Measles Causes, Symptoms, Complications, Diagnosis, Treatment, Prevention, Vaccine

Measles Causes, Symptoms, Complications, Diagnosis, Treatment, Prevention, Vaccine


What is measles?


Measles is a very contagious (easily spread) infection that causes a rash all over your body. It is also called rubeola or red measles.

Measles is a highly contagious viral disease that can be fatal. In most people, the disease produces fever (temperature > 101 F [38.3 C]), a generalized rash that last greater than three days, cough, runny nose (coryza), and red eyes (conjunctivitis). The complications of measles that result in most deaths include pneumonia and inflammation of the brain (encephalitis).

The measles vaccine protects against the illness. This vaccine is part of the MMR (measles, mumps, and rubella) and MMRV (measles, mumps, rubella, and varicella [chickenpox]) vaccines. Most children get the vaccine as part of their regular shots. This is why measles is rare in the U.S. and Canada.

Read more: Melanoma (Skin Cancer) Causes, Signs, Symptoms, Treatment, Prevention

What is rubella?


Rubella is the scientific name used of German measles, a different viral illness. While German measles is rarely fatal, it is dangerous in that it causes birth defects and can cause miscarriage and fetal death.

What is the history of measles?


Cases of measles were described as early as the seventh century. However, it was not until 1963 that researchers first developed a vaccine to prevent measles. Before the vaccine was made available, almost every child became infected with the virus because it is so easily spread. Before routine vaccination, there were approximately 3-4 million cases of measles and 500 deaths due to measles each year in the United States.

There were initially two types of vaccines developed against measles. One was developed from a virus that had been killed, and the other was developed using a live measles virus that was weakened (attenuated) and could no longer cause the disease. Unfortunately, the killed measles virus (KMV) vaccine was not effective in preventing people from getting the disease, and its use was discontinued in 1967. The live virus vaccine has been modified a number of times to make it safer (further attenuated) and today is extremely effective in preventing the disease. The currently used vaccine is a live attenuated vaccine.

What causes measles?


Measles is caused by a virus. It is spread when an infected person coughs, sneezes, or shares food or drinks. The measles virus can travel through the air. This means that you can get measles if you are near someone who has the virus even if that person doesn't cough or sneeze directly on you.

You can spread the virus to others from 4 days before the rash starts until 4 days after the rash appeared. The virus is most often spread when people first get sick, before they know they have it.

If you have had measles, you can't get it again. Most people born before 1957 have had measles.

Who is at risk of measles?


Unvaccinated young children are at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.

Measles is still common in many developing countries – particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

How is measles spread?


The measles virus is highly contagious. Measles is spread through droplet transmission from the nose, throat, and mouth of someone who is infected with the virus. These droplets are sprayed out when the infected person coughs or sneezes. Among unimmunized people exposed to the virus, over 90% will contract the disease. The infected person is highly contagious for four days before the rash appears until four days after the rash appears. The measles virus can remain in the air (and still be able to cause disease) for up to two hours after an infected person has left a room.

How does one become immune to measles?


Anyone who has had measles is believed to be immune for life. People who have received two doses of vaccine after their first birthday have a 98% likelihood of being immune. Infants receive some immunity from their mother. Unfortunately, this immunity is not complete, and infants are at increased risk for infection until they receive the vaccination at 12 to 15 months of age.

Is measles deadly?


Measles can cause death. In 2008, approximately 164,000 people died of measles in the world. However, measles is rarely fatal in the United States. This is due to the fact that most people are immunized, which results in very infrequent outbreaks. Also, people most likely to have complications (including death) are those who are malnourished or who have weakened immune systems.

Signs and symptoms of Measles


The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands and feet. The rash lasts for five to six days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).

Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.

Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care. Women infected while pregnant are also at risk of severe complications and the pregnancy may end in miscarriage or preterm delivery. People who recover from measles are immune for the rest of their lives.

What complications are seen with measles?


Approximately 30% of cases of measles have an associated complication. These complications can include diarrhea (8%), ear infections (7%), pneumonia (6%), blindness (1%), acute brain inflammation (encephalitis) (0.1%), and persistent brain inflammation (subacute sclerosing panencephalitis) (0.0001%).

Blindness associated with measles is due to a combination of poor nutrition (specifically vitamin A deficiency) and the measles infection. Prevention is the most effective treatment. In third-world countries, post-measles blindness is the leading cause of blindness, with up to 60,000 cases occurring annually.

Acute encephalitis, although rare, is extremely dangerous and results in death in approximately 15% of patients who develop it. When it occurs, acute encephalitis generally starts six days after onset of the rash. Symptoms can include fever, headache, vomiting, stiff neck, drowsiness, seizures, and coma.

Subacute sclerosing panencephalitis (SSP) is an extremely rare degenerative condition of the brain and spinal cord (central nervous system). It is believed to be caused by a chronic infection of the central nervous system with the measles virus. Typically, symptoms start years after the patient had measles (average seven years, range one month to 27 years). The patient has a slow and progressive loss of brain function, seizures, and eventually death results. There is no known treatment for SSP.

