What is measles (rubeola)?

From the Guidelines

Measles (rubeola) is a highly contagious viral disease characterized by fever, cough, runny nose, red eyes, and a distinctive rash that spreads from the face to the rest of the body, caused by the rubeola virus, a paramyxovirus of the genus Morbillivirus.

Key Characteristics of Measles

• The disease is known to be spread through droplet transmission from the nose, throat, and mouth of infected persons if they cough or sneeze 1.
• Among unimmunized people exposed to the virus, over 90% will have the disease 1.
• Measles can be accompanied by pneumonia, blindness, brain damage, and even death, with a high case-fatality rate, especially in developing countries 1.

Prevention and Treatment

• Vaccination is the most effective prevention method, with the MMR (measles, mumps, rubella) vaccine recommended for children at 12-15 months and again at 4-6 years of age 1.
• For those exposed to measles without immunity, post-exposure prophylaxis with the MMR vaccine within 72 hours or immunoglobulin within 6 days may prevent or reduce severity of infection.
• Treatment is primarily supportive, including rest, fluids, acetaminophen or ibuprofen for fever (avoiding aspirin in children), and vitamin A supplementation in severe cases (50,000-200,000 IU depending on age) 1.

Complications and Transmission

• Complications can include ear infections, pneumonia, and encephalitis, with higher risk in young children, pregnant women, and immunocompromised individuals 1.
• Measles is transmitted through respiratory droplets and remains contagious from four days before to four days after the rash appears, making community vaccination crucial for herd immunity 1. Some of the key points to consider when dealing with measles include:
• The virus's high infectivity (one person can infect 12-18 others) 1.
• The importance of isolation during the contagious period to prevent spread.
• The need for community vaccination to achieve herd immunity and prevent outbreaks.

From the Research

Definition and Characteristics of Measles

• Measles, also known as rubeola, is a highly contagious illness that classically presents with a rash, fever, cough, coryza, and conjunctivitis 2.
• It is a highly contagious human pathogen, member of the genus Morbillivirus in the family Paramyxoviridae 3.
• Measles is an acute febrile illness, potentially fatal and highly contagious, which is transmitted through the respiratory mode 4.
• Symptoms include fever, maculopapular rash, and at least one of cough, coryza, or conjunctivitis, although vaccinated individuals can have milder or even no symptoms 5.

Transmission and Epidemiology

• Cases in the United States since 2000 have been attributed mainly to travelers who are infected abroad and then spread the illness to small, susceptible populations within the United States 2.
• Measles outbreaks have occurred because of insufficient vaccination coverage 3.
• The disease is still endemic in many countries and causes considerable morbidity and mortality, especially among children in resource-poor settings 5.

Clinical Presentation and Complications

• Clinical suspicion should be confirmed with laboratory testing, which is most commonly a serum immunoglobulin M 2.
• Complications from measles are relatively common and can be associated with significant morbidity and mortality 2.
• Complications can affect many organs and often include otitis media, laryngotracheobronchitis, pneumonia, stomatitis, and diarrhoea 5.
• Neurological complications are uncommon but serious, and can occur during or soon after the acute disease or months or even years later 5.

Management and Prevention

• The management of measles is mainly supportive, and may include the measles vaccine, intravenous immunoglobulin, vitamin A, and even ribavirin 2.
• Patient management mainly involves supportive therapy, such as vitamin A supplementation, monitoring for and treatment of secondary bacterial infections with antibiotics, and rehydration in the case of severe diarrhoea 5.
• Prevention through measles vaccination has a cardinal role for measles' elimination, and public education and vaccination have led to an estimated 79% decrease in global measles deaths from 2000 to 2015 4.