Rubeola (Measles)

What is Rubeola (Measles)?

Measles, also known as rubeola, is an infectious disease caused by a virus. This virus can spread very easily from person to person through physical contact and the air around us. Due to its easy spread and ability to stay in the air for a long period, the virus can quickly infect many people. This is why there are still yearly outbreaks of measles around the world, especially in people who haven’t been vaccinated.

When a person is exposed to measles, they not only show signs of the disease, but they also risk developing various additional health problems. Measles remains a leading cause of death in children under five years old worldwide. Even those who survive can face long-term health issues affecting the nervous system, lungs, and digestive system.

Unfortunately, there isn’t a specific medicine to treat measles. The only treatment is one that supports the body as it fights off the virus. Because of this, the main role of a doctor is to try to prevent the disease. Understanding measles, recognizing its symptoms, understanding how it affects the body, providing vaccinations to those who can receive them, and starting an assessment and treatment as early as possible are all part of this role. This helps not only the patient in front of them but also reduces the risk of spreading the disease. The following details will give an overview of the causes, symptoms, evaluation, preventative methods, and overall approach to managing a patient with measles.

What Causes Rubeola (Measles)?

Measles is a type of virus that has a specific shape and contains a substance called ribonucleic acid (RNA), which is responsible for encoding the virus’s genetic information. This virus belongs to a family of viruses called Paramyxoviridae and a subgroup known as morbillivirus. It contains approximately 15,894 units of genetic code, which create eight different viral proteins.

These proteins have various roles in the virus’s activity. For example, two of these proteins, called the HN glycoprotein and fusion glycoprotein, handle the absorption of the host’s receptors and penetration into the host cell. They do this by merging the virus and cellular membranes. On the other hand, the matrix protein forms the foundation of the virus’s outer shell. There also exist two proteins named C and V, which are coded by the gene P and these proteins, have a role in controlling the response of the host cell’s immune system.

That is to say, the measles virus is classically complex, and it operates by interacting with the host cell’s systems in many ways to cause an infection.

Risk Factors and Frequency for Rubeola (Measles)

Measles is a highly contagious virus that used to cause about 2.6 million deaths before vaccines were introduced. The spread of vaccines has greatly reduced deaths from measles by 75%. However, in countries where measles has almost been eradicated, infections can still occur through imported cases from other countries. Most measles cases globally happen in countries with weak health systems.

In 2012, a global plan was presented to further lower measles and rubella cases, which had two main goals:

• Decrease global deaths from measles by at least 95% by the end of 2015
• Eradicate measles and rubella in at least 5 World Health Organization regions by 2020

Measles is a disease that only affects humans and is caused by a virus that thrives in throat and lung cells. The virus is usually spread from person to person through droplets in the air. When on surfaces or in the air, the virus can remain active and contagious for up to two hours. An infected person can spread the virus from 4 days before the rash appears to 4 days after. The incubation period of the measles virus is normally 7 to 18 days from exposure.

Measles outbreaks most commonly occur in late winter and early spring in temperate climates. In tropical climates, it typically follows the rainy season. Children between 4 and 5 years old, especially those who are malnourished or live in countries with weaker health systems, are most at risk. Pregnant women and people with weakened immune systems are also at higher risk from measles.

Signs and Symptoms of Rubeola (Measles)

Measles is a disease that usually unfolds in three stages – the prodromal stage, the eruptive stage, and the convalescent stage. It’s often associated with a trio of symptoms known as the three “Cs”: cough, conjunctivitis (eye inflammation), and coryza (runny nose).

• The prodromal stage lasts 4 to 6 days and includes symptoms like a high fever, malaise (feeling unwell), coryza, conjunctivitis, eyelid swelling, and a dry cough. The person might also display characteristic spots of the disease called Koplik spots, which show up in the mouth around the second molar 2 to 3 days before the rash starts and disappear by the third day of the rash.
• The eruptive stage sees the appearance of a rash that may merge into larger patches over time. The rash starts behind the ears and along the hairline then spreads to the face, chest, and limbs.
• The convalescent stage begins 3 to 4 days after the rash starts and lasts until it fades away, by which time the fever and feeling unwell also usually subside. The disappearing rash leaves behind brown spots and may cause the skin to peel slightly.

