Measles Overview

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Measles Overview

Contents 

Overview
 Signs & Symptoms
 Diagnosis
 Supportive Therapy
 Parental Education
 Guideline References

 

OVERVIEW

Measles, also known as rubeola, is a highly contagious viral disease characterized by fever, an enanthem, cough, coryza & a distinct exanthem

Etiology

  • Measles virus is a paramyxovirus, genus Morbillivirus
  • Transmission is through resp tract or conjunctivae following contact w/ droplet aerosols
  • Highly communicable from 4 days before the rash up to 4 days after its onset
  • Incubation period from exposure to prodrome averages 7-21 days

Signs & Symptoms 

Typical Measles

  • Prodrome begins w/ fever followed by conjunctivitis w/ photophobia, coryza, cough; cough usually lasts for 10 days
  • Koplik spots found on the inner aspects of the cheeks at the level of the premolars, may also spread in the labial mucosa, hard & soft palate & gingiva
    • Appear as punctate bluish white spots on an erythematous base
    • Pathognomonic for measles
  • Erythematous maculopapular rash initially appears around the forehead or posterior occipital area, spreads downward & outward
    • Begins at the peak of resp symptoms, about 2-3 days after emergence of Koplik spots
    • May become confluent on the face & upper trunk
    • Rash diminishes in the same progression as it appeared, followed by fine desquamation
  • Generalized lymphadenopathy esp prominent in the cervical & occipital areas
  • Gastrointestinal symptoms may occur eg diarrhea, loss of appetite, vomiting, abdominal pain

Atypical Measles

  • Occurs in patients who received inactivated or killed measles vaccine
  • Characterized by fever, pneumonia, pleural effusions & edema
  • Rash may be maculopapular, petechial, urticarial, purpuric or vesicular & it appears initially on the wrists or ankles

Black Measles or Severe Hemorrhagic Measles

  • High-grade fever
  • Seizures
  • Changes in mental status

Modified Measles

  • An attenuated form of measles that may occur in patients who were previously given immunoglobulin (Ig) as post exposure prophylaxis to measles
  • Signs & symptoms are milder than those of typical measles

Refer to Symptoms for more information

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TREATMENT

Supportive Therapy

  • Patients are provided w/ supportive therapy
    • Oxygen therapy
    • Hydration & nutrition
    • Antipyretics
    • Vitamin A

Parental Education

  • Parents are advised to
    • Isolate the child 4 days after the initial appearance of rashes
    • Immunize the child w/ measles vaccine
    • Give post-exposure prophylaxis to susceptible contacts of measles patients

Refer to Treatment for more information

Below is the overview of the disease management of MEASLES:

Measles1

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Version: 7 Aug  2015

Guideline References:
  1. Centers for Disease Control and Prevention. Measles (Rubeola). Centers for Disease Control and Prevention website. http://www.cdc.gov/measles/hcp/. May 2015. Accessed 06 Aug 2015.
  2. Centers for Disease Control and Prevention. Measles. In: Atkinson W, Hamborsky J, McIntyre L, et al, eds. Epidemiology and prevention of vaccine preventable disease. 10th ed. 2nd printing. Washington, DC: Public Health Foundation; 2008.
  3. Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years-United States, 2008. MMWR. 2007;56(51&52):Q1-Q4. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm
  4. Communicable Diseases Network Australia (CDNA). Measles: national guidelines for public health units. Australian Government Department of Health website. http://www.health.gov.au/internet/main/publishing.nsf/Content/BD2AD79FD34BFD14CA257BF0001D3C59/$File/Measles-SoNG-final-April2015.pdf. Feb 2015. Accessed 06 Aug 2015.
  5. Dyne P. Pediatrics, measles. eMedicine. http://www.emedicine.com/EMERG/topic389.htm. Dec 2007
  6. Fiebelkorn AP, Goodson JL. Measles (Rubeola). In: Centers for Disease Control and Prevention. Yellow book: Infectious diseases related to travel; 2013 Aug. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/measles-rubeola. Accessed 04 Dec 2013.
  7. Maldonado YE. Rubeola virus (measles and subacute sclerosing panencephalitis). In: Long SS, Pickering LK, Prober CG. Principles and practice of pediatric infectious diseases. 3rd ed. Philadelphia, PA: Elsevier; 2008.
  8. Marin M, Broder KR, Temte JL, Snider DE, Seward JF, Centers for Disease Control and Prevention (CDC). Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010 May;59(RR-3):1-12. http://www.cdc.gov/mmwr/pdf/rr/rr5903.pdf. PMID: 20448530
  9. Mason WH. Measles. In: Kliegman RM, Behrman RE, Jenson HB, et al, eds. Nelson textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders, Elsevier; 2007.
  10. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS; Centers for Disease Control and Prevention. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013 Jun;62(RR-04):1-34. http://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. Accessed 06 Aug 2015. PMID: 23760231