Do you notice rashes on the body? Do you have symptoms like fever, cough, and watery eyes? These are all signs and symptoms associated with the human disease measles caused by the measles virus. It is usually transmitted by direct contact and through the air, and can cause severe problems, even fatality, for those infected. The primary way of prevention is through immunisation with the Measles, Mumps and Rubella (MMR) vaccine. According to the World Health Organization (WHO), the death rate for measles recorded in 2018 was over 140,000, primarily in children. Death rates have decreased after immunisation campaigns globally.1 This article will provide information about measles, its signs and symptoms, treatment and management, and preventative measures.
Causes of measles
Measles is caused by the measles virus, a single-strandedRNA virus with 1 serotype, whose only host is humans. The measles virus can be transmitted either through the the inhalation of airborne droplets or through direct contact with the the infected person or the contaminated fomite. It is not necessary to have direct contact with the infected person to get infected with the disease because measles virus can survive and remain in the air or fomite for up to two hours. For this reason, it is considered a highly contagious disease where 90% of the susceptible contacts are prone to infection2 .
Signs and symptoms of measles
Measles infection is primarily recognised by the appearance of a rash on the body 10 to 14 days post infection. The virus spreads rapidly from the respiratory tract to multiple organs of the body. Prior to the appearance of the rash, the virus can spread over several days during the clinically asymptomatic incubation time.2
Rashes are not the only symptoms of measles.
There are several other symptoms that can be very dangerous, especially for infants and babies. Some of the first symptoms associated with measles can include watery eyes, high fever, cough, and runny nose and usually appear 7 to 14 days prior to infection. After the appearance of the first symptoms, white spots may appear inside the mouth known as Koplik spots. Rashes usually break out three to five days prior to the commencement of the further symptoms and can spread from the hairline of the face to the neck and down to the arms, legs, and feet. You may notice bumps appearing on the red spots, joint bumps as they spread all over the body, and a significant increase in the body temperature when the rash appears.
Management and treatment for measles
There is no antiviral therapy used specifically to treat and eliminate measles. The goal of the currently available treatments is to help manage and relieve the symptoms associated with measles. Measles patients with severe symptoms and neglected cases who are not taken into consideration from the initial stage of infection may find themselves admitted to the Emergency Department. Therefore, at the initial stages, the patient should be isolated and given targeted treatment to control the symptoms associated with measles. The preferred isolation period is for four days post-development of rashes. Treatments include taking oral fluids and antipyretics to reduce the fever. Clinical assessments may be conducted to confirm the presence of measles virus; this can include an otoscopy to examine the structure of the ear, in particular the middle part of the ear as secondary inflammation is a common indicator of a weakened immune system concurrent with measles infection. A chest examination may also be conducted to check for any dry or moist rales in the lungs which will help identify complications and if there is a need for antibiotics to treat secondary bacterial infections.3
Children with severe cases of measles should be given vitamin A treatment following age-specific doses immediately on diagnosis. For infants aged under six months, a dose of 50,000 IU (international units) should be administered . Infants aged six to eleven months should take a dose of 100,000 IU. Children aged 12 months and older should be given a dose of 200,000 IU.4
There are other precautions that can be taken to help ease the pain caused by the symptoms of measles and lessen the spread of the infection. It is recommended to maintain hydration by resting and drinking plenty of water and other fluids throughout the day. Painkillers like paracetamol and ibuprofen can also be taken to decrease the high temperature. Medications such as aspirin should not be given to children under sixteen years old and crusts should be gently removed from eyes using cotton and warm water. It is also advisable to stay isolated and off school or work to avoid contacting and infecting babies, pregnant women, or immunocompromised people with weak immune systems.
Nevertheless, it is always important to remember that prevention is better than treating measles. One of the main ways to avoid getting infected and prevent complications is getting vaccinated with a measles-containing vaccine. One dose of the Measles, Mumps and Rubella (MMR) vaccine is 93% effective at preventing measles infections but increases to 97% effectiveness upon receiving the the second dose.6
Vaccination against measles
Certain recommendations should be followed getting vaccinated:
For children, it is recommended that the first dose of the MMR vaccine should be taken between 12 and 15 months of age. The second dose should be taken 28 days following the first dose or between four to six years of age. The Measles, Mumps, Rubella, and Varicella (MMRV) vaccine is also available to children aged between 12 months to 12 years of age.
For students post-high school age who have no evidence of immunization against measles, two doses of the MMR vaccine should be taken.
Adults should at least get one dose of the MMR vaccine if born during or after 1957 and have no evidence of immunisation
If you are planning to travel internationally and worried about getting infected with measles, there are other specific recommendations to follow.
