Measles, long ago eradicated in the United States, still thrives in many regions of the world. And because of the ubiquity of global travel and the growth of the anti-vaccine movement in this country, measles can spread quickly and easily. The December 2014 outbreak at California's Disneyland is just the latest frightening example of how measles can suddenly flare up and become a serious health concern. Here's everything you need to know about measles.
Measles, also known as rubeola, is a highly contagious infectious disease caused by a virus in the paramyxovirus group. It's transmitted in the air via respiratory droplets, spreading easily from person to person by a cough or sneeze. The measles virus can live on surfaces or in the air for up to two hours and can infect 90 percent of susceptible people who come in contact with it.
Symptoms typically start with red eyes, a runny nose, coughing, and fever, and is followed by a red, spotted rash. The disease is marked by three phases:
Before the rash appears, there may be tiny, irregular red spots with a bluish-white center on the inside of the mouth and lips. And fever is usually very high -- frequently in the 104° to 105° range, says Dr. Gonzalez.
Measles is usually mild in children, but it can have serious complications in both kids and adults, especially in those with weakened immune systems, says Daniel McGee, M.D., a pediatrician at Helen DeVos Children's Hospital in Grand Rapids. Measles can lead to secondary illnesses, including pneumonia, ear infections, heart inflammation, deafness, and permanent brain damage, and even to death.
About 20 percent of patients may be hospitalized, mainly for pneumonia, though less commonly because of encephalitis, an irritation and swelling of the brain that develops within eight days of the onset of symptoms. "It's rare, but 1 in 1,000 cases of the measles can result in encephalitis and 1 to 3 out of 1,000 people can die from these complications," says Andrea Sperduto, M.D., a pediatrician and infectious disease specialist at Cleveland Clinic Children's.
Measles is considered preventable in nearly everyone who receives two doses of the MMR (measles, mumps, rubella) vaccine. In the United States, the vaccine is generally given as this three-vaccine combination; although it's sometimes administered with the varicella (V) vaccine as well, and in this case it's called MMRV. The measles vaccine is recommended for all babies at 12 to 15 months of age, with a second dose given between 4 and 6 years. The second shot is offered because about 5 percent of people don't respond to the first one, so an immune response is the goal the second time around. With one dose, the protection rate is 93 percent; a second bumps it up to about 97 percent.
Washing your hands regularly is a good habit, but because respiratory droplets spread the measles, this isn't sufficient protection, stresses Dr. Gonzalez. The measles vaccine is extremely effective, easy to obtain, and covered by insurance. "Some people seem to be tired of hearing it, but the vaccine is the best chance parents have to keep their kids healthy," says Dr. Sperduto.
Unfortunately, there are no specific antiviral medications that are used to treat measles. Because a cough, fever, conjunctivitis, and runny nose are the initial symptoms, a humidifier, fever-reducing medication [but not aspirin], fluids, and bed rest are often the first line of defense. "Conjunctivitis causes a sensitivity to light, so avoiding brightly lit rooms can help," says Samuel Katz, M.D., a spokesperson for the Infectious Diseases Society of America and chairman emeritus of pediatrics at Duke University School of Medicine. If pneumonia develops and it is bacterial in nature -- not due to the measles virus alone -- then antibiotics can be given. Similarly, a bacterial ear infection can be treated with antibiotics. (This will help the ear infection, but won't affect the measles.)
In some instances, an immune serum globulin can be given to an unvaccinated person within five or six days after exposure to the measles to prevent a bout of illness. If this serum is given in time, it can prevent measles in nearly 100 percent of cases. But this treatment is generally reserved for unusual cases -- a baby under 6 months of age, a pregnant woman, a patient with an immune-compromising disorder, or one on immune suppressing medication for example -- and the protection lasts only for about 6 to 8 weeks, meaning that if re-exposure occurs, susceptibility returns. If it does, the globulin should be repeated. Although these injections offer some temporary protection, they don't replace the need for the vaccine, which should be given 5 to 6 months later.
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