Measles

Dr. Parang Mehta, MD.

Before the vaccine became available, this disease killed millions of children around the world every year.  Measles is a viral disease that lasts only a few days but leaves the surviving children weakened for months afterwards.  We do not yet have an effective drug against this viral disease.

Measles is a highly infectious disease, and is spread from person to person, through the air. The disease appears 1-2 weeks after exposure. Children with measles are infectious to others from the beginning of the illness to 3-4 days after the rash appears.

The Disease

The disease starts with fever, cough, and sticky eyes.   The fever can be very high.  The child has a sore mouth, making eating difficult.  Diarrhoea usually occurs, and can be severe.  The typical rash appears after 2-3 days of fever.

The rash is red, and flat to slightly raised.  It always appears first on the head and neck, and progresses down the body in orderly fashion, taking about two or three days to reach the feet.  It fades in the same sequence.  The fever is very high before the rash appears, and often drops abruptly after the rash has reached the feet.

Measles is a viral disease and we do not have a treatment for it.  The acute attack is treated with rest and fever medicines.  Since the appetite is reduced, a lot of liquids must be offered to the child at small intervals.  Cough syrups do not usually help much.

Subacute Sclerosing Panencephalitis (SSPE)

A delayed complication is Subacute Sclerosing Panencephalitis (SSPE), which affects the brain several years after the original measles attack.  Though a rare complication, it is much feared because of its incurable nature.  It is relentlessly progressive and invariably fatal.

SSPE usually first manifests itself as a deterioration in school performance. The child has changes in behaviour, becomes lethargic, and loses interest in activities. Frank seizures are uncommon, but most affected children go through a stage when they have myoclonic jerks affecting the whole body. As the disease progresses, these children become comatose, and may develop rigidity of the body. The course of the disease may be as short as a few months, to as long as ten years.

Complications of Measles

Measles is feared for its complications, both acute and long term.  Measles reduces the immunity of the child, and this effect persists for several weeks, allowing him to fall prey to various infections.  Among these infections, tuberculosis is important.

Pneumonia may be because of the measles virus itself, or because of a secondary bacterial infection.  It is the most common reason for death in children with measles.

Encephalitis occurs in 1-2/1,000 cases, and can be fatal. A quarter of survivors have residual neurologic deficits.

During the acute attack of measles or shortly after, the child may suffer pneumonia, encephalitis (inflammation of the brain), ear infection, and infections elsewhere. Diarrhea is one of the most common complications, and can be quite severe.

Otitis media (ear infection) also occurs frequently after measles.

Prevention of Measles

Measles can be prevented by the use of the measles vaccine.  It is now available as a combination with the mumps and rubella vaccines (MMR vaccine) or the MMR-V vaccine, which has varicella (chicken pox) as the fourth component.

See also: The Measles Vaccine

 

Last Revision: May 20, 2020.

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