MEASLES

DEFINITION

Measles is a viral infection (an infection caused by a virus). Its most characteristic feature is a reddish skin rash. Measles is also known as rubeola, five-day measles, or hard measles.

DESCRIPTION

Measles infections occur throughout the world. At one time, they reappeared in two- or three-year cycles, usually in the winter and spring. Today, there is a very effective measles vaccine. This vaccine has greatly reduced the occurrence of measles in many parts of the world.

Babies up to the age of eight months usually do not get measles. They receive special cells from their mothers that protect them against the disease. A person who has had measles will never get the disease again.

CAUSES

Measles is a very contagious disease. That is, it can be transmitted from one person to another very easily. The usual method of transmission is through coughing or sneezing. The virus that causes measles is contained in tiny droplets of moisture released when an infected person coughs or sneezes. A person who inhales those droplets will almost certainly develop measles.

The incubation period for measles is seven to eighteen days. The incubation period is the time between the moment the virus enters a person's body and the appearance of symptoms. A person is contagious (capable of passing on the infection) from three to five days before symptoms appear to about four days after the rash shows up.

SYMPTOMS

The first signs of measles are a fever, runny nose, red and runny eyes, and a cough. A few days later, a rash appears in the mouth. The rash consists of tiny white dots on a reddish bump. This rash is called Koplik's spots. They are important in diagnosing measles because they do not occur with other diseases. Koplik's spots are accompanied by a red, sore, swollen throat.

About two days after Koplik's spots appear, the measles rash begins. It first shows up on the head, face, and neck. It then travels to the abdomen and, finally, to the arms and legs. At first, the rash consists of flat, red patches. Eventually, bumps appear. The rash may or may not be itchy. As the rash develops, the patient's temperature begins to rise and may so as high as 105°F (40.5°C). Other symptoms include nausea, vomiting, diarrhea, and swollen lymph nodes. The patient usually feels very ill.

The rash normally lasts about five days. As it fades, it becomes more brownish in color. The affected skin becomes dry and flaky.

A bout of measles leads to other infections in 5 percent to 15 percent of patients. Some of these infections are caused by bacteria. These include ear infections, sinus infections, and pneumonia (see pneumonia entry). Other infections are caused by viruses. Some common viral infections are croup, bronchitis (see bronchitis entry), laryngitis (see laryngitis entry), and viral pneumonia. Inflammation of the liver, appendix, intestines, and lymph nodes are other problems that may develop as a result of a measles infection. Less common complications include inflammation of the heart or kidney, loss of blood platelets (the blood cells that help blood clot; pronounced PLATE-lits), and recurrence of old tuberculosis (see tuberculosis entry) infections.

Probably the most serious complication of a measles infection is encephalitis (see encephalitis entry). Encephalitis is a brain infection that results in a very high fever and swelling of the brain. Symptoms of encephalitis include fever, headaches, sleepiness, seizures, and coma. People with encephalitis may suffer serious, long-term brain damage. Encephalitis occurs in about 1 out of every 1,000 cases of measles. About 10 percent to 15 percent of those who develop the disease die from it.

A very rare complication of measles is called subacute sclerosing panencephalitis. This disease can occur up to ten years after infection by the measles virus. It develops slowly over a period of years and causes massive destruction of the brain. It eventually results in death.

DIAGNOSIS

Measles is fairly easy to diagnose because of its characteristic symptoms. The presence of Koplik's spots is often the most important clue. The appearance of a rash that travels from the head and neck out to the arms and legs is also an important indicator of a measles infection.

In case of doubt, a variety of laboratory tests can be performed. These tests are used to identify the presence of the measles virus in body fluids, such as urine and mucus.

The measles rash starts on the head, face, and neck, and eventually spreads to the abdomen, arms, and legs. The rash may or may not be itchy. (Reproduced by

Custom Medical Stock Photo

)

TREATMENT

There is no treatment that can kill the measles virus or stop the course of the disease. Treatments instead are used to make a patient feel more comfortable during the disease. For example, acetaminophen (pronounced uh-see-tuh-MIN-uhfuhn, trade name Tylenol) can relieve pain and fever. Aspirin, however, should never be given to children who have measles. Aspirin has been found to cause Reye's syndrome (see Reye's syndrome entry), a potentially fatal disease.

A cool-mist vaporizer may help relieve the cough that comes with measles. Patients should also drink lots of liquids. The patient should be watched carefully to make sure that complications do not appear. If they do, antibiotics may be used to treat bacterial infections.

Alternative Treatment

Some practitioners believe that certain herbs can strengthen the body's immune system. Purple coneflower (echinacea; pronounced ek-i-NAY-see-uh) is one such herb. Homeopathic support can also be effective in helping a person feel more comfortable during a measles infection.

Some of the symptoms of measles can be relieved by using various herbs, such as bupleurum, peppermint, witch hazel, chickweed, or eyebright (for sore eyes). A preparation made from empty cicada shells has also been recommended.

PROGNOSIS

The prognosis for a child who is otherwise in good health is usually very good. In developing countries, however, death rates from measles can reach 15 percent to 25 percent. The prognosis for adolescents and adults is less favorable. Women who contract the disease while pregnant may give birth to a baby with hearing problems.

The most serious consequence of a measles infection is encephalitis. One in 1,000 measles patients will develop encephalitis. Of this number, about 10 percent to 15 percent will die; 25 percent will suffer permanent brain damage.

PREVENTION

A highly effective vaccine is now available to prevent measles. The vaccine is usually given at about fifteen months of age. A repeat injection should be given at about ten or eleven years of age.

Measles virion seen through a microscope. (Reproduced by permission of

Custom Medical Stock Photo

)

FOR MORE INFORMATION

Books

Silverstein, Alvin, Virginia Silverstein, and Robert Silverstein. Measles and Rubella. Hillside, NJ: Enslow Publishers, Inc., 1997.

Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley & Sons, 1995.

Periodicals

Ramsey, Alison. "Childhood Diseases Are Back." Reader's Digest (February 1996): pp. 73+.

Organizations

Centers for Disease Control and Prevention. http://www.cdc.gov.