Learn to recognize measles | Ada

What is measles?

Measles is a highly infectious, viral illness. Children are most often affected, although it can occur at any age. Although the illness is unpleasant, most people make a full recovery. However, in certain cases, serious complications can develop.

Vaccination programs have had a huge impact on reducing the number of cases of measles. However, measles is still a common disease in many other countries.

The measles virus is contained in water droplets and most often spread through the nose or mouth of an infected person. Physical contact, coughing and sneezing are the most common causes of infection spreading.

People with measles typically experience flu-like symptoms, such as a runny nose and coughing, fever, feeling generally unwell and a gradual rash. The symptoms of measles usually get better within seven to 10 days.

Types of measles

There are two types of measles. Although they share some of the same symptoms, they are caused by different viruses:

• Standard measles, sometimes known as red measles, or hard measles, is caused by the rubeola virus.
• German measles, also known as rubella, is an entirely separate illness caused by the rubella virus and is usually a milder infection than standard measles. For more information, read this resource on rubella.

Symptoms of measles

Once an affected person has caught measles, the virus multiplies in the back of the throat and begins to spread gradually throughout the body.

It can take up to 10 days for an infected person to show symptoms. The most common early symptoms are:

• Cold-like symptoms, such as a runny nose, sneezing and coughing
• A high temperature or fever
• Sore, red eyes
• Sensitivity to light
• Grey-white spots inside the cheeks, mouth and throat
• Nausea
• Tiredness
• Lack of appetite
• Aches and pains

Around three to four days after the first symptoms, a skin rash will normally begin to appear. The rash is perhaps the most noticeable symptom of measles and is recognizable by:

• Red-brown spots, either flat or slightly raised, that may join together to form blotches
• Spots usually start on the head and neck and then gradually spread downwards through the rest of the body
• The rash may turn pale when pressed at first, but will gradually fade and become non-blanching (stays red when pressed)
• Slight itching

Generally, the rash takes two to three days to cover the body and then another few days to fade, beginning on the head and disappearing in the same order in which it appeared. As other symptoms begin earlier, affected people usually feel most unwell on the first or second day that the rash is present.

Symptoms of measles usually begin to appear on average around seven to 14 days after becoming infected. However, affected people are usually infectious four days before to four days after the measles rash appears.

Overall, most people with measles feel better within seven to 10 days of first experiencing symptoms. On occasion, a dry cough may persist after all other symptoms have gone. Check your symptoms with the Ada app.

During the measles infection, the immune system builds up a resistance to the virus. It is therefore highly unlikely for anyone to have measles more than once in their lifetime.

Causes of measles

Measles is caused by a viral infection, and is highly contagious. It is estimated that around 90 percent of unvaccinated people close to someone who is in the contagious phase of measles will also become infected.

Measles is transmitted in a similar way to colds and flu, i.e. breathing in the airborne water droplets coughed or sneezed out by an infected person. Although physical contact, coughing and sneezing are the most common causes of infection spreading, it is also possible to contract measles simply by breathing in contaminated air, or touching a contaminated surface and then breathing in the droplets.

The measles virus can live for up to two hours on surfaces and in an airspace.

Risk factors

Measles is very rare in countries that have a vaccination program. In recent decades, the number of measles cases in the United States has significantly declined due to the introduction of the Measles, Mumps and Rubella (MMR) vaccine. However the disease has not been completely eradicated. In 2017 there were 120 reported cases of measles in the United States according to the Centers for Disease Control and Prevention (CDC). The majority of these cases were in people who were unvaccinated.

Unvaccinated people are at most risk of contracting measles, in particular people with a weakened immune system. Unvaccinated pregnant women should also be especially cautious. Pregnant women with measles may develop serious complications that can result in miscarriage or premature labor. See more below.

Diagnosing measles

A doctor will usually look for a combination of characteristic symptoms such as a skin rash, fever and cough to diagnose measles.

However, a blood or saliva test is the only way to definitively confirm the diagnosis. These tests check for Immunoglobulin M and Immunoglobulin G antibody levels, both of which may indicate the current or past presence of measles.

If measles is suspected, it is important to call the surgery and tell the staff when making a doctor’s appointment. Because measles is very contagious, it is common for medical professionals to ask initial questions over the phone to help them decide how likely the diagnosis of measles is, and whether a trip to the surgery can be avoided. If an appointment with a doctor is necessary, the doctor may make special arrangements, such as a home visit, in order to reduce the risk of infecting other patients.

If you are worried that you or someone you know may have measles, You can start a free symptom assessment with the Ada app at any time.

Treatment of measles

There is no specific medicine used to treat measles. Because the disease is viral and not bacterial, antibiotics are not effective.

Treatment for measles instead aims to manage and ease the symptoms until the body’s natural immune system can clear the infection. Symptoms usually improve within seven to 10 days. Typical treatment recommendations include:

• Plenty of bed rest to help boost the immune system
• Drinking lots of fluids such as water, fruit juices and herbal teas, to prevent dehydration and help ease a sore throat; alcohol and caffeine should be avoided
• Closing curtains and dimming lights to control sensitivity to light
• A humidifier or sitting in a steamy bathroom to help ease a cough or sore throat
• Ibuprofen and paracetamol/acetaminophen may be recommended to relieve fever and aches
• Vitamin A supplements may be recommended to people suffering from measles, particularly children, in order to lessen the severity of the condition and the risk of complications

Please note that ingesting a high amount of vitamin A can result in a condition called hypervitaminosis A, or vitamin A toxicity. This is usually the result of a person taking high-dose dietary supplements, so always discuss vitamin A supplementation with a doctor before starting.

Prevention of measles

The best precaution against measles is to be vaccinated against it.

Vaccinations

The most common vaccine is the MMR vaccine, which immunizes against measles, mumps and rubella. According to CDC, two doses of the MMR vaccine are about 97 percent effective at preventing measles, and a single dose is about 93 percent effective.

In countries with a vaccination program, the MMR vaccine is first administered to children around 12-15 months, with a second, booster dose when they are between four to six years old. For babies travelling to countries with a high rate of measles infection, the first dose of the vaccine may be given as early as six months old.

Adults can request the measles vaccine from their doctors if they have never been immunized.

There is a further vaccine called MMRV, which protects against measles, mumps, rubella and varicella (chickenpox). Currently this vaccine is only licensed for use in children aged between 12 months and 12 years old.

Travelling and the risk of measles

The measles virus remains common in many countries in the world, particularly in parts of Africa and Asia. Measles outbreaks in the United States most often occur when returning travellers spread the disease to other unvaccinated people, having contracted the illness in another country.

It is best to take precautions to reduce the risk of contracting and spreading the measles virus when travelling internationally. The most important of these is to receive the MMR vaccination prior to travelling. Children can receive their first dose at six months old when travelling internationally. Other ways to help prevent illness include:

• Wash hands frequently, ideally with soap and water, or alternatively hand sanitizer
• Cover the mouth and nose with a tissue, not the hands, when coughing and sneezing
• Avoid contact with people who are sick, especially close contact such as kissing, hugging and sharing cooking or eating utensils
• Do not touch the eyes, nose or mouth unless hands are fully clean

Good to know: Always contact a doctor when feeling seriously unwell.

Side-effects of the MMR vaccine

The benefits of the MMR vaccine outweigh the risks, but side effects are possible. These commonly include:

• Aching, sore arm from the shot
• Short term, mild rash
• Temporary stiffness in the joints. Most commonly affects teenage and adult women
• Fever

Less common side effects include:

• Fits caused by fever, such as febrile seizures. These are rare and are not a sign of any long-term health problems
• A temporary low platelet count which affects the blood’s ability to clot. Again this is rare and usually goes away without treatment or any long-term issues
• Swelling of the glands in the cheeks, neck or jaw for a couple of days

In very rare cases, a person may have a serious allergic reaction after a dose of the MMR vaccine. For this reason, anyone who has had an allergic reaction to any component of the vaccine may be advised not be vaccinated. If there are any concerns about the MMR vaccine and allergies, it is important to discuss these with a doctor.

Despite concerns that the MMR vaccine may cause autistic spectrum disorders, multiple studies have shown there is no link between being vaccinated and developing autism.

Isolation

Due to how contagious the measles virus is, it is important to limit the risk of spreading the infection to others. Symptoms of measles usually begin to appear on average around seven to 14 days after first becoming infected. However, affected people are usually infectious four days before to four days after the measles rash appears.

For this reason, people with this condition should stay home from the moment symptoms begin to appear until four days after the rash disappears.

Friends, family, co-workers, classmates, carers and teachers should be notified if they may have come into contact with someone who has measles during the infectious period. This is particularly important if they are a vulnerable person.

Contact with vulnerable people such as young children, pregnant women and those with weakened immune systems should be especially limited.

Complications of measles

In the majority of cases, people with the measles virus make a full recovery after around seven to 10 days and will experience no further complications. However serious complications which can be life-threatening do occur.

Measles complications can happen at any age, but are more likely to occur in certain groups of people, such as:

• Children younger than five years old
• Children who have a poor diet or are malnourished
• Children with a weakened immune system, such as those with leukaemia or HIV
• Adults older than 20 years of age
• Pregnant women

Common complications

There are a number of common complications that may arise from measles, such as:

• Vomiting and diarrhoea, which can lead to dehydration
• Eye infection, conjunctivitis
• Ear infection, otitis media, which can lead to earache
• Inflammation of the voice box, laryngitis

While these symptoms can be distressing, they are not usually serious. However, affected people should see a doctor if they are concerned.

Uncommon complications

More uncommon complications from measles may include:

• A squint, if the measles virus affects the nerves or muscles of the eye
• Fits caused by fever, such as febrile seizures
• Inflammation of the liver, known as hepatitis
• Infection of the airways and lungs, such as pneumonia, bronchitis or croup, which can be very serious

Rare complications

In rare cases, measles can lead to:

• Serious eye disorders such as infection of the optic nerve, which can lead to blindness
• Infection of the membranes around the brain and spinal cord, such as viral meningitis
• Inflammation of the brain, or encephalitis, affects roughly 1-3 out of every 1,000 cases
• Central nervous system disease known as subacute sclerosing panencephalitis (SSPE) which can develop several years after contracting measles. This disease can be fatal but is extremely rare, occurring in roughly two per 100,000 cases

If any concerning symptoms develop, always contact a doctor.

Measles and pregnancy

Pregnant women who contract measles have an increased risk of developing serious complications which can lead to miscarriage, stillbirth or premature labor.

The CDC guidelines recommend that the MMR vaccine be administered to unvaccinated women no less than a month before becoming pregnant. The MMR vaccine not only protects against measles, but also against mumps and rubella. Rubella can also cause severe problems during pregnancy, including birth defects, miscarriage and stillbirth.

Good to know: Women who are planning a pregnancy should discuss vaccination options with their doctor.

Measles FAQs

Q: Are measles and German measles the same?
A: No. Measles, also known as rubeola, and German measles, also known as rubella, are two completely separate illnesses. They do have certain symptoms in common, including:

• Cold-like symptoms such as a runny nose, sneezing and coughing
• A high temperature or fever
• Sore, red eyes
• A skin rash

They are also both spread in the airborne water droplets coughed or sneezed out by an infected person, as well as prevented by the MMR vaccine. However, they are caused by different viruses and have different specific symptoms, complications and treatments.

Q: What does the measles rash look like?
A: The measles rash is characterized by red-brown spots that may join together to form blotches. It is usual for spots to first appear on the head and then gradually spread down throughout the body. For some people the rash will be slightly itchy, but this is not always the case. Generally the rash takes around two to three days to cover the body and then another few days to fade in order of appearance.

Q: Is there a vaccine against measles?
A: Yes. The MMR vaccine protects against measles, mumps and rubella, and two doses of the vaccine have been shown to be around 97 percent effective at preventing measles. Children aged between 12 months and 12 years old may also get the MMRV vaccine, which immunizes against measles, mumps, rubella and varicella (chickenpox).

Q: What is the treatment for measles?
A: Because there is no medication that targets the measles virus, most treatment focuses on managing and easing the symptoms of measles.

