Measles

Measles is a highly contagious viral infection.  An infected person transmits the virus to nine out of ten people who come in close contact with him/her. It is an airborne disease that is transmitted by contact with infected micro-droplets that spread in the air when an infected person breathes, coughs, or sneezes. Thereafter, the virus can remain active in the atmosphere for around two hours.

What is Measles?

Measles, a severely communicable viral infection, is one of the major causes of deaths among children globally. Although it has become uncommon in most developed countries due to the effectiveness of the measles vaccine, it occasionally erupts in small pockets when people travelling carry it to their countries inadvertently. Measles can occur in any person, irrespective of age, if he/she has not been vaccinated or had not contracted it earlier. However, it commonly occurs in children. Once infected with measles, a person develops a life-long immunity to the virus.

There are two types of measles based on the virus type - Rubeola and Rubella. Historically, they were thought to be caused by the same virus, but later on, it was discovered that these are two different diseases.

• Measles
  This is a standard form of measles, and the rubeola virus is the causative agent.
• Rubella or German measles
  In this type of measles, the rubella virus is the causative agent.

The severity and infectiousness of the rubella virus are less than that of the standard measles, but foetuses are at high risk when pregnant women contract the rubella infection. 

The symptoms of measles appear one after the other in a fixed order as the infection progresses and manifest in 7-14 days after a person is exposed to the virus. This period is known as the incubation period.

• Fever
  The characteristic symptom of measles is a fever. Fever is usually accompanied with at least one of the three ‘C's’:
  • Cough
  • Coryza or a runny nose, and
  • Conjunctivitis or red and watery eyes
• Koplik Spots
  Within two or three days after fever occurs, tiny white spots called Koplik spots may appear inside the mouth. These are the early indicative signs of a measles infection.
• Measles Rash
  A rash begins to appear on the face around three to five days after the symptoms first appear. It is a flat red spot occurring on the face near the hairline and spreads downwards towards the neck, arms, body, legs, and feet. Tiny raised bumps may appear on the red spots, and the spots then merge as they spread throughout the body. The rash is mostly accompanied by high fever. The rash eventually subsides in a few days and the fever starts to come down.
• Other symptoms, such as sensitivity to light and muscle pain, may also be present.

If you have a fever accompanied by any of the three ‘C's’ even after two weeks of travelling to places that have high incidences of measles, it is important that you inform the doctor about your travel and convey your suspicions.

Measles is easily transmitted from one person to another through micro-droplets released from the mouth, nose, or throat of an infected person. The virus survives on the mucosal surfaces of infected individuals, such as the throat and nostrils.

It passes from one person to another when:

• The infected person sneezes or coughs.
• One touches the objects handled by an infected person, which are contaminated, and then touches his/her own eyes, nose, or mouth.

The virus can also survive outside the human body on the surfaces of objects used by an infected person for around two hours. If other people handle these objects during this time, the virus can infect them also.

Risk factors

People who are not vaccinated and who have not been previously infected can acquire the infection. However, children below 5 years of age and people older than 20 years of age are more prone to measles and its complications. People who have a compromised immune system due to diseases, such as HIV-AIDS, and leukaemia, and pregnant women are more susceptible to the infection and its complications.

One of the easiest and the most effective ways to protect yourself from measles is by vaccination. In India, the Ministry of Health and Family Welfare has initiated a measles-rubella (MR) vaccination program in a phased manner across the nation, with an aim to vaccinate all children between 9 months to 15 years of age.

Vaccination

• The measles, mumps, and rubella (MMR) vaccine protects against these three serious illnesses. MMR has been used since the 1970s and is considered extremely safe. Some people tend to experience mild and temporary reactions, such as joint pain, which last for a day or two.
• Two doses of MMR vaccine is nearly 100% effective in preventing measles.
• In India, all children between 9 to 12 months, and thereafter, between 16 to 24 months of age are now given the MMR vaccine.
• It is recommended that all adults who have not been infected by the virus and who have not been vaccinated should take two doses of the MMR vaccine separated by a period of at least 28 days to protect themselves from measles.