Most deaths from measles are due to pneumonia in children and encephalitis in adults. There are approximately 2.2 deaths per 1,000 people who get the measles. The people most likely to have complications (including death) are those who are malnourished or who have weakened immune systems (for example, people with AIDS or other conditions that weaken the immune system).

How is measles diagnosed?


Your doctor will ask you about your symptoms and examine you. If your doctor suspects that you have measles, he or she may do a blood test and/or viral culture.

If you think you have measles, call your doctor so he or she can report the illness to the local health department.

Treatment for Measles


No specific antiviral treatment exists for measles virus.

Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.

All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This treatment restores low vitamin A levels during measles that occur even in well-nourished children and can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.

Prevention for Measles


Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for over 40 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a child against measles.

The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form.

In 2011, about 84% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose.

Vaccine for Measles


Measles vaccine (contained in MMR, MR and measles vaccines) can prevent this disease.
The MMR vaccine is a live, attenuated (weakened), combination vaccine that protects against the measles, mumps, and rubella viruses. It was first licensed in the combined form in 1971 and contains the safest and most effective forms of each vaccine.
It is made by taking the measles virus from the throat of an infected person and adapting it to grow in chick embryo cells in a laboratory. As the virus becomes better able to grow in the chick embryo cells, it becomes less able to grow in a child’s skin or lungs. When this vaccine virus is given to a child it replicates only a little before it is eliminated from the body. This replication causes the body to develop an immunity that, in 95% of children, lasts for a lifetime.

A second dose of the vaccine is recommended to protect those 5% who did not develop immunity in the first dose and to give "booster" effect to those who did develop an immune response.

You do NOT need the measles, mumps, rubella vaccine (MMR) if:


  • You had blood tests that show you are immune to measles, mumps, and rubella.
  • You are a man born before 1957.
  • You are a woman born before 1957 who is sure she is not having more children, has already had rubella vaccine, or has had a positive rubella test.
  • You already had two doses of MMR or one dose of MMR plus a second dose of measles vaccine.
  • You already had one dose of MMR and are not at high risk of measles exposure.

You SHOULD get the measles vaccine if you are not among the categories listed above, and


  • You are a college student, trade school student, or other student beyond high school.
  • You work in a hospital or other medical facility.
  • You travel internationally, or are a passenger on a cruise ship.
  • You are a woman of childbearing age.

What is the danger of getting measles while pregnant?


If you contract measles while you are pregnant, you may have a miscarriage, a stillbirth, or a preterm delivery. There appears to be no risk of having birth defects (unlike an infection with the rubella virus, known as German measles).

What should I do if I have been exposed to measles?


People who have been appropriately vaccinated (or who have had the disease) and who are exposed to a patient with measles do not need to do anything. If an unimmunized person is exposed to a patient with measles, they should receive the vaccine as soon as possible. This may prevent the disease if given within 72 hours of exposure. Immune globulin may have some benefit if given within six days of exposure. The CDC recommends that immune globulin be utilized for household contacts of infected people, immunocompromised people, and pregnant women. It is not recommended that immune globulin be utilized to control a measles outbreak.

How can I prevent contracting measles?


The only way to prevent measles is by receiving measles immunization: This is commonly given as a shot containing measles, mumps, and rubella vaccine (MMR) or a shot containing measles, mumps, rubella, and varicella vaccine (MMRV). The MMRV is not recommended for anyone older than 12 years of age. The current recommendation is that everyone receives two doses of the vaccine after 1 year of age. If the vaccine is received before 1 year of age, the person should receive two additional doses.

The measles vaccine is also available as a single vaccine; however, in most cases, there is no reason to utilize the measles vaccine alone without mumps and rubella vaccine.

Who should not receive measles vaccinations?


The following groups of people should not receive measles vaccinations:

  • People who have suffered a severe allergic reaction to either the measles vaccine or its components (gelatin or neomycin) should not receive the vaccine.
  • Women known to be pregnant should not receive the vaccine. Pregnancy should be avoided for four weeks after vaccination.
  • Severely immunocompromised patients (cancer patients or patients who are receiving large doses of corticosteroids) should not receive the vaccine. However, those leukemia patients who have been in remission for three months may receive the MMR.
  • Patients with severe human immunodeficiency virus (HIV) infections should not receive the vaccine. However, asymptomatic patients with HIV are considered to be safe for vaccination. The CDC has issued guidelines for vaccination based on the CD4+ T-lymphocyte counts.
  • People with a moderate to severe acute illness should wait until their illness resolves before receiving the vaccine.
Patients with history of thrombocytopenic purpura or thrombocytopenia (low platelets) may be at increased risk, and immunization should be decided on a case-by-case basis.

Who should be revaccinated against measles?


The following group of people should be considered unvaccinated and should receive at least one dose of vaccine:

  • People vaccinated before their first birthday should be revaccinated.
  • Anyone known to have been vaccinated with the killed measles vaccine (KMV) should be revaccinated.
  • Anyone vaccinated with KMV who received their dose of live measles vaccine with four months of their last dose of vaccine should be revaccinated.
  • Anyone vaccinated before 1968 in whom it is not known if the vaccine was KMV or not should be revaccinated.