Q: What precautions can be taken against measles?
A: The only way to prevent measles is by having a vaccination. Measles is very contagious, so it is important for people with this condition to stay home from the moment symptoms begin to appear to four days after the rash disappears.

Other useful preventative methods include:

• Washing hands frequently, ideally with soap and water or hand sanitizer
• Covering the mouth and nose with a tissue when coughing and sneezing
• Avoiding close contact with people who are sick
• Avoid touching the eyes, nose or mouth unless hands are fully clean

Measles: Causes, symptoms, and treatment

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Measles is an infectious illness caused by the rubeola virus. It spreads either through direct contact with a person who has the virus or through droplets in the air.

Measles is a highly contagious disease that can lead to life-threatening complications. According to the Centers for Disease Control and Prevention (CDC), around 20% of people in the United States who get measles need to spend time in the hospital, and it is fatal in 1–3 of every 1,000 cases.

Vaccination offers effective protection from measles. Some people cannot have the vaccination due to other health conditions, such as a weakened immune system. However, according to an article published by the World Health Organization (WHO), if 93–95% of the population receives the vaccine, those who are at risk are unlikely to catch measles.

The WHO also estimate that over 140,000 people died from measles in 2018, and most were under 5 years of age. Due to effective vaccination programs, however, this figure 73% lower than it was in 2000.

Measles is a viral disease that causes uncomfortable symptoms and can lead to life-threatening or life-changing complications.

The CDC state that symptoms usually appear 7–14 days after exposure. However, according to the WHO, they can take up to 23 days.

Symptoms include:

• a fever, possibly up to 104°F (40°C)
• a cough
• a runny nose
• sneezing
• watery eyes
• body aches
• small white spots in the mouth, appearing 2–3 days after early symptoms
• a red rash, appearing around 3–5 days after symptoms start

The rash usually starts at the hairline and spreads down through the body. It may begin as flat, red spots, but small bumps may appear on top. The spots may join together as they spread.

Complications

Complications can arise, some of which can be severe.

They include:

During pregnancy, measles can lead to:

• loss of pregnancy
• early delivery
• low birth weight

Those most at risk of complications include:

Infection with the rubeola virus causes measles.

How symptoms develop

The virus enters the body through the mouth, nose, or eyes. Once there, it most likely enters the lungs, where it infects immune cells.

These cells move to the lymph nodes, where the virus transfers to other cells. These cells travel through the body, releasing virus particles into the blood.

As the blood travels around the body, it carries the virus to different body organs, including the liver, the skin, the central nervous system, and the spleen.

In the skin, the measles virus causes inflammation in the capillaries. This gives rise to the hallmark measles rash.

The virus crosses the blood-brain barrier and enters the brain in around 1 in 1,000 people. This can cause swelling in the brain that may be life-threatening.

An infection in the lungs causes a person to cough, which transmits the virus to other people.

Anyone who has never had measles or the vaccination can become ill if they breathe in infected droplets or are in close physical contact with someone who has measles.

The disease is contagious. The CDC indicate that a person can transmit the virus from 4 days before and about 4 days after the rash appears.

The infection spreads through:

• physical contact with a person who has measles
• being near a person with measles when they cough or sneeze
• touching a surface with the virus on and then putting fingers into the mouth, or rubbing the nose or eyes

After a person coughs or sneezes, the virus remains active in the air for around 2 hours.

If one person has measles, they can pass it to up to 90% of those around them, unless they have immunity or have had the vaccination.

Measles only affects humans. No animal species can transmit it.

A person should see a doctor if:

• they have symptoms that could indicate measles
• the fever rises over 100.4º F (38º C)
• there is chest pain or breathing difficulty
• they cough up blood
• there are signs of confusion or drowsiness
• they experience a convulsion

A doctor can usually diagnose measles by looking at the signs and symptoms, but they may order a blood test to confirm a diagnosis.

Is it chickenpox or measles? Find out how to tell the difference here.

There is no specific treatment for measles, and symptoms usually go away within 7 to 10 days.

If there are no complications, the doctor will recommend rest and plenty of fluids to prevent dehydration. If there is a risk of complications, the doctor may recommend spending time in the hospital.

If a child needs treatment in the hospital, a doctor will prescribe vitamin A.

The following tips may help manage symptoms:

• Pain and fever: Tylenol or ibuprofen can help manage a fever, aches, and pains. A doctor can advise on options for young children. Children under 16 years should not take aspirin.
• A cough: Use a humidifier or put a wet towel on a warm radiator to moisten the air. A warm lemon and honey drink may help, but do not give honey to babies under 1 year.
• Dehydration: Encourage the person to drink plenty of fluids.
• Eyes: Remove any crustiness with cotton wool soaked in water. Dim the lights if the eyes are hypersensitive.

The measles is a viral infection, and antibiotics will not help. However, a doctor may prescribe them if a person develops an additional bacterial infection.

Tylenol or ibuprofen are available for purchase online.

After a person has measles once, they usually have immunity and are unlikely to have it again.

A doctor will usually recommend vaccination for those who have not had measles and do not have immunity.

Measles vaccination

In the United States, the CDC recommend that people have the measles, mumps, and rubella (MMR) vaccine as follows:

• one shot at 12–15 months of age
• a booster shot at 4–6 years, before starting school

Newborns have immunity from their mother for several months after birth if the mother has immunity.

In some cases, however, a doctor may recommend vaccination before the age of 12 months. This may happen if there is a risk of an outbreak in the area where they live.

Adults do not need a vaccine in the U.S. if:

• They were born or lived in the U. S. before 1957 unless they work in a healthcare setting and have no evidence of immunity.
• They received at least one MMR shot after the age of 12 months, or two doses for those at high risk, such as healthcare workers.
• A blood test shows they have immunity.

Some people should not have the vaccine. They include those who:

• are pregnant or may be pregnant
• have certain allergies
• have a personal or family history of immune system problems
• have tuberculosis
• currently feel moderately to severely unwell
• have had another vaccination within the last 4 weeks

Anybody who is not sure whether they should have the vaccine should ask their doctor for advice.

There has been concern about an alleged link between the MMR vaccine and a risk of autism. However, the CDC state that experts have found no evidence of a link.

When considering whether or not to opt for vaccination, it is essential to talk to a doctor about how the risks of measles compare with the risks of a vaccine.

Learn more here about vaccination myths and facts.

Measles (Rubeola) | Michigan Medicine

Topic Overview

What is measles?

Measles is a very contagious (easily spread) infection that causes a rash all over your body. It is also called rubeola or red measles.

The measles vaccine protects against the illness. This vaccine is part of the MMR (measles, mumps, and rubella) and MMRV (measles, mumps, rubella, and varicella [chickenpox]) vaccines. Most children get the vaccine as part of their regular shots. This is why measles is rare in the United States and Canada.

What causes measles?

Measles is caused by a virus. It is spread when an infected person coughs, sneezes, or shares food or drinks. The measles virus can travel through the air. This means that you can get measles if you are near someone who has the virus even if that person doesn’t cough or sneeze directly on you.

You can spread the virus to others from 4 days before the rash starts until 4 days after the rash appeared. The virus is most often spread when people first get sick, before they know they have it.

If you have had measles, you can’t get it again. Most people born before 1957 have had measles.

What are the symptoms?

The first symptoms of measles are like a bad cold—a high fever, a runny nose, sneezing, a sore throat, and a hacking cough. The lymph nodes in your neck may swell. You also may feel very tired and have diarrhea and red, sore eyes. As these symptoms start to go away, you will get red spots inside your mouth, followed by a rash all over your body.

When adults get measles, they usually feel worse than children who get it.

It usually takes about 7 to 18 days to get symptoms after you have been around someone who has measles. This is called the incubation period.

How is measles diagnosed?

If you think you have measles, call ahead and explain your symptoms before you go to a doctor’s office.

After you’ve had an exam, your doctor may order a blood test and/or viral culture if he or she suspects that you have measles.

How is it treated?

Measles usually gets better with home care. You can take medicine to lower your fever, if needed. Read and follow all instructions on the label. Also, get plenty of rest and drink lots of fluids. Stay away from other people as much as you can so that you don’t spread the disease. Anyone who has measles should stay out of school, day care, work, and public places until at least 4 days after the rash first appeared.

Your doctor may suggest vitamin A supplements if your child has measles.

Most people get better within 2 weeks. But measles can sometimes cause dangerous problems, such as lung infection (pneumonia) or brain swelling (encephalitis). In rare cases, it can even cause seizures or meningitis.

If you have been exposed to measles and you have not had the vaccine, you may be able to prevent the infection by getting immunoglobulin (IG) or the measles vaccine as soon as possible. Babies who are younger than 12 months, pregnant women, and people who have impaired immune systems that can’t fight infection may need to get IG if they are exposed to measles.

Why is prevention important?

Getting your child vaccinated is important, because measles can sometimes cause serious problems.

False claims in the news have made some parents concerned about a link between autism and vaccines. But studies have found no link between vaccines and autism.

Measles is one of the most contagious diseases. Outbreaks can easily occur. For instance, a person from another country may have measles and not know it yet. If that person travels outside his or her own country, he or she could spread measles to people who are not immune. Also, if you travel to another country and you are not immune to measles, you may be at risk.

If you don’t know whether you’re immune to measles and you plan to travel, check with your doctor or local health clinic to see whether you should get the vaccine before you travel.

Measles – Better Health Channel

To help you protect yourself and your family, the Department of Health and Human Services have produced videos featuring the Victorian Deputy Chief  Health Officer Dr Angie Bone on :

Measles is a contagious viral illness that causes a skin rash and fever. Serious and sometimes fatal complications include pneumonia and encephalitis (brain inflammation). Measles is also known as rubeola, not to be confused with rubella (German measles). Worldwide, measles is the fifth highest cause of illness and death in children.Measles is rare in Australia because of the widespread use of the measles vaccine. It is important to continue immunising children in Australia, because there is a risk that the infection can be brought in by people arriving or returning from overseas.

Symptoms of measles

The signs and symptoms of measles may include:

• fever
• general discomfort, illness or lack of wellbeing (malaise)
• runny nose
• dry cough
• sore and red eyes (conjunctivitis)
• red and bluish spots inside the mouth (Koplik’s spots)
• red and blotchy skin rash that appears first on the face and hairline, and then spreads to the body.

Complications of measles

Possible complications of measles include:

• otitis media – inflammation of the middle ear
• diarrhoea and vomiting – may cause further complications such as dehydration
• respiratory infections – such as bronchitis, croup or laryngitis
• pneumonia – a type of lung inflammation that causes about 60 per cent of measles deaths
• pregnancy problems – if a pregnant woman contracts measles, she risks miscarriage or premature labour
• encephalitis – or brain inflammation, affects about one person with measles in every 1000. About 10 to 15 per cent of people with encephalitis die and 15 to 40 per cent of survivors have permanent brain damage to varying degrees
• subacute sclerosing panencephalitis (SSPE) – occurs in about one in every 100,000 cases of measles. SSPE is an extremely rare progressive inflammation of the brain that causes brain degeneration and is always fatal. SSPE usually begins about seven years after the measles infection. 

Causes of measles

Measles is most commonly spread when someone swallows or inhales the cough or sneeze droplets from an infected person. The measles virus is carried inside mucus or saliva droplets and remains alive for several hours. 

Infection can also occur if someone touches contaminated surfaces or objects and then touches their own mouth or nose or eats before washing their hands. Symptoms usually occur about 10 to 12 days after infection.

Measles is very contagious. Estimates suggest that a person with measles will infect about nine in every 10 people they have contact with who have not been immunised or previously infected with measles.

High-risk groups

Measles is rare in Australia because of the immunisation program, but cases still occur. Anyone who hasn’t been immunised, particularly children and healthcare workers, are at high risk of infection.

People who are at increased risk of potentially fatal measles complications include:

• anyone with a chronic illness
• children younger than five years
• adults.

Diagnosis of measles

Tests used to diagnose measles may include:

• medical history, including immunisation status and travel history
• physical examination
• blood test.

