Measles: Infection, Symptoms, Treatment
Measles is a highly contagious, feverish viral infection (5). It usually begins with flu-like symptoms before the typical measles rash develops (2). In most cases, measles heals easily on its own (6). Sometimes, however, complications such as inflammation of the middle ear (9), pneumonia (8) or dangerous encephalitis (7) may occur. Children under the age of five (3) and adults (1) are particularly susceptible to these complications (4). Read all about measles here!
ICD code for this disease is B05
- What are measles? A highly contagious viral infection that is spread worldwide. It is one of the “children’s diseases”, although it is increasingly affecting adolescents and adults as well.
- Infection: Droplet infection, direct contact with infectious nasal or pharyngeal secretions of patients (e.g. through sharing cutlery)
- Symptoms: In the first stage flu-like symptoms, a first fever attack and whitish spots on the oral mucosa (Koplik spots). In the second stage, the typical measles rash (red, merging spots, starting from the ears) and a second fever attack.
- Treatment: Bed rest, rest, possibly antipyretic measures (such as antipyretic medication, calf compresses), cough medicine, antibiotics (in case of additional bacterial infection)
- Possible complications: e.g. inflammation of the middle ear, pneumonia, bronchitis, diarrhoea, pseudo-Krupp (Krupp syndrome), encephalitis; late complications: chronic encephalitis (subacute sclerosing panencephalitis, SSPE)
- Prognosis: Measles usually heals without problems. Complications occur in 10 to 20 per cent of patients. About one in 1,000 patients can die.
On the one hand, the measles viruses are transmitted by droplet infection: infected persons spread tiny, virus-containing saliva droplets in the ambient air when speaking, coughing and sneezing. Other people can inhale them: as soon as the viruses in the saliva droplets make contact with the mucous membranes in the respiratory tract, they can infect the new “victim”. By the way: Measles viruses can survive in the air for up to two hours! This is much more than coronavirus.
On the other hand, one can also become infected with measles through direct contact with infectious secretions from the nose and throat of infected persons. This happens, for example, when using patients’ cutlery or drinking glasses.
Measles viruses are extremely contagious! Of 100 people who have not yet had measles and have not been vaccinated against it, 95 fall ill after contact with measles viruses.
How long are measles patients contagious?
Anyone who has contracted measles is already infected three to five days before the appearance of the typical measles rash and up to four days afterwards. The greatest ability to become infected is immediately before the rash breaks out.
Measles: Incubation period
The time between infection with a pathogen and the appearance of the first symptoms is called the incubation period. It is usually eight to ten days for measles. The typical measles rash (second stage of the disease) usually appears two weeks after infection.
Symptoms Of Measles
Measles progresses in two stages with two fever attacks and other symptoms:
Preliminary stage (prodromal stage): The disease begins with a moderate fever, rhinitis, sore throat and dry cough. The face is swollen. Fatigue, headaches and stomach aches, constipation or diarrhoea, and conjunctivitis with photophobia are also possible symptoms. Typical of measles in the early stages are the so-called Koplik spots on the mucous membrane of the mouth: These are circumscribed, small, red spots with a white centre (“lime splash spots”). They form from the 2nd or 3rd day of illness, preferably on the cheek mucosa in the area of the molars. From the 3rd day on, the entire mouth and throat mucosa reddens. In addition, fever rises sharply.
Measles does not appear until about nine days after infection. But they are contagious at an early stage.
The preliminary stage lasts about three to four days Towards the end the fever initially drops again.
The main stage (exanthema stage): In this phase of the disease, the fever rises sharply again. The typical measles rash develops irregular, three to six millimetre large, initially light red spots that flow into each other. These red spots first form behind the ears and then spread over the whole body. Only the palms of the hands and soles of the feet are left out. Within days the spots become darker, brownish-purple.
After four to seven days, the measles spots fade away again, in the same order in which they appeared (starting from the ears). This fading is often associated with flaking of the skin. At the same time, the other complaints subside.
It takes about two weeks for the patient to recover. However, the immune system is weakened even longer: for about six weeks there is an increased susceptibility to other infections.
In newborns who still carry measles antibodies from the mother, the measles infection is usually less severe. Such “mitigated measles” can sometimes also be observed in other people. These include patients who have not received the complete measles vaccine and therefore have weak, incomplete vaccination protection. Mitigated measles does not have a fully developed rash. This can make diagnosis difficult. Nevertheless, those affected are contagious.
