Measles

Introduction 

Measles is an acute, highly infectious disease characterized by fever, respiratory symptoms, Koplik spots and a maculopapular rash. 

-Measles virus is a highly contagious, spherical, single-stranded, enveloped RNA virus that is a member of the Paramyxoviridae family.

-The virus gains access to the human body via the respiratory tract and is transmitted primarily by respiratory droplets

-Measles is endemic throughout the world.

Symptoms & Signs 

Incubation period: The incubation period for measles is 10 days to fever onset and 14 days to rash onset. 

Prodromal Phase: Cough, Coryza, Conjunctivitis, high-grade fever. Coryza consists of nasal obstruction, sneezing, and sore throat resembling upper respiratory infections. 

Koplik spots

-Pathognomonic of measles

-typically occur 2 days before the rash and only last 12 to 72 hours. 

-they appear as small, irregular and red with whitish center on the palatal or buccal mucosa opposite the molars or on vaginal membranes – ‘grains of sand’ or ‘table salt crystals’ 

Rash: Maculopapular rash progressing in  “downward and outward” fashion; appears 3 – 4 days after onset of prodrome, begins on the face and behind the ears; then spreads to the trunk and extremities, including the palms and soles

-Patients are contagious during the prodromal phase (2–4 days) and the first 2–5 days of rash In the hospital setting, patients with measles should be placed under air-borne precautions.

Diagnosis 

-Diagnosis is made based on clinical features 

-Labs: Leukopenia, thrombocytopenia, proteinuria  

-A positive serum immunoglobulin (Ig) M antibody for measles confirms the diagnosis. Treatment 

-Antipyretics, fluid resuscitation 

-Vitamin A treatment to reduce morbidity and mortality 

-Limited use of antivirals like ribavirin 

-Serious complications include otitis media, encephalitis, pneumonia, and bleeding disorders. 

Infection confers lifelong immunity.

Prevention

Vaccination 

Two doses of vaccine are estimated to be 97% protective. 

Children: Measles, mumps, and rubella vaccinations should be given as MMR or MMRV at 12–15 months and again at 4–6 years of age. 

Adults: Adults born in 1957 or later should have at least one dose of MMR vaccine 

Contraindications: Vaccine contraindicated in pregnant women, women intending to become pregnant within the next 28 days, immunocompromised persons, and persons with an anaphylactic reaction to a prior dose or vaccine components like neomycin, gelatin, and in children receiving high-dose corticosteroid therapy 

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