Treatment for measles

A case of measles without complications usually lasts about 14 days and most people make a full recovery. Antibiotics don’t work because the illness is viral. Treatment aims to ease symptoms and reduce the risk of complications. Options may include:

• bed rest
• plenty of fluids
• paracetamol to reduce pain and fever
• isolation to reduce the risk of transmission.

Occasionally, measles develops into a serious disease that requires urgent treatment and can even be life threatening. Sometimes, people can die from complications even if they receive prompt medical attention.

Treatment depends on the complication but may include:

• hospitalisation
• supportive care – for example, to maintain hydration, and to check for fever and infection
• antibiotics – to treat bacterial infection.

Contact with someone with measles

If you’ve been in contact with someone with measles and you are not immune to measles (have not been immunised or have not had a measles infection), there are different treatment options. Speak with your doctor about your options.

Depending on your situation, these may include:

• If you were in contact with someone with measles in the last 72 hours – have a measles immunisation immediately.
• If you were in contact with someone with measles in the last three to seven days – immunoglobulin can be given for interim protection. This is known as passive immunisation. Measles vaccination, or active immunisation, should be given later to prevent further risk of infection, but not until five months after you received the immunoglobulin. Normal human immunoglobulin is given as an injection.

Immunisation against measles

Immunisation is the best protection against measles. A person who receives the recommended two doses of a measles vaccine has 99 per cent immunity against measles infection. If you have been infected with measles, you will usually have lifelong immunity. 

There are two types of measles vaccine. In the first type, the vaccine is a combined measles, mumps and rubella (German measles) vaccine and is commonly known as the MMR vaccine. In the second type (available from July 2013), the vaccine is a combined measles, mumps, rubella and varicella (chickenpox) vaccine and is commonly known as the MMRV vaccine.

Protection against measles is available under the National Immunisation Program Schedule. In Victoria, immunisation against measles is free of charge for:

• Children at 12 months – the first dose of measles vaccine is given as the MMR combination vaccine.
• Children at 18 months of age – the second dose of measles vaccine is given as the MMRV combination vaccine.
• All children younger than 10 years of age can receive the free National Immunisation Program vaccines. 
• Young people under 20 years of age can receive the free National Immunisation Program vaccines.
• Children up to and including nine years – catch-up immunisations are available for children who have not been fully immunised.
• Women planning pregnancy or after the birth of their child – two doses of MMR are available for women who have low immunity or no immunity to rubella.
• Aboriginal and Torres Strait Islander people, refugees and asylum seekers and vulnerable people – catch-up immunisations are available for people who have not been fully vaccinated.
• All people born during or since 1966, without evidence of two documented doses of valid MMR vaccine or without a blood test showing evidence of immunity to measles, mumps and rubella, are eligible for one or two doses of MMR vaccine. (If two MMR doses are required they should be given a minimum of 28 days apart.) If you have not received the vaccine, ask your doctor about catch-up doses.  

Infants as young as 6 months of age can receive free MMR vaccine prior to travel overseas to countries where measles is endemic, or where measles outbreaks are occurring. 

Note: The MMRV vaccine is not recommended for people aged 14 years and over.

See our video for more information on protecting yourself and your family against measles.

People who should not be immunised against measles

Not everyone is a suitable candidate for a measles vaccine. A person with an impaired immune system should not be immunised.

Some of the possible causes of impaired immunity include:

• infection with human immunodeficiency virus (HIV) or the presence of acquired immunodeficiency syndrome (AIDS) from an HIV infection
• taking certain medications, such as high-dose corticosteroids
• receiving immunosuppressive treatment including chemotherapy and radiotherapy
• having some types of cancer, such as Hodgkin’s disease or leukaemia
• having an immune deficiency with extremely low levels of antibodies (hypogammaglobulinaemia, multiple myeloma or chronic lymphoblastic leukaemia).

If you have an impaired immune system, speak with your doctor about what options might be available.

Pregnancy and MMR immunisation

You should not be given the MMR vaccine if you are already pregnant. Pregnancy should also be avoided for 28 days after the immunisation. The MMRV vaccine is not recommended for people 14 years and over.

Where to get help

2. The History and Pathology of Measles

History of Measles Outbreaks

[Unless otherwise cited, this section was taken from the CDC, 2018a.]

Measles is a highly contagious disease caused by the morbillivirus, also known as the rubeola virus. It most commonly affects young children and can easily be prevented by a vaccine, which has been available since 1963. Prior to the modern vaccine, for centuries millions of children contracted measles and many died from its fatal complications.

Measles is an ancient disease and its clinical manifestations were first written about in the seventh century by the Persian doctor Rhazes, who tried to distinguish the measles from smallpox, stating measles was more dreaded than smallpox.

The first written record of measles in the United States was in 1657 by a citizen of Boston, Massachusetts. John Hull, in his personal journal, stated “the disease of measles went through the town, but fortunately there were very few deaths” (College of Physicians, 2020). Twenty years later an English doctor, Thomas Sydenham, published Medical Observations on the History and Cure of Acute Diseases, and successfully distinguished measles from scarlet fever and smallpox. In 1740 German measles was identified by a German physician, Friedrich Hoffmann, as rubella (also called three-day measles).

It wasn’t until 1757 that the Scottish physician Francis Home found that the virus was detectable in the blood, and lifelong immunity was possible after recovery from the disease. He produced the disease in healthy people by inoculating people without the disease with blood samples from infected people, proving it was a bloodborne disease. 

It is estimated that, prior to the current vaccine, the reported U.S. incidence was at least 12,000 measles-related deaths each year and up to 4 million people were infected annually. Among the reported cases of measles, 8,000 were hospitalized and a thousand suffered encephalitis as a serious and often fatal complication. Up to 75% of measles deaths were of children younger than 5 years old. Prior to the 1950s, nearly all children got the measles and developed active immunity from the active disease (unless they died).

It wasn’t until 1954 that a vaccine was created from blood samples of ill students in a breakout in Boston, Massachusetts. Up until then, nearly all children got the measles by age 15. Most children recovered without problem, however it did still cause about 500 deaths annually, which was 0. 2% of those with the disease.

Serious complications from measles include:

• Chronic otitis media
• Pneumonia
• Encephalitis
• Corneal ulceration leading to blindness

The measles vaccine was licensed in 1963 after demonstrated safety and efficacy in monkeys and then in humans. In 1968 it was improved and renamed Attenuvax; the new vaccine did not require an additional injection of gamma globulin antibodies to reduce the typical inflammatory reactions. In 1971 Attenuvax was merged in a trivalent combination with the mumps and rubella vaccines to produce the current MMR vaccine in 1971. This combination promotes up to 95% immunity against measles when the first vaccine is received by a child at 12 months of age

In 1971 less than 100 American children had measles due to the widespread availability of the vaccine.

Now, in 2019, cases of measles outpace those of the previous decades. Why is it back after it had been eliminated? Outbreaks in 2013 and 2014 were largely due to unvaccinated children in tight-knit communities of Orthodox Jews in New York, an Amish community in Ohio, a Slavic community in Washington, and a Somali community in Minnesota—all of whom had opted out of the recommended vaccine; this demonstrates the potential for epidemics.  

Incidence and Prevalence of Measles

[Material in this section is from CDC, 2019 unless otherwise noted.]

The Centers of Disease Control and Prevention (CDC) in 1978 set the goal of eliminating measles in the United States population within 3 years, which drastically reduced the incidence of measles by 80%. After an outbreak in 1989, the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) then recommended a second dose of MMR vaccine for all children.

Because of the lack of legislation mandating MMR vaccination, low vaccination rates continued to lead to outbreaks. From 1989 to 1991, CDC reported 55,622 cases with 123 deaths, and 90% of cases were unvaccinated children. They stated: “Surveys in areas experiencing outbreaks among preschool-age children indicated that as few as 50% of children had been vaccinated against measles by their second birthday, and that black and Hispanic children were less likely to be age-appropriately vaccinated than were white children (CDC, Pink Book 2018.)

Incidence of Measles Week by Week in the United States,

January through April, 2019

Source: CDC. The year was only a third over, and already there have been more measles cases in 2019 than the United States has seen in 25 years.

The year 2019 is a record year for measles compared with previous decades following the availability of the measles vaccine. The CDC monitors reported cases of measles through the National Notifiable Disease Surveillance System. This system helps epidemiologists keep track of trends and epidemics to assess for patterns and causes. The 23 states with the highest new cases were New York, New Jersey, Michigan, Washington, and California among unvaccinated communities. An outbreak is defined by three or more cases of measles. Because measles is highly contagious, one case easily becomes more. Compared with another highly contagious disease, 1 Ebola patient likely infects 1.5 persons, while 1 measles patient infects 18 others. Without federal legislation mandating that people be immunized, or adequate federal funding for vaccines, the outbreaks continue. 

In the year 2000 the CDC declared it had finally reached the worthy goal of measles eradication in the United States after decades of public health education. The term eliminationhas replaced the term eradication, but it is still limited to the definition of having no reported cases within the past 12 months. Unfortunately, that declaration of measles elimination was reversed in 2010 due the lack of child immunization and the resultant outbreaks throughout the nation.  

As of May 2019, 839 cases of measles have been documented in twenty-three states, with 75% of the victims not being immunized and 13% being younger than 12 months of age. Because the first vaccine for measles is not given younger than 12 months of age, these infants become susceptible in outbreaks in close-knit communities. The largest outbreaks have been in New York and Washington. Although national compliance rates for the CDC vaccine recommendations are 95%, 1 in 12 children are still not receiving their first dose of the MMR on time, creating unneeded exposure risk.

Epidemiologic studies have confirmed that the majority of current cases in the United States have been in U.S. citizens who were unvaccinated and then became infected during international travels, bringing measles back to America.  Many cases are the children of parents who opt out of the CDC recommendations for measles vaccine. Currently, the government allows people to withhold from vaccine recommendations for religious or personal reasons.

A recent example of the consequences of abstaining from CDC-recommended vaccines is a cruise ship owned by the Church of Scientology that was quarantined in the Caribbean after a crew member was diagnosed with measles. Fearing an outbreak, approximately 300 people onboard were ordered by the health officials of St. Lucia not to embark in St. Lucia but to stay onboard until the danger had past.

The debate continues between freedom of religious and personal freedom on the one hand and the good of the community on the other. Meantime, herd immunity may be achieved when 95% of a community are immunized; the immunity of the 95% protects the remaining 5%. Notably, when the immunized group decreases, the protection for non-immunized persons decreases also.

Source: CDC.

The Pathophysiology of Measles

The measles virus is transmitted by air as droplets infect the respiratory system; it is manifested in a widespread skin rash. The measles virus is transmitted via the respiratory route and replicates in the nasopharynx and regional lymph nodes within 2 to 3 days after exposure. A secondary viremia occurs 1 week later and is spread to nearby tissues. The incubation period from exposure to prodrome (early stage of symptoms indicating a disease) is 10 to 12 days, with the onset of rash within 14 to 21 days (CDC, 2019). There are 22 known versions of the measles virus.

Six different conditions are caused by the rubeola virus.  They include:

• Classic measles.
• Modified measles: someone vaccinated but without adequate immunity. The clinical course is generally not as severe.
• Atypical measles: the clinical syndrome from those who were vaccinated with the killed virus vaccine between 1963 and 1967, who did not receive adequate immunity. They may develop the clinical symptoms, but symptoms may be milder.
• Post-infectious neurologic measles: causes acute decimated encephalomyelitis (ADEM) and subacute sclerosing pan encephalitis (SSPE)
• Severe measles.
• Complications: giant cell pneumonia, and measles inclusion-body encephalitis

The Clinical Symptoms

There are four stages of classic measles, which include incubation, prodrome, exanthem stage of rash, and recovery. In the incubation period, patients generally do not feel symptoms for 8 to 10 days and don’t know they have been infected.

