Understanding the causes of measles

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Last updated Mon 15 May 2017

By Christian Nordqvist

Reviewed by Karen Gill, MD

However, if measles enters an area where the people have never been exposed, the
result can be devastating.

Vaccination prevents many cases of measles around the world. The World Health
Organization (WHO) estimate that 2.6 million people who have not had the vaccine die of
measles every year.

Fast facts on measles

Here are some key points about measles. More detail is in the main article.

Measles is a highly infectious condition

Scientists have identified 21 strains of the measles virus
Symptoms of measles can include watery eyes, sneezing, and a dry hacking cough
There is no specific treatment for measles. Prevention is better than cure
Pregnant women should not take the vaccine

What is measles?
Measles is a viral disease that can spread rapidly.

Also known as rubeola or morbilli, measles is an endemic disease, meaning it is

continually present in a community, and many people develop resistance.

It is an unpleasant condition but one that normally passes without treatment within 7 to
10 days.

After a bout of measles, a person gains immunity for the rest of their life. They are very
unlikely to contract measles a second time.

Symptoms
Measles is often noticed through a breakout of spots.
The symptoms of measles always include fever and at least one of the three Cs:

cough
coryza, or runny nose
conjunctivitis

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Symptoms will appear about 9 to 11 days after initial infection.

Symptoms may include:

runny nose
dry hacking cough
conjunctivitis, or swollen eyelids and inflamed eyes
watery eyes
photophobia, or sensitivity to light
sneezing
a reddish-brown rash
Koplik's spots, or very small grayish-white spots with bluish-white centers in the
mouth, insides of cheeks, and throat
generalized body aches

There is often a fever. This can range from mild severe, up to 40.6 degrees Centigrade. It
can last several days, and it may fall and then rise again when the rash appears.

The reddish-brown rash appears around 3 to 4 days after initial symptoms. This can last
for over a week.

The rash usually starts behind the ears and spreads over the head and neck. After a
couple of days, it spreads to the rest of the body, including the legs. As the spots grow,
they often join together.

Most childhood rashes are not measles, but a child should see a doctor if:

a parent suspects the child may have measles

symptoms do not improve, or they get worse
the fever rises to above 38º Centigrade (ºC) or 100.4º Fahrenheit (ºF)
other symptoms resolve, but the fever persists

Complications
The measles vaccine is widely available and is said to have dropped global rates of measles
by over 75 percent.
Complications from measles are fairly common. Some can be serious.

People most at risk are patients with a weak immune system, such as those with HIV,
AIDS, leukemia, or a vitamin deficiency, very young children, and adults over the age of
20 years.

Older people are more likely to have complications than healthy children over the age of
5 years.

Complications can include:

diarrhea
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 vomiting
eye infection
respiratory tract infections, such as laryngitis and bronchitis
difficulty breathing
ear infections, which can lead to permanent hearing loss
febrile seizures

Patients with a weakened immune system who have measles are more susceptible to
bacterial pneumonia. This can be fatal if not treated.

The following less common complications are also possible:

Hepatitis: Liver complications can occur in adults and in children who are taking
some medications.
Encephalitis: This affects around 1 in every 1,000 patients with measles. It is an
inflammation of the brain that can sometimes be fatal. It may occur soon after
measles, or several years later.
Thrombocytopenia, or low platelet count, affects the blood's ability to clot. The
patient may bruise easily.
Squint: Eye nerves and eye muscles may be affected.

Complications that are very rare but possible include:

Neuritis, an infection of the optic nerve that can lead to vision loss
Heart complications
Subacute sclerosing panencephalitis (SSPE): A brain disease that can affect 2 in
every 100,000 people, months or years after measles infection. Convulsions, motor
abnormalities, cognitive issues, and death can occur.
Other nervous system complications include toxic encephalopathy, retrobulbar
neuritis, transverse myelitis, and ascending myelitis.

Pregnancy
Measles during pregnancy can lead to miscarriage, early delivery, or low birth weight. A
woman who is planning to become pregnant and has not been vaccinated should ask
her doctor for advice.

Types
There are two types of measles:

Measles: This is the standard form caused by the rubeola virus.

Rubella, or German measles: This is caused by the rubella virus.

Rubella generally presents as mild but presents more of a risk to unborn infants than
young children if a woman contracts the virus while she is pregnant.

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It is neither as infectious nor as severe as standard measles.

The measles, mumps, and rubella (MMR) vaccine contains immunizations for both types.

Causes
Measles is caused by infection with the rubeola virus. The virus lives in the mucus of the
nose and throat of an infected child or adult.

