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Measles

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Synonyms of Measles

Disorder Subdivisions

General Discussion

Measles is a highly contagious viral disease occurring primarily in children. This disease is characterized by fever, cough, acute nasal mucous membrane discharge (coryza), inflammation of the lining of the eyelids (conjunctivitis), a spreading rash, and eruption of small, irregular, bright red spots (Koplik's spots) on the inner cheeks in the mouth with a minute bluish or white speck in the center of each.

It is often difficult to avoid exposure to measles because it can be contracted from someone whose symptoms have not yet appeared. Measles is not contagious four days after appearance of the rash.

As a result of vaccination to prevent measles, all cases that now occur in the United States have been brought from other countries. Measles continues to be a significant public health problem in developing countries, with 30-40 million cases per year. Most reported cases are from Africa.

Symptoms

Measles usually begins like a common cold after a seven to fourteen day incubation period, with sinus congestion, a runny nose, a cough, and red, irritated eyes. Two days later, although often unnoticed, Koplik's spots (small red spots with blueish-white specks in the center) form inside the mouth opposite the molars. After four days of these worsening symptoms, a telltale rash appears first on the face and neck, then on the trunk, arms and legs. Patients may have some degree of sensitivity to light. After two to four days of listlessness, the rash, cough, stuffiness and red eyes (conjunctivitis) abruptly improve. If no complications have set in, measles has run its course by the tenth day.

Measles patients can have lowered resistance to infections such as bronchitis, ear infections, or other bacterial infections. Possible direct complications may include pneumonia and inner ear infections such as otitis media and mastoiditis that can possibly lead to deafness. Approximately 1 in 1,000 people with measles develop inflammation of the brain (encephalitis) that can result in mental retardation. Approximately 1 in 1,000 people die from measles.

Measles virus may also be associated with subacute sclerosing panencephalitis (SSPE), a slow virus infection. (Slow viruses may stay dormant in humans for extended periods of time, then for reasons yet unknown, may become reactivated.) SSPE is a chronic brain disease of children and adolescents that can occur months to years (usually years) after an attack of measles. SSPE can cause intellectual deterioration, convulsive seizures, coma and motor abnormalities. (For more information on this disorder, choose "SSPE" as your search term in the Rare Disease Database.)

Causes

Measles is caused by a paramyxovirus. The disease is highly contagious and can be transmitted from four days before the rash begins. The virus lives in the mucus in the nose and throat of an infected person and is spread into the air when the infected person sneezes or coughs.

Affected Populations

Measles affects males and females equally and occurs worldwide. As a result of vaccination to prevent measles, all cases that now occur in the United States have been brought from other countries. Measles continues to be a significant public health problem in developing countries, with 30-40 million cases per year. Most reported cases are from Africa.

Related Disorders

Rubella, or three-day measles, is marked by mild constitutional symptoms that may result in abortion, stillbirth, or congenital defects in infants born to mothers infected during the early months of pregnancy. Other symptoms may include a two to three week incubation period with no recognizable symptoms, mild course of short duration, low fever, rash (less extensive than other types of measles), a reddish flush simulating that of scarlet fever which may be noticed on the face, enlargement of lymph nodes, and a normal blood count.

Symptoms are usually mild in children with rubella. Adults characteristically experience fever, discomfort, headache, weakness or exhaustion, stiff joints, and mild nasal membrane inflammation (rhinitis). Encephalitis is a rare complication that has occurred during extensive outbreaks of rubella among young adults in the armed services. Transient testicular pain is also a frequent complaint in affected adult males. (For more information on rubella, choose "rubella" as your search term in the Rare Disease Database.)

Scarlet fever is an infection caused by bacteria that usually affects the mouth/throat area (pharynx), but may also affect the skin or birth canal. Patients may experience headache, abdominal pain, nausea, and a skin rash. Rarely, complications are lymphocytic meningitis and hepatitis. A reddish flush may be apparent on the face, chest and extremities, with tiny red spots in some cases. The disease is much milder now than in the past, and complications are rare when properly treated.

Roseola infantum (exanthem subitum or pseudorubella) is an acute disease of infants or very young children characterized by high fever, absence of localizing symptoms or signs, and appearance of red spots (a rubelliform eruption) simultaneously with, or following, lowering of the fever (defervescence). The cause and mode of transmission are not known, but the disease is probably communicable and caused by a neurodermotropic virus. It occurs most often in the spring and fall. Minor local epidemics have been reported.

Atypical measles syndrome (AMS) is most common in adolescents and young adults and usually associated with prior immunization using the original killed measles vaccines, which are no longer in use. However, live measles vaccine administration has also been known to precede development of AMS, perhaps as a result of inadvertent inactivation due to improper storage. Presumably, inactivated measles virus vaccines do not prevent wild virus infection and can sensitize patients so that disease expression is altered significantly. AMS may begin abruptly, with high fever, toxicity, headache, abdominal pain, and cough. The rash may appear one to two days later, often beginning on the extremities. Swelling (edema) of the hands and feet may occur, pneumonia is not uncommon, and nodular densities in the lungs may persist for three months or longer.

Standard Therapies

Diagnosis
Measles is diagnosed by physical findings. This disease is characterized by fever, cough, acute nasal mucous membrane discharge (coryza), inflammation of the lining of the eyelids (conjunctivitis), a spreading rash, and eruption of small, irregular, bright red spots (Koplik's spots) on the inner cheeks in the mouth with a minute bluish or white speck in the center of each. Confirmation of measles virus infection can be done with a blood test called a measles virus sandwich-capture immunoglobulin (IgM) antibody assay. This test is most accurate if performed after the third day of rash up to one month after the beginning of rash.

Treatment
There is no specific treatment for measles. Vitamin A is recommended for some infected children. Symptoms can be treated with bed rest, Tylenol (acetaminophen) and humidified air. The use of aspirin to treat viral diseases in children and young adults should be avoided because of the risk of Reye syndrome, a rare but life-threatening condition. (For more information on this disorder, choose "Reye" as your search term in the Rare Disease Database.)

Vaccination for measles is the most effective method to prevent outbreaks of measles. The vaccine approved in 1963 is no longer in use. Anyone who received vaccine between 1962 and 1969 should be re-immunized with the current vaccine. The current live vaccine is strong enough to produce immunity to measles, but not so strong as to produce severe reactions. Vaccine failure occurs in 5% of cases.

The American Academy of Pediatrics recommends that an initial immunization of measles, mumps, and rubella (MMR) be given at fifteen months of age and a second MMR immunization be given at the beginning of middle school or junior high school. Students entering high school and college should have their immunization records reviewed to be sure that they have received both doses of vaccine.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Measles Resources

Organizations:

References

JOURNAL ARTICLES
Fennelly, G. Measles. eMedicine. Last Updated: 11/1/04.

Centers for Disease Control. National Immunization Program. Measles, Measles History, Last Updated: 2/04/05.

Centers for Disease Control. National Immunization Program. Recommendations for Prevention, Measles-What You Need to Know, FAQ's About Measles, Last updated: 2/15/01.

Helfand RF, Heath JL, Anderson LJ. Diagnosis of measles with an IgM capture EIA: the timing of specimen collection after rash onset. J Infect Dis. 1997: 175(1):195-9.

Hosoya M, Shigeta S, Mori S. High-dose intravenous ribavirin therapy for subacute sclerosing panencephalitis. Antimicrob Agents Chemother 2001; 45(3):943-5.

Report last updated: 2008/05/03 00:00:00 GMT+0