Source: CDC. Public Domain

The prodrome lasts from 2 to 8 days and includes the symptoms of fever, peaking as high as 105º F, followed by dry hacking cough, runny nose (coryza), and conjunctivitis. The Three “C’s” include cough, coryza (rhinitis) and conjunctivitis. Fever is also present and should alert the medical provider to a higher concern than a common cold. Sneezing may also be present, representing the body’s response to a respiratory attack.

Red and white spots present on the mucous membrane of the mouth 1 to 2 days before the generalized body rash and are known as Koplik spots—identified by Henry Koplik, an American pediatrician, in 1896 (HxBenefit, 2019). In the palate, the spots look like grains of white sand on a hot red background. Koplik spots, which are specific to measles, generally appear about 48 hours before the rash appears.

Did You Know. . .

Koplik spots are unique to measles and no other medical condition has them. Identifying oral mucosal spots in the posterior of the oral cavity can be helpful in distinguishing measles from other childhood conditions with fever and rash.

The measles exanthem rash is characterized as a maculopapular rash beginning at the head and mouth and progressing downward and outward (confluence) to the chest, hands, and feet, and lasting for less than 1 week. It usually spares the palms and soles of the feet. Initially the lesions blanch but by days 3 to 4 they do not blanch and may create fine desquamation and peeling of hands and feet. The lesions and rash disappear in the same order they appeared. Additional symptoms include anorexia, diarrhea, malaise, and generalized lymphadenopathy as the body works to kill and rid itself of the bloodborne virus. After the rash appears, 48 hours will see additional fevers but recovery of the Koplik. If the rash continues after 48 hours, it is a signal of potential complications.

Measles Rash Seen on Light and Dark Skin

Left: Child with classic measles rash after 4 days. Right: Skin sloughing off of a child healing from measles infection. Source: CDC. Public domain. From https://www.cdc.gov/measles/symptoms/photos.html

Complications are seen in 30% of measles cases, more commonly among children younger than 5 years of age, or adults older than age 20. There have not been many cases of elders with measles because those born before 1963 had childhood exposure and lifetime immunity. Common complications include diarrhea in approximately 8% of cases, otitis media in 7% of cases, and pneumonia in 6% of reported cases; pneumonia is the most common cause of measles-related death, accounting for 60% of those who contract it (CDC, 2019).

Nausea, vomiting, febrile seizures, anorexia, and complications from dehydration may occur. Patients may develop photosensitivity and should protect their eyes if in sunlight during the duration of the illness. Thrombocytopenia also affects the body’s ability to clot and may affect bleeding risk. Neuritis and an infection of the optic nerve leading to blindness may result. Encephalitis, toxic encephalopathy, may occur in 1 in 200 people and is a serious complication leading to death.

The person is infectious 4 days after the fever and before the rash appears and continues to be infectious 4days after the rash has appeared. Exposure occurs either by direct contact with the infected person by droplets in the air of the coughing or sneezing measles patient (for up to 2 hours). The virus remains viable even on inanimate objects up to 2 hours. A child who rubs the runny nose and touches others, or objects, may infect others. Approximately 90% of people who are not immunized against measles will develop measles if they inhabit the same household.

Atypical measles is found in persons vaccinated by the inactivated killed measles vaccine (KMV) between 1963 and 1967, which sensitized but didn’t protect recipients against the virus. The resultant illness from exposure creates the same clinical symptoms but the rash seems to be limited to the wrist and ankles.

It is recommended that those who received the killed measles vaccine during those years receive the second MMR.

Diagnosing Measles

Not all childhood rashes are measles, but the systemic rash from head to toe is a clinical symptom common to measles. A unique clinical manifestation is the Koplik spots. Although the virus can be isolated from urine, the nasopharynx, blood, and throat cell samples within 7 days of symptoms, it is not routinely done for initial diagnosis. Diagnosis is often done by clinical symptoms, history of international travel, risk factors and exposure to others with measles. Two positive serum specimens are required for positive serologic testing by enzyme-linked immunoassay (ELISA). Blood tests for measles IgM antibodies is done to confirm reportable cases.  A confirmed case must be reported to the local health department, in addition to the infectious disease departments of hospitals and healthcare facilities.

Lab test results may show decreased platelets, low white blood cells, specifically low T-cells, which puts those who are already immunocompromised at greater risk. Chest x-ray may show pneumonitis. In addition to clinical symptoms of Koplik spots and rash, lab values such as circulating antibodies IgM and IgG are helpful in diagnosing the disease. IgM is the most responsive to an acute attack and indicates a recent infection. IgG (think of as “g” for gone) represents the memory of a past infection. The IgM will rise within two days of the rash, is specific for rubeola, and then declines within one month. The IgM capture Elisa and indirect Elisa are diagnostic tests and are both specific and sensitive. 

Other diseases that may look similar to measles because of the full-body rashes include rubeola, rubella, erythema infectiosum, roseola infantum, and hand-foot-mouth disease. Many other childhood conditions present with fever and rash and knowing the different clinical presentations can be useful. The following table compares the clinical symptoms of various similar childhood diseases to help identify the differences between them.

Measles | DermNet NZ

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2002. Updated by Dr Jannet Gomez, October 2016. Updated October 2020

What is measles?

Do you have confirmed measles? Send DermNet your pictures.

Measles, also known as English measles, rubeola or morbilli, is a highly contagious viral infection causing fever and a rash.

Measles is a notifiable disease.

Measles

See more images of measles.

What is the cause of measles?

Measles is caused by the measles virus, which belongs to the morbillivirus family.

How common is measles?

Before widespread immunisation against measles in industrialised countries, measles was a very common childhood disease that carried a high death rate. Nowadays in countries where measles is part of an immunisation programme, the risk of exposure and incidence of actual disease cases is low. A recent trend by some parents not to immunise their children has led to an increase in the number of cases of measles, and its complications.

In developing countries, measles still occurs frequently and is associated with a high rate of complications and death. It remains a common disease even in some developed countries of Europe and Asia. 

WHO reported a surge in cases worldwide in 2018, with nearly 10 million cases, and more than 140,000 deaths mostly in children under 5 years of age. The highest incidence rates were in the Ukraine, Somalia, Democratic Republic of Congo, Liberia and Madagascar. The US reported its highest rate of infection in 25 years, and four countries in Europe lost their ‘measles elimination’ status.

How do you get measles?

Measles is highly contagious and is easily spread from person to person by breathing in airborne respiratory droplets from an infected person’s coughing or sneezing.

An infected person is contagious 2 days before any symptoms show, and remains infectious for at least 5 days after the onset of rash.

An acute infection of measles almost always gives lifelong immunity.

Who is at risk of measles?

Individuals at particular risk of measles infection include:

• Infants who have lost their passive immunity from their mothers (acquired from their mother through the transfer of antibody across the placenta) and before their first immunisation
• Unvaccinated travellers to areas where measles is endemic
• Individuals with immunodeficiency (eg, due to infection with HIV/AIDS, leukaemia, cancer, corticosteroid therapy), regardless of their immunisation status
• Migrants and refugees.

The greatest risk for severe measles and its complications is seen in:

• Malnourished individuals (particularly children who are deficient in vitamin A)
• Those with an underlying immune deficiency
• Pregnant women.

What are the signs and symptoms of measles?

Measles develops through distinct clinical stages.

Incubation period

• Ranges from 7–14 days (average 10–11 days).
• The patient usually has no symptoms.
• Some may experience symptoms of primary viral spread (fever, spotty rash, and respiratory symptoms due to virus in the bloodstream) within 2–3 days of exposure.

Prodrome

• Generally begins 10–12 days after exposure.
• Presents as fever, malaise, and loss of appetite, followed by conjunctivitis (red eyes), cough, and coryza (blocked or runny nose).
• 2–3 days into the prodromal phase, Koplik spots appear. These are blue-white spots on the inside of the mouth opposite the molars, and occur 24–48 hours before the exanthem (rash) stage.
• Prodromal symptoms usually last for 2–5 days but in some cases may persist for as long as 7–10 days.

Exanthem (rash)

• Flat red spots ranging from 0.1–1.0cm in diameter appear on the 4th or 5th day following the start of symptoms.
• This non-itchy rash begins on the face and behind the ears. Within 24–36 hours it spreads over the entire trunk and extremities (palms and soles rarely involved).
• The spots may join together, especially in areas of the face.
• The onset of the rash usually coincides with a high fever of at least 40C.
• The rash begins to fade 3–4 days after it first appears. It fades first to a purplish hue and then to brown/coppery coloured lesions with fine scales.

Recovery

• A cough may persist for 1–3 weeks.
• Measles-associated complications may be the cause of persisting fever beyond the 3rd day of the rash.

How is measles diagnosed?

Diagnosis of measles is based on the characteristic history and physical examination. Because the disease is now so rarely seen in developed countries, any suspected cases require laboratory confirmation. This is particularly useful in the following situations:

• Sporadic cases
• Atypical cases
• Confusion with other diseases.

Acute measles is usually confirmed on a viral nasopharyngeal or throat swab analysed by polymerase chain reaction (PCR). Blood and urine samples can also be used. This should be done within 5 days of onset of rash, however, positive results are sometimes obtained up to 10–14 days after the rash has resolved.

Blood is also taken for measles IgM and IgG antibodies (serology). Levels of specific IgM become elevated during the active infection phase and IgG antibody appears during the recovery phase.

Viral culture of the throat and nasopharyngeal swabs is preferred in immunocompromised patients where serological evidence might be absent due to decreased immune response. An immunofluorescence test for measles antigen can also be considered in patients with poor immunity.

What is the treatment of measles?

There is no specific treatment for measles, which is why immunisation is so important. Treatment for mild cases of measles is supportive. Bed rest is vital, as it prevents complications and prevents the spread of the virus.

• Give paracetamol for fever. Aspirin should not be given to a child with a viral illness, as it is associated with the development of Reyes syndrome.
• Vitamin A for children in developing countries or that are malnourished.  WHO recommends a dose of 200,000 international units (IU) of vitamin A for two days, for reducing measles and its complications. A Cochrane Review found this reduced mortality and pneumonia-related mortality in children under the age of 2 years.
• Maintain adequate fluid intake to prevent dehydration.  
• Use a humidifier to provide relief from cough/sore throat.
• Provide nutritional support as necessary.
• Observe high-risk individuals carefully to prevent complications.

Patients with drowsiness, dehydration, or discomfort breathing require hospitalisation for supportive care.  

Antibiotics are only needed to treat secondary bacterial infections such as otitis media, infectious diarrhoea, pneumonia, and sepsis. 

Ribavirin (antiviral) is used to treat measles infection in immunocompromised patients and in those affected with subacute sclerosing panencephalitis.

What are the complications from measles?

Approximately 30% of reported measles cases have one or more complications. 

• Gastrointestinal: diarrhoea that may be fatal if dehydration occurs, mouth ulceration,  appendicitis, hepatitis, mesenteric adenitis, and pancreatitis.
• Ears: otitis media (almost exclusively in children) may lead to deafness.
• Respiratory tract: laryngobronchitis, measles croup, and pneumonia (either primary viral or secondary bacterial) — the most common cause of death from measles.
• Heart: myocarditis and pericarditis.
• Haematological system: thrombocytopenia, causing bleeding and disseminated intravascular coagulation (DIC).
• Eyes: conjunctivitis and/or corneal ulceration leading to blindness (especially if vitamin A deficient), and squint.
• Kidneys: acute glomerulonephritis (inflammation of kidneys) and renal failure.
• Nervous system: febrile seizures and encephalitis.
• Malnutrition (especially if from a poor community).
• Measles infection during pregnancy increases the risk of premature labour and delivery, fetal loss and maternal death.

Rarely, subacute sclerosing panencephalitis—a fatal condition—develops decades after a measles infection due to persistence of the measles virus in the central nervous system.

How can measles be prevented?

Measles can be prevented by vaccination with live attenuated measles vaccine. It is available as a single antigen preparation or combined with live attenuated mumps and/or rubella vaccines. Combined measles, mumps and rubella (MMR) vaccine is currently part of routine immunisation programmes in most industrialised countries, including New Zealand.