- Infants aged 6 to 11 months should receive one dose of the MMR vaccine. It is important to remember that if the infant already received one dose before 12 months of age, two more doses should be taken according to the recommended schedule. Documentation of the prior MMR vaccine doses should be consulted before booking another dose
- Teenagers or adults born during and after 1957 are likely to have been infected naturally and most probably protected against measles, mumps, and rubella (MMR). However, if in doubt it is always best to check with a doctor or healthcare specialist5
If you think you have been exposed to measles and do not have evidence of getting an immunization, you will be given post-exposure prophylaxis (PEP) which consists of the MMR vaccine or immunoglobulin (Ig). It is only used for asymptomatic susceptible contact with measles and only once for emergencies. Both PEP treatments should not be given together as administering MMR vaccine and Ig can invalidate the efficacy of the vaccine.
How is measles diagnosed?
Measles can be diagnosed by healthcare providers in patients showing febrile rash illness or other measles symptoms. Measles infection can be confirmed through a variety of laboratory tests which detect antibodies in the serum and the RNA through a technique known as real-time polymerase chain reaction (RT-PCR). A serum sample and a thorough swab should be obtained only by health professionals. Alternatively, urine samples may also be requested as they may contain traces of the virus. If feasible, both respiratory and urine samples should be taken to more accurately detect the measles virus.
How can I prevent measles?
Get vaccinated! You should follow the recommendations and get vaccinated with the MMR vaccine. The MMR vaccine will not only protect you from measles but also give protection against mumps and rubella, by allowing your immune system to recognise the diseases before genuine infection occurs.
What are the complications of measles?
Two common complications of measles are ear infections and diarrhoea. Ear infections occur in about one of every ten children, whereas diarrhoeaoccurs in less than one in every ten children diagnosed with measles.
The severe complications associated with measles include pneumonia and encephalitis which are infections of the lung and swelling to the brain, respectively. These complications may lead to hospitalisation and death in severe cases. The respiratory and neurologic complications of measles infection among children can lead to the death of nearly one in every thousand infected children. These severe complications are rare, and most commonly occur in immunocompromised individuals.
Who is at risk of measles?
People who are at risk of measles complications are infants and children aged under five, adults over 20, pregnant women, and people with weak immune systems including HIV and Leukemia patients.
Is measles contagious?
Measles is an extremely contagious disease. If you are unvaccinated, there is a high probability of getting infected if you come into contact with a measles infected patient. Strict precautionary procedures are highly recommended. Patients should be nursed in isolated healthcare units and special equipment should be used by doctors and other health professionals when in contact with patients.
How common is measles?
Measles is more common in certain parts of the world including Africa, China, the Philippines, and the Middle East, especially Yemen. In 2022, around 21 large measles outbreaks were recorded to disrupt daily health and life globally- though the actual number of outbreaks is suspected to be underreported due to the coronavirus pandemic taking precedence in healthcare. Since the Covid-19 outbreak, a record twenty-three million children globally were not vaccinated against measles allowing for the virus to spread quicker amongst unprotected communities. Due to this, there was a 79% increase in the rates of measles cases at the beginning of 2022 compared to a year before.7 There are many contributing factors to the spread of this virus such as conflict and instability, natural disasters, and national immunization interruption.
When should I see a doctor?
You should see a doctor if you think you or your child are displaying measles symptoms or if you have been in close contact with a measles patient without being immunized, particularly if you have never had measles before. If you are pregnant and think you have been in contact with a measles patient, you should seek immediate help; measles can cause serious side effects in pregnancy including miscarriages, premature birth, and low birth weight in the baby. Urgent help should also be asked for if you have a weakened immune system
Measles is a contagious virus that can cause severe health complications and still remain an important public health issue. People with weakened immune systems, children, and pregnant women are at risk of infection complications including ear infections, diarrhoea, and pneumonia. Some of the most common signs and symptoms of measles include rashes on the body, fevers, coughs, and watery eyes. It can be diagnosed by health providers conducting laboratory testing. The The MMR vaccine is one of the best preventative measures and can protect you and your child. It is always advisable to consult ahealthcare professional as soon as possible should you notice any of the symptoms associated with measles or have come into contact with any infected person.
- MMR Vaccine (Measles, Mumps and Rubella Vaccine). University of Oxford. https://vaccineknowledge.ox.ac.uk/mmr-vaccine.
- Measles: a disease often forgotten but not gone. HKMJ. https://www.hkmj.org/abstracts/v24n5/512.htm [Accessed 18th August 2023].
- Griffin DE. Measles virus persistence and its consequences. Current Opinion in Virology. 2020;41: 46–51. https://doi.org/10.1016/j.coviro.2020.03.003 .
- O’Donnell S, Davies F, Vardhan M, Nee P. Could this be measles? Emergency Medicine Journal. 2019;36(5): 310–314. https://doi.org/10.1136/emermed-2019-208490 .
- McEldrew EP, Lopez MJ, Milstein H. Vitamin a. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. http://www.ncbi.nlm.nih.gov/books/NBK482362/ [Accessed 18th August 2023].
- Measles, mumps, and rubella (MMR) vaccination | cdc. https://www.cdc.gov/vaccines/vpd/mmr/public/index.html [Accessed 18th August 2023].
- Measles Cases Are Spiking Globally | UNICEF. https://www.unicef.org/stories/measles-cases-spiking-globally.