What is measles?
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Measles is a childhood infection caused by a virus. Once quite common, measles can now almost always be prevented with a vaccine.
Also called rubeola, measles can be serious and even fatal for small children. While death rates have been falling worldwide as more children receive the measles vaccine, the disease still kills more than 100,000 people a year, most under the age of 5.
As a result of high vaccination rates in general, measles hasn’t been widespread in the United States for more than a decade. The United States had about 30 cases of measles in 2004 but more than 600 cases in 2014. Most of these cases originated outside the country and occurred in people who were unvaccinated or who didn’t know whether they had been vaccinated.
Measles is a highly infectious illness caused by the rubeola virus. However, if measles enters an area where the people have never been exposed, the result can be devastating. Vaccination prevents many cases of measles around the world. The World Health Organization (WHO) estimates that 2.6 million people who have not had the vaccine die of measles every year.
Fast facts on measles:
Measles is a highly infectious condition:
- Scientists have identified 21 strains of the measles virus
- Symptoms of measles can include watery eyes, sneezing, and a dry hacking cough
- There is no specific treatment for measles. Prevention is better than cure
- Pregnant women should not take the vaccine
Measles signs and symptoms appear around 10 to 14 days after exposure to the virus. Signs and symptoms of measles typically include:
- Dry cough
- Runny nose
- Sore throat
- Inflamed eyes (conjunctivitis)
- Tiny white spots with bluish-white centers on a red background are found inside the mouth on the inner lining of the cheek — also called Koplik’s spots
- A skin rash made up of large, flat blotches that often flow into one another
The infection occurs in a sequence of stages during a period of two to three weeks.
- Infection and incubation. For the first 10 to 14 days after you’re infected, the measles virus incubates. You have no signs or symptoms of measles during this time.
- Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis), and sore throat. This relatively mild illness may last two or three days.
- Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first.
- Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs, and feet. At the same time, the fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C). The measles rash gradually recedes, fading first from the face and last from the thighs and feet.
- Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.
Patients with a weakened immune system who have measles are more susceptible to bacterial pneumonia. This can be fatal if not treated.
The following less common complications are also possible:
- Hepatitis: Liver complications can occur in adults and in children who are taking some medications.
- Encephalitis: This affects around 1 in every 1,000 patients with measles. It is an inflammation of the brain that can sometimes be fatal. It may occur soon after measles, or several years later.
- Thrombocytopenia, or low platelet count, affects the blood’s ability to clot. The patient may bruise easily.
- Squint: Eye nerves and eye muscles may be affected.
Complications that are very rare but possible include:
- Neuritis is an infection of the optic nerve that can lead to vision loss
- Heart complications
- Subacute sclerosing panencephalitis (SSPE): A brain disease that can affect 2 in every 100,000 people, months, or years after measles infection. Convulsions, motor abnormalities, cognitive issues, and death can occur.
- Other nervous system complications include toxic encephalopathy, retrobulbar neuritis, transverse myelitis, and ascending myelitis.
Measles during pregnancy can lead to miscarriage, early delivery, or low birth weight. A woman who is planning to become pregnant and has not been vaccinated should ask her doctor for advice.
There are two types of measles:
- Measles: This is the standard form caused by the rubeola virus.
- Rubella, or German measles: This is caused by the rubella virus.
Rubella generally presents as mild but presents more of a risk to unborn infants than young children if a woman contracts the virus while she is pregnant.
It is neither as infectious nor as severe as standard measles.
The measles, mumps, and rubella (MMR) vaccine contain immunizations for both types.
Measles is caused by infection with the rubella virus. The virus lives in the mucus of the nose and throat of an infected child or adult.
The disease is contagious for 4 days before the rash appears, and it continues to be contagious for about 4 to 5 days after.
The infection spreads through:
- Physical contact with an infected person
- being near infected people if they cough or sneeze
- touching a surface that has infected droplets of mucus and then putting fingers into the mouth, or rubbing the nose or eyes
The virus remains active on an object for 2 hours.
