Measles Symptoms and Management
Measles is characterized by a prodrome of fever, cough, coryza (runny nose), and conjunctivitis followed by a maculopapular rash that begins on the face and spreads downward to the trunk and extremities, with potential for severe complications including pneumonia and encephalitis. 1
Clinical Presentation
Incubation and Prodromal Phase
- Incubation period averages 10-12 days from exposure to prodrome and 14 days from exposure to rash (range: 7-18 days) 1
- Prodromal symptoms include:
- Fever (often high)
- Cough
- Coryza (runny nose)
- Conjunctivitis ("pink eye") 1
- Koplik spots (small white spots on a red background inside the mouth) appear during the prodrome and are considered pathognomonic for measles 1
Rash Phase
- Characteristic rash typically appears 3-4 days after fever onset 2
- Rash progression:
- Rash appearance coincides with peak symptom intensity 2
Common Complications
- Diarrhea (most common complication) 1
- Middle ear infection (otitis media) 1
- Bronchopneumonia 1, 2
- Encephalitis (occurs in approximately 1 per 1,000 cases) 1
- Death (occurs in 1-2 per 1,000 reported cases in the United States) 1
High-Risk Populations
- Infants and young children face higher mortality risk than older children 1
- Adults also experience higher complication rates 1
- Pregnant women may experience increased rates of premature labor, spontaneous abortion, and low birth weight infants 1
- Immunocompromised individuals (particularly those with leukemias, lymphomas, or HIV) may develop severe, prolonged infection, sometimes without the typical rash 1
Management
Diagnosis
- Clinical suspicion based on characteristic symptoms and rash pattern 3
- Laboratory confirmation:
Supportive Care
- Hydration and antipyretics for fever management 2
- Nutritional support, particularly in malnourished patients 1
Specific Treatments
- Vitamin A supplementation:
- All children with clinical measles should receive vitamin A 1
- Children <12 months: 100,000 IU orally 1
- Children ≥12 months: 200,000 IU orally 1
- Repeat dose for children with complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems) on day 2 1
- Additional dose 1-4 weeks later for those with vitamin A deficiency eye symptoms 1
Management of Complications
- Antibiotics for secondary bacterial infections (particularly pneumonia) 1, 2
- Oral rehydration therapy for diarrhea 1
- Hospitalization for severe complications (pneumonia, encephalitis) 2, 4
Infection Control
- Isolation during contagious period (4 days before rash to 4 days after rash appears) 1
- Airborne precautions in healthcare settings 3
- Use of N-95 masks by healthcare workers 3
Prevention
- Vaccination is the cornerstone of measles prevention 1, 4
- MMR (measles-mumps-rubella) vaccine:
- Post-exposure prophylaxis:
Special Considerations
- Undernutrition is NOT a contraindication for measles vaccination; it should be considered a strong indication for vaccination 1
- Fever, respiratory tract infection, and diarrhea are not contraindications for measles vaccination 1
- Unimmunized persons infected with HIV should receive the vaccine unless severely immunosuppressed 1
Prognosis
- Case fatality rate in the United States: 1-2 per 1,000 reported cases 1
- Case fatality rate in developing countries: can be as high as 25% 1
- Long-term sequelae may include permanent brain damage from encephalitis 1
- Subacute sclerosing panencephalitis (SSPE) is a rare but fatal late complication that appears years after infection 1