Measles

Dr. Santosh N. Madrewar
Consultant Paediatrician , Nimai Hospitals, Aurangabad.

Measles is a childhood infection caused by a virus.
Once quite common, measles can now almost
always be prevented with a vaccine.
Also called rubeola, measles spreads easily and
can be serious and even fatal for small children.
While death rates have been falling worldwide as
more children receive the measles vaccine, the
disease still kills more than 200,000 people a year,
mostly children.

Symptoms

Measles signs and symptoms appear around 10 to 14 days after exposure to the
virus. Signs and symptoms of measles typically include:
• Fever
• Dry cough
• Runny nose
• Sore throat
• Inflamed eyes (conjunctivitis)
• Tiny white spots with bluish-white centres on a red background found
inside the mouth on the inner lining of the cheek — also called Kolpik’s
spots
• A skin rash made up of large, flat blotches that often flow into one
another

The infection occurs in stages over 2 to 3 weeks

• Infection and incubation. For the first 10 to 14 days after infection, the
measles virus spreads in the body. There are no signs or symptoms of
measles during this time.
• Nonspecific signs and symptoms. Measles typically begins with a mild
to moderate fever, often with a persistent cough, a runny nose, inflamed
eyes (conjunctivitis) and a sore throat. This relatively mild illness may
last 2 to 3 days.
• Acute illness and rash. The rash is made up of small red spots, some
of which are slightly raised. Spots and bumps in tight clusters give the
skin a splotchy red appearance. The face breaks out first.
Over the next few days, the rash spreads down the arms, chest and
back, then over the thighs, lower legs and feet. At the same time, the
fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C).
• Recovery. The measles rash may last about seven days. The rash
gradually fades first from the face and last from the thighs and feet. As
other symptoms of the illness go away, the cough and darkening or
peeling of the skin where the rash was may stay for about 10 days.

When can a person spread the measles virus?
A person with measles can spread the virus to others for about eight days, starting
four days before the rash appears and ending when the rash has been present for
four days.

When to see a doctor
Call your health care provider if you think you or your child may have been exposed
to measles or if you or your child has a rash that looks like measles.
Review your family’s vaccination records with your provider, especially before your
children start day care, school or college and before international travel.

Causes

Measles is a highly contagious illness. This means it’s very easily spread to others.
Measles is caused by a virus found in the nose and throat of an infected child or adult. When someone with measles coughs, sneezes or talks, infectious droplets spray into the air, where other people can breathe them in. The infectious droplets
can hang in the air for about an hour.
The infectious droplets may also land on a surface, where they can live and spread
for several hours. You can get the measles virus by putting your fingers in your
mouth or nose or rubbing your eyes after touching the infected surface.
Measles is highly contagious from about four days before to four days after the rash
appears. About 90% of people who haven’t had measles or been vaccinated against
measles will become infected when exposed to someone with the measles virus.

Risk factors

Risk factors for measles include:
• Being unvaccinated. If you haven’t had the measles vaccine, you’re
much more likely to get measles.
• Traveling internationally. If you travel to countries where measles is
more common, you’re at higher risk of catching measles.
• Having a vitamin A deficiency. If you don’t have enough vitamin A in
your diet, you’re more likely to have more-severe symptoms and
complications of measles.

Complications

Complications of measles may include:
• Diarrhea and vomiting. Diarrhea and vomiting can result in losing too
much water from the body (dehydration).
• Ear infection. One of the most common complications of measles is a
bacterial ear infection.
• Bronchitis, laryngitis or croup. Measles may lead to irritation and
swelling (inflammation) of the airways (croup). It can also lead to
inflammation of the inner walls that line the main air passageways of the
lungs (bronchitis). Measles can also cause inflammation of the voice box
(laryngitis).

• Pneumonia. Measles can commonly cause an infection in the lungs
(pneumonia). People with weakened immune systems can develop an
especially dangerous type of pneumonia that sometimes can lead to
death.
• Encephalitis. About 1 in 1,000 people with measles can develop a
complication called encephalitis. Encephalitis is irritation and swelling
(inflammation) of the brain. The condition can be especially dangerous
for people with weakened immune systems. Encephalitis may occur right
after measles, or it might not occur until months later. Encephalitis can
cause permanent brain damage.
• Pregnancy problems. If you’re pregnant, you need to take special care
to avoid measles because the disease can cause premature birth, low
birth weight and fetal death.

Prevention

Indian Academy of pediatrics (IAP) recommends that children and adults receive the
measles vaccine to prevent measles.

Measles vaccine in children

The measles vaccine is usually given as a combined measles-mumps-rubella (MMR)
vaccine. IAP recommend that children receive the MMR vaccine between 9 and 15
months of age, and again between 4 and 6 years of age — before entering school.
The MMR vaccine’s two doses are 97% effective in preventing measles and
protecting against it for life. In the small number of people who get measles after
being vaccinated, the symptoms are generally mild.

Keep in mind:

• If you’ll be traveling internationally when your child is 6 to 11 months old,
talk with your child’s health care provider about getting the measles
vaccine earlier.
• If your child or teenager didn’t get the two doses of the vaccine at the
recommended times, your child may need two doses of the vaccine four
weeks apart.

• In current scenario of measles outbreak government of India may ask for
additional dose of MMR in-spite of your previous vaccination status, you
shall vaccinate your child in this scenario.
Babies born to women who have received the vaccine or who are already immune
because they had measles are usually protected from measles for about 6 months
after birth. If a child requires protection from measles before 12 months of age — for
example, for foreign travel — the vaccine can be given as early as 6 months of age.
But children who are vaccinated early still need to be vaccinated at the
recommended ages later.
Providing a child with the MMR vaccine as a combination of recommended vaccines
can prevent a child’s delay in protection against infection from measles, mumps and
rubella — and with fewer shots. The combination vaccine is as safe and effective as
the vaccines given separately. Side effects are generally mild and may include a
sore arm where the shot was given and fever.

Measles vaccine in adults

You may need the measles vaccine if you’re an adult who does not have proof of
immunity and:
• Has an increased risk of measles, such as attending college, traveling
internationally or working in a hospital environment.
• If you’ve already had measles, your body has built up its immune system
to fight the infection, and you can’t get measles again.
Proof of immunity — protection from getting measles infection — includes:
• Written documentation of appropriate measles vaccinations
• Lab tests that show evidence of immunity
• Lab tests that show you’ve had measles in the past
If you’re not sure if you need the measles vaccine, talk to your health care provider.

Preventing measles during an outbreak or known infection

If someone in your household has measles, take these precautions to protect family
and friends without immunity:
• Isolate. Because measles is highly contagious from about four days
before to four days after the rash appears, people with measles should
stay home and not return to activities where they interact with other
people during this period.
People who aren’t vaccinated — siblings, for example — should also
stay away from the infected person.
• Vaccinate. Be sure that anyone who’s at risk of getting measles who
hasn’t been fully vaccinated receives the measles vaccine as soon as
possible.

Preventing new infections

Getting vaccinated with the measles vaccine is important for:
• Promoting and preserving widespread immunity. Since the
introduction of the measles vaccine, measles has virtually been
eliminated in the U.S., even though not everyone has been vaccinated.
This effect is called herd immunity.
But herd immunity may now be weakening a bit, likely due to a drop in
vaccination rates. The incidence of measles in the U.S. recently
increased significantly.
• Preventing a resurgence of measles. Steady vaccination rates are
important because soon after vaccination rates decline, measles begins
to come back.
Here’s one example. In Mumbai measles outbreak happened just
because of poor vaccination coverage during Covid times.