Measles - A Comprehensive Guide

Measles in the UK

Overview

Measles is a highly contagious disease caused by infection with the measles virus. In the absence of vaccination, it mainly affects the children although people of any age who are not immunized can be infected. Being an endemic disease, this unpleasant condition is continually found across infants and children. What are its causes and complications? Let’s find out. This blog gives you everything you need to know about Measles.

Symptoms

When the virus invades your body, it takes time to incubate and no symptoms are seen in the initial days. The following symptoms show up 10–12 days after the infection

  • Cough
  • Fever
  • Conjunctivitis
  • Runny nose
  • Sneezing
  • Red and watery eyes
  • Sensitivity to light
  • Sore throat
  • Body aches
  • White spots inside the mouth or Koplik's spots

Once the virus establishes itself, the symptoms become severe.

Skin Rash: The characteristic symptom of Measles is skin rash which starts developing on the head and advances to other parts of the body. This consists of white dots, surrounded by a halo of red inflammation. When the rash develops, the person may have a fever up to 104°F. The rashes can appear within 14 days after the onset of the infection and can last up to 7 days. Measles is contagious; rashes are not. 

In adults, it can be accompanied by gastroenteritis and hepatic involvement. Adults also experience painful joints when the wrists, knees and hands are affected.

Causes

The cause is infection by the measles virus which belongs to the Paramyxovirus family. Out of 24 types of measles, only 6 are currently common. These viruses can spread rapidly and cause devastating results. Measles is typically an airborne disease. If you are susceptible, then you have a 90% chance of developing measles when this virus invades your body. And you can spread this virus to 9 to 18 susceptible persons. What is worse? The virus starts to spread even before you get aware of this infection.Can animals spread this virus? No, animals cannot act as the carrier of this infection.

Measles is a highly contagious disease that is transmitted through direct contact with an infected person or through the air. Usually, the virus starts its infection in the respiratory system.  Tiny secretion with small aerosol particles expelled during talking, sneezing, or coughing from the nose, mouth or throat has the ability to transmit the infection. How? The virus resides in the mucus of the infected person; when they cough or sneeze, the virus in the mucus gets into the air and reaches the nearby person. The infected particles can also land on the other objects and contaminate the remaining spaces too. The landed virus can be active at least for a period of 2 hours outside the body. When you get into prolonged physical contact with the infected child or adult, you have a high chance of getting affected by this virus. Young