Measles, a highly contagious viral infection, continues to be a significant global health concern. Despite the availability of an effective vaccine, outbreaks still occur worldwide, posing a serious threat to unvaccinated individuals, particularly children. The disease has an impact on millions of lives each year, causing a range of symptoms from mild discomfort to severe complications.
This article aims to provide essential information about measles to increase awareness and understanding. It will cover the nature of the disease, its symptoms and diagnosis, treatment options and potential complications, as well as prevention strategies and the importance of vaccination. By exploring these key aspects, readers will gain valuable insights to protect themselves and their communities from this preventable yet potentially dangerous illness.
What is Measles?
Measles is a highly contagious viral disease caused by the measles virus, a member of the Paramyxoviridae family and the morbillivirus genus. The virus contains approximately 15,894 nucleotides, encoding eight viral proteins within six genes. It spreads easily through contact with infected nasal or throat secretions, such as when an infected person breathes, coughs, or sneezes.
Virus and transmission
The measles virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days before to four days after the appearance of the rash. The virus has an incubation period that varies from 7 to 18 days from exposure to the onset of fever, and about 14 days until the rash appears.
Global impact
Despite the availability of a safe and effective vaccine, measles remains a significant cause of death among young children globally. In 2022, there were an estimated 136,000 measles deaths, mostly among children under the age of five. The overwhelming majority of measles deaths occur in countries with low per capita incomes and weak health infrastructures.
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Vaccination efforts
Vaccination has prevented an estimated 57 million deaths between 2000 and 2022. However, measles is still common in many developing countries, particularly in parts of Africa and Asia. Member States in all WHO Regions have adopted measles elimination goals, with WHO being the lead technical agency responsible for coordination of immunization and surveillance activities supporting all countries to achieve these goals.
Symptoms and Diagnosis
The initial symptoms of measles typically appear 7 to 14 days after exposure to the virus. These early signs include high fever (which may spike to more than 104°F), cough, runny nose (coryza), red and watery eyes (conjunctivitis), and sore throat. As the disease progresses, tiny white spots with bluish-white centers on a red background, known as Koplik’s spots, may develop inside the mouth.
Rash Development
Around 3 to 5 days after the initial symptoms begin, a characteristic measles rash appears. The rash starts as flat red spots on the face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, the fever may spike to more than 104°F.
Koplik’s Spots
Koplik’s spots are considered a diagnostic feature of measles in the pre-eruptive stage. They appear as bluish-white spots, slightly raised with a diameter of approximately 2 to 3 mm on an erythematous base on the buccal mucosa opposite the first molar. This characteristic appearance is sometimes referred to as “grains of salt on a red background.” Koplik’s spots usually appear one day before the onset of the rash and persist for 2 or 3 days.
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Diagnostic Tests
To diagnose an active measles infection, healthcare providers may use the following tests:
- IgM antibody test: This blood test looks for IgM antibodies, which are proteins produced by the immune system when the measles virus is present in the body.
- Molecular tests: These tests, such as RT-PCR (real-time reverse transcription-polymerase chain reaction), detect the presence of the measles virus in samples of blood, fluid from the nose or throat, or urine. Molecular tests have the greatest diagnostic sensitivity when specimens are collected at the first contact with a suspected case.
In addition to these tests, healthcare providers will perform a thorough physical examination and assess the patient’s symptoms to make an accurate diagnosis of measles. Early detection is crucial for controlling the outbreak of this highly infectious disease.
Treatment and Complications
Treatment for measles primarily focuses on providing supportive care to relieve symptoms and address complications. There is no specific antiviral therapy for measles. Patients with severe complications, such as bacterial superinfections, pneumonia, or dehydration, may require hospitalization. Antibiotics are used to treat secondary bacterial infections like otitis media or pneumonia. Severe measles cases among children, especially those who are hospitalized, should receive vitamin A supplementation. The recommended age-specific daily doses are 50,000 IU for infants younger than 6 months, 100,000 IU for infants 6-11 months, and 200,000 IU for children 12 months and older. Children with clinical signs of vitamin A deficiency should receive a third age-specific dose 2-4 weeks later.
Potential complications of measles include:
- Middle ear infection (otitis media) that may lead to hearing loss
- Pneumonia
- Laryngotracheobronchitis (croup)
- Diarrhea
- Encephalitis, which can cause permanent brain damage
Approximately 1 in 1,000 measles cases develops acute encephalitis, and 1 to 3 out of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.
Certain groups are at higher risk for severe complications from measles:
- Infants and children under 5 years of age
- Adults over 20 years old
- Pregnant individuals
- People with weakened immune systems, such as those with leukemia or HIV infection
Complications are most common in children under 5 and adults over 30. They are more likely in children who are malnourished, especially those with insufficient vitamin A, or those with weakened immune systems.
Prevention and Vaccination
The most effective way to prevent measles is through vaccination with the measles, mumps, and rubella (MMR) vaccine. The MMR vaccine is a safe and highly effective vaccine that provides protection against these three viral diseases. Two MMR vaccines, M-M-R II are available for use in the United States and are fully interchangeable for all indications for which MMR vaccination is recommended.
MMR Vaccine
The MMR vaccine is a live attenuated vaccine, meaning it contains weakened versions of the measles, mumps, and rubella viruses. When administered, the vaccine stimulates the immune system to produce antibodies against these viruses, providing long-lasting protection. The vaccine is typically given as a series of two doses, with the first dose administered between 12 and 15 months of age and the second dose between 4 and 6 years of age.
Vaccination Schedule
The Centers for Disease Control and Prevention (CDC) recommends the following vaccination schedule for the MMR vaccine:
- Children should receive two doses of MMR vaccine, with the first dose given between 12 and 15 months of age and the second dose between 4 and 6 years of age.
- Teenagers and adults who have not been vaccinated or have no evidence of immunity should receive at least one dose of MMR vaccine.
- Healthcare personnel, international travelers, and students at post-high school educational institutions should ensure they have received two doses of MMR vaccine, separated by at least 28 days.
It is important to follow the recommended vaccination schedule to ensure optimal protection against measles, mumps, and rubella.
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Herd Immunity
Herd immunity, also known as community immunity, occurs when a significant portion of a population is immune to an infectious disease, making the spread of the disease from person to person unlikely. As a result, even individuals who are not vaccinated or cannot be vaccinated due to medical reasons are indirectly protected because the disease has little opportunity to spread within the community.
To achieve herd immunity against measles, a high percentage of the population, typically around 95%, needs to be vaccinated. This high threshold is necessary because measles is highly contagious. When vaccination rates drop below this level, outbreaks can occur, as the virus can spread more easily among unvaccinated individuals.
Maintaining high vaccination rates is crucial for protecting public health and preventing the resurgence of measles. Vaccination not only protects the individual but also contributes to the overall health and well-being of the community by reducing the spread of the disease.
Conclusion
Measles continues to have a significant impact on global health, particularly affecting young children in regions with limited healthcare resources. The disease’s highly contagious nature and potential for serious complications underscore the importance of widespread vaccination efforts. By understanding the virus, its symptoms, and available preventive measures, individuals and communities can play a crucial role to protect themselves and others from this preventable illness.
The MMR vaccine stands as a cornerstone to prevent measles outbreaks and safeguard public health. Its effectiveness in creating herd immunity highlights the need for maintaining high vaccination rates across populations. As we move forward, ongoing education about measles and the benefits of vaccination remains essential to combat misinformation and ensure the continued success of global efforts to eliminate this disease. Ultimately, the fight against measles serves as a reminder of the power of preventive healthcare and collective action to improve public health worldwide.