Complications Derived From Measles
Occasionally a measles infection with complications develops. Due to the weakness of the immune system lasting several weeks, the patient is exposed to other pathogens such as bacteria. The most common diseases associated with measles are inflammation of the middle ear (otitis media), bronchitis, pneumonia and diarrhoea.
Strong inflammation of the laryngeal mucosa is also possible. Doctors also speak of Krupp syndrome or pseudo croup. Those affected have attacks of dry, barking coughs and breathing difficulties (up to respiratory distress), especially at night.
Foudroyant (toxic) rashes are rare: The affected patients get, among other things, high fever as well as skin and mucous membrane bleeding. The mortality rate for this measles complication is high!
Another rare but dreaded complication is encephalitis (inflammation of the brain). It manifests itself about four to seven days after the beginning of the measles rash with headache, fever and loss of consciousness (up to coma). About 10 to 20 percent of patients die. In another 20 to 30 percent, measles-related encephalitis causes permanent damage to the central nervous system.
Very rarely, on average six to eight years after the measles infection, an always fatal late complication occurs – a chronic inflammation of the brain known as subacute sclerosing panencephalitis (SSPE): Measles viruses that have invaded the brain multiply, causing irreversible nerve damage. At first, changes in behaviour become apparent. As the disease progresses, neurological disorders such as muscle twitching and seizures as well as nerve failures are added to the symptoms. In the final stage, all brain functions fail – the patient dies.
Four to eleven out of 100,000 measles patients receive SSPE. Children under the age of five are particularly susceptible to this deadly late complication of measles. In this age group, there are an estimated 20 to 60 cases of SSPE per 100,000 measles patients.
In people whose immune system is suppressed by medication or another disease (immunosuppression) or has a congenital defect, measles can be quite weak externally. The measles rash may be absent or look untypical. However, there is a risk of serious organ complications. These include a progressive form of pneumonia (giant cell pneumonia). Sometimes a special type of encephalitis (measles-inclusion body encephalitis, MIBE) develops: it leads to death in about three out of ten patients.
Causes And Risk Factors Of Measles
This condition is caused by the highly infectious measles virus. The pathogen belongs to the paramyxovirus family and is spread worldwide.
The disease is of particular importance in African and Asian developing countries: It is one of the ten most common infectious diseases and is often fatal.
The number of measles cases has decreased since the introduction of the corresponding vaccination. However, regional or nationwide measles outbreaks occur again and again for a limited period of time. In addition, it has been observed for some years now that an increasing number of adolescents and (young) adults are contracting this “childhood disease”.
Examinations And Diagnosis Of Measles
The symptoms of the disease, especially the rash, provide the doctor with important information thereof. However, there are some diseases with similar symptoms, namely rubella, ringworm and scarlet fever. To avoid confusion, a laboratory examination must, therefore, confirm the suspicion of this disease. Various tests can be used, the most common of which is the detection of antibodies against viruses of this disease:
- Detection of specific antibodies against the virus: the fastest and safest method of diagnosis. Blood of the patient is used as sample material (in case of suspected encephalitis possibly cerebrospinal fluid). The test usually turns out positive as soon as the typical measles rash appears. However, the antibodies are sometimes not detectable before this.
- Detection of the viral genetic material (measles virus RNA): A urine sample, saliva sample, tooth pocket fluid or a throat swab is taken. The traces of viral genetic material found therein are amplified by means of polymerase chain reaction (PCR) and can thus be clearly identified.
- Cultivation of measles viruses: For this purpose, sample material (urine sample, saliva sample, etc.) is exposed to optimal growth conditions in order to cultivate the pathogens it contains. In this way, they can be identified. This procedure is very time-consuming and is only carried out in special cases (for example, in patients with suppressed immune systems).
Measles Is A Notifiable Condition
Measles belongs to the group of notifiable diseases. As soon as the first symptoms indicate measles, a doctor should be consulted. The suspicion, the actual illness and also death from this condition must be reported by the doctor to the relevant health office (with the patient’s name).
If the condition is suspected or a proven infection is detected, those affected must stay away from communal facilities (schools, daycare centres, etc.). This also applies to employees of such facilities. Patients may be admitted again at the earliest five days after the outbreak of the rash.
Treatment Of Measles
There is no specific treatment. However, they can relieve the symptoms and support the healing process. This includes bed rest in the acute phase of the disease and physical rest. If the patient’s eyes are sensitive to light, the patient’s room should be somewhat darkened – direct light on the patient should be avoided. Also, make sure that the room is well ventilated and not stuffy.
