Alternate Names: Measles

Causes and Risks: Rubeola, or measles, is caused by the paramyxovirus. The infection is spread by droplets from the nose, mouth or throat of an infected person. The incubation period is 10 to 14 days before symptoms generally appear. An immunity to the disease occurs after vaccination, after active infection, and passive immunity of an infant whose mother is immune lasts most of the first year of life. Before widespread immunization, measles was very common during childhood so that 90% of the population had been infected by age 20. Measles cases have dropped by 99% in the U.S. and Canada after widespread immunization. Only 9,600 cases were reported in the U.S. in 1991. Susceptible individuals are young infants as the maternal antibody decreases, and those who refuse immunization. Teenagers and young adults who have not received a second immunization are also susceptible.

Prevention: The routine immunization of children at 12 to 15 months old with MMR (live mumps, measles, and rubella) vaccine prevents infection. A second MMR immunization (vaccine) is now given between 4 and 6 years of age.

Symptoms:

• a sore throat
• a runny nose
• a barking cough
• muscle pain
• fever
• bloodshot eyes
• tiny white spots inside the mouth (called Koplik’s spots) appearing 3 to 4 days after the onset of symptoms
• photophobia (light sensitivity)
• rash
  • appears around the fifth day of the disease
  • may last 4 to 7 days
  • usually starts on the head and spreads to other areas, progressing downward
  • maculopapular rash--appears as both macules (flat discolored areas) and papules (solid, red, elevated areas) that later merge together (confluent); occasionally may bleed very slightly
• itching of the rash

Signs and Tests:

• a blood differential
• a viral culture (rarely done)
• a measles serology

Treatment: There is no specific treatment of measles. Symptomatic relief may be achieved from bed rest, acetaminophen - oral, and humidified air.

Prognosis: The probable outcome is excellent in uncomplicated cases. The probable outcome is worse with complicating encephalitis.

Complications: A bacterial infection may cause otitis media, bronchitis, or pneumonia. Encephalitis occurs in approximately 1 out of 3,000 measles cases. Hemorrhagic measles is a rare complication and causes generalized bleeding.

Call your health care provider if earache, productive cough, or severe lethargy develop in a person with measles; or if symptoms do not begin to improve within 1 week.

Emergency symptoms (rare) include convulsions and generalized bleeding.