VPMD: Measles
In the past few years, there has been a lot of media coverage surrounding the increase in incidence of measles’ cases throughout the U.S. Prior to this, measles was considered eliminated about 25 years ago, a milestone achieved about 37 years after the first vaccine was made available and about 11 years after the second dose was recommended. The recent resurgence in cases has been attributed to a decline in vaccination rates.
What is Measles?
Measles is an infectious disease caused by the Rubeola virus. The classic symptoms begin with fever, cough, conjunctivitis and runny/stuffy nose (coryza). This initial stage of the infection is said to occur for about 2-4 days before the development of the characteristic red flat/bumpy (morbilliform) rash that begins on the face and progresses downward to involve the torso and extremities. You may or may not also notice white spots inside the cheeks, called Koplik spots that are reported to transiently arise between the onset of fever and rash. Symptoms vary in those whom are immunocompromised. Measles is considered a highly contagious diseases which is spread primarily through respiratory droplets from the nose and mouth. The virus can remain active in the air for up to 2 hours.
How is it diagnosed?
Measles is confirmed by detection of viral genetic material via PCR from nasopharyngeal swabs/urine and/or presence of antibodies associated with acute infection (IgM) in the blood.
How is it treated?
There is no specific treatment for the measles virus. Management is focused on controlling symptoms and preventing complications. Vitamin A supplementation, has a role, as its deficiency has been tied to prolonged illness and complications including blindness.
What are the complications?
As is common with other viral illnesses: dehydration, diarrhea and secondary bacterial infections (pneumonia, ear infections) are common. More severe complications include inflammation of the brain (encephalitis), giant cell pneumonia, blindness and death. The time frame for developing these complications varies from about 1 week to 10 years. Risks for complications and severe disease varies but as with several infectious diseases, can be seen in young children, older adults and immunocompromised.
How is it prevented?
Vaccination for measles is given to children in the US usually at 12 months and 4 years old. It may be offered earlier if traveling to certain countries or when exposed to measles and are un/under vaccinated.
Measles antibodies are available for those exposed to measles and are not eligible for vaccination due to age or immune status.
When infected, isolation is paramount in controlling spread of virus along with disinfecting common surfaces and washing hands regularly.