The Children’s Emergency Room (CHER) was a house of commotion in my training days in the Medical School in the early 1980s. Measles was in town and was reigning practically unchallenged. Babies at different disease stages of measles were in attendance. George Orwell told us that all animals are equal but some are more equal than others. He wasn’t wrong at all. Some measles are more ‘measle’ than others! You needed to witness the suffering to make you make a determination to prevent another child from having measles. That is not to say that measles do not affect adults.
Measles is a childhood infection caused by a virus. Once quite common, measles can now almost always be prevented with a vaccine.
Measles also called rubeola spreads easily and can be serious and even fatal for small children.
CAUSES
Measles is a highly contagious and serious disease caused by a virus. It is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus infects the respiratory tract, then spreads throughout the body. Measles is a human disease and is not known to occur in animals. The virus remains active and contagious in the air or on infected surfaces for up to 2 hours. It can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts.
Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children.
WHO IS AT RISK??
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. WHO has recently reported that nearly 40 million children worldwide have missed their measles vaccine dose especially due to the Covid-19 pandemic. This decline has caused a setback to the global progress in eradicating measles.
The paradox of the pandemic is that while vaccines against COVID-19 were developed in record time and deployed in the largest vaccination campaign in history, routine immunization programmes were badly disrupted, and millions of kids missed out on life-saving vaccinations against deadly diseases like measles.
SIGNS AND SYMPTOMS
The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts 4 to 7 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 3 days, the rash spreads, eventually reaching the hands and feet. The rash lasts for 5 to 6 days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of 7 to 18 days).
The infection occurs in stages over 2 to 3 weeks.
- Infection and incubation: There are no signs or symptoms of measles during this time -usually in the first 10-14 days of contact with the virus.
- Nonspecific signs and symptoms: Characterized by relatively mild illness and may last 2 to 3 days. Typically begins with a mild to moderate fever, often with a persistent cough, a runny nose, inflamed eyes (conjunctivitis) and a sore throat.
- Acute illness and rash: The rashes are small red spots, some of which are slightly raised. These are bumps and spots in packed clusters giving the skin a blotchy red appearance. The rashes first show up on the face.
- In the subsequent few days, the rash spreads down the upper limbs, trunk and sequentially down to the feet. Concurrently, the fever rises sharply, often as high (40 C to 41 C).
- Recovery: The rash gradually fades first from the face and last from the thighs and feet. The rash usually last about 7 days. 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.
There are numerous complications that can occur if proper care is not taken. Such complications are:
- Diarrhea and vomiting
- Ear infection
- Bronchitis or laryngitis
- Pneumonia
- Tiny bleeds in the mucous membranes may cause blood in stool or urine.
- Pregnancy problems in the case of an infected pregnant woman.
Erythema multiforme:
Measles erythema multiforme was first described in the medical literature in 1887. The condition is thought to be caused by an immune reaction to the measles virus. Measles erythema multiforme is most commonly seen in children, but can occur in adults as well.
There is no specific treatment for measles erythema multiforme. The condition typically resolves on its own within 2-3 weeks. Treatment is typically focused on relieving symptoms. Topical steroids and antihistamines may be used to relieve itching. In some cases, oral steroids may be necessary.
Before the introduction of the measles vaccine in 1963 and widespread vaccination, more than 140 000 people died from measles in 2018 – mostly children under the age of 5 years, despite the availability of a safe and effective vaccine
TREATMENT
There is no specific antiviral treatment for measles.
Supportive treatment are deployed for specific clinical situations and complications that emerge. Intravenous fluids, where oral fluids appear inappropriate, are used to manage dehydration form diarrhea. Antibiotics are used to combat bacterial super-infection. Two doses of Vitamin A supplements are given 24 hours apart, to prevent blindness and even reduce mortality.
PREVENTION
Vaccines are usually given to children within 12 and 15 months of age (as part of MMR, a vaccine that protects against measles, mumps, and Rubella)
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. Then at age 9 months are expected to take measles vaccine.
Measles outbreaks show weakness in the immunization program and other health care services. The United States of America had measles epidemics in the recent past on account of discontinued measles immunization and loss of herd immunity. Severe outbreaks are uncommon in jurisdictions that continue to run proper immunization schedules.
You may read my earlier blogs on Cholera, Typhoid Fever, Climate Change, Malaria, Genital Herpes, Head Lice, Scabies, Telemedicine, Success Mindset, Conjuctivitis, Ebola Virus Disease
We encourage community protection and personalized care.