How does a measles infection develop?
As soon as the virus enters the body, it multiplies in the back of the throat, lungs, and the lymphatic system. It later infects and replicates in the urinary tract, eyes, blood vessels, and central nervous system.
The virus takes 1 to 3 weeks to establish itself, but symptoms appear between 9 and 11 days after the initial infection.
Anyone who has never been infected or vaccinated is likely to become ill if they breathe in infected droplets or are in close physical contact with an infected person.
Approximately 90 percent of people who are not immune will develop measles if they share a house with an infected person.
There is no specific treatment. If there are no complications, the doctor will recommend rest and plenty of fluids to prevent dehydration.
Symptoms usually go away within 7 to 10 days.
The following measures may help:
- If the child’s temperature is high, they should be kept cool, but not too cold. Tylenol or ibuprofen can help control fever, aches, and pains. Children under 16 years should not take aspirin. A doctor will advise about acetaminophen dosage, as too much can harm the child, especially the liver. There is an excellent selection online if you want to buy Tylenol or ibuprofen.
- People should avoid smoking near the child.
- Sunglasses, keeping the lights dim or the room darkened may enhance comfort levels, as measles increases sensitivity to light.
- If there is crustiness around the eyes, gently clean with a warm, damp cloth.
- Cough medicines will not relieve a measles cough. Humidifiers or placing a bowl of water in the room may help. If the child is over 12 months, a glass of warm water with a teaspoon of lemon juice and two teaspoons of honey may help. Do not give honey to infants.
- A fever can lead to dehydration, so the child should drink plenty of fluids.
- A child who is in the contagious stage should stay away from school and avoid close contact with others, especially those who are not immunized or have never had measles.
- Those with a vitamin A deficiency and children under 2 years who have measles may benefit from vitamin A supplements. These can help prevent complications, but they should only be taken with a doctor’s agreement.
Antibiotics will not help against the measles virus, but they may sometimes be prescribed if an additional bacterial infection develops.
In the United States, the measles, mumps, and rubella (MMR) vaccine is routinely given at 12 to 15 months of age, followed by a booster shot before entering the school at the age of 4 to 6 years.
Newborns carry their mother’s immunity for a few months after birth if their mothers are immune, but sometimes the vaccine is recommended before the age of 12 months, and as early as 6 months.
This may happen if they are, or are likely to be, in an area where there is a serious outbreak.
The WHO estimates that measles vaccination programs led to a 79 percent drop in measles deaths globally, from 2000 to 2015, preventing around 20.3 million deaths.
Adults do not require a vaccine in the U.S. if they:
- were born or lived in the U.S. before 1957 in the U.S., unless they work in a healthcare setting and have no evidence of immunity
- received two MMR shots after they were 12 months old
- had one MMR vaccine plus a second dose of measles vaccine
- are found to be immune to measles, mumps, and rubella after a blood test
The vaccine should not be taken by:
- women who are pregnant or plan to become pregnant soon
- people with a serious allergy to gelatin or neomycin, an antibiotic
Anybody whose immune system may be compromised by a condition or treatment for a condition should ask their doctor whether they should receive the vaccine.
There has been concern about an alleged link between the MMR vaccine and the risk of autism, but scientists have found no evidence of a link.
The CDC points out that during an outbreak of measles in the U.S. between 1989 and 1991, 90 percent of fatal cases were among those with no history of vaccination.
“The most important cause of the measles resurgence of 1989-1991 was low vaccination coverage.”
When to see a doctor:
Call your doctor if you think you or your child may have been exposed to measles or if you or your child has a rash resembling measles.
Review your family’s vaccination records with your doctor, especially before your children start elementary school or college and before international travel.
Risk factors for measles include:
- Being unvaccinated. If you haven’t received the vaccine for measles, you’re much more likely to develop the disease.
- Traveling internationally. If you travel to developing countries, where measles is more common, you’re at higher risk of catching the disease.