In some unusual cases, the onset of measles is severe and comes with additional symptoms such as high fever, headache, stomachache, and muscle ache. The rash may be minor or not present in children who’ve been vaccinated against measles. Also, they might not have one or more of the three “Cs” symptoms. Measles can sometimes lead to complications like pneumonia, ear infections, heart inflammation, and brain inflammation.

Testing for Rubeola (Measles)

The process of diagnosing measles involves three key parts: identifying the symptoms, understanding the patient’s exposure to the disease, and performing laboratory tests. Various lab tests can help confirm a diagnosis of measles. These include blood tests that measure specific proteins called immunoglobulin G (IgG) and immunoglobulin M (IgM), genetic tests using reverse transcription-polymerase chain reaction techniques, and tests that can isolate the measles virus itself.

The presence of measles-specific IgM antibodies in the blood is very indicative of a measles infection. These antibodies are usually detectable from the third day of the rash appearing and can remain in the body for about one to two months. Immunoglobulin G (IgG), on the other hand, increases by more than four times between the start and recovery stages of the disease.

Additionally, a test that looks for measles RNA, the genetic material of the virus, can also be used to confirm the disease. This is done by taking swabs from the throat or nose, or urine samples. This genetic test not only confirms the presence of measles but can also identify the specific type of measles virus present.

Treatment Options for Rubeola (Measles)

The most effective way to prevent measles is through routine vaccination. This usually starts with the first dose between 12 to 15 months of age, followed by a second dose between 4 to 6 years old. In some cases, a second dose can be given as early as 28 days after the first one. In areas where there’s a high risk of measles or during an outbreak, early vaccination (one dose) is recommended for children older than 6 months but under 12 months.

If a person who hasn’t been immunized is exposed to measles, different measures need to be taken according to the person’s age and health conditions:

For babies:

• Babies from 0 to 5 months should receive immune globulin, a substance that strengthens the immune system, within 6 days of exposure.
• Babies from 6 to 11 months can either get a measles vaccination within 72 hours of exposure or immune globulin within 6 days of exposure.
• Children older than 12 months who haven’t been vaccinated should get the measles vaccine within 72 hours of exposure. If the exposure happened more than 72 hours but less than 6 days ago, they should receive immune globulin, unless the child has a condition that weakens their immune system.

For pregnant women who haven’t been immunized, it’s recommended that they receive immune globulin. The measles vaccine, which is often combined with the mumps and rubella vaccines, isn’t recommended for pregnant women.

People with a weakened immune system should get immune globulin, regardless of whether they’ve been immunized or previously contracted measles.

Healthcare workers who haven’t been vaccinated and don’t have evidence of immunity to measles should receive two doses of the measles vaccine. If they were exposed to a patient with measles and they don’t have evidence of immunity, they should not work from the 5th to the 21st day after exposure.

Anyone who hasn’t been immunized and who was exposed to measles and received immune globulin should get the measles vaccine no sooner than 6 months after receiving immune globulin unless the measles vaccine isn’t recommended for them. If someone may have measles, measures should be taken to prevent the disease from spreading through the air. This needs to continue for four days after a rash appears in people with normal immune systems, and for the duration of the illness in people with weakened immune systems.

There’s no specific treatment for measles other than taking measures to relieve common symptoms. This includes antipyretic medicines for fevers, staying hydrated, and maintaining good nutrition. For children with measles, the World Health Organization recommends giving them vitamin A. This vitamin is particularly important for children living in areas with a high death rate from measles, areas with a known deficiency in vitamin A, and severe cases of measles. This is because vitamin A is necessary for maintaining the skin and the immune system. During a measles infection, the body uses up its stores of vitamin A, making it harder to fight off the infection and any other infections that might occur at the same time.

If vitamin A is needed, the first dose should be given as soon as a diagnosis is made, and the second dose the following day. The amount depends on the child’s age: 50,000 IU for babies under 6 months, 100,000 IU for children between 6 and 12 months, and 200,000 IU for children over 12 months. A study review showed that giving two doses of 200,000 IU of vitamin A on consecutive days reduced the overall risk of death and death from pneumonia. The American Academy of Pediatrics recommends giving vitamin A to all children with severe measles.