Measles vaccine induces long-term (probably life-long) immunity in most individuals. Vaccination schedules recommend a two-dose immunisation strategy; the first dose at 12–15 months of age, followed by a second dose at 4–6 years.

Measles vaccine should not be given during pregnancy. Women not previously immunised against measles should avoid pregnancy for one month (28 days) after receiving the MMR vaccine.

Immune globulin does not prevent measles, but it is helpful in decreasing the severity of illness in those exposed to the virus. It is recommended for:

• Pregnant women 
• People with immune deficiency
• Infants. 

Individuals vaccinated prior to 1968 may require revaccination, as vaccines used before this time may not have conferred life-long immunity.

Measles – StatPearls – NCBI Bookshelf

Continuing Education Activity

Measles, also known as rubeola, is a preventable, highly contagious, acute febrile viral illness. It remains an important cause of global mortality and morbidity, particularly in the regions of Africa and Southeast Asia. It accounts for about 100,000 deaths annually despite the availability of an effective vaccine. Public health officials declared the elimination of measles from the U.S. in 2000, marking the absence of continuous disease transmission for one year and from the region of the Americas in 2016. However, outbreaks continue to occur through imported disease and transmission among unvaccinated groups of children in the community. According to the Center for Disease Control (CDC) there were 372 cases in 2018 and 764 cases through May of 2019. This activity provides an overview of measles prevention, transmission, and diagnosis, and highlights the role of the interprofessional team in helping their patients prevent this disease.

Objectives:

• Describe the pathophysiology of measles.

• Describe the epidemiology of measles.

• Summarize the role of vaccination in the prevention of measles.

• Describe the importance of communication between the interprofessional care teams and patients to improve vaccination rates and thereby limit morbidity and mortality associated with measles.

Earn continuing education credits (CME/CE) on this topic.

Introduction

Measles, also known as rubeola, is a preventable, highly contagious, acute febrile viral illness. It remains an important cause of global mortality and morbidity, particularly in the regions of Africa and Southeast Asia.[1][2] It accounts for about 100,000 deaths annually despite the availability of an effective vaccine. Public health officials declared the elimination of measles from the U.S. in 2000, marking the absence of continuous disease transmission for one year and from the region of the Americas in 2016. However, outbreaks continue to occur through imported disease and transmission among unvaccinated groups of children in the community. Measles is a reportable disease in most nations including the United States.[3]

Etiology

The causative organism is the measles virus, a member of the Paramyxoviridae family and Morbillivirus genus. It is an enveloped, single-stranded, nonsegmented, negative-sense RNA virus. The genome encodes six structural proteins and two non-structural proteins, V and C. The structural proteins are nucleoprotein, phosphoprotein, matrix, fusion, haemagglutinin (HA), and large protein. The HA protein is responsible for virus attachment to the host cell.[4]

Epidemiology

The epidemiology of measles is variable across the globe and is related to immunization levels achieved in a particular region. Before implementing widespread vaccination programs, measles accounted for an estimated 2.6 million deaths. Despite vaccination in the present era, The World Health Organization (WHO) reported that approximately 134,200 deaths (15 deaths/hour) occurred in 2015 due to measles.  According to the CDC, there were 372 cases in 2018 and 764 cases through May of 2019.  Measles is a reportable disease in most nations including the United States.

Measles virus has no animal reservoir and occurs only in humans. The virus is highly contagious with each case capable of causing 14 to 18 secondary cases among susceptible populations. Measles is transmitted from person to person by respiratory droplets, small particle aerosols, and close contact. The incubation period is 10 to 14 days although longer periods have been reported. Unvaccinated young children and pregnant women are at high risk for contracting measles, and measles most commonly affects young children. More recently, there has been a shift to older children and adolescents due to increasing levels of immunization coverage and alterations in the levels of population immunity at different ages. Young infants born to mothers with acquired immunity are protected from measles due to passive antibody transfer, but as these antibodies wane, they become susceptible. Infectiousness of a case is maximal in the four days before and four days after rash develops, which coincides with peak levels of viremia and the features of cough, conjunctivitis, and coryza.[5][6][7][8]

Pathophysiology

The inhaled virus from the exposed droplets initially infects the respiratory tract’s lymphocytes, dendritic cells, and alveolar macrophages. It then spreads to the adjacent lymphoid tissue and disseminates throughout the bloodstream resulting in viremia and spread to distant organs. The virus residing in the dendritic cells and lymphocytes transfers itself to the epithelial cells of the respiratory tract which are shed and expelled as respiratory droplets during coughing and sneezing, infecting others and perpetuating the cycle. The initial inflammation leads to symptoms of coryza, conjunctivitis, and cough. The appearance of fever coincides with the development of viremia. The skin rash occurs after dissemination and is due to perivascular and lymphocytic infiltrates.

During the prodromal phase the measles virus depresses host immunity by suppressing interferon production through its nonstructural proteins, V and C. The increasing viral replication then triggers both humoral and cellular immunological responses. The initial humoral response consists of IgM antibody production, which is detectable 3 to 4 days after the rash appears and can persist for 6 to 8 weeks. Subsequently, IgG antibodies are produced, primarily against the viral nucleoprotein. Cellular immune responses are essential for recovery as demonstrated by elevated Th2 dependent plasma interferon-gamma levels during the acute phase, and subsequent elevation of Th3 dependent interleukin 4, interleukin 10, and interleukin 13 levels.[9]

The measles virus is known to induce immunosuppression that can last for weeks to months, even years. This causes increased susceptibility to secondary bacterial and other infections. While the mechanisms causing this phenomenon are unclear, it is hypothesized that measles infection induces proliferation of measles-specific lymphocytes that replace the previously established memory cells causing “immune amnesia.” This results in enhanced susceptibility of the host to secondary infections, leading to most of the morbidity and mortality associated with measles. The neutralizing IgG antibodies against hemagglutinin are responsible for lifelong immunity as they block host cell receptors from binding to the virus.

History and Physical

The WHO clinical case definition of measles is “any person with fever, generalized maculopapular rash, cough, coryza, or conjunctivitis.” Measles is an acute febrile exanthema that is characterized by the three “Cs”: cough, coryza, and conjunctivitis. Koplik spots, small white papules on the buccal mucosa, are pathognomonic for measles and appear a day or two before the rash, although they are not always seen. The rash precedes the onset of fever, appearing first on the face and spreading caudally to become generalized. Uncomplicated measles typically resolves in a week after the rash onset.[10]

Evaluation

The diagnosis of measles hinges on a high clinical suspicion, especially when evaluating children with febrile illness and a maculopapular rash. A complete blood count may show leukopenia, particularly lymphopenia, and thrombocytopenia. Electrolyte abnormalities may be detected in children with poor intake or diarrhea. Identification of measles-virus-specific IgM antibodies in serum or plasma confirms the diagnosis, although it may be a false negative in up to 25% of cases when done early (less than 3 days of rash onset.) These antibodies usually peak within 1 to 3 weeks after the onset of a rash and become undetectable by 4 to 8 weeks. The gold standard test is the plaque reduction neutralization assay which has the highest sensitivity. Measle virus can be cultured from nasopharyngeal secretions, but this is labor intensive and not practical.[11]

In current clinical practice, polymerase chain reaction detection of viral ribonucleic acid from throat, nasal, nasopharyngeal, and urine samples is most often performed, with sensitivity approaching 100%.  

Treatment / Management

There is no specific antiviral therapy for measles; treatment is primarily supportive. Control of fever, prevention and correction of dehydration, and infection control measures including appropriate isolation form the mainstay of therapy.[12]

The WHO recommends administration of daily doses of vitamin A for 2 days and more days for malnourished children. Measles complications should be identified early and appropriate therapy initiated.[13]

Prognosis

While many will recover from measles with no complications, there is a risk of poor prognosis.  The more common complications due to infection with measles include otitis media and diarrhea.  The otitis may lead to hearing loss.  Those more likely to have severe complications include infants and children under the age of five years, adults over the age of twenty, pregnant women and those who are immunocompromised.  Encephalitis may occur in 1 out of every 1000 infected children and 1-2 of all infected children will die of neurologic or respiratory complications from measles.

Complications

Complications of measles occur most commonly in young infants, pregnant women, and malnourished or immunocompromised children. The most common complication is pneumonia that can be due to the measles virus itself (Hecht giant cell pneumonia) or a secondary bacterial infection. Other complications include croup, otitis media, and diarrhea from secondary infections. Pregnant women with measles are at increased risk for maternal death, spontaneous abortion, intrauterine fetal death, and low birth-weight infants. Measles keratoconjunctivitis occurs mostly in children with vitamin A deficiency and can lead to blindness. Central nervous system complications include acute disseminated encephalomyelitis (ADEM), measles inclusion body encephalitis (MIBE), and subacute sclerosing panencephalitis (SSPE).[14] ADEM is an autoimmune demyelinating disease that occurs within days to weeks.[15] MIBE is thought to be a progressive brain infection in patients with impaired cellular immunity occurring within months of the initial infection. SSPE is a progressive neurological disease that presents 5 to 10 years after the acute illness and thought to be caused by an abnormal host response to the production of mutated virions.[16] It occurs mostly among children that developed measles before 2 years of age and manifests with seizures and progressive loss of cognitive and motor function.

Pearls and Other Issues

Measles is a preventable disease due to the availability of a safe, inexpensive, and effective vaccine. The vaccine is a live attenuated measles strain that is used either as a single component or as a combination vaccine (MMR, MMR-V). The WHO recommends two doses of measles vaccination beginning at age 9 to 12 months and 15 to 18 months in countries where incidence and mortality are still high in the first year of life. In the United States and other developed countries, the first vaccine is given at 12 to 15 months and the second at 4 to 5 years. The WHOs Global Vaccine Action Plan has targeted measles and rubella for elimination in five WHO Regions by 2020. To eliminate measles, vaccination rates of the population must be in the 93% to 95% range.

A widely discredited and withdrawn Lancet article in 1998 created considerable misinformation, purporting a link between the MMR vaccine and autism that lead to declining immunization rates, particularly in the United Kingdom and the United States. Many subsequent studies have debunked this myth.

Enhancing Healthcare Team Outcomes

Measles is a preventable infection and hence all healthcare workers including nurses and pharmacists should educate patients on the importance of vaccination. Patients should be informed that the adverse effects of the measles vaccination are rare and minor; without vaccination, there is a high risk of transmitting the infection to others and inducing serious neurological complications.

Continuing Education / Review Questions

Figure

Measles. Contributed by DermNetNZ

Figure

This patient presented on the third pre-eruptive day with “Koplik spots” indicative of the beginning onset of measles. In the prodromal or beginning stages, one of the signs of the onset of measles is the eruption of “Koplik spots” (more…)

Figure

Exanthem subitum (meaning sudden rash), also referred to as roseola infantum (or rose rash of infants), sixth disease (as the sixth rash-causing childhood disease) and (confusingly) baby measles, or three day fever, is a benign disease of children, generally (more…)

Figure

This child shows a classic day-4 rash with measles. Contributed by Centers for Disease Control and Prevention (Public Domain)

Figure

Pathology, Transmission electron micrograph, (TEM), Paramyxovirus virion, viral nucleocapsids, Measles, Mumps, Rubella, Vaccine. Contributed by Dr. Fred Murphy, Centers for Disease Control and Prevention

References

1.

Moss WJ. Measles. Lancet. 2017 Dec 02;390(10111):2490-2502. [PubMed: 28673424]

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Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016 Dec 01;170(12):1209-1215. [PubMed: 27695849]

3.

Goodson JL, Seward JF. Measles 50 Years After Use of Measles Vaccine. Infect Dis Clin North Am. 2015 Dec;29(4):725-43. [PubMed: 26610423]

4.

