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Measles

Measles is a common childhood disease that now can be prevented with a vaccine. Signs and symptoms of measles include cough, runny nose, inflamed eyes, sore throat, fever and a red, blotchy skin rash.

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 several hundred thousand people a year, most under the age of 5.

By 2000, the measles vaccine had practically eliminated measles in the United States. But there has been a recent resurgence of the disease, as more people have chosen not to vaccinate their children.

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Measles

Measles symptoms and signs appear 10 to 12 days after exposure to the virus. They typically include:

• Fever
• Dry cough
• Runny nose
• Inflamed eyes (conjunctivitis)
• Sensitivity to light
• Tiny white spots with bluish-white centers found inside the mouth on the inner lining of the cheek, called Koplik's spots
• A skin rash made up of large, flat blotches that often flow into one another

The course of the measles virus
Measles typically begins with a mild to moderate fever, accompanied by other signs and symptoms, such as a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. Two or three days later, Koplik's spots — a characteristic sign of measles — appear. Then a fever spikes, often as high as 104 or 105 F (40 or 40.6 C). At the same time, a red blotchy rash appears, usually on the face, along the hairline and behind the ears. This slightly itchy rash rapidly spreads downward to the chest and back and, finally, to the thighs and feet. After about a week, the rash fades in the same sequence that it appeared.

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 exhibits symptoms that make you suspect measles. Review your family's immunization records with your doctor, especially before starting elementary school, before college and before international travel.

The cause of measles is a very contagious virus, which lives in the mucus in the nose and throat of an infected child or adult. That child or adult is contagious from four days before the rash appears to four days after.

When someone with measles coughs, sneezes or talks, infected droplets spray into the air, where other people can inhale them. The infected droplets may also land on a surface, where they remain active and contagious for several hours. You can contract the virus by putting your fingers in your mouth or nose or rubbing your eyes after touching the infected surface.

• No vaccination. People who have not received the vaccine for measles are much more likely to develop the disease.
• International travel. Unvaccinated people traveling to developing countries, where measles is more common, are at higher risk of catching the disease.
• Vitamin A deficiency. People who don't have enough vitamin A in their diets are more likely to contract measles and to have more-severe symptoms.

Most people recover from measles in 10 to 14 days. As many as 20 percent will develop complications, which 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 develops encephalitis, an inflammation of the brain that may cause vomiting, convulsions and, rarely, coma or even death. Encephalitis can closely follow measles, or it can occur years later.
• Pregnancy problems. Pregnant women need to take special care to avoid measles, because the disease can cause miscarriage, premature labor or babies with low birth weights. Rubella, or German measles, is a separate disease that can cause birth defects during pregnancy.
• Low platelet count (thrombocytopenia). Measles may lead to a decrease in platelets — the type of blood cells that are essential for blood clotting.

If you suspect that you or your child has measles, you need to see your family physician.

What you can do
You may want to write a list that includes:

• Detailed descriptions of the symptoms
• Information about past medical problems
• Information about the medical problems of parents or siblings
• Recent history of exposure to measles
• Questions you want to ask the doctor

What to expect from your doctor
In addition to listening to your description of symptoms, your doctor will perform a physical exam — paying special attention to any rash on the skin or inside the mouth.

Your doctor can usually diagnose measles based on the disease's characteristic rash as well as the small, bright red spots with bluish-white centers on the inside lining of the cheek, called Koplik's spots. If necessary, a blood test can confirm whether the rash is truly measles.

No treatment can get rid of an 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) that can fight off infection, called immune serum globulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.

Medications

• Analgesics. You or your child may also take over-the-counter medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) or naproxen (Aleve) to help relieve the fever that accompanies measles. Don't give aspirin to children because of the risk of Reye's syndrome — a rare but potentially fatal disease.
• 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.

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 nonimmunized people — siblings, for example — out of the infected person's house. Talk with your doctor about keeping someone with measles isolated.

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 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 light from a reading lamp or from the television is bothersome.

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.

Vaccine saves lives
Before the vaccine became available in the mid-1960s, measles killed between 400 and 500 people in the United States each year. As vaccination programs have spread into developing countries, the global death rates from measles have fallen dramatically.

According to the World Health Organization, about 576 million children were vaccinated against measles between 2000 and 2007. This resulted in a 74 percent decrease in measles deaths worldwide.

Herd immunity
Prior to the measles vaccine, more than 3 million people in the United States caught measles every year. In 2000, health officials declared that measles had been eliminated from the United States.

That was good news for people who have medical conditions that prevent them from being vaccinated against measles. Their chances of exposure to the measles virus plummeted because so few people in the community, or "herd," get measles now.

But that protection may be weakening a bit. The Centers for Disease Control and Prevention reports that the number of people contracting measles in the United States appears to be rising. Between 2000 and 2007, the average number of measles cases per year was 63. That rate more than doubled in 2008.

Autism concerns
In the United States, the measles vaccine is most commonly given in a combination inoculation, the MMR vaccine, which also includes protection from mumps and rubella.

In recent years, some news reports have raised concerns about a connection between the MMR vaccine and autism. However, extensive reports from the American Academy of Pediatrics, the Institute of Medicine and the Centers for Disease Control and Prevention conclude that there's no scientifically proven link between the MMR vaccine and autism.

These organizations note that autism is often identified in toddlers between the ages of 18 months and 30 months, which happens to be about the time children are given their first MMR vaccine. But this coincidence in timing shouldn't be mistaken for a cause-and-effect relationship.

When should children be vaccinated?
Doctors recommend that children receive the MMR vaccine between 12 and 15 months of age, and again between 4 and 6 years of age — before entering school.

Usually babies are protected from measles for about six months after birth because of the immunity passed on from their mothers. However, unvaccinated mothers who have not had measles will have no immunity to pass on to their babies.

If a child requires protection from measles before 12 months of age — for example, for certain foreign travel or in case of an outbreak — the vaccine can be given as early as 6 months of age. But it needs to be repeated after 12 months of age.

Do adults need the MMR vaccine?
You don't need to be vaccinated if you:

• Were born before 1957
• Had two doses of the MMR vaccine after 12 months of age or one dose of the MMR vaccine plus a second dose of measles vaccine
• Have blood tests that prove you're immune to measles, mumps and rubella

You should be vaccinated if you don't fit the criteria listed above and you:

• Are a nonpregnant woman of childbearing age
• Attend college, trade school or postsecondary school
• Work in a hospital, medical facility, child care center or school
• Plan to travel overseas or take a cruise

The vaccine is not recommended for:

• Pregnant women or women who plan to get pregnant within the next four weeks
• People who have had a life-threatening allergic reaction to gelatin or the antibiotic neomycin

If you have cancer, a blood disorder or another disease that affects your immune system, talk to your doctor before getting an MMR vaccine.