• Measles

    (Rubeola)

    Definition

    Measles is a highly contagious viral infection. It causes fever, cough, and a rash. It was once a common childhood illness. Measles is now seen less often in the United States. This is due to the use of the measles vaccine. But, there have been outbreaks in recent years.
    Measles Rash
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    Causes

    The measles virus is spread by:
    • Direct contact with nasal or throat secretions of infected people
    • Airborne transmission (less frequently)
    Measles is communicable from:
    • 1-2 days before onset of symptoms
    • 3-5 days before the rash
    • 4 days after the appearance of the rash

    Risk Factors

    These factors increase your chance of developing measles:
    • Unvaccinated or inadequately vaccinated
    • Living in crowded and/or unsanitary conditions
    • Traveling to less developed countries where measles is common
    • Season: winter and spring
    • Immunosuppressed state (for example, untreated HIV), even if vaccinated
    • Born after 1956 and either:
      • You have never been diagnosed with measles.
      • You received a vaccine before 1968, and you have never been fully vaccinated since.
    Tell your doctor is you have any of the risk factors.

    Symptoms

    Symptoms, which usually occur 8-12 days following exposure, include:
    • Fever (often high)
    • Runny nose
    • Red eyes
    • Hacking cough
    • Sore throat
    • Exhaustion
    • Very small spots inside the mouth (2-4 days after initial symptoms)
    • Raised, itchy rash:
      • Starts around the ears, face, and side of neck 3-5 days after initial symptoms appear
      • Generally spreads to the arms, trunk, and legs over the next two days
      • Lasts about 4-6 days
    Full recovery, without scarring, generally takes 7-10 days from the onset of the rash.

    Diagnosis

    The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis is made from the symptoms and the rash. Lab tests are usually not needed.

    Treatment

    Measles are caused by a virus. Therefore, it cannot be treated with antibiotics. The focus is on relieving symptoms.

    Comfort Measures

    • Gargle with warm salt water to relieve sore throat. Using a humidifier may also help.
    • Treat high fever with non-aspirin medication. This includes acetaminophen. Cold sponge baths may also help.
      • Note: Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reyes syndrome. Ask your doctor which other medicines are safe for your child.
    • Get plenty of rest.
    • Drink plenty of liquids.
    • Eat a soft, bland diet.

    Complications

    In most cases, complications are rare. You may need to be hospitalized if you have a severe case. Complications may include:
    If you are diagnosed with measles, follow your doctor's instructions.
    If you are diagnosed with measles, follow your doctor's instructions.

    Prevention

    Getting vaccinated is the best way to prevent measles. The vaccine contains live viruses that can no longer cause disease. There is a single vaccine to prevent measles, and it is also available in combination with:
    The regular schedule for giving the vaccine is at age 12-15 months and again at age 4-6 years. If you or your child has never been vaccinated against the measles, talk to the doctor.
    In some cases, the MMR vaccine is given within three days after exposure. This can prevent or reduce symptoms. Immune globulin is given to certain unvaccinated people within six days of exposure. This is usually for infants and pregnant women.
    If you or someone in your family gets measles, family members may need to be vaccinated or given immune globulin.
    Ask your doctor if the vaccine is right for you. In general, avoid the vaccine if you:
    • Have had severe allergic reactions to vaccines or vaccine components
    • Are pregnant—Avoid pregnancy for 1-3 months after receiving the vaccine.
    • Have a weakened immune system
    • Have a high fever or severe upper respiratory tract infection
    If you are not vaccinated, avoid contact with someone who has measles. Recent outbreaks of measles have occurred in Europe and the United States. They may have been caused by increasing numbers of children who are not vaccinated. Discuss the benefits of vaccination with your doctor.

    RESOURCES

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

    National Foundation for Infectious Diseases http://www.nfid.org

    CANADIAN RESOURCES

    Caring for Kids http://www.caringforkids.cps.ca

    Public Health Agency of Canada http://www.phac-aspc.gc.ca

    References

    Bellini WJ, Rota JS, Lowe LE, et al. Subacute sclerosing panencephalitis: more cases of this fatal disease are prevented by measles immunization than was previously recognized. J Infect Dis. 2005 Nov 15;192(10):1686-93.

    Berkow R. The Merck Manual of Medical Information. 17th ed. New York, NY: Simon and Schuster, Inc; 2000.

    Glickman-Simon R. Measles vaccine. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated February 2008. Accessed July 22, 2008.

    Kassianos G. Vaccination for tomorrow: the need to improve immunization rates. J Fam Health Care. 2010;20(1):13-6.

    Measles (rubeola). Centers for Disease Control and Prevention website. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/measles-rubeola.htm. Updated July 1, 2011. Accessed February 16, 2012.

    Peter G, Gardner P. Standards for immunization practice for vaccines in children and adults. Infect Dis Clin North Am. 2001;15:9-19.

    Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Washington, DC: American Academy of Pediatrics; 2003.

    5/27/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Measles—United States, January—May 20, 2011. MMWR Morb Mortal Wkly Rep. 2011 May 20 early online.

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