Laksono BM, de Vries RD, McQuaid S, Duprex WP, de Swart RL. Measles Virus Host Invasion and Pathogenesis. Viruses. 2016 Jul 28;8(8) [PMC free article: PMC4997572] [PubMed: 27483301]

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Coughlin MM, Beck AS, Bankamp B, Rota PA. Perspective on Global Measles Epidemiology and Control and the Role of Novel Vaccination Strategies. Viruses. 2017 Jan 19;9(1) [PMC free article: PMC5294980] [PubMed: 28106841]

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Santibanez S, Hübschen JM, Ben Mamou MC, Muscat M, Brown KE, Myers R, Donoso Mantke O, Zeichhardt H, Brockmann D, Shulga SV, Muller CP, O’Connor PM, Mulders MN, Mankertz A. Molecular surveillance of measles and rubella in the WHO European Region: new challenges in the elimination phase. Clin Microbiol Infect. 2017 Aug;23(8):516-523. [PubMed: 28712666]

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Furuse Y, Oshitani H. Global Transmission Dynamics of Measles in the Measles Elimination Era. Viruses. 2017 Apr 16;9(4) [PMC free article: PMC5408688] [PubMed: 28420160]

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Colavita F, Biava M, Castilletti C, Quartu S, Vairo F, Caglioti C, Agrati C, Lalle E, Bordi L, Lanini S, Guanti MD, Miccio R, Ippolito G, Capobianchi MR, Di Caro A., Lazzaro Spallanzani Institute for Research and Health Care Ebola Virus Disease Sierra Leone Study Group. Measles Cases during Ebola Outbreak, West Africa, 2013-2106. Emerg Infect Dis. 2017 Jun;23(6):1035-1037. [PMC free article: PMC5443435] [PubMed: 28518027]

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Bentley J, Rouse J, Pinfield J. Measles: pathology, management and public health issues. Nurs Stand. 2014 May 27;28(38):51-8. [PubMed: 24844521]

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Cockbain BC, Bharucha T, Irish D, Jacobs M. Measles in older children and adults. BMJ. 2017 Feb 16;356:j426. [PubMed: 28209781]

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Hübschen JM, Bork SM, Brown KE, Mankertz A, Santibanez S, Ben Mamou M, Mulders MN, Muller CP. Challenges of measles and rubella laboratory diagnostic in the era of elimination. Clin Microbiol Infect. 2017 Aug;23(8):511-515. [PubMed: 28412379]

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Khan L. Measles in Children. Pediatr Ann. 2018 Sep 01;47(9):e340-e344. [PubMed: 30208191]

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Bello S, Meremikwu MM, Ejemot-Nwadiaro RI, Oduwole O. Routine vitamin A supplementation for the prevention of blindness due to measles infection in children. Cochrane Database Syst Rev. 2016 Aug 31;(8):CD007719. [PubMed: 27580345]

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Fisher DL, Defres S, Solomon T. Measles-induced encephalitis. QJM. 2015 Mar;108(3):177-82. [PubMed: 24865261]

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Chowdhary J, Ashraf SM, Khajuria K. Measles with acute disseminated encephalomyelitis (ADEM). Indian Pediatr. 2009 Jan;46(1):72-4. [PubMed: 19179725]

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Baldolli A, Dargère S, Cardineau E, Vabret A, Dina J, de La Blanchardière A, Verdon R. Measles inclusion-body encephalitis (MIBE) in a immunocompromised patient. J Clin Virol. 2016 Aug;81:43-6. [PubMed: 27315036]

90,000 Beware of measles! | Measles | Measles vaccine

Measles symptoms!

• significant temperature rise;
• at the initial stage, a runny nose, cough, redness of the eyes and lacrimation may appear, as well as small white spots on the mucous surface of the cheeks;
• a rash appears a few days later, usually on the face and upper neck;
• After about three days, the rash spreads over the body, arms and legs

Measles is especially dangerous for children under five years old and for adults over 20 years old , for pregnant women, as well as for people with a suppressed immune system.

Measles can cause serious complications: encephalitis, meningitis, otitis media, blindness, severe diarrhea, respiratory tract infections, and central nervous system damage. Moreover, complications can sometimes occur several years after the infection. Before measles vaccination became mandatory, the disease was one of the leading causes of child death.

Measles vaccine

Measles vaccination is included in the National Vaccination Schedule, given to children a year, revaccination – at 6 years old.The effectiveness of the vaccine is very high – according to studies, it protects 97% of those vaccinated. Those who have been vaccinated and still get sick, the infection proceeds much easier with minimal risk of complications.
If you are not sure if you were vaccinated against measles in childhood, donate blood for antibodies to this disease. If they are absent, consult a doctor and get vaccinated!

Draw an infographic on this data: http://prntscr.com/n2z40x

Measles Story!

Measles has been known for a long time.The first description of this disease was made by the Arab physician Razes (about 865 – about 925). However, measles was described as an independent disease only in the 18th century. The measles virus was isolated in 1967, and in 1969 it was possible to prove that it is measles that is the cause of sclerosing panencephalitis. In 1919, a serum for the treatment of measles was first produced. The measles vaccine was first created in 1966.

Measles vaccine is often combined with rubella and / or mumps vaccines in countries where rubella is a problem.It is equally effective as a monovaccine or as a combined preparation.

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Measles

Measles

Overview

Measles is one of the most highly contagious viral infections known to man.

Measles is a dangerous infectious disease that can cause serious complications, even death, especially in children under 5 years of age.

Anyone who is not immune to the measles virus (not vaccinated or developed immunity) is at risk of contracting measles.

Also in , the risk group includes employees of medical institutions and educational organizations, trade workers, migrants, nomadic groups of the population, etc.

Source of infection – only a person with measles.

The measles virus is transmitted by airborne droplets, sneezing, coughing, and talking.

The risk of contracting measles is high, even with short-term contact with a patient.

The patient is infected from the last day of the incubation period until the first 5 days after the onset of the rash.The infectious period can extend up to 10 days after the onset of the rash if complications develop.

The most common measles symptoms include:

• fever (38 ⁰ C and above)
• general intoxication
• phased appearance of rash (1 day – face, neck; 2 day – trunk; 3 day – legs, arms) and pigmentation
• cough
• conjunctivitis

Measles complications:

• blindness
• encephalitis (leading to cerebral edema), occurs in 1 in 1000 cases
• meningitis, meningoencephalitis and polyneuritis (mainly observed in adults)
• respiratory tract infections (pneumonia)
• measles can worsen the course of tuberculosis
• severe diarrhea
• otitis media

After a previous illness, lifelong immunity is formed.

Measles prevention

Quarantine

When a focus of infection is detected in an organized team (preschool, general education, as well as with round-the-clock stay of adults), those who have been in contact with a patient with measles are under medical supervision for 21 days. Until 21 days after the detection of the last case, the institution does not accept those who have not been vaccinated against measles and who have not had measles.

When talking about preventing measles, you should start with the most effective preventive measure – vaccine prevention.

Vaccination against measles can be carried out both routinely and according to epidemic indications.

Routine vaccination

In the Russian Federation, measles immunization is carried out in accordance with the National Calendar of Preventive Vaccinations, which regulates the timing of drug administration. Vaccination against measles for children is carried out, as a rule, at the same time as vaccination against mumps (complex measles-mumps vaccine), as well as against rubella.

Routine immunization of children is carried out at the age of 1 year and at 6 years. Adults who have not had measles before, not vaccinated or vaccinated against measles once, are vaccinated before the age of 35 years. Adults belonging to risk groups (medical workers, employees of educational organizations, transport workers, trade workers, etc.) are vaccinated up to the age of 55 inclusive.

After two doses of the vaccine, as well as after recovering from measles, a stable long-term immunity to this infection is formed.

The measles vaccine is effective and safe.

Epidemic indications immunization

Conducted for persons who have had contact with a patient with measles (if the disease is suspected), have not had measles before, not vaccinated, vaccinated once – without age restrictions.

Immunization against measles for epidemic indications is carried out in the first 72 hours from the moment of contact with the patient.

Children who have had contact with measles who cannot be vaccinated against measles for one reason or another (who have not reached the vaccination age, who have not been vaccinated due to medical contraindications or parents’ refusal to vaccinate), no later than the 5th day from the moment contact with the patient is injected with normal human immunoglobulin.

Children and adults who have received the full vaccination, in whose blood serum antibodies are not found in sufficient quantities, are re-vaccinated.

If vaccination status is not known?

An indicator of the presence of immunity to measles is the presence of specific immunoglobulins of class G (IgG) in the blood.

If laboratory-confirmed normal antibody titer is used, vaccination is not performed.

If the antibody titer is below normal, or absent altogether, vaccination is carried out.

Particular attention is paid to identifying those who are not vaccinated or sick among the hard-to-reach strata of the population (migrants, refugees, nomadic groups of the population).

To effectively protect the population from measles, measles vaccination coverage should be at least 95%, i.e. 95% of the population must be vaccinated and revaccinated.

TO THE QUESTION OF IMPLEMENTING THE MEASLES ELIMINATION PROGRAM IN THE WESTERN PACIFIC COUNTRIES WHO | Antipova

1.Antipova A.Yu., Bichurina M.A., Lavrentyeva I.N., Totolyan Areg A. Measles in the countries of the WHO African region at the stage of infection elimination // Actual infections in the Republic of Guinea: epidemiology, diagnosis and immunity / ed. A.Yu. Popova. SPb .: FBUN NIIEM named after Pasteur, 2017, pp. 264–278. [Antipova A.Yu., Bichurina M.A., Lavrentieva I.N., Totolian Areg A. Kor’v stranakh Afrikanskogo regiona VOZ na etape eliminatsii infektsii // Aktual’nye infektsii v Gvineiskoi Respublike: epidemiologiya, diagnostika red i immunitet.A.Yu. Popovoi. [Measles in countries of the WHO African Region during the elimination phase. In: Actual infections in the Republic of Guinea: epidemiology, diagnosis and immunity. Ed. A.Yu. Popova]. St. Petersburg: St. Petersburg Pasteur Institute, 2017, pp. 264-278.]

2. Popova A.Yu., Bichurina M.A., Lavrentyeva I.N., Zheleznova N.V., Antipova A.Yu., Shcherbakova S.A., Buaro M.Y., Totolyan A.A. Study of the level of immunity to the measles virus in selected groups of the population of the Republic of Guinea in the framework of the global measles elimination program.Message 1 // Infection and immunity. 2016. T. 6, No. 4. P. 353–358. Popova A.Yu., Bichurina M.A., Lavrentyeva I.N., Zheleznova N.V., Antipova A.Yu., Shcherbakova S.A., Boiro M.Y., Totolian A.A. Measles virus immunity level study in particular population groups of the Republic of Guinea within the framework of Global measles elimination program. Report 1. Infektsiya i immunitet = Russian Journal of Infection and Immunity, 2016, vol. 6, no. 4, pp. 79–84. doi: 10.15789 / 2220-7619-2016-4-353-358 (In Russ.)]

3. Popova A.Yu., Bichurina M.A., Lavrentyeva I.N., Zheleznova N.V., Antipova A.Yu., Shcherbakova S.A., Buaro M.Y., Totolyan A.A. Study of the level of immunity to the measles virus in selected groups of the population of the Republic of Guinea in the framework of the global measles elimination program. Message 2 // Infection and immunity. 2017. T. 7, No. 1. P. 79–84. [Popova A.Yu., Bichurina M.A., Lavrentyeva I.N., Zheleznova N.V., Antipova A.Yu., Shcherbakova S.A., Boiro M.Y., Totolian A.A. Measles virus immunity level study in particular population groups of the Republic of Guinea within the framework of Global measles elimination program. Report 2. Infektsiya i immunitet = Russian Journal of Infection and Immunity, 2017, vol. 7, no. 1, pp. 79–84. doi: 10.15789 / 2220-7619-2017-1-79-84 (In Russ.)]

4. Hang L.K.N., Do L.P., Van T.T.T., Nguyen S.V., Hoang P.V.M., Pham H.T., Le T.T., Tran H.T.T., Vuong C.D., Mai T.Q.L. Viral co-infections among children with confirmed measles at hospitals in Hanoi, Vietnam, 2014. Asian Pac. J. Trop. Med., 2017, vol. 10, no. 2, pp. 171-174.