Basic Hygiene and Protection

• Practice hand hygiene by frequently washing hands with soap.  
• In the absence of soap and water, use a sanitizer to clean your hands.
• Avoid close contact with people who have measles and do not share utensils.
• If you have to be near a person who has measles, avoid touching your eyes, nose, and mouth.
• Ask the infected person to cover his/her mouth while sneezing or coughing, and develop a habit of covering your mouth and nose with a tissue or a handkerchief. Do not use your hands to cover your mouth and nose as you may let the virus enter your body.

Medication after Exposure

If you have been in close contact with a person who has measles, your doctor may administer the serum immunoglobulin (the proteins of the immune system which fight disease-causing organisms) within six days of exposure. This will reduce the chances of acquiring the disease. However, if you still acquire measles after taking the serum, the infection tends to be mild.

Measles is diagnosed by its symptoms, which include high fever accompanied with any of the three ‘C's’ (cough, coryza, or conjunctivitis). Diagnosis of the condition is confirmed by the doctors on the appearance of Koplik spots and when the rash spreads downwards from the head to the trunk and then to the arms and legs. However, since several of these symptoms are also similar to other infections, your doctor may order a blood test to confirm the diagnosis.

Measles does not have any specific treatment and the condition generally subsides by itself within 7-10 days. The medication is aimed at providing relief from the symptoms of measles, i.e., symptomatic therapy.

People who are infected are advised to stay indoors and avoid going to school, work, or other public places for at least four days after the first appearance of the measles rash. It is important to avoid contact with people who are at risk of easily contracting the infection, such as children and pregnant women. The symptomatic treatment includes:

• Fever control
  Paracetamol or ibuprofen are usually prescribed by doctors to bring down the fever and to provide relief from body aches.
• Hydration
  It is important to drink an ample amount of liquids and stay well hydrated during fever to avoid the risk of dehydration. Adequate intake of liquids also provides relief from throat pain caused due to coughing.
• Eye Care
  It is recommended to keep the eyes clean and remove any build up around the eyelids and eyelashes by gently wiping these areas with fresh clean cotton soaked in water. Dimming lights and drawing curtains may help if bright lights are hurting the eyes.
• Cough and Cold
  If measles is accompanied by symptoms of cold and cough, your doctor will prescribe medicines to treat the condition. Taking steam and sipping warm drinks will help loosen the mucus and provide relief.
• Other measures
  Keep a lookout for signs, such as shortness of breath, coughing up blood, drowsiness, confusion, and fits. Contact your doctor and visit the emergency department of a hospital if you notice any of these symptoms. 

Prognosis

Most people who get measles tend to recover completely without any side effects. Complications are rare in healthy people. Timely diagnosis and effective treatment help prevent loss of life associated with complications.

Complications

Measles can cause complications in people of all age groups, but they are more common in children who are younger than one year, do not eat properly, and have a compromised immune system. Adults and teenagers are also more likely to develop complications. The complications could be mild or common, severe, and long-term.

• Common Complications
  • Ear infections are common in children who have measles. One in ten children with measles has ear infections. These ear infections can result in a permanent hearing loss. Appropriate and timely treatment reduces the chances of permanent damage.
  • Diarrhoea is a common complication that affects less than one in ten individuals who have measles.
• Severe Complications
  Measles can cause severe complications are very dangerous conditions requiring immediate hospitalisation to prevent loss of life.
  • Pneumonia (infection of the lungs) is one of the most common causes of death in young children due to measles. Around one out of 20 children who get measles tend to get pneumonia.
  • Encephalitis (swelling of the tissues of the brain) can cause convulsions and lead to lifelong disability, such as deafness or intellectual disability. 1 in 1000 children who have measles is prone to encephalitis.
  • Statistics reveal that 1 or 2 of every 1000 children affected by measles lose their life due to measles.
  • If a pregnant woman acquires measles, it can lead to premature delivery and the birth of a low weight baby
• Long-term Complications
  Long-term complications of measles include the possibility of developing a very rare but fatal disease of the central nervous system known as subacute sclerosing panencephalitis. This condition can develop years after a person has recovered from measles. Children with measles who are aged below two years are at a greater risk of developing this condition.