is a highly preventable infection. A very effective vaccine exists, made of live measles viruses which 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 will quickly recognize the organism, and kill it off. Measles vaccines are usually given at about 15 months of age; because 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 10 or 11 years of age. Outbreaks on college campuses have occurred among unimmunized 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.