5. Ji Y., Xu S., Zhang Y., Zhu Z., Mao N., Jiang X., Ma C., Lu P., Wang C., Liang Y., Zheng H., Liu Y. , Dai D., Zheng L., Zhou J., Wang S., Zhang Z., Wu S., Nan L., Li L., Liang X., Featherstone DA, Rota PA, Bellini W. J., Xu W. Genetic characterization of wild-type measles viruses isolated in China, 2006-2007. Virol. J., 2010, vol. 7, pp. 105.

6. Kien V. D., Minh H.V., Giang K.B., Mai V.Q., Tuan N.T., Quam M.B. Trends in childhood measles vaccination highlight socioeconomic inequalities in Vietnam. Int. J. Public Health., 2017, vol. 62, no. 1, pp. S41 – S49.

7.Kremer J.R., Nguyen G.H., Shulga S.V., Nguyen Ph.H., Nguyen U.T., Tikhonova N.T., Muller C.P. Genotyping of recent measles virus strains from Russia and Vietnam by nucleotide-specific multiplex PCR. J. Med. Virol., 2007, vol. 79, pp. 987-994.

8. Ma C., Hao L., Zhang Y., Su Q., Rodewald L., An Z., Yu W., Ma J., Wen N., Wang H., Liang X., Wang H. , Yang W., Lia L., Luo H. Monitoring progress towards the elimination of measles in China: an analysis of measles surveillance data.Bulletin of the World Health Organization, vol. 92, no. 5, pp. 340-347. doi: 10.2471 / BLT.13.130195

9. MacIntyre C.R., Karki S., Sheikh M., Zwar N., Heywood A.E. The role of travel in measles outbreaks in Australia – an enhanced surveillance study. Vaccine, 2016, vol. 34, no. 37, pp. 4386-4391. doi: 10.1016 / j.vaccine.2016.07.023

10.Marin M., Nguyen H.Q., Langidrik J.R., Edwards R., Briand K. , Papania M.J., Seward J.F., LeBaron C.W. Measles transmission and vaccine effectiveness during a large outbreak on a densely populated island: implications for vaccination policy. Clin. Infect. Dis., 2006, vol. 42, no. 3, pp. 315-319. doi: 10.1086 / 498902

11. NIID. Measles in Japan, 2012. Infectious Agents Surveillance Report, 2013, vol. 34, no. 2.

12.NIID. Measles in Japan (IDSC). Infectious Agents Surveillance Report, 2014, vol. 35, pp. 278-280.

13. NIID. Measles in Japan, as of March 2015. Infectious Agents Surveillance Report, 2015, vol. 36, no. 4, pp. 51-53.

14. Pham V. H., Nguyet D. P. H., Mai Kh. N. H., Truong Kh.H., Huynh L.V., Measles epidemics among children in Vietnam: genomic characterization of virus responsible for measles outbreak in Ho Chi Minh city, 2014.EBioMedicine, 2014, vol. 1, pp. 133-140.

15. Roberts L. In Vietnam, an anatomy of a measles outbreak. Science, 2015, vol. 348, iss. 6238, pp. 962.doi: 10.1126 / science.348.6238.962

16. Schluter W. W., Xiaojun W., Mendoza-Aldana J., Jee Y., Diorditsa S. Progress Toward Measles Elimination – Western Pacific Region, 2009–2012. MMWR Morb.Mortal. Wkly Rep., 2013, vol. 62, no. 22, pp. 443-447.

17. Sniadack D.H., Mendoza-Aldana J., Huyen D.T.T., Van T.T.T., Cuong N.V., Olive J.M., Toda K., Hien N.T. Epidemiology of a measles epidemic in Vietnam 2008–2010. J. Infect. Dis., 2011, vol. 204, no. 1, pp. S476 – S482.

18. Soakai T.S., Sadr-Azodi N., Ozturk M., Clements C.J. Measles control in pacific island countries and territories. Ann. Virol. Res., 2016, vol. 2, no. 3, pp. 1022.

19. Tran D. Respiratory viral coinfection and clinical disease severity. J. Pediatr., 2013, vol. 89, no. 5, pp. 421-423.

20. WHO. Draft measles and rubella elimination in the Western Pacific: regional strategy and plan of action.URL: http://www.wpro.who.int/about/regional_committee/68/documents/wpr_rc68_4_annex_measles_rubella_elimination.pdf

21. WHO. Brunei Darussalam, Cambodia, Japan verified as achieving measles elimination. Western Pacific Region achieves progress towards measles elimination, but challenges remain. News release, 2015. URL: http://www.wpro.who.int/mediacentre/releases/2015/20150327/en

22.WHO. Expanded program on immunization. Regional and country profiles of measles elimination. URL: http://www.wpro.who.int/immunization/documents/measles_regional_country_profile/en

23. WHO. Global measles and rubella strategic plan: 2012–2020. Geneva, Switzerland: World Health Organization, 2012. URL: http: // www.who.int/immunization/newsroom/Measles_Rubella_StrategicPlan_2012_2020.pdf

24.WHO. Global Measles and Rubella Update. April 2018. Measles. URL: http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/Global_MR_Update_April_2018.pdf?ua=1

25. WHO. Immunization, Vaccines and Biologicals. Measles and Rubella surveillance data. URL: http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en

26.WHO. Manual for the laboratory diagnosis of measles and rubella virus infection. Second edition. URL: https://globalhealthlaboratories.tghn.org/site_media/media/articles/measles_procedures.pdf

27. WHO. Measles-Rubella Bulletin. 2018, vol. 12, no. 2, pp. 1-10. URL: http://www.wpro.who.int/immunization/documents/measles_rubella_bulletin/en

28.WHO. Measles and Rubella status report: progress, challenges and lessons. Meeting of the WHO Strategic Advisory Group of Experts. 7 November, 2012. URL: http://www.who.int/immunization/sage/meetings/2012/november/2_Measles_Figueroa.pdf

29. WHO. Regional health leaders target elimination of: measles and rubella; HIV, hepatitis B and syphilis in babies. News release. URL: http://www.wpro.who.int/mediacentre/releases/2017/20171011/en

30.WHO. Reported measles cases and incidence rates by WHO States 2013, 2014 as of 11 February 2015. URL: http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measlesreportedcasesbycountry.pdf

31. Zhang Y. An update for the western pacific region including an update on the current outbreak in mongolia. WHO. Report on the 13th global measles and rubella laboratory network meeting, WHO / HQ Geneva, 29 June – 1 July 2015, pp.18-19. URL: http://www.who.int/immunization/monitoring_surveillance/burden/laboratory/13th_GMRLN_Draft_Report_final.pdf

FBUZ MSCh No. 32 FMBA of Russia

Measles is an acute highly contagious viral disease transmitted from person to person, characterized by severe intoxication, inflammation of the upper respiratory tract and conjunctiva, as well as a kind of rash. The transmission route is airborne. The infectivity index is very high – out of 100 contacts, approximately 95-96 people get sick.

Measles has been known to mankind for over two millennia. In the “pre-vaccination” period, she was one of the most formidable infections, leading to high mortality and terrifying mothers around the world.

The situation has changed since 1919, when seroprophylaxis of measles by administering human serum was first introduced, which significantly reduced mortality from this disease.

A revolutionary event was the creation of the measles vaccine, the use of which made it possible to make measles a controllable infection, reduce the incidence hundreds of times and prevent the death of millions of people.In our country, live measles vaccine has been used in the compulsory routine vaccination program since 1967.

But, unfortunately, until now, measles in a number of countries is in first place in the total infectious morbidity of the population. According to the WHO, up to 30 million people fall ill with measles in the world every year, of which more than 500 thousand die. This is most often the case in countries where national health programs are poorly funded and where vaccines are inadequately procured.

Why is measles so dangerous? The fact is that the measles virus damages the vascular walls of almost all tissues and organs in the human body; in addition, the virus has an affinity for the cells of the central nervous system, and also causes a sharp decrease in immunity in a sick person. Therefore, measles often proceeds with complications: pneumonia up to severe cases; inflammation of the larynx, leading to difficulty breathing up to asphyxiation; otitis media, pyelonephritis, but the most dangerous complications are encephalitis and meningo-encephalitis.In addition, measles is the cause of the development of one of the so-called slow infections – subacute sclerosing panencephalitis develops several years after the illness and inevitably leads to dementia and death; develops more often in unvaccinated babies.

Specific therapy for measles has not been developed, therefore, the treatment is limited to symptomatic means, with the development of complications, treatment is carried out according to the general principles of treatment of this disease.

Based on the above, it can be concluded that the only reliable means of protecting oneself and children from measles is preventive vaccination, which is carried out according to the national calendar of preventive vaccinations at the age of 1 and 6 years.

In connection with the implementation of additional measures for the prevention of measles among the population in accordance with the Decree of the Chief State Sanitary Doctor in the Sverdlovsk Region, we invite the following categories of citizens for additional vaccination against measles:

1. Persons from 1 to 35 years of age who have not been previously vaccinated or vaccinated once, or who do not have documented data on vaccinations in the absence of justified medical contraindications.
2. Persons over 18 years of age, without age restrictions, who have not had measles (those who have recovered must have a serological confirmation by blood test), who have not been vaccinated against measles or vaccinated once, who do not have documented evidence of measles vaccinations from among the following citizens:

– employees of medical and educational organizations, regardless of their organizational and legal form;

– citizens arriving in the territory of the Sverdlovsk region for the purpose of carrying out labor activities;

– citizens who arrived from Ukraine.

For all questions related to measles immunization, you can contact your local pediatricians and therapists, as well as the infectious diseases office (No. 302) during admission hours.

90,000 Which vaccinations are mandatory, which ones are desirable

The national vaccination calendar will be gradually expanded – by 2025 it will include four new items. This implies an action plan approved by the Cabinet of Ministers for the Strategy for the Development of Immunoprophylaxis until 2035.The corresponding order is posted on the website of the Government. From what the state intends to vaccinate Russians free of charge and whether this means that new vaccinations will become mandatory, Parlamentskaya Gazeta figured out.

National calendar will expand

Judging by the presented plan, from 2022 the national calendar will include vaccination against rotavirus infection, from 2023 – chickenpox, from 2024 – human papillomavirus, and from 2025 – meningococcal infection. For this, the Ministry of Health, the Ministry of Industry and Trade, the Ministry of Finance, the Ministry of Economic Development, Rospotrebnadzor and the Federal Medical and Biological Agency should prepare amendments to the Law “On Immunoprophylaxis of Infectious Diseases”.

The main goal of the strategy is to protect Russians from such dangerous infections as diphtheria, measles, rubella, hepatitis B. At least 95 percent of the country’s residents must be vaccinated, the document suggests. For this, the state is ready to support vaccine manufacturers.

Thought out to the smallest detail

The National Immunization Schedule is a system for making the best use of vaccines. It helps to form immunity against the most dangerous diseases in a short time. The document is approved by the Ministry of Health of Russia.It defines specific types of vaccinations, the timing of their introduction and the time required for the formation of immunity. The intervals between revaccinations from a specific infection and between other vaccines are also taken into account.

Now in the national calendar – vaccination against hepatitis B, hemophilic infection, influenza, diphtheria, whooping cough, measles, rubella, poliomyelitis, tetanus, tuberculosis, mumps.

The graph looks like this:

• hepatitis B – in the first 24 hours of life, followed by revaccination at 1 month of life, and then at 2 or 6 months, depending on the vaccine;
• tuberculosis – 3-7 days of life with subsequent revaccination at 7, 14, 21, 28 years old;
• pneumococcal infection – 2 months, 15 months;
• whooping cough, diphtheria, tetanus – 3 months, 18 months, 6-7, 14 and 18 years old;
• Haemophilus influenza – 3 months, 4-5 and 6 months (terms may vary depending on the vaccine), followed by revaccination at 18 months;
• poliomyelitis – 3 months, 4-5 months and 6 months, followed by revaccination at 18 months, 20 months and 14 years;
• measles, rubella – 12 months, followed by revaccination at 6 years old;
• rubella – 13 years old;
• measles – 15-17 years old.

