Measles: Causes, Symptoms, and Prevention

Measles, also known as rubeola, is a highly contagious viral infection caused by the measles virus. Before the introduction of the measles vaccine, it was a common childhood illness that could lead to severe complications and death. Today, widespread vaccination has drastically reduced the number of measles cases worldwide, but outbreaks can still occur, particularly in areas with low vaccination coverage. Understanding the nature of the disease, its symptoms, and preventive measures is crucial to stopping its spread.

What Is Measles?

Measles is a respiratory disease caused by the measles virus, which belongs to the paramyxovirus family. It is primarily spread through respiratory droplets when an infected person coughs or sneezes. The virus can remain infectious in the air or on surfaces for up to two hours, making it highly contagious. In fact, measles is one of the most contagious diseases known—about 90% of non-immune individuals exposed to the virus will become infected.

Measles is not just a childhood disease; it can affect people of all ages, though it is more severe in young children, pregnant women, and people with weakened immune systems.

How Does Measles Spread?

Measles spreads through close contact with an infected person or by breathing in virus-laden droplets in the air. The disease is contagious from about four days before the rash appears to about four days after. Once contracted, the virus multiplies in the back of the throat and lungs, entering the bloodstream and spreading to the rest of the body.

Because the measles virus is airborne, it can easily infect people in densely populated or confined spaces, such as schools, hospitals, or daycare centers.

Symptoms of Measles

Measles symptoms generally appear about 7 to 14 days after exposure to the virus. The illness typically progresses through several stages, starting with early symptoms that resemble a cold or flu.

1. Early Symptoms (Prodromal Stage):
- High Fever: One of the first signs of measles, often rising to 104°F (40°C) or higher.
- Cough: A dry, persistent cough.
- Runny Nose: Nasal congestion and discharge.
- Red, Watery Eyes (Conjunctivitis): Inflammation of the eye membranes, making the eyes sensitive to light.
- Koplik Spots: Tiny white spots with bluish centers that appear inside the mouth, usually on the inner lining of the cheeks. These spots are a hallmark sign of measles and typically appear 2-3 days before the rash.

2. Rash Stage:
- Measles Rash: About 3 to 5 days after the onset of symptoms, a red, blotchy rash appears. It typically starts on the face, particularly around the hairline, and spreads downward to the neck, trunk, arms, legs, and feet. The rash is made up of flat, red spots, some of which may be slightly raised. As it spreads, the rash may merge into large patches.
- The rash lasts for about 5-7 days and then fades, sometimes leaving behind a brownish discoloration or peeling skin.

3. Recovery:
- The fever usually subsides as the rash begins to fade, and recovery follows. However, the body’s immune system can be weakened for weeks after a measles infection, increasing the risk of secondary infections.

Complications of Measles

Although measles is often mild, it can lead to serious complications, particularly in young children, adults over 20, pregnant women, and those with compromised immune systems. Some of the potential complications include:

1. Ear Infections: Common in young children, leading to temporary hearing loss.
2. Pneumonia: A severe lung infection is the leading cause of death in children with measles.
3. Encephalitis: Inflammation of the brain can occur, leading to convulsions, hearing loss, and, in severe cases, permanent brain damage.
4. Diarrhea and Dehydration: Measles can cause severe diarrhea, leading to dehydration, particularly in infants and young children.
5. Subacute Sclerosing Panencephalitis (SSPE): A rare but fatal condition that occurs years after a measles infection, affecting the central nervous system and leading to a gradual loss of motor skills and mental abilities.

Measles and Pregnancy

Measles during pregnancy can have serious consequences for both the mother and the baby. Pregnant women who contract measles are at a higher risk of complications such as pneumonia. The virus can also increase the risk of miscarriage, premature birth, or low birth weight in newborns.

Measles Vaccination and Prevention

The most effective way to prevent measles is through vaccination. The measles, mumps, and rubella (MMR) vaccine provides immunity against all three diseases. The vaccine is typically given in two doses:

- First Dose: Between 12-15 months of age.
- Second Dose: Between 4-6 years of age, or before starting school.

The MMR vaccine is highly effective, with one dose being about 93% effective at preventing measles and two doses about 97% effective. Vaccination has led to a dramatic decrease in measles cases and deaths worldwide.

For individuals who are not vaccinated, additional preventive measures include:

1. Herd Immunity: When a large portion of the population is vaccinated, it provides indirect protection to those who cannot be vaccinated, such as infants or people with certain medical conditions.
2. Isolation: If someone is diagnosed with measles, they should stay home and avoid contact with others to prevent the spread of the virus. Those exposed to measles who have not been vaccinated or had the disease should receive the MMR vaccine within 72 hours of exposure to prevent or reduce the severity of the illness.

Diagnosing Measles

A healthcare provider can usually diagnose measles based on the characteristic rash and other symptoms. The presence of Koplik spots inside the mouth can also help confirm the diagnosis. In some cases, a blood test or a throat swab may be used to detect the measles virus or antibodies in the blood.

Measles Treatment

There is no specific antiviral treatment for measles. Instead, treatment focuses on relieving symptoms and preventing complications. In most cases, the illness resolves on its own within 10-14 days, but supportive care can help make the patient more comfortable and prevent dehydration or secondary infections.

Common treatments for measles include:

- Fever Reducers: Acetaminophen (Tylenol) or ibuprofen can help reduce fever and relieve discomfort. Aspirin should not be given to children due to the risk of Reye’s syndrome.
- Hydration: Encourage fluids to prevent dehydration, especially if the child has a fever or diarrhea.
- Rest: Ensure the patient gets plenty of rest to help the body fight off the infection.
- Vitamin A: In some cases, especially in developing countries, vitamin A supplements are given to reduce the severity of measles and lower the risk of complications, as vitamin A deficiency can worsen outcomes.

When to Seek Medical Attention

Parents or caregivers should seek medical attention if the child or patient shows any of the following signs of severe measles complications:

- Difficulty breathing or shortness of breath.
- Persistent high fever or a fever that returns after initially improving.
- Lethargy or confusion.
- Convulsions or seizures.
- Severe diarrhea or vomiting, leading to dehydration.

Global Impact and Outbreaks

Despite the availability of an effective vaccine, measles remains a significant public health concern in many parts of the world, particularly in regions with low vaccination rates. Outbreaks can occur when communities have pockets of unvaccinated individuals, allowing the virus to spread quickly.

The World Health Organization (WHO) has made great strides in reducing measles deaths, especially through vaccination campaigns in low- and middle-income countries. However, recent vaccine hesitancy and misinformation have led to a resurgence of measles in some parts of the world, even in high-income countries.

Measles is a serious and highly contagious viral infection that can lead to life-threatening complications, especially in vulnerable populations. While it is preventable through vaccination, outbreaks still occur in areas where vaccine coverage is insufficient. The MMR vaccine remains the most effective way to prevent measles and protect public health. Ensuring widespread vaccination is key to eliminating measles and preventing future outbreaks.