- Having a vitamin A deficiency. If you don’t have enough vitamin A in your diet, you’re more likely to have more severe symptoms and complications.
Complications of measles may include:
- Ear infection. One of the most common complications of measles is a bacterial ear infection.
- Bronchitis, laryngitis, or croup. Measles may lead to inflammation of your voice box (larynx) or inflammation of the inner walls that line the main air passageways of your lungs (bronchial tubes).
- Pneumonia. Pneumonia is a common complication of measles. People with compromised immune systems can develop an especially dangerous variety of pneumonia that is sometimes fatal.
- Encephalitis. About 1 in 1,000 people with measles develop a complication called encephalitis. Encephalitis may occur right after measles, or it might not occur until months later.
- Pregnancy problems. If you’re pregnant, you need to take special care to avoid measles because the disease can cause preterm labor, low birth weight, and maternal death.
The Centers for Disease Control and Prevention recommends that children and adults receive the measles vaccine to prevent measles.
Measles vaccine in children:
To prevent measles in children, doctors usually give infants the first dose of the vaccine between 12 and 15 months, with the second dose typically given between ages 4 and 6 years. Keep in mind:
- If you’ll be traveling abroad when your child is 6 to 11 months old, talk with your child’s doctor about getting the measles vaccine earlier.
- If your child or teenager didn’t get the two doses at the recommended times, he or she may need two doses of the vaccine four weeks apart.
Measles vaccine in adults:
You may need the measles vaccine if you’re an adult who:
- Has an increased risk of measles — such as attending college, traveling internationally, or working in a hospital environment — and you don’t have proof of immunity. Proof of immunity includes written documentation of your vaccinations or lab confirmation of immunity or previous illness.
- Was born in 1957 or later and you don’t have proof of immunity. Proof of immunity includes written documentation of your vaccinations or lab confirmation of immunity or previous illness.
If you’re not sure if you need the measles vaccine, talk to your doctor.
Preventing measles during an outbreak or known infection:
If someone in your household has measles, take these precautions to protect vulnerable family and friends:
- Isolation. Because measles is highly contagious from about four days before to four days after the rash breaks out, people with measles shouldn’t return to activities in which they interact with other people during this period. It may also be necessary to keep non-immunized people — siblings, for example — away from the infected person.
- Vaccinate. Be sure that anyone who’s at risk of getting measles who hasn’t been fully vaccinated receives the measles vaccine as soon as possible. This includes infants older than 6 months and anyone born in 1957 or later who doesn’t have written documentation of being vaccinated, or who doesn’t have evidence of immunity or have had measles in the past.
Preventing new infections:
If you’ve already had measles, your body has built up its immune system to fight the infection, and you can’t get measles again. Most people born or living in the United States before 1957 are immune to measles, simply because they’ve already had it.
For everyone else, there’s the measles vaccine, which is important for:
- Promoting and preserving widespread immunity. Since the introduction of the measles vaccine, measles has virtually been eliminated in the United States, even though not everyone has been vaccinated. This effect is called herd immunity. But herd immunity may now be weakening a bit, likely due to a drop in vaccination rates. The incidence of measles in the U.S. recently increased significantly.
- Preventing a resurgence of measles. Steady vaccination rates are important because soon after vaccination rates decline, measles begins to come back. In 1998, a now-discredited study was published incorrectly linking autism to the measles-mumps-rubella (MMR) vaccine. In the United Kingdom, where the study originated, the rate of vaccination dropped to an all-time low of about 80% of all children in 2003-2004. In 2008, there were nearly 1,400 lab-confirmed cases of measles in England and Wales.
Your doctor can usually diagnose measles based on the disease’s characteristic rash as well as a small, bluish-white spot on a bright red background — Koplik’s spot — on the inside lining of the cheek. However, many doctors have never seen measles, and the rash can be confused with a number of other illnesses. If necessary, a blood test can confirm whether the rash is truly measles. The measles virus can also be confirmed with a test that generally uses a throat swab or urine sample.
There’s no specific treatment for established measles infection. However, some measures can be taken to protect vulnerable individuals who have been exposed to the virus.
- Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus to provide protection against the disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter time.
- Immune serum globulin. Pregnant women, infants, and people with weakened immune systems who are exposed to the virus may receive an injection of proteins (antibodies) called immune serum globulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.
- Fever reducers. You or your child may also take over-the-counter medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Children’s Motrin, others), or naproxen sodium (Aleve) to help relieve the fever that accompanies measles. Don’t give aspirin to children or teenagers who have measles symptoms. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.
- Antibiotics. If a bacterial infection, such as pneumonia or an ear infection, develops while you or your child has measles, your doctor may prescribe an antibiotic.
- Vitamin A. Children with low levels of vitamin A are more likely to have a more severe case of measles. Giving vitamin A may lessen the severity of the measles. It’s generally given as a large dose of 200,000 international units (IU) for children older than a year.
Lifestyle and home remedies:
If you or your child has measles, keep in touch with your doctor as you monitor the progress of the disease, and watch for complications. Also, try these comfort measures:
- Take it easy. Get rest and avoid busy activities.
- Sip something. Drink plenty of water, fruit juice, and herbal tea to replace fluids lost by fever and sweating.
- Seek respiratory relief. Use a humidifier to relieve a cough and sore throat.
- Rest your eyes. If you or your child finds bright light bothersome, as do many people with measles, keep the lights low or wear sunglasses. Also, avoid reading or watching television if the light from a reading lamp or from the television is bothersome.
Herbal Remedies For measles:
The following are an effective natural cure for measles:
Licorice: Liquorice is a very effective natural cure for measles. Powder licorice root and add honey to this powder, take half a teaspoon of each daily for better results
Tamarind seeds and turmeric: Tamarind seeds and turmeric are a very effective natural cure for measles. Powder tamarind seeds, mix an equal portion of the tamarind seeds powder with turmeric powder, this mix should be given in doses of 350gm to 425gm, three times, daily to the person suffering from measles.
Margosa leaves: Margosa leaves contain antiviral and antiseptic properties, which are effective in treating measles. Margosa leaves can be added to hot bathing water, to relieve the patient of itching, that comes with the rash. Patients should be immersed in the water for at least 20 minutes, for better results.
Garlic: Garlic also can be an effective natural cure for measles. Powder the cloves of garlic and mix with honey and this can be had daily for better results.
Lemon juice: Lemon juice is also a very effective natural cure for measles. Taking about 15-25ml of lemon juice, mixed with water can be an effective cure for measles.
Bitter gourd leaves and turmeric root: Powder turmeric root and mix with honey and add the juice of bitter gourd leaves. This is a very effective natural cure for measles.
Coconut water and flesh: Coconut water has nutrients and natural sugar, which help in cleansing the body of toxic elements, which makes it a very effective drink. Coconut flesh is rich in anti-oxidants and a liberal intake of coconut water helps in speedy recovery from measles.
Indian gooseberry (Amla): Indian gooseberry powder mixed with water is very effective in getting rid of itching and burning sensation during measles. Amla powder mixed with water can also be used to wash the body.
Barley: Barley water is a very effective natural cure to treat the coughs, in measles. The patient should drink barley water flavored with a few drops of sweetened almond oil as frequently as possible.
Calendula flowers: Calendula flowers, contain essential minerals, which help in speeding the healing process of measles. Boil three cups of water and add one tablespoon of the powdered flower. Drain and drink twice a day until the symptoms of measles exist. Peppermint oil and/or sugar can be added, to make it more effective and palatable.
Eggplant seeds: Eggplant seeds help in developing immunity against measles. The patient can be given about half to one gram of the seeds daily for three days, for better results.
Orange juice: Orange is an excellent natural cure for measles. As the patient will feel a loss of appetite and the lack of saliva on his tongue, often the patient does not feel thirsty or hungry. Orange juice makes good for this loss of appetite.
Butter: If measles is accompanied by fever, mix butter and sugar candy in equal quantity and lick 2 tsp. In the morning.
Precautions in handling a measles patient:
- Measles patients must be kept in isolation, for the disease is infectious, and should be given complete rest, which will facilitate a speedy recovery.
- The patient can be given lots of warm water to drink, as this flushes the toxins out of the system. For better results, drink them in the mornings on an empty stomach and in the evenings.
- Initially, the patient should be given juices of fruits like orange and lemon, as the person experiences loss of appetite, this would be sufficient.
- Gradually, the patient can start eating fruits and a well-balanced diet, which includes lots of green vegetables and fruits, to boost the immune system.
- Measles patients should be kept in a well-ventilated room.
- Avoid sunlight as measles damages eye tissues which results in watery eyes. The room should have subdued light, to not further cause damage to the eyes.
- Avoid milk, and milk products, as they may worsen the condition. If the child is heavily dependent on milk, limit the intake.
- Ensure that the room and the surroundings are clean and tidy
Infants and young children most at risk of fatal complications, health agencies warn:
5 December 2019 Joint News Release
Worldwide more than 140,000 people died from measles in 2018, according to new estimates from the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC). These deaths occurred as measles cases surged globally, amidst devastating outbreaks in all regions.
Most deaths were among children under 5 years of age. Babies and very young children are at greatest risk from measles infections, with potential complications including pneumonia and encephalitis (swelling of the brain), as well as a lifelong disability – permanent brain damage, blindness, or hearing loss.
Recently published evidence shows that contracting the measles virus can have further long-term health impacts, with the virus damaging the immune system’s memory for months or even years following infection. This ‘immune amnesia’ leaves survivors vulnerable to other potentially deadly diseases, like influenza or severe diarrhea, by harming the body’s immune defenses.
“The fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world’s most vulnerable children,” said Dr. Tedros Adhanom Ghebreysus, Director-General of the World Health Organization. “To save lives, we must ensure everyone can benefit from vaccines – which means investing in immunization and quality health care as a right for all.”
Measles is preventable through vaccination. However, vaccination rates globally have stagnated for almost a decade. WHO and UNICEF estimate that 86% of children globally received the first dose of measles vaccine through their country’s routine vaccination services in 2018, and fewer than 70% received the second recommended dose.
Worldwide, coverage of the measles vaccine is not adequate to prevent outbreaks. WHO recommends that 95% vaccination coverage with two doses of measles vaccine is needed in each country and all communities to protect populations from the disease.
The Poorest countries are the hardest hit but measles remains a staggering global challenge:
Estimating the total number of cases and deaths globally and by region, the report finds that the worst impacts of measles were in sub-Saharan Africa, where many children have persistently missed out on vaccination.
In 2018, the most affected countries – the countries with the highest incidence rate of the disease – were the Democratic Republic of the Congo (DRC), Liberia, Madagascar, Somalia, and Ukraine. These five countries accounted for almost half of all measles cases worldwide.
“We’ve had a safe and effective measles vaccine for over 50 years,” said Dr. Robert Linkins, Branch Chief of Accelerated Disease Control and Vaccine-Preventable Disease Surveillance at the CDC and Chair of the Measles & Rubella Initiative. “These estimates remind us that every child everywhere needs – and deserves – this life-saving vaccine. We must turn this trend around and stop these preventable deaths by improving measles vaccine access and coverage.”
While the greatest impacts have been in the poorest countries, some wealthier countries have also been battling measles outbreaks, with significant ramifications for people’s health.
This year, the United States reported its highest number of cases in 25 years, while four countries in Europe – Albania, Czechia, Greece, and the United Kingdom – lost their measles elimination status in 2018 following protracted outbreaks of the disease. This happens if measles re-enters a country after it has been declared eliminated and if the transmission is sustained continuously in the country for more than a year.
Always consult your doctor if you suffer from any symptoms. Prevention is always better than cure.
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