Measles is an infection caused by a virus, which causes an illness
displaying a characteristic skin rash known as an exanthem. Measles is
also sometimes called rubeola, five-day measles, or hard measles.
Measles is a very contagious disease primarily characterized by
, runny nose, red eyes (
), and a characteristic rash on the skin and inside of the cheeks. The
most common complications are ear infection and
, although more serious complications can include
. Measles is fatal (due to complications) in about two out of every 1,000
Measles infections appear all over the world. Prior the effective
immunization program used in the early
2000s, large-scale measles outbreaks occurred on a two to three-year
cycle, usually in the winter and spring. Smaller outbreaks occurred during
the off years. Babies up to about eight months of age are usually
protected from contracting measles, due to immune cells they receive from
their mothers in the uterus. Once someone has had measles infection, he or
she can never get it again.
Causes and symptoms
Measles is caused by a type of virus called a paramyxovirus. It is an
extremely contagious infection, spread through the tiny droplets that may
spray into the air when an individual carrying the virus sneezes or
coughs. About 85 percent of those people exposed to the virus will become
infected with it. About 95 percent of those people infected with the virus
will develop the illness called measles. Once someone is infected with the
virus, it takes about seven to 18 days before he or she actually becomes
ill. The most contagious time period is the three to five days before
symptoms begin through about four days after the characteristic measles
rash has begun to appear.
The first signs of measles infection are
; extremely runny nose; red, runny eyes; and a cough. A few days later, a
rash appears in the mouth, particularly on the mucous membrane that lines
the cheeks. This rash consists of tiny white dots (like grains of salt or
sand) on a reddish bump. These are called Koplik's spots and are
unique to measles infection. The throat becomes red, swollen, and sore.
A couple of days after the appearance of the Koplik's spots, the
measles rash begins. It appears in a characteristic progression, from the
head, face, and neck, to the trunk, then abdomen, and next out along the
arms and legs. The rash starts out as flat, red patches but eventually
develops some bumps. The rash may be somewhat itchy. When the rash begins
to appear, the fever usually climbs higher, sometimes reaching as high as
105°F (40.5°C). There may be
, diarrhea, and multiple swollen lymph nodes. The cough is usually more
problematic at this point, and the patient feels awful. The rash usually
lasts about five days. As it fades, it turns a brownish color and
eventually the affected skin becomes dry and flaky.
Many patients (about 5–15%) develop other complications. Bacterial
infections, such as ear infections, sinus infections, and pneumonia are
common, especially in children. Other viral infections may also strike the
, laryngitis, or viral pneumonia. Inflammation of the liver, appendix,
intestine, or lymph nodes within the abdomen may cause other
complications. Rarely, inflammations of the heart or kidneys, a drop in
(causing episodes of difficult-to-control bleeding), or reactivation of
infection can occur.
An extremely serious complication of measles infection is swelling of the
brain. Called encephalitis, this condition can occur up to several weeks
after the basic measles symptoms have resolved. About one out of every
thousand patients develops this complication, and about 10 to 15 percent
of these patients die. Symptoms include fever,
, sleepiness, seizures, and coma. Long-term problems following recovery
from measles encephalitis may include seizures and
A very rare complication of measles can occur up to ten years following
the initial infection. Called subacute sclerosing panencephalitis, this is
a slowly progressing, smoldering swelling and destruction of the entire
brain. It is most common among people who had measles infection prior to
the age of two years. Symptoms include changes in personality, decreased
with accompanying school problems, decreased coordination, involuntary
jerks and movements of the body. The disease progresses so that the
individual becomes increasingly dependent, ultimately becoming bedridden
and unaware of his or her surroundings. Blindness may develop, and the
temperature may spike (rise rapidly) and fall unpredictably as the brain
structures responsible for temperature regulation are affected. Death is
Measles during pregnancy is a serious disease, leading to increased risk
of a miscarriage or stillbirth. In addition, the mother's illness
may progress to pneumonia.
