What causes measles?
Measles is caused by the measles virus, belonging to the morbillivirus family.
How widespread is measles?
Before widespread vaccination against measles in industrialized countries, measles was a widespread childhood disease with an extremely high death rate. Today, in nations where measles has been identified as an element of an immunization program, there is a lower risk of exposure, and the incidence of actual cases is very low. Recent trends by certain parents not to immunize their children have increased chances of measles and its associated complications.
In less developed nations, measles occurs regularly and is associated with more complications and deaths. Measles is still a prevalent illness, even in certain advanced countries in Europe as well as Asia.
WHO has reported an increase in the number of cases in 2018, with over 10 million patients and more than 140,000 people dying, primarily children under five years old. The highest rates of infection were found in Ukraine, Somalia, the Democratic Republic of Congo, Liberia, and Madagascar. The US had the highest number of measles in the last 25 years. Four countries in Europe were stripped of their measles elimination status.
How do you get measles?
Measles can be highly infectious and easily transmitted between people by breathing in airborne respiratory droplets caused by an infected person’s coughing or sniffing.
An infected person can be infectious two days before symptoms manifest and will remain infected for at most five days following the onset of the rash.
An acute measles infection generally confers a lifetime of immunity.
Who is at risk of contracting measles?
People who are at a higher risk of measles include:
- The infants have lost passive immunity from their mothers (acquired by their mother via transmission of antibodies to the placenta) before their first vaccination.
- Travelers who are not vaccinated to regions in which measles is widespread
- People with an immune deficiency (e.g., due to HIV/AIDS infection, leukemia, cancer, corticosteroid treatment), regardless of vaccination status
- Refugees and migrants.
The most significant risk for measles severe and its complications is found in:
- Individuals who are malnourished (particularly children lacking in Vitamin A)
- People who suffer from an immune deficiency
- Women who are pregnant.
What are the symptoms and signs of measles?
Measles is a disease that develops in distinct clinical phases.
Incubation period
- Variations from 7-14 days (average 10- 11 days).
- The patient is usually not suffering from symptoms.
- A few may show signs that result from the initial spreading of viral illness (fever spots, rash, and respiratory symptoms caused by the virus within the bloodstream) within a few days of exposure.
Prodrome
- Typically, it begins 10-12 days following exposure.
- Symptoms include fever, malaise, and a loss of appetite, followed by conjunctivitis (red eyes) and cough. Coryza (blocked and runny nose).
- After about two days, 2-3 days into 2 to 3 days after the stage, Koplik spots appear. They are white spots that appear blue on the mouth’s inside, opposite the molars. They can be seen 24 to 48 hours before the exanthem (rash) stage.
- Prodromal symptoms generally last between 2 and 5 days, but in some instances, symptoms could be present for 7-10 days.
Exanthem (rash)
- The red spots, which are flat, range between 0.1-1.0cm in diameter and are seen in the fourth or fifth days after the onset of symptoms.
- The non-itchy rash begins on the face and then behind the ears. Within 24 to 36 hours, it will spread all over the body and even the extremities (palms and soles are not often involved).
- The spots can join, particularly in the parts of the face.
- The appearance of the rash is typically accompanied by a fever, usually at a minimum of 40C.
- The rash starts to fade within 3 to 4 days from when it first shows up. It begins to fade to a purplish shade before changing to brown/coppery-colored spots with delicate skin scales.
Recovery
- The cough can last for up to a week.
- Measles-related complications can be the cause of persistent fever after the third day of the eruption.
Exanthem for Measles
How do I diagnose measles?
The distinctive symptoms and the physical examination determine the diagnosis of measles. Since the disease is sporadic in the developed world, all suspected cases must be confirmed with a lab. This is especially useful in the following circumstances:
- Sporadic cases
- Atypical cases
- Confusion with other conditions.
Measles that is acute usually gets confirmed by the basis of a viral nasal and throat swab that is analyzed through Polymerase Chain Reaction ( PCR). Urine and blood samples may also be tested. It is recommended to do this within five days after the onset of the rash. However, positive results can be found up to 10-14 days after the rash is gone.
The blood sample is also examined for measles IgM and IgG antibodies ( serology). Concentrations of specific IgM increase in the active phase of infection and IgG antibody is detected in the degree of recovery.
The viral cultures of the throat and nasopharyngeal swabs can be recommended for patients with immunocompromised patients in whom the serological evidence is not evident because of a diminished immune response. The immunofluorescence examination to detect measles antigen could also be recommended in patients with a weak immune system.
What is the treatment for measles?
There is no particular measles cure, and that’s the reason why vaccination is essential. Treatment for mild measles cases is beneficial. It is vital to rest because it helps prevent complications and helps prevent the spread of measles.
- Take paracetamol if you are experiencing a fever. Aspirin should not be administered to children suffering from a viral illness since it can trigger the formation of Reyes syndrome.
- Vitamin A for children who live in poor countries or who are malnourished. WHO suggests 200 000 International units (IU) of vitamin A over two days to help reduce measles and its associated complications. A Cochrane Review found this reduced death and pneumonia-related mortality among children under two years old.
- Make sure you drink enough fluids to avoid dehydration.
- Utilize a humidifier for relief from a cough or sore throat.
- Offer nutritional assistance as needed.
- Pay attention to high-risk patients to avoid any complications.
Patients who experience drowsiness, dehydration, or difficulty breathing need hospitalization for support.
Antibiotics treat secondary infections with bacterial causes like otitis media, pneumonia, diarrhea with infectious symptoms, and sepsis.
Ribavirin ( antiviral) treats measles in patients with immunodeficiency and subacute sclerosing encephalitis.
What are the effects of measles?
About 30% of measles cases reported are associated with at least one of the complications.
- Gastrointestinal: diarrhea which can be fatal if it is caused by dehydration, mouth ulceration, appendicitis, hepatitis mesenteric, mesenteric Adenitis, and pancreatitis.
- Otitis media: Ears (almost only in children) can cause deafness.
- Respiratory tract, laryngobronchitis, measles croup, and pneumonia (either primary viral or secondary bacterial) are the most frequently reported measles-related deaths.
- Heart: myocarditis and pericarditis.
- The hematological system is thrombocytopenia which causes bleeding and disseminated intravascular blood coagulation (DIC).
- Eyes: conjunctivitis, corneal ulceration causing blindness (especially when vitamin A is insufficient), and eyes that squint.
- Kidney problems: acute glomerulonephritis ( inflammation of kidneys) and kidney failure.
- Nervous system: febrile seizures and encephalitis.
- Insufficiency (especially in a community that is poor).
- The presence of measles during pregnancy increases the chance of preterm labor, birth in the fetus, and maternal death.