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Measles

What are measles?

Measles is a highly infectious disease caused by a virus. Before measles immunization was widely available, it used to be a significant cause of childhood illness and death. Measles is often confused with other viral fevers accompanied with rash by the elders in the household. In North India it is generally referred to as “khasra”. All fevers accompanied by rash are not measles.
How is the disease spread?

Measles is transmitted from one infected person to another as a droplet infection. This means that when an infected person sneezes or coughs, the liquid droplets carry the virus which when inhaled by another person spreads infection. It takes 7 to 14 days from the time of contact with an infected person for the disease to appear. This is called the incubation period. A person is capable of infecting others from the onset of symptoms to about 4 days after the onset of rash. During this time, he may not be allowed to come in close contact with others, including going to school.
What are the symptoms?

Measles is characterised by sudden onset of high grade fever accompanied by cough, runny nose, watering of eyes and the appearance of a typical rash on the 3rd, 4th or 5th day of the fever, which typically gradually progresses from the upper body and face down to the feet. The fever normally subsides only when the rash has reached the feet on the 6th or 7th day of illness. Health professionals learn to recognise the illness by the presence of typical salt grain like spots on the inner side of the cheeks called “Koplik's spots”. These may, however, be absent in some cases.

The Doctor must be consulted immediately if one of the following occurs:
Rapid breathing with flaring of nostrils and persistent coughing
Refusal to eat or drink leading to reduction in urine output.
Severe ear pain or discharge from the ears.
Very high temperature or if the fever does not subside by the 7th day of illness
Severe hoarseness of voice
Delirium, fits and change in alertness.

What are the complications of measles?

Almost 20% of cases of measles especially in the underprivileged, low socio-economic and under-nourished group, have complications like:

Mouth ulcers

Pneumonia

Ear infection

Brain infection called encephalitis

Failure to thrive

Occasionally underlying tuberculosis may flare up after an attack of measles. Measles pneumonia may lead to collection of pus in the lungs (lung abscess) or in the chest cavity (empyema). Measles may also severely set back a child by several months in terms of growth and attainment of developmental milestones. The child may require a long time to nurse him back to health. If the child suffers from measles very early in life, then very rarely, he may develop a fatal degenerative brain disease called sub-acute sclerosing panencephalitis a few years later which has no cure.

What is the treatment?

The child is kept comfortable in a cool room, with comfortable loose cotton clothing. Fever is treated with acetaminophen or paracetamol, or ibuprofen. Aspirin is not prescribed in children. Fluids are encouraged so that hydration and urine output are maintained. Normally antibiotics are not given but complications such as chest infections, ear infections or throat infection (laryngitis) are treated with appropriate antibiotics. Vitamin supplements especially extra Vitamin A is usually given.

Can measles be prevented?

If a child has had measles once, he is protected for life against another attack. In those children who have not had measles, the disease can be prevented by a vaccine that is usually given to children at the age of 9 months and once again at 15th months as part of the MMR vaccine.