While lab tests have shown that the measles virus may be susceptible to the medication ribavirin, there isn’t enough clinical data to routinely recommend it. However, it may be considered for certain high-risk groups.

What else can Rubeola (Measles) be?

Measles is a disease that needs to be differentiated from other conditions that might appear similar. These could include particular childhood diseases, autoimmune disorders, and adverse reactions to drugs. Here are some of the conditions that could be mistaken for measles:

• Rubella: This causes a rash similar to measles, mild respiratory symptoms, and doesn’t come with conjunctivitis. However, it does often involve swollen lymph nodes.
• Roseola: This starts with a high fever, which goes away after a few days. This fever is accompanied by a rash in the center body. Roseola doesn’t have Koplik points, which are small spots with blue-white centers often found inside the mouth before the measles rash appears.
• Mononucleosis: Also known as “mono”, this is a viral disease characterized by a sore throat, swollen lymph nodes, and an enlarged spleen and liver. The accompanying rash could look different depending on the case. During childhood, it usually has few symptoms, but the disease is more severe in older individuals.
• Kawasaki disease: One distinctive feature of this disease is an eye condition with non-purulent conjunctivitis, or inflammation of the eye without discharge. Unlike measles, it doesn’t involve respiratory problems.
• Scarlet fever: This is caused by a group A Streptococcus infection. The rash can also look similar to the measles rash. It’s often linked with a sore throat.

Therefore, it’s important to carefully assess the symptoms and possibly perform specific tests to accurately diagnose if the condition is actually measles or one of these other diseases.

What to expect with Rubeola (Measles)

Most people usually recover from this illness without any severe health complications. However, in developing countries, there’s a higher risk for certain groups. Malnourished children, those with a weakened immune system, and pregnant women have been reported to have a fatality rate as high as 12%. This increased risk is due to complications that can come from the disease, such as damage to the lungs (known as respiratory failure) and inflammation of the brain, called encephalitis.

Pregnant women who are infected are also at higher risk of giving birth prematurely, having a miscarriage, or their baby passing away before birth.

Possible Complications When Diagnosed with Rubeola (Measles)

Pregnant women, babies, and people with weakened immune systems have the highest chances of experiencing complications from measles. Such complications could include diarrhea, swelling of the windpipe and air passages in the lungs, pneumonia, ear infections, brain inflammation, and a rare but serious condition known as Subacute Sclerosing Panencephalitis (SSPE).

The lungs are often affected by the measles virus, either directly or due to secondary bacterial infections later on in the course of the illness. Ear infections related to measles are usually due to bacteria that invade during or after the primary measles infection.

SSPE is a serious complication of measles that results from a lingering infection in the brain, which usually happens several years after the initial measles infection. Early signs include damage to the white matter of the brain, which worsens over time to include behavioral changes, muscle twitches, seizures, dementia, coma, and death. Unfortunately, death from SSPE is inevitable within 1 to 3 years after being diagnosed. Deaths from measles are often due to viral or bacterial pneumonia, or brain inflammation following the virus.

Complications of Measles:

• Diarrhea
• Swelling of the windpipe and air passages in the lungs
• Pneumonia
• Ear infections
• Brain inflammation
• Subacute Sclerosing Panencephalitis (SSPE), a serious brain condition
• Deaths due to viral or bacterial pneumonia, or brain inflammation following the virus

Preventing Rubeola (Measles)

It’s important for patients, along with parents of children who are old enough to receive vaccines, to understand the high risk of catching measles and the protection offered by vaccination. However, it’s also necessary to understand that getting the measles vaccine may cause side effects like fever, skin rashes and swelling of the lymph nodes. Serious side effects like severe allergic reactions, fever-related seizures, low platelet count, and a rare form of brain inflammation are very uncommon.

Parents may be concerned about a link between the measles vaccine and autism when considering vaccination for their children. However, they should be informed that the original studies claiming this connection were proven to be false. Further, other studies have consistently found no such link between the measles vaccine and the development of autism.