Measles – Summary

Measles is a highly contagious airborne infection caused by a morbillivirus of the paramyxovirus family.
It is spread by coughing or sneezing, close personal contact, or direct contact with nasal or throat secretions. Nearly all susceptible people (primarily children) who come into contact with the virus become infected, but once infected lifelong immunity develops.

Although endemic in the UK in the past, measles has become relatively rare since the introduction of measles immunization. However, in recent years, the infection has become more prevalent due to a failure of uptake of vaccination.

The main complications of measles are of the respiratory tract or central nervous system and include:

Otitis media (7–9% of children).

Pneumonia (1–6% of children.

Febrile convulsions (about 1 in 200 children).

Encephalitis (about 1 in 1000 children).

Subacute panencephalitis (a rare but serious complication affecting about 1 in 25,000 people with measles).

Measles tends to be more severe in adults, who have more complications than children; about 3% of adults require hospitalization.
Measles in pregnancy may result in miscarriage, premature birth, and low birthweight.

Measles is usually a self-limiting condition; symptoms usually resolve over the course of about a week. Prodromal symptoms include cough, coryza, conjunctivitis with fever, and the appearance of the rash (with or without Koplik’s spots) are highly suggestive of measles.

Other infections that are commonly misdiagnosed as measles include:

Parvovirus B19, the virus that causes fifth disease (erythema infectiosum, also known as slapped cheeks syndrome) that usually affects young children.

Streptococcal infection can cause skin reactions with a similar appearance to measles, but sore throat is usually the most prominent symptom.

Herpes virus type 6 (roseola infantum).

If a diagnosis of measles is considered likely, it is essential to notify the local Health Protection Unit (HPU), and it may be necessary to confirm the infection through laboratory investigation.

Paracetamol or ibuprofen provide symptomatic relief.

People with measles should stay away from school or work for 4 days after the initial development of the rash, and avoid contact with susceptible people (people who are not fully immunized through vaccination or natural exposure, infants, pregnant women, or immunosuppressed people).

Admission may be necessary if the person develops a serious complication of measles, for example:

Pneumonia.

Neurological problems, such as febrile convulsions in children, or encephalopathy.

G Mohan