Many vaccinations are recommended to be repeated in adulthood. For example, it is also necessary to get vaccinated against diphtheria and tetanus at the age of 24-26, against measles at 35, rubella from 18 to 25, and hepatitis B from 18 to 55.

Getting vaccinated in the national calendar is a guarantee of only one thing: Russians will get it for free. Although conditionally these vaccinations are considered mandatory, you can always refuse them. No negative consequences other than health risks will follow.

On demand of the epidemiological situation

In addition to the national vaccination calendar, the Ministry of Health has attached a calendar of preventive vaccinations for epidemic indications.Vaccination was introduced there, which is vital in unfavorable epidemiological situations, for example, when there is a threat of infection with certain infections. This includes cholera, plague, anthrax, typhoid fever. Some vaccinations from this calendar need to be given to people who work, live or plan to travel to regions where infections are common and there is a high risk of infection. Some of these vaccines are supplied to specialists in certain fields. For example, vaccinations against rabies for prophylactic purposes are given to veterinarians, hunters, gamekeepers and foresters.Before traveling to some countries, you need to be vaccinated against yellow fever, typhoid fever, dysentery. From chickenpox, they will vaccinate conscripts for military service who have not yet had chickenpox.

Thus, for the majority of the population of Russia, vaccination is a purely voluntary matter. If the epidemiological situation allows, people have the right to refuse vaccinations.

At the same time, if there is a threat of the spread of infectious diseases that pose a danger to others, the chief sanitary doctors in the regions may decide to vaccinate all residents or individual groups.In this case, employees of enterprises and institutions may also not be vaccinated, but they will be suspended from work for a period of epidemiological trouble. Vaccination is mandatory for those whose specialty belongs to the list of jobs, the performance of which is associated with a high risk of infectious diseases. This list was approved by Government Decree No. 825 in 1999.

Read also:

• Who should not be vaccinated against COVID-19
• Vaccinations against chickenpox and papilloma are planned to be included in the national calendar
• The Ministry of Health has included vaccination against COVID-19 in the vaccination calendar

Explanatory work required

Vaccinations against influenza, coronavirus, pneumococcal infection remain voluntary and free in our country.At the same time, the first of them is included in the national vaccination calendar, and the second and third – in the vaccination calendar according to epidemiological indications. The benefits of these vaccines are clear. For example, over the past four years, the number of people vaccinated against influenza has increased by 12.2 percent, during the same time the incidence of influenza has decreased from 60.5 to 37.3 cases per 100 thousand of the population.

The number of pneumonia during vaccination against pneumococcal infection in old age can be halved, the risk of strokes – by six percent, said Olga Tkacheva, chief geriatrician of the Ministry of Health at the end of last year.

The duty of the authorities and doctors is to inform the population as much as possible about vaccination, to carry out explanatory work, said Dmitry Morozov, Chairman of the State Duma Committee on Health Protection. There is not enough information available about vaccinations today, he admitted. “They are in scientific journals, but not all parents read them,” the deputy said.

One of the parliamentarian’s proposals is to modernize the official website on immunization. “We need opinion leaders, experts, chats and hotlines,” he stressed.

A member of the Federation Council Committee on Social Policy Vladimir Krugly considers it necessary to organize an educational campaign in the regions about the importance of vaccinations against coronavirus. “The only way to stop the pandemic is through vaccination,” he said.

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Measles

– Measles is a viral infection with a very high susceptibility.If a person has not been vaccinated against this infection, then after contact with a patient , infection occurs in almost 100% of cases . The measles virus is very volatile.
– The period from contact with a sick measles until the first signs of the disease appear ( incubation period ) lasts from 7 to 14 days . During this period, the patient becomes a source of infection for others!
– The disease begins with severe headache , weakness , temperature rise to 40 degrees C .A little later, runny nose , cough and almost complete lack of appetite join these symptoms. The appearance of conjunctivitis is very typical for measles, which is manifested by photophobia, lacrimation, sharp redness of the eyes, and subsequently – the appearance of purulent discharge. These symptoms continue 2 to 4 days .
– On 4th day of illness , rash appears, which looks like small red spots of various sizes with a tendency to merge.The rash occurs on the face and head (especially behind the ears) and spreads throughout the body for 3-4 days. It is very characteristic of measles that the rash leaves behind pigmentation (dark spots that persist for several days), which disappears in the same sequence as the rash appeared.
– With measles, quite serious complications can occur : pneumonia (pneumonia), otitis media (otitis media), encephalitis (brain inflammation), carditis , to intestinal bleeding .
– Sources of infection – patients with measles , rubella , mumps (or if these infections are suspected) – are subject to compulsory hospitalization.
– After measles strong lifelong immunity develops . All those who have had measles become immune to this infection.
– The only reliable protection against this disease is measles vaccination , which is included in the National Vaccination Schedule.
– Immunizations against measles according to epidemic indications are subject to persons who had contact with the patient (if the disease is suspected), who have not had measles before , not vaccinated , who have no information about vaccinations against measles, as well as persons vaccinated against measles once – no age limit.
– Immunization against measles according to epidemic indications is carried out within the first 72 hours from the moment the patient is identified.With the expansion of the boundaries of the measles outbreak (at the place of work, study, within the district, settlement), the immunization period can be extended to 7 days from the moment the first patient is identified in the outbreak.
– Children , not vaccinated against measles or mumps (under the vaccine age or not vaccinated due to medical contraindications or refusal to vaccinate), no later than the 5th day from the moment of contact with the patient normal human immunoglobulin (hereinafter – immunoglobulin) is introduced in accordance with the instructions for its use.
– Information about the vaccinations carried out and the introduction of immunoglobulin is entered into the accounting forms in accordance with the requirements for the organization of vaccination.
– Contact persons from outbreaks of measles, rubella or mumps, not vaccinated and not sick with these infections before, are not allowed to planned hospitalization in non-infectious medical organizations and social organizations throughout during the period of medical observation
– Hospitalization of such patients during the period of medical observation in medical organizations of a non-infectious profile is carried out for health reasons , while in hospital additional sanitary and anti-epidemic (preventive) measures are organized in order to prevent the spread of infection.
– Immunization of the population against measles, rubella and mumps is carried out within the framework of the national calendar of preventive vaccinations and of the calendar of preventive vaccinations for epidemic indications (Order of the Ministry of Health of the Russian Federation of March 21, 2014 No. 125n “On the approval of the national the calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications).
– Upon detection of a focus of infection in preschool organizations and educational institutions , as well as in organizations with round-the-clock stay of adults from the moment the first patient is detected until 21 days from the moment of detection of the last sick person , persons who have not had measles, rubella or mumps and have not been vaccinated against these infections are not admitted to the team.

Persons (children and adults) who have not been vaccinated against measles, who have not been sick and have no information about vaccinations, in case of a disease in the team, (pre-school, school, university, etc.) are not allowed into it! (SP 3.1.2952-11).

Dear parents, we kindly ask you to vaccinate and protect your children from measles-mumps!
Contact your local pediatrician or healthy child’s room, or your child’s kindergarten or school health worker to get your child (previously vaccinated) vaccinated to get vaccinated.90,021 90,000 Measles and diphtheria can kill again? How the COVID pandemic affected vaccination »Society» www.24.kg

The top officials of Kyrgyzstan refused to be vaccinated against COVID-19, citing the presence of antibodies and good immunity. This example has only reinforced the mistrust of a part of the population in the vaccination campaign. At the same time, not only the fight against coronavirus suffers, but also the immunization of controlled childhood diseases, approved by the national calendar of preventive vaccinations.

According to it, 12 types of vaccines are used in the republic against 13 infections, including against tuberculosis, whooping cough, diphtheria, tetanus, poliomyelitis, measles and others.

According to experts from the World Health Organization, every year immunization prevents 2-3 million deaths.

If the global coverage is increased, this figure could become even higher. Vaccination of children under five is a particularly important preventive measure.

Prevention is cheaper than cure

Every year WHO publishes a list of ten global threats to humanity. In 2019, for the first time, the trend of deliberate refusal of vaccination fell into it. The problem is observed both in low-income countries and in developed countries.

Kyrgyzstan also faced the impact of declining immunization coverage, leading to an outbreak of measles among young children in 2018-2019. Over these two years, according to the National Statistical Committee, 3.38 thousand cases of measles have been registered in the country.

This disease is mainly accompanied by a high fever and rash, and if complications occur, it can lead to blindness, pneumonia, encephalitis and death of the patient.

“The rapid rise in the incidence of measles carries great risks, both socially and economically.The risk of death of children, disability of the population, deterioration of health of citizens is growing. Immunoprophylaxis is a very costly measure, but the damage caused by diseases that can be prevented by immunization in people is ten times higher, ”says Rakhat Ismanbaeva, a fellow of the Soros Foundation program.

According to her calculations, the cost of vaccinating one person costs the state an average of 73 soms, and the cost of treating one case of the disease – 6 thousand 876 soms.This is 94 times more expensive than one vaccination.

Net cost savings in the implementation of the immunization program for ten years (2010-2019) amounted to 99 million 713.8 thousand soms.

All attention to COVID-19

According to evidence-based medicine specialist Bermet Baryktabasova, due to the excessive excitement in the information space around influenza and COVID-19 vaccines, everyone is missing attention and control over classic childhood vaccines. “Resources, services, primary immunization – all work for covid and influenza vaccines.Yes, this may be a priority in the current situation, but children will not survive diphtheria and whooping cough, they also die from measles, polio is terrible and can return in a matter of days, ”she fears.

At the end of March 2021, WHO announced a polio outbreak in neighboring Tajikistan. Although the planned vaccine coverage there has exceeded 90 percent in recent years.

The Ministry of Health and Social Development of the Kyrgyz Republic hastened to reassure: our situation is stable. But anti-epidemiological measures have been stepped up in order to prevent the import of the virus from Tajikistan.

Bermet Baryktabasova is a supporter of routine vaccination according to the national vaccination schedule.

These vaccines have been tested for decades, all possible side effects are known in advance and are listed point by point.

Bermet Baryktabasova

“Penta vaccine (against whooping cough, diphtheria, tetanus, hepatitis B and haemophilus influenzae) is given at intervals of 45 days. These are strict rules! And now the intervals happen in two or three months, and even six months, – the expert is indignant.- Quarantine allegedly prevented, there are no vaccines or doctors had no time. The classical vaccination was left without proper control. ”

“I have received reports from parents living in Bishkek that there is simply no DPT vaccine (against whooping cough, diphtheria and tetanus) and MMR (against measles, mumps and rubella) in polyclinics. They came for vaccinations several times, but there they were footballing all the time, ”she said.

Children will not receive a proper immune response from the vaccine after the technology is violated.Why is all this necessary then?

Bermet Baryktabasova

She applied to the Republican Center for Immunoprophylaxis (RCI). There 24. kg stated: “It is impossible to speak for the whole republic just because of one incident. There is no MMR vaccine left in one of the family medicine centers. It is ten-dose and does not open for one child. There were many visitors that day. The vaccine was supposed to be additionally brought from the center of the State Sanitary and Epidemiological Supervision, but the parents were outraged.We made a comment to the UCM to leave more applications. It was a human factor. ”

According to the director of the RCI Gulbara Ishenapisova, during the quarantine period (in March-April 2020), the planned vaccination was suspended, the cargo was delayed somewhere, and during the July outbreak there were not enough doctors. “However, the vaccination process was resumed in May, and catch-up immunization was carried out until the end of the year. We attracted 65 mobile brigades, their goal is geographically inaccessible population, migrants and others.In 2020, five rounds were held, but they did not stop there, the work continues, ”she said.

There is no threat of an outbreak of measles or polio today.

Gulbara Ishenapisova

When there is no trust

“Unfortunately, the population does not trust either the authorities or the quality of vaccines. Also, people do not have complete information. The Ministry of Health does not provide complete, objective data. If people were sure that the Ministry of Health is honest with them, and the government is making tremendous efforts to take care of the health of the population in the best possible way, of course, the level of trust would be higher, ”Bermet Baryktabasova is sure.