Measles: Symptoms, Causes, Diagnosis, Treatment & Risk Factors

What are Measles?

Measles also known as rubeola, which is a viral infection that begins in the respiratory system. An effective and safe vaccine is available for prevention from this infection, but this infection is still one of the significant causes of death throughout the world.

What are the symptoms of Measles?

The symptoms for Measles start appearing within 10- 12 days from getting exposed to the virus. The following symptoms are seen:

• Fever
• Cough
• Runny nose
• Sore throat
• White spots in the mouth

A skin rash all over the body is a classic sign of Measles.This skin rash can last  upto 7 days and appears within 14 days from the exposure to the virus. It commonly starts with the head and then slowly progresses towards other parts of the body.

What causes Measles?

The viral infection that leads to Measles is mainly caused by a virus from the paramyxovirus family morbilivirus. A virus is a tiny parasitic microbe, which uses cellular components of the host cell that it has invaded to complete its life cycle. The viral infection begins in the respiratory tract first and then spreads to the other parts of the body through blood.

How do Measles spread?

Measles can spread easily from one person to another through the air from respiratory droplets and small aerosol particles and is highly contagious.

• This virus releases into the air when an infected person coughs or sneezes.

• The respiratory droplets from this air can settle on objects and surfaces like a door handle or any contaminated object and a person can get infected when a contaminated object comes in contact.
• A person who is susceptible or has a weak immune system, and is exposed to the virus can easily get affected by the viral infection.
• A person who is infected with the virus is contagious for four days before and 4 to 5 days after the characteristic skin rash appears.
• The main risk for a person to get affected by Measles is being unvaccinated, especially young children, people with a weak immune system and pregnant women.

How is Measles diagnosed?

• A person suspected to get infected with Measles is examined for the characteristic skin rash and checked for symptoms such as white spots in the mouth, cough, fever and sore throat.
• If the symptoms are confirmed a blood test is ordered to check for Measles virus.

How is Measles treated?

A viral infection like Measles has no specific treatment  as viral infections are not sensitive to antibiotics.

• Measles can be managed with the help of medications as the virus and the symptoms usually disappear in 2 to 3 weeks.
• Measles can be prevented if the vaccine is taken within 72 hours of exposure to the virus.
• Immunoglobulin which is a dose of immune proteins is taken within six days of exposure.

Who is at risk?

Even though Measles are associated with childhood infections, adults who are not vaccinated are at a higher risk of getting affected.

• Adults over the age of 20 years can have severe complications same as seen in young children as this infection is more common in children. Complications like pneumonia,encephalitis and blindness are seen.
• If a person is unsure about the vaccination status, it is advised to visit the doctor and receive at least one dose of the vaccine .

Measles in babies:

• The vaccine for Measles is not administered to children until 12 months of age and a child is more vulnerable to getting infected with the Measles virus in this time period.
• A baby receives some protection from the virus as passive immunity, which is passed on from mother to the baby through placenta or while breastfeeding and can be lost after birth if breastfeeding is discontinued.
• Complications are more likely in children under 5 years of age and may include complications like pneumonia, encephalitis, ear infections that can lead to hearing loss.

How can Measles be prevented?

Taking a vaccination for Measles is the best preventive measure for Measles as two doses of the vaccine are effective against the viral infection to almost upto 97% prevention.

• Children can receive their first dose of the vaccine at 12 months and the second dose can be given between 4 to 6 years of age.

This vaccine is not recommended for people

• Who have a history of life threatening reaction to the vaccine for Measles
• Pregnant women
• Who are immunocompromised , including people suffering from HIV or AIDS, people taking immunosuppressants or people undergoing cancer treatment.

The side effects like fever and mild rash from this vaccine are mild and disappear in a few days and in rare cases low platelet count or seizures are seen.

Other preventive methods can be practised to prevent the spread of Measles. If a person is susceptible to Measles virus they should;

• Wash hands properly before and after any activity like eating , using the bathroom or before touching the face, eyes or nose.
• Should avoid sharing personal items with people who may be affected.

What measure should be taken when affected with Measles?

If a person is affected with Measles then he should:

• Stay indoors until he isn’t contagious. This is four days after he developed the rash for Measles.
• Should avoid coming in contact with people who may be vulnerable to infection, such as infants below 12 months of age or immunocompromised people.
• Keep the nose and mouth covered while coughing or sneezing.
• Wash hands frequently and properly and to sanitize every surface or object that is in regular contact.

What is the prognosis of the Measles?

The death rate for Measles is low in healthy children and adults and the people who get affected usually recover completely. The complications for Measles are at higher risk in the following groups:

• Children below 5 years of age
• Adults above 20 years of age
• Pregnant women
• Immunocompromised people
• People who are malnourished
• People having vitamin A deficiency

What are the complications from Measles?

About 30 % of the people affected from Measles may experience one or  more complications. This viral infection can lead to life threatening complications like pneumonia and encephalitis.

The other complications from Measles are:

• Ear infections
• Severe diarrhea
• Blindness
• Bronchitis
• Complications in pregnancy such as miscarriage

If an individual gets affected with Measles virus, then they develop immunity for the virus and don’t get affected more than once.

Measles and its severe complications can be prevented through vaccination at the right time.

Measles and COVID-19

Children are the most unknown and invisible victims of COVID-19 pandemic and a lot of them have missed their Measles and rubella vaccine, making a future Measles outbreak inevitable.

• The Measles virus is known as the most infectious virus, is unforgiving of immunity gaps and is certain to resurge after COVID-19 pandemic.
• There is an increase in Measles related deaths as there is increased malnutrition due to the shortage of food supplies for impoverished children in this pandemic along with a delay of vitamin A supplementation which is given during campaigns.
• The risk of Measles virus continues as there is a decrease in the immunization drives, which were done regularly for children to vaccinate them.
• The COVID-19 pandemic has grabbed the attention from the worst Measles scenario happening throughout the world.
• A follow up vaccination drive should be arranged so that all the children who have missed their vaccination can get vaccinated along with children who are vulnerable. 
• Complete infection control measures should be taken for people administering the vaccine. .
• The vaccine for COVID-19 should be monitored carefully and safely so as to maintain the confidence in such vaccines and to not stir up general vaccine hesitancy which can cause harm to the childhood immunization coverage.
• Everybody should be prepared for a Measles outbreak due to the present situation and should manage the crisis by adhering to prevention, preparedness, response and recovery actions.
• The tragic avalanche of deaths from Measles in 2018 and 2019 provides compelling evidence that the world cannot ‘mark time’ with Measles.

Conclusion

• Measles is the most infectious virus and is contagious.
• It is always advised to get vaccinated for Measles at the right time .
• This COVID-19 pandemic has led to an increase in the number of people being affected with Measles.

References:

• Measles, WebMD: https://www.webmd.com/children/vaccines/what-is-measles
• Measles, Healthline: https://www.healthline.com/health/Measles
• Nature medicine, Measles future: https://www.nature.com/articles/s41591-021-01237-5
• Measles, Science daily: https://www.sciencedaily.com/releases/2020/11/201116112632.htm

About Author –

Dr. N. Tushar Ram Rao, Consultant General Physician & Critical Care , Yashoda Hospitals – Secunderabad

M.B.B.S, M.D (General Medicine)