Measles

What is measles?

Measles is a highly infectious illness caused by the rubeola virus. The virus lives in the mucus of the nose and throat of people with this infection. Physical contact, coughing and sneezing can spread the infection. In addition, infected droplets of mucus can remain active and contagious for around two hours. This means that the virus can live outside the body, for example on surfaces and door handles.

What are the symptoms of measles?

It takes between 6-21 days for the virus to cause symptoms. Once you are infected with the virus, it multiples in the back of your throat and in your lungs. It then spreads throughout your body. The following are the most common symptoms of measles:

• A high temperature, sore eyes (conjunctivitis), and a runny nose usually occur first.
• Small white spots usually develop inside the mouth a day or so later.
• A harsh dry cough is usual.
• Going off food, tiredness, and aches and pains are usual.
• Diarrhoea and/or vomiting is common.
• A red blotchy rash normally develops about 3-4 days after the first symptoms. It usually starts on the head and neck, and spreads down the body. It takes 2-3 days to cover most of the body. The rash often turns a brownish colour and gradually fades over a few days. For websites that give pictures of rashes see www.patient.co.uk/showdoc/1097/
• Children are usually quite unwell and miserable for 3-5 days. After this the fever tends to ease, and then the rash fades. The other symptoms gradually ease and go.

Most children are better within 7-10 days. An irritating cough may persist for several days after other symptoms have gone. The immune system makes antibodies during the infection. These fight off the virus and then provide lifelong immunity. It is therefore rare to have more than one bout of measles.

Some people mistake rashes caused by other viruses for measles. Measles is not just a mild red rash that soon goes. The measles virus causes an unpleasant, and sometimes serious, illness. The rash is just one part of this illness.

Note: you are infectious for 2-4 days before the rash of measles appears and for about five days after it appears.

How is measles diagnosed?

Your doctor will usually be able to diagnose measles from the combination of your symptoms, especially the characteristic rash and the small spots inside your mouth. However, a simple blood or saliva test may be taken which can confirm the diagnosis.

What are the possible complications of measles?

Complications are more likely in children with a poor immune system (such as those with leukaemia or AIDS), those who are malnourished, and children under five years and adults.

Many malnourished children in the world die when they get measles, usually from a 'secondary' pneumonia. There are still the occasional reports of children in the UK who die from complications of measles. These children have usually not been immunised.

More common complications include:

• Conjunctivitis (eye infection)
• Laryngitis (inflammation of the voicebox)
• Ear infection causing earache
• Infections of the airways, such as bronchitis and croup, which can be common.

Although these are distressing, they are not usually serious.

Less common complications of measles are listed below:

• A febrile convulsion (fit) occurs in about 1 in 200 cases. This can be alarming, but full recovery is usual.
• Brain inflammation (encephalitis) is a rare but very serious complication. It occurs in about 1 in 5,000 cases. It typically causes drowsiness, headache and vomiting which starts about 7-10 days after the onset of the rash. Encephalitis may cause brain damage. Some children die from this complication.
• Hepatitis (liver infection).
• Pneumonia (lung infection) is a serious complication that sometimes develops. Typical symptoms include fast or difficult breathing, chest pains, and generally becoming more ill.
• Squint is more common in children who have had measles. The virus may affect the nerve or muscles to the eye.

A very rare brain disease called subacute sclerosing panencephalitis (SSPE) can develop years later in a very small number of people who have had measles. This can sometimes occur several years after getting measles. This condition can be fatal.

What are the treatments for measles?

There is no specific medicine that kills the measles virus. Treatment aims to ease symptoms until the body's immune system clears the infection. For most cases, rest and simple measures to reduce a fever are all that are needed for a full recovery. Symptoms will usually disappear within 7-10 days.

The following measures are often useful:

• Children should drink as much as possible to prevent dehydration. Ice lollies are a useful way of giving extra fluid and keeping cool.
• Paracetamol or ibuprofen can be taken to ease fever and aches and pains.
  You should keep the child cool (but not cold).
• Cough remedies have little benefit on any coughs.
• Antibiotics do not kill the measles virus and so are not normally given. They may be prescribed if a complication develops, such as a ear infection or pneumonia. Antibiotics kill bacteria and then help in these complications.

Vitamin A supplements

Vitamin A supplements have been shown to be effective in preventing serious complications arising from a measles infection.

Supplements are generally recommended for children with a vitamin A deficiency (which is a rare condition in the UK, but common in the developing world) and also children with severe measles who are under two years of age.

Your doctor will be able to advise you about whether your child would benefit from taking vitamin A supplements.

When to see a doctor?

Most children recover. A doctor will normally confirm that the illness is measles. However, you should see a doctor again if symptoms get worse, or if you suspect a complication (see above).

The main serious symptoms to look out for are:

• Drowsiness.
• Dehydration. This may be developing if the child drinks little, passes little urine, has a dry mouth and tongue or becomes drowsy.
• Breathing difficulties.
• Convulsion (fit).

Is measles infectious?

Yes, it is very infectious. It is passed on by coughing and sneezing the virus into the air. It takes 10-14 days to develop symptoms after being infected. You are infectious from a day before symptoms begin until about five days after the rash first appears. Therefore, children with measles should not mix with others and should stay off school.

Anyone who has not had measles before can be infected. However, cases of re-infection after having had the virus are extremely rare because the body will have built up immunity to the virus.

Measles immunisation

Immunisation is routine in the UK as part of the Measles, Mumps and Rubella (MMR) vaccine. Two doses are usual - the first for children aged about 13 months and the second about three years later. Immunisation gives excellent protection and so measles is now rare in the UK. However, unfortunately, measles is becoming more common again in children in some areas of the UK. This is due to some children not receiving the MMR vaccine.

References

• Measles, Clinical Knowledge Summaries (November 2009)
• Mishra A, Mishra S, Jain P, et al; Measles related complications and the role of vitamin A supplementation. Indian J Pediatr. 2008 Sep;75(9):887-90. Epub 2008 Jun 21. [abstract]
• Huiming Y, Chaomin W, Meng M; Vitamin A for treating measles in children. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001479. [abstract]
• Kabra SK, Lodha R, Hilton DJ; Antibiotics for preventing complications in children with measles. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001477. [abstract]