Measles infection is almost always diagnosed based on its characteristic
symptoms, including Koplik's spots, and a rash which spreads from
central body structures out towards the arms and legs. If there is any
doubt as to the diagnosis, then a specimen of body fluids (mucus, urine)
can be collected and combined with fluorescent-tagged measles virus
antibodies. Antibodies are produced by the body's immune cells that
can recognize and bind to markers (antigens) on the outside of specific
organisms, in this case the measles virus. Once the fluorescent antibodies
have attached themselves to the measles antigens in the specimen, the
specimen can be viewed under a special microscope to verify the presence
of measles virus.
Measles rash on a child's face.
(© CNRI/Photo Researchers, Inc.)
As of 2004 there are no treatments available to stop measles infection.
Treatment is primarily aimed at helping the patient to be as comfortable
as possible and watching carefully so that
can be started promptly if a bacterial infection develops. Fever and
discomfort can be treated with
. Children with measles should never be given aspirin, as aspirin is
correlated with the fatal disease
. A cool-mist vaporizer may help decrease the cough. Patients should be
given a lot of liquids to drink, in order to avoid
from the fever.
Some studies have shown that children with measles encephalitis benefit
from relatively large doses of vitamin A.
The prognosis for an otherwise healthy, well-nourished child who contracts
measles is usually quite good. In developing countries, however, death
rates may reach 15 to 25 percent. Adolescents and adults usually have a
more difficult course. Women who contract the disease while pregnant may
give birth to a baby with
. Although only one in 1,000 patients with measles will develop
encephalitis, 10 to 15 percent of those who do will die, and about another
25 percent will be left with permanent brain damage.
—A special protein made by the body's immune system as a
defense against foreign material (bacteria, viruses, etc.) that enters
the body. It is uniquely designed to attack and neutralize the specific
antigen that triggered the immune response.
—A substance (usually a protein) identified as foreign by the
body's immune system, triggering the release of antibodies as
part of the body's immune response.
—Inflammation of the brain, usually caused by a virus. The
inflammation may interfere with normal brain function and may cause
seizures, sleepiness, confusion, personality changes, weakness in one or
more parts of the body, and even coma.
—A skin eruption regarded as a characteristic sign of such
diseases as measles, German measles, and scarlet fever.
—Tiny spots occurring inside the mouth, especially on the inside
of the cheek. These spots consist of minuscule white dots (like grains
of salt or sand) set onto a reddened bump and are characteristic of
Measles vaccine should not be given to pregnant women, however, in spite
of the seriousness of gestational measles. The reason for not giving this
particular vaccine during pregnancy is the risk of transmitting measles to
the unborn child.
New cases of measles began being reported in some
countries—including Great Britain—in 2001 because of
parents' fears about vaccine safety. The combined vaccine for
(MMR) was claimed to cause
or bowel disorders in some children. However, the World Health
Organization (WHO) position is there is no scientific merit to these
claims. The United Nations expressed concern that unwarranted
of the vaccine would begin spreading the disease in developing countries
and ultimately in developed countries as well. Parents in Britain began
demanding the measles vaccine as a separate dose, and scientists were
exploring that option as an alternative to the combined
. Unfortunately, several children died during an outbreak of measles in
Dublin because they had not received the vaccine. Child mortality due to
measles is considered largely preventable, and making the MMR vaccine
widely available in developing countries is part of WHO strategy to reduce
child mortality by two-thirds by the year 2015.
Katz, Samuel L. "Measles (Rubeola)." In
Practice of Pediatric Infectious Diseases
, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.
Maldonado, Yvonne. "Measles." In
Nelson Textbook of
Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.
Kerr, C. "Good response rate for MMRV vaccine."
3 (December 2003): 748.
Stalkup, J. R. "A review of measles virus."
20 (April 2002): 209–215.
American Academy of Pediatrics (AAP).
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Centers for Disease Control and Prevention.
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