Measles (RUBEOLA)

Measles is a highly contagious disease caused by a virus. Maximum number of cases occur in children less than 2 years of age. The disease occurs in all seasons but is more common in winter and springs. It is characterized by fever, conjunctivitis, coryza, cough and rash. It is a self-limiting disease unless complication occurs. Serious and fatal complication may occur with this disease.

Spread of Infection
This disease spreads from infected person to normal person by droplet spray (respiratory tract secretions and secretions of nose and throat). An infected person remain contagious, i.e. can spread infection from 4 days before to 6 days after the appearance of rash.

Clinical Manifestations
The incubation period of disease is 10-12 days. The disease starts with low grade to moderate fever, hacking cough, running nose, sneezing, redness of eyes and watering from eyes. These symptoms last for 3-5 days.

The rash of measles appears on 4th day and at this times temperature rises abruptly and often reaches 40-40.50C (104-1050F). The rash starts behind the ears, along the hairline, on the upper lateral part of neck and on posterior part of the cheeks. In next 2-3 days rash spreads to back, abdomen, arms, thigh and finally reaches the feet. As this rash reaches the feet it starts fading from the face and then proceeds downwards in the same sequence in which it appeared. At this stage other symptoms also subside rapidly and patient who was looking desperately ill appears essentially well.

Loss of apetite and malaise are seen in patients, lymph nodes are also enlarged. Sometimes measle becomes haemorrhagic (Black measles) and bleeding may occur from mouth, nose and bavel.

Complications of measles
Respiratory tract complication of measles are most frequent. Pneumania may occurs because of measles virus itself or due to secondarily invading bacteria. Primary tuberculosis may flare up fallowing measles.

Otitis media (ear infection) is also commonly seen in children following measles infection.

Digestive system - diarrhaea, dysentry and appendicitis may occur following measles infection.

Malnutition - An attack of measles predisposes children to malnutrition. Measles has a higher rate of complication in already malnourished children.

Neurological complications - Encephalitis may occur, either in the early stage or in late stages. One third of the patiens may die and another one third may be left with neurological deficits.

Treatment
Treatment is mainly supportive and symptomatic. Fever is controlled by paracetamol and hydrotherapy. Cough should not be suppressed and dry irritating cough may be helped by humidification of the room. Adequate amount of fluid should be given. A good nourishing diet should be given. Vitamin A should be given to children as it reduces the severity of the disease. In case of complication the doctor should be consulted

Prevention
Active immunization with measles vaccine - In developing countries measles vaccine is given at 9 months of age and in developed countries it is given at 15 months of age. Immunization with measles vaccine with in 72 nos. of exposure to a measles case may modify the illness and provide protection in certain cases hence in school based outbreaks it should be considered.

Contraindication to Measles Vaccine - Measles vaccine is not recommended for Pregnant women, children with untreated tuber lenkemia and thase recicning immunosuppresent drugs. In case these children are expired to measles, measles immunogobin (Human) should be given.

Children with AIDS - Children with AIDS should receive measles vaccine as mortality due to measles is high in this group and vaccine is well to treated. In case these children are exposed they should be given gammaglobulin in double dose.

Passive Immunization
Measles can be prevented by using gamma globulin with in 5 days after exposure to measles case.

Suggested Reading -
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Measles - An extremely contagious illness of childhood, which can cause complications if not managed well.

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