Measles (Rubeola or Nine-Day Measles)

Basic Information

Measles, along with chickenpox, is known as one of the most highly contagious infectious diseases. Once the scourge of childhood, measles have declined dramatically since the universal use of the MMR (measles, mumps, rubella) vaccine. For instance, compare the number of cases diagnosed in the U.S. in 1962 (481,530) to 1994 (963). The vaccine has a proven success record. However, a resurgent outbreak of measles occurred in the U.S. between 1989 and 1994. Reasons for the outbreak are believed to be:

failure to immunize vaccine-eligible children, adolescents, high school and college students (64%)
influx of unimmunized immigrants
primary immunization failure -- 5% of vaccinated children are apparently not responsive to the vaccine

In almost all cases the measles virus could have been avoided had those persons eligible for immunization taken advantage of the vaccination.

Measles is spread by:

infected airborne droplets
small droplets from the ears, nose and throat of an infected person during the early eruptive stage

The incubation period for measles is one to two weeks and the duration of the illness is anywhere from four to ten days even though it is called nine-day measles.

Though primarily a disease associated with children, anyone can catch the virus, and as with chickenpox, rubella and mumps, consequences of measles are usually far greater and longer lasting for adults.

Measles is identified by the red rash that begins on the face, usually on the forehead or around the ears, then moves downward through the rest of the body. It begins to fade by the time it reaches the feet. Also by the time the rash fades, the virus has gone from the ears, nose and throat.

There are complications associated with measles. The most common are:

pneumonia
encephalitis (one in one thousand cases)
meningitis
strep throat
ear infections

Symptoms

Symptoms generally begin to appear following the one to two week incubation period. They tend to appear sequentially. The first symptom is usually:

fever

followed by:

fatigue
loss of appetite

followed by:

dry, hacking cough
conjunctivitis
sneezing, runny nose
a sensitivity to light
mild itching

These symptoms are followed by one of the most classic signs of measles infection:

Koplik's spots -- very small, grayish-blue spots appearing opposite the molars in the mouth and in the throat

Then comes the classic red rash appearing three to five days after the onset of symptoms and one to two days after the appearance of Koplik's spots. The rash starts at the top of the head and around the ears then goes down the body to the feet where it starts to fade, although there can be a brownish discoloration due to the rash which usually fades within one to two weeks.

Fever may be quite high (greater than 104 degrees at the peak of the illness) but falls within three to five days.

Diagnosis/Treatment

Diagnosis is made by physical examination. The presence of Koplik's spots and the red rash along with high fever and malaise usually confirm measles diagnosis.

Due to the highly contagious nature of the illness, it is recommended that the patient be isolated for at least four days after the initial appearance of the rash.

Symptoms are treated since measles is a viral infection for which there is no cure.

It is important for the patient to rest in bed until the rash has disappeared. There should be an intake of plenty of fluids to counter the fever. But no one under sixteen years of age with this infection should take aspirin because of the association with Reye's syndrome. The use of nonaspirins to reduce the fever is permitted.

A child should be kept home from school for seven to ten days after both the rash and fever have disappeared.

Though it may seem humorous, the use of sunglasses helps with light sensitivity, and saline drops help moisturize and soothe irritations in the eyes.

PREVENTION

The MMR (measles, mumps, rubella) vaccine is indicated for infants and children. (See Childhood Immunizations for vaccination schedule.) Adolescents and adults may also benefit from this vaccine. (See Adult Immunizations for vaccination schedule.)

But certain patients should not take the vaccine including those who have leukemia or other malignancies. AIDS patients and immunocompromised patients should avoid the vaccine as well since it is taken from live, attenuated measles virus. Measles is an extremely serious illness for patients with AIDS -- in fact, it can cause death. Also there are quite rare potentially deadly diseases associated with measles including atypical measles syndrome (AMS) and subacute sclerosing panencephalitis (SSPE).

But for most healthy children and adults, measles resolve on their own without serious complication, and once you have had measles you have a lifetime immunity against the disease.

If you or your child has measles or if you or your child need to be immunized for measles please see your health care provider promptly.