Infectious Diseases A to Z – Measles (Rubeola)

With this new column, Elite Healthcare will compile an index of various infectious diseases, with occasional highlights of emerging conditions.

Measles (Rubeola)

General definition and information:

An extremely contagious and rare respiratory infection, measles was a common condition at one time in the United States before a vaccine was developed in the early 1970s and the disease was temporarily eradicated as of the year 2000. Characterized by a well-recognizable red rash that can cover most of the patient’s body (literally beginning from the hairline and moving down), measles is caused by the rubeola virus, which lives in the mucus of the nose and throat of the infected person and n the nasopharynx and lymph nodes. Although highly preventable by use of the vaccine, measles has recently become somewhat controversial in that some believe the vaccine can be linked to autism development,1 and outbreaks have occurred in recent years due in part to the unwillingness of some parents to vaccinate their children.1 Generally a mild condition for those who contract it, measles can cause serious complications and be fatal, especially among babies and children younger than 5 years of age.

Symptoms generally appear about 7-14 days after infection, often beginning with high fever (potentially higher than 104° Fahrenheit), cough, runny nose, and conjunctivitis. Within 2-3 days of symptom onset, tiny white spots, known as Koplik spots, may appear inside the mouth before the rash begins to develop and spread 3-5 days after symptoms begin. The rash usually begins as flat, red spots that appear on the face and spread downward to the neck, trunk, arms, legs, and feet.2

Common measles complications include ear infections and diarrhea. The ear infections can be severe enough to result in permanent hearing loss and other serious complications of the condition include pneumonia and encephalitis, the latter of which can be serious enough to lead to permanent intellectual damage. According to the Centers for Disease Control and Prevention (CDC), one or two children will die from measles for every 1,000 diagnosed, most commonly due to pneumonia. Measles can also be especially dangerous among pregnant women, potentially causing premature birth and/or low-birth-weight babies. Additional long-term complications include subacute sclerosing panencephalitis (SSPE) another extremely rare disease of the central nervous system that can result 7-10 years after initial infection and prove to be fatal, even if the patient seems to have previously fully recovered from the illness.

Causes & Modes of Transmission:

The disease is spread through the air by respiratory droplets (coughing or sneezing) by saliva (kissing or shared drinks), skin-to-skin contact (including handshakes and hugs), and/or by touching a contaminated surface (including blankets and doorknobs). A disease spread only by humans to humans, the measles virus can live for up to 2 hours in an airspace where an infected person coughed or sneezed, according to the CDC, which describes the contagious rate of the condition to the point that up to 90% of the people who come close to one infected person will acquire the condition if they are not immune to it. Those who are infected can spread the condition four days before through four days after the appearance of the rash.

A more common condition in countries outside of the U.S., measles is said to infect an estimated 10 million people globally per year, according to the CDC, and causes about 110,000 deaths. Most measles cases in the U.S. are a result of international travel,3 commonly brought into the country by those who are unvaccinated,3 though two of three of these unvaccinated travelers are Americans, according to the CDC.

Treatment Strategies: No specific antiviral treatment for measles exists. Those who have been exposed to the virus and have not been immunized, including infants, may still be given the vaccination within 72 hours of exposure to provide protection against the disease, according to the Mayo Clinic. If measles still develops among this population, the illness is typically milder symptoms and shorter lasting.

Pregnant women, infants, and people with weakened immune systems who are exposed to the virus may receive an injection of immune serum globulin that, when given within six days of exposure, can prevent the disease or make symptoms less severe.

Over-the-counter fever reducers may also be utilized to help relieve the fever that accompanies measles. However, officials warn against the use of aspirin with children or teenagers who have measles symptoms because of the link to Reye’s syndrome among such children.4

For those who develop pneumonia or an ear infection, along with measles, antibiotics may also be prescribed and prescribing vitamin A may lessen the severity of the measles, according to the Mayo Clinic. Vitamin A is generally given as a large dose of 200,000 international units for children younger than 1 year.4

Prevention Parameters:

Measles can be prevented with measles, mumps, rubella (MMR) vaccine. The CDC recommends that children receive two doses of MMR vaccine, starting with the first dose at 12-15 months of age and the second dose at 4-6 years of age. (Teens and adults should also be up to date on their MMR vaccination.) According to the CDC, two doses of MMR vaccine are about 97% effective at preventing measles while one dose is about 93% effective. Additionally, children who are ages 12 months-12 years may also get MMRV (measles, mumps, rubella, varicella [chickenpox] vaccine.

The CDC also offers a series of tips that healthcare providers are encouraged to share with parents and caregivers.5

Healthcare providers can also promote save traveling tips that can help protect people from measles, including (ideally) being fully vaccinated at least 2 weeks before departing.6 Those who travel internationally are also encouraged to monitor their health status closely for at least three after their return home.

References

  1. Darrah J. Measles outbreaks continue. Elite Learning. 2019. Accessed online:

www.elitecme.com/resource-center/nursing/measles-outbreaks-continue

  1. Measles (rubeola) signs and symptoms. CDC. 2018. Accessed online: www.cdc.gov/measles/about/signs-symptoms.html
  2. Measles (rubeola) plan for travel. CDC. 2019. Accessed online: www.cdc.gov/measles/travelers.html
  3. Measles. Mayo Clinic. 2018. Accessed online: www.mayoclinic.org/diseases-conditions/measles/diagnosis-treatment/drc-20374862
  4. Measles (rubeola) educational resources for parents and childcare providers. CDC. 2018. Accessed online: www.cdc.gov/measles/resources/parents-caregivers.html
  5. Measles (rubeola) plan for travel. CDC. 2019. Accessed online: www.cdc.gov/measles/travelers.html

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