Measles 

Also called as Rubeola, Morbilli, Red measles, 9-day measles, 10 day measles, Khasra etc.

Measles is a highly contagious viral disease caused by the measles virus, which belongs to the genus Morbillivirus. It is one of the most wellknown childhood diseases, although it can affect individuals of all ages if they are not vaccinated or have not previously contracted the disease. Historically, measles has been a significant cause of illness and death worldwide, especially before the widespread availability of vaccines. Understanding measles is crucial for public health as it remains a serious concern in many parts of the world, particularly in regions with low vaccination rates.

 

Causes and Transmission

• Causative Agent: Measles is caused by the measles virus, an RNA virus that specifically targets the respiratory tract and immune system.
• Modes of Transmission: Measles spreads primarily through airborne respiratory droplets released when an infected person coughs, sneezes, or talks. It can also spread through direct contact with secretions from the nose or throat of an infected individual. The virus is highly contagious and can survive in the air or on surfaces for several hours.
• Infectious Period: A person infected with measles is contagious from about four days before the appearance of the rash to four days after the rash fades. This makes the disease challenging to contain, especially in crowded environments.

 

Symptoms and Stages

 Measles symptoms develop in stages, typically 10-14 days after exposure:

•  Early Symptoms:
• High fever, usually exceeding 104°F (40°C).
• Persistent cough.
• Runny nose.
• Red, watery eyes (conjunctivitis).

• Later Symptoms:
• Small white spots known as Koplik spots may appear inside the mouth, particularly on the inner lining of the cheeks.
• A characteristic red, blotchy rash begins on the face, typically at the hairline, and spreads downward to cover the body. The rash can last for several days before fading.

 

Koplik’s spots (arrows) seen on buccal mucosa in the early stages of clinical measles.

Typical measles rash

Stages of Measles Infection:

1. Incubation Period: The virus remains dormant, and no symptoms are present.
2. Prodromal Phase: Early symptoms like fever and cough emerge.
3. Rash Phase: The appearance of the rash marks this phase, which is often the most recognizable stage of measles.
4. Recovery: Symptoms gradually resolve, and the rash fades.

 

Diagnosis

Diagnosing measles typically involves a combination of clinical evaluation and laboratory tests:

• Clinical Diagnosis: 
• Healthcare providers often identify measles based on its characteristic symptoms, such as Koplik spots and the progression of the rash.
• Laboratory Tests:
• Serological tests to detect measles specific IgM antibodies in the blood confirm recent infection.
• Reverse transcriptase polymerase chain reaction (RTPCR) tests can identify the virus's genetic material for more precise diagnosis.

Complications

 

Measles can lead to a range of complications, some of which are life threatening:

• Common Complications:
• Ear infections, which can leading in hearing loss.
• Diarrhea, leading to dehydration.
• Severe Complications:
• Pneumonia, the most common cause of measles related deaths.
• Encephalitis, an inflammation of the brain that can result in seizures, brain damage, or death.
• Subacute sclerosing pan-encephalitis (SSPE), a rare but fatal degenerative neurological condition that develops years after measles infection.

At Risk Groups: Young children, pregnant women, and individuals with compromised immune systems are at higher risk of severe complications.

 

Prevention

Vaccination:

The MMR vaccine, which protects against measles, mumps, and rubella, is the most reliable method for preventing measles. It is usually given in two doses: the first dose is administered between 12 and 15 months of age, and the second dose is provided between 4 and 6 years of age. Vaccination is highly effective, with a single dose providing about 93% protection, and two doses increasing efficacy to about 97%.

Herd Immunity: Achieving high vaccination coverage in a population reduces the spread of the virus and protects those who cannot be vaccinated, such as infants or immunocompromised individuals.

Public Health Strategies: Efforts include routine immunization programs, outbreak response initiatives, and educational campaigns to address vaccine hesitancy and improve coverage rates.

 

Treatment

There is no specific antiviral treatment for measles. Care target on relieving symptoms and preventing complications:

Supportive Care:

• Ensuring adequate hydration.
• Managing fever with antipyretics like acetaminophen or ibuprofen.
• Vitamin A Supplementation: Providing high doses of vitamin A has been shown to reduce the severity of measles and prevent complications, especially in malnourished children.
• Management of Complications: Timely treatment of secondary infections, such as bacterial pneumonia, with antibiotics.

 

Epidemiology

• Global Prevalence: While measles incidence has declined significantly due to vaccination, outbreaks still occur, particularly in regions with low vaccine coverage.
• Impact of Vaccination Programs: Countries with robust immunization programs have dramatically reduced measles cases and deaths.
• Challenges: Factors such as vaccine misinformation, conflict, and logistical barriers in remote areas hinder elimination efforts.

Public Health Implications

• Importance of Vaccination: Immunization remains the cornerstone of measles prevention and control.
• Addressing Vaccine Hesitancy: Public health campaigns must combat misinformation and emphasize the safety and efficacy of vaccines.
• Role of International Organizations: Groups like the World Health Organization (WHO) and UNICEF play critical roles in coordinating global measles eradication efforts and supporting vaccination campaigns in underserved regions.

Difference between measles and German measles (rubella):

Aspect	Measles	German Measles (Rubella)
Causative Agent	Measles virus (Paramyxoviridae family)	Rubella virus (Togaviridae family)
Common Name	Measles	German measles
Severity	Generally more severe	Usually milder
Incubation Period	7–14 days	14–21 days
Mode of Transmission	Respiratory droplets or direct contact	Respiratory droplets or close contact
Key Symptoms	High fever (104°F or higher) Red, blotchy rash (starts on face, spreads) Cough, runny nose, conjunctivitis Koplik spots (white spots inside mouth)	Mild fever (low-grade) Fine pink rash (starts on face, spreads) Swollen lymph nodes (behind ears, neck) Joint pain (in adults)
Complications	Pneumonia, encephalitis, death Ear infections	Congenital rubella syndrome (CRS) in pregnancy Rarely encephalitis or thrombocytopenia
Risk Groups	Unvaccinated children and adults Malnourished individuals	Pregnant women and unborn babies
Vaccine	MMR vaccine (measles, mumps, rubella)	MMR vaccine
Contagious Period	4 days before and after rash onset	1 week before and after rash onset
Global Impact	Causes high mortality in outbreaks	Mild but can lead to severe birth defects in CRS
Eradication Status	Not yet eradicated globally	Near eradication in some regions with vaccination

 

Conclusion

Measles is a preventable but highly contagious disease with significant implications for public health. Despite progress, it continues to pose a threat in areas with low vaccination coverage. By ensuring widespread access to vaccines, addressing misinformation, and strengthening public health systems, the global community can move closer to eliminating measles. Investing in prevention and education today will save lives and reduce the burden of this disease in the future.

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• German measles

Multiple-Choice Questions

1. What is the primary difference between measles and German measles (rubella)?

   • A. Measles is caused by a virus, while rubella is caused by bacteria.
   • B. Measles is more severe and causes higher fever, while rubella is milder.
   • C. Rubella causes Koplik spots, while measles does not.
   • D. Measles and rubella have identical symptoms and severity.

2. Which of the following is a complication specifically associated with German measles (rubella) during pregnancy?

   • A. Encephalitis
   • B. Pneumonia
   • C. Congenital rubella syndrome (CRS)
   • D. Ear infections

3. What is the common vaccine used to prevent both measles and German measles?

   • A. DTP vaccine
   • B. BCG vaccine
   • C. MMR vaccine
   • D. Hepatitis B vaccine