The disease is contagious for 4 days before the rash appears, and it continues to be
contagious for about 4 to 5 days after.

Infection spreads through:

physical contact with an infected person

being near infected people if they cough or sneeze
touching a surface that has infected droplets of mucus and then putting fingers
into the mouth, or rubbing the nose or eyes

The virus remains active on an object for 2 hours.

How does a measles infection develop?

As soon as the virus enters the body, it multiplies in the back of the throat, lungs, and the
lymphatic system. It later infects and replicates in the urinary tract, eyes, blood vessels,
and central nervous system.

The virus takes 1 to 3 weeks to establish itself, but symptoms appear between 9 and 11
days after initial infection.

Anyone who has never been infected or vaccinated is likely to become ill if they breathe
in infected droplets or are in close physical contact with an infected person.

Approximately 90 percent of people who are not immune will develop measles if they
share a house with an infected person.

Treatment
Measles gives people a fever.
There is no specific treatment. If there are no complications, the doctor will recommend
rest and plenty of fluids to prevent dehydration.

Symptoms usually go away within 7 to 10 days.

The following measures may help:

If the child's temperature is high, they should be kept cool, but not too cold. Tylenol
or ibuprofen can help control fever, aches, and pains. Children under 16 years
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 should not take aspirin. A doctor will advise about acetaminophen dosage, as too
much can harm the child, especially the liver. There is an excellent selection online
if you want to buy Tylenol or ibuprofen.
People should avoid smoking near the child.
Sunglasses, keeping the lights dim or the room darkened may enhance comfort
levels, as measles increases sensitivity to light.
If there is crustiness around the eyes, gently clean with a warm, damp cloth.
Cough medicines will not relieve a measles cough. Humidifiers or placing a bowl of
water in the room may help. If the child is over 12 months, a glass of warm water
with a teaspoon of lemon juice and two teaspoons of honey may help. Do not give
honey to infants.
A fever can lead to dehydration, so the child should drink plenty of fluids.
A child who is in the contagious stage should stay away from school and avoid
close contact with others, especially those who are not immunized or have never
had measles.
Those with a vitamin A deficiency and children under 2 years who have measles
may benefit from vitamin A supplements. These can help prevent complications,
but they should only be taken with a doctor's agreement. If you want to buy vitamin
A supplements, then there is an excellent selection online with thousands of
customer reviews.

Antibiotics will not help against the measles virus, but they may sometimes be prescribed
if an additional bacterial infection develops.

Diagnosis
A doctor can normally diagnose measles by looking at the signs and symptoms. A blood
test will confirm the presence of the rubeola virus.

In most countries, measles is a notifiable disease. The doctor has to notify the authorities
of any suspected cases. If the patient is a child, the doctor will also notify the school.

A child with measles should not return to school until at least 5 days after the rash
appears.

Prevention
People who have already had measles are normally immune and they are unlikely to get
it again.

People who are not immune should consider the measles vaccine.

Measles vaccination

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In the United States, the measles, mumps, and rubella (MMR) vaccine is routinely given
at 12 to 15 months of age, followed by a booster shot before entering school at the age
of 4 to 6 years.

Newborns carry their mother's immunity for a few months after birth if their mothers
are immune, but sometimes the vaccine is recommended before the age of 12 months,
and as early as 6 months.

This may happen if they are, or are likely to be, in an area where there is a serious
outbreak.

The WHO estimate that measles vaccination programs led to a 79 percent drop in
measles deaths globally, from 2000 to 2015, preventing around 20.3 million deaths.

Adults do not require a vaccine in the U.S. if they:

were born or lived in the U.S. before 1957 in the U.S.

received two MMR shots after they were 12 months old
had one MMR vaccine plus a second dose of measles vaccine
are found to be immune to measles, mumps, and rubella after a blood test

The vaccine should not be taken by:

women who are pregnant or plan to become pregnant soon

people with a serious allergy to gelatin or neomycin, an antibiotic

Anybody whose immune system may be compromised by a condition or treatment for a

condition should ask their doctor whether they should receive the vaccine.

There has been concern about an alleged link between the MMR vaccine a risk of autism,
but scientists have found no evidence of a link.

The CDC points out that during an outbreak of measles in the U.S. between 1989 and
1991, 90 percent of fatal cases were among those with no history of vaccination.

They say:

"The most important cause of the measles resurgence of 1989-1991 was low vaccination
coverage."

The CDC encourage people to have their children vaccinated, to prevent the spread of
measles and the risk of an outbreak.

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Article last updated by Adam Felman on Mon 15

May 2017.

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