Measles is also known as rubeola. It is a highly infectious disease. It kills more than 100000 people over a year. Even though there is a vaccination, it is a worldwide health problem. It is mainly present in Southern Asia and Africa. In US in 2000, this virus declared as an eliminated virus. Still the outbreaks occur.  

Measles varies widely. It is associated with the vaccination rates. Before the invention of vaccine, it killed 2.6 million peoples. WHO reported around 134200 deaths in 2015. This virus is high infectious and it affects the humans. It spreads by respiratory droplets, aerosols and intimate contact. 

Measles epidemiology varies globally and is linked to vaccination levels. Prior to comprehensive immunization, measles caused 2.6 million fatalities. In 2015, the World Health Organization recorded 134,200 fatalities.  

The virus is highly infectious and affects humans, spreading through respiratory droplets, aerosols, and intimate contact. The incubation period is 10-14 days. Young children are most affected, especially unvaccinated and pregnant women. 

As vaccination coverage increases, there has been a shift towards older children due to changes in population immunity levels. 

The measles virus can infect the parts of the respiratory tracts like dendritic cells, lymphocytes, and alveolar macrophages. It spreads by the circulation and cause viremia. It can go to the distant organ and lymphoid tissue. The virus causes cough, fever, coryza, conjunctivitis and viremia growth. Lymphocytic and perivascular infiltrates spread and generate a cutaneous rash.  

The virus inhibits the synthesis of interferon and reduces the host immunity. The primary humoral response consists of the synthesis of antibody. This antibody detects after 3 to 4 days. This will last for up to 6 to 8 weeks.  

IgG antibodies are produced against the viral nucleoprotein. There is an increased plasma level of Th1-dependent interferon-gamma and Th2-dependent interleukin 4, interleukin 13 levels and interleukin 10 cellular immune responses during recovery. The immunosuppression of the virus lasts for weeks, months or years. This will increase the susceptibility to the bacteria and cause the secondary infections. 

Most of measles morbidity and mortality rate are increased because of the increased susceptibility to ongoing infections. Neutralizing IgG antibodies give the protection against the hemagglutinin. 

The measles virus is a negative sense RNA virus. This virus is a a member of the Paramyxoviridae family and genus. It is a non-segmented single stranded virus. It consists enclosed 6 structural proteins and 2 non structural proteins C and V. The structural proteins are haemagglutinin (HA), matrix, large protein, nucleoprotein, and phosphoprotein. The virus attaches to the host cell via HA protein.  

Passive antibody transfer protects early infants who are born to mothers who have gained immunity against measles. When the antibodies decrease, they become affected. When the infection occurs, rash appear before and after the 4 days. It is also associated with the high viremia, cough, conjunctivitis and coryza.  

Measles can lead to poor prognosis. Many people got recovered from this disease without any complications. The side effects include otitis media and diarrhea. 

Infants, children under the age of 5, people over the age of 20, pregnant female and who has weakened immune systems have serious consequences. 

One in 1000 infected children may lead to encephalitis. 1 to 2 % of the children die because of the measles-related neurologic or respiratory problem. 

Prodromal Phase (1 to 4 days) 

Measles begins with a high fever reaches upto 101°F. Malaise is a general discomfort or unease. Persistent cough is a common early symptom. 

Koplik Spots (2 to 4 days) 

Small white spots with a blue white center and a red halo appear inside the mouth. 

Rash (3 to 5 days) 

A red, maculopapular rash appear on the face and spreads on the body. It remain for 5 to 6 days. It leads to high fever. 

Conjunctivitis (1 to 5 days) 

Inflammation in the eye lead to redness and watering. 

Respiratory Symptoms (1 to 5 days):  

Respiratory symptoms like runny nose and sneezing, cough and respiratory distress. 

The common symptoms include like kolpik spots, rash, inflammation, respiratory problems, fever, discomfort.  

Supportive Care 

There is no specific antiviral treatment for measles. Supportive care is essential to help manage symptoms and complications. Adequate rest is crucial for the body to recover.  

Fever and Pain Management 

Acetaminophen or ibuprofen is used to reduce the fever and pain. 

Vitamin A Supplementation 

Vitamin A supplements is suggested if patients have vitamin A deficiency. It reduces the symptoms, complications in children. 

Prevention 

Measles, mumps and rubella (MMR) vaccine is used to manage the measles. Non-immune persons who exposed to with measles may benefit from post-exposure prophylaxis with the MMR vaccination. 

Infectious Disease

Immune globulin should be provided independently to status of immunity or vaccination. 

Infectious Disease

Infants for 0 to 5 months of age   

Infants whose age is between 0 to 5 months should receive immune globulin within 6 days of infection. The first dose should be given immediately and second dose should be given on the next day. The dosage amount for these infants is 50,000 IU. 

Infants for 6 to11 months of age 

Infants whose age is between 6 to 11 months should receive the immune globulin within 72 hours of infection. The first dose is given immediately and second dose is given on the next day. The dosage amount for these infants is 100000 IU. 

For children greater than 12 months of age  

Children whose age is above 12 years should receive the vaccination within 72 hours of infection. If the infection lasts for 27 hours to 6 days, they should receive the immune globulin. It is suggested if they have not taken any vaccination dose. The dosage amount is 200000 IU in two separate doses. 

Infectious Disease

Vitamin A is important in the maintenance of the epithelial tissue and immunological function. During measles infection, vitamin A decreases. The WHO advises to suggest vitamin A to children who are having measles.   

Infectious Disease

Cool compresses and calamine lotion is used to manage the rash. Calamine lotion contains zinc oxide which can reduce the itching. Keep nail short and gentle skincare is useful. 

Infectious Disease

Acetaminophen or ibuprofen is used to reduce the fever and pain. 

Infectious Disease

Apply a cool compress to the eye to soothe irritation. Artificial tears or lubricating eye drops is used to prevent the dryness and discomfort. 

Infectious Disease

Dehydration symptoms include like dry mouth, sunken eyes, lethargy, fast breathing, and decreased urine production.  

Oral rehydration solutions are used to replace the lost fluids and electrolytes. The intravenous fluids are used in severe cases.