What is Measles?
Measles, sometimes called rubeola, is a disease that can be prevented. It’s very contagious and causes a severe fever due to a type of virus. It’s a significant health concern worldwide, especially in Africa and Southeast Asia, causing around 100,000 deaths every year. This is in spite of the fact that there is an effective vaccine available.
In the year 2000, public health officials announced that measles had been wiped out in the U.S. This meant that the disease had stopped spreading continuously for a year. In 2016, the same was declared for the whole of the Americas. Still, there are occasional outbreaks, usually due to the disease being brought in from abroad or spreading among groups of unvaccinated children in the community.
Most countries, including the U.S., need to be informed when someone has measles so they can monitor and control the disease.
What Causes Measles?
The measles virus causes measles. This virus is part of the Paramyxoviridae family and the Morbillivirus genus. Measles virus is a type of virus that is covered in a layer and contains a single strand of RNA, a genetic material similar to DNA. This single strand is not divided into segments and carries the information in a ‘negative’ way. The virus’s genetic material codes for eight different proteins, six of which structurally make up the virus while the other two, known as V and C, do not contribute to the virus’s structure.
The six structural proteins include nucleoprotein, phosphoprotein, matrix, fusion, haemagglutinin (HA), and a large protein. The haemagglutinin, or HA protein, specifically, is critical in helping the virus attach and enter the cells of the body, which then allows the virus to cause infection.
Risk Factors and Frequency for Measles
Measles is a contagious disease that spreads among people, and is more common in parts of the world where immunization levels are low. Before we had vaccinations, measles caused about 2.6 million deaths. Even with vaccinations today, the World Health Organization recorded around 134,200 measles-related deaths in 2015. The U.S Centers for Disease Control and Prevention noted 372 cases in 2018 and 764 cases by May 2019. In many countries, including the US, measles is a disease that must be reported to health authorities.
Only humans can get measles; there’s no animal equivalent. The measles virus is very contagious and can spread easily from person to person through respiratory droplets, fine air particles, or close contact. After being exposed to the virus, it typically takes 10 to 14 days to start showing symptoms.
The people most at risk of getting measles are unvaccinated young children and pregnant women. However, higher immunization rates and changes in immunity in different age groups have led to more cases in older children and teenagers. Newborn babies can get temporary immunity from their mothers, but they’ll be vulnerable to measles once this wears off. A person with measles is most likely to spread the disease in the four days before and the four days after their rash appears, which is also when they are likely to have a cough, eye inflammation, and a runny nose.
Signs and Symptoms of Measles
Measles, according to the World Health Organization, is defined as a condition in someone who has a fever, a widespread skin rash, a cough, a runny nose, or eye inflammation. This illness is often identified by three main symptoms, also known as the three “Cs”: cough, runny nose (coryza), and eye inflammation (conjunctivitis). Measles can also cause Koplik spots, which are small white spots that can appear in the mouth a day or two before the skin rash does, although these are not always observed. The fever usually starts before the rash. The rash, which first shows on the face and then spreads to the rest of the body, is a key sign of measles. If there are no additional complications, the symptoms of measles usually disappear about a week after the rash first appears.
- Fever
- Widespread skin rash
- Cough
- Runny nose (coryza)
- Eye inflammation (conjunctivitis)
- Koplik spots in the mouth (sometimes)
- Rash spread from face to rest of the body
- Resolution of symptoms a week after rash onset
Testing for Measles
If your child shows signs of fever and a spotty rash, your doctor may suspect measles. To confirm this, they might request a complete blood count. This test might show a lower-than-normal number of white blood cells, especially lymphocytes (a specific type of white blood cell), and platelets (blood cells that help stop bleeding). They might also check for any abnormalities in electrolyte levels, which might indicate dehydration due to poor intake of food and fluids or diarrhea.
To make a definitive diagnosis, they will need to identify specific antibodies (proteins that your immune system produces to fight off viruses and bacteria) against the measles virus. These antibodies usually reach their highest levels between 1 to 3 weeks after the rash appears and typically disappear between 4 to 8 weeks after that.
A very accurate test, called a plaque reduction neutralization assay, can also be used to diagnose measles. Additionally, it’s possible to grow the measles virus from nose or throat swabs, but this is a time-consuming and difficult process, so it’s not commonly done.
In most cases today, doctors use a technique called polymerase chain reaction (PCR) to look for the presence of the measles virus’s genetic material in throat, nasal, nasopharyngeal (the part of the throat at the back of the nose), and urine samples. This method is almost always accurate.
Treatment Options for Measles
Measles is a viral illness for which there isn’t a specific treatment to kill the virus. Instead, the main focus of treatment is on providing supportive care to help manage the symptoms. This usually includes things like keeping the patient’s fever under control, preventing the patient from getting dehydrated, and keeping them isolated to prevent the spread of the virus.
The World Health Organization (WHO) advises giving vitamin A to patients with measles for at least two days. It’s even more important for children who are malnourished to receive vitamin A for additional days. It’s crucial to identify any complications caused by measles as soon as possible, and start appropriate treatment promptly.
What else can Measles be?
There are several conditions that can be associated with infections in children, including:
- Drug infections
- Erythema infectiosum
- Kawasaki disease
- Meningitis
- Parvovirus B19 infection
- Enteroviral infections
- Rubella
- Sepsis
- Toxic shock syndrome
- Scarlet fever
What to expect with Measles
While many people recover from measles without any complications, some may experience harmful effects. The most common issues caused by measles infection include otitis media (an infection in the middle ear) and diarrhea. The ear infection can cause hearing loss. Those more likely to experience serious complications are children under five years old, adults over twenty, pregnant women, and individuals with weak immune systems.
In severe cases, encephalitis, an inflammation of the brain, may occur in 1 out of every 1000 infected children. Also, out of all infected children, 1-2 may die from neurological (relating to the nervous system) or respiratory (related to breathing) complications caused by measles.
Possible Complications When Diagnosed with Measles
Measles can get more complicated, particularly in young babies, pregnant women, malnourished, or children with weakened immune systems. The most common complication is pneumonia, which is either directly caused by the measles virus or brought on by a secondary bacterial infection. There are additional complications like croup, ear infections, and diarrhea that can result from secondary infections.
If a pregnant woman gets measles, it increases her risk of dying during childbirth, suffering a miscarriage, the death of the fetus in the uterus, and having babies that are low in weight at birth. Keratoconjunctivitis caused by measles mostly affects children who lack vitamin A, and this can potentially cause blindness.
There are also complications that can affect the brain. Acute disseminated encephalomyelitis happens within days to weeks and is an autoimmune disease that damages the protective covering of the nerve fibers. Measles inclusion body encephalitis occurs in people with compromised immunity. This progressive brain infection happens within months of getting the initial infection. Another complication is subacute sclerosing panencephalitis, seen in children who had measles before the age of 2. It shows up 5 to 10 years after the initial illness, causing seizures and a gradual loss of mental and physical functions.
Common Complications of Measles:
- Pneumonia
- Croup
- Ear infections
- Diarrhea from secondary infections
- Risks to pregnant women: maternal death, miscarriage, death of the fetus in the uterus, low birth-weight babies
- Measles keratoconjunctivitis (potential blindness)
- Acute disseminated encephalomyelitis
- Measles inclusion body encephalitis
- Subacute sclerosing panencephalitis