Experts recommend that patients drink enough – especially if they have a fever or sweat. Instead of a few large portions, several small meals should be eaten throughout the day.
Calf compresses and, if necessary, antipyretic medication can help against fever. However, the use of these drugs should first be discussed with a doctor. The same applies if you want to use cough medicine (cough expectorant or cough blocker).
The fever and pain reliever acetylsalicylic acid (ASS) are not suitable for children. In connection with feverish infections, the rare but life-threatening Reye’s syndrome can otherwise develop!
If there is an additional infection with bacteria (for example in the form of middle ear or pneumonia), the doctor usually prescribes antibiotics.
If this condition trigger a Krupp syndrome or encephalitis, treatment in hospital is necessary!
Prognosis Of Measles And Disease Progression
This disease heals without problems in most patients. However, complications occur in 10 to 20 percent of cases. Children under five years of age and adults over 20 are particularly affected.
Such complications can also be fatal under certain circumstances. This is especially true for encephalitis, which develops either shortly after infection or as late complications years later. According to the World Health Organization (WHO), the overall mortality rate for this condition in developed countries is up to 0.1 percent (1 death per 1,000 patients). In developing countries, it can be significantly higher, for example, due to malnutrition.
You can only contract measles once in your life: anyone who has survived an infection is protected for life against reinfection with viruses f this disease. During infection, the immune system forms specific antibodies against the pathogen. Some of these antibodies remain in the body even after healing. If there is renewed contact with these viruses later, the antibodies become active immediately and eliminate the intruder.
Pregnant women who have antibodies against this disease also transmit them to the unborn child via the umbilical cord. The maternal antibodies remain in the child’s body until a few months after birth and thus prevent infection. This so-called nest protection lasts until about the sixth month of life.
Measles can cause rare but serious complications and even death. Therefore, all infants, toddlers and unvaccinated adults must be vaccinated.
Vaccination is mandatory for children attending childcare. The same applies to school children. But adults working in community facilities, such as teachers, kindergarten teachers and medical staff, are also subject to the compulsory vaccination, provided they have not already undergone the measles. The same applies to refugees living in refugee accommodation.
The measles vaccine is a so-called live vaccine. It, therefore, contains attenuated measles viruses that have partially or completely lost their pathogenic effect. Nevertheless, the immune system reacts by forming specific antibodies against the viruses (therefore the measles vaccine is a so-called active vaccination). This antibody formation takes some time, but after four to six weeks the specific antibodies are detectable in the blood.
However, two doses of vaccine are necessary for the vaccination to develop its full protective effect: The first vaccine dose is usually administered to infants between the ages of 11 and 14 months. The second should be given between 15 and 23 months (at the earliest four weeks after the first dose).
The measles vaccine is usually administered together with the vaccines against mumps and rubella. This is called the MMR vaccine.
Even adults who are not subject to compulsory vaccination should, according to the recommendations, take the MMR vaccination in the form of a single dose, provided that:
- They have not received such a vaccination (or not all recommended doses of vaccine) as a child, or
- It is not clear whether they have been vaccinated (unclear vaccination status).
This is especially true for adults born after 1970. In this age group, many have neither been vaccinated nor have they undergone this disease as children. It causes more serious complications in adults than in children.
Possible side effects of vaccination
The vaccination is generally well tolerated. Sometimes there is redness, swelling and pain at the injection site. Neighbouring lymph nodes may also swell. Increased body temperature, tiredness, headaches and gastrointestinal complaints are also possible. However, such complaints are only temporary and will soon subside.
In about five percent of those vaccinated, the so-called vaccine masers usually develop in the second week after the vaccination. This is the term used to describe attenuated symptoms such as moderate fever, mild rash and respiratory problems. B
If unprotected people have had contact with a patient, they can be quickly vaccinated for up to three days afterwards. This can usually prevent an outbreak of the disease. For this “emergency” vaccination, the combination vaccine against measles, mumps and rubella (MMR vaccination) is recommended.
For people with a weakened immune system, post-exposure measles vaccination can also be carried out by means of passive immunization: Two to six days after the (suspected) infection, ready-to-use antibodies against measles viruses are injected. In contrast to “normal” (active) measles vaccination, this gives the vaccinated person immediate protection. However, this protection lasts only for a limited time: The “foreign” antibodies are gradually broken down by the immune system.
Pregnant women and children under six months of age can also receive passive immunisation as a precautionary measure after a possible infection. Active measles vaccination is not permitted during pregnancy and not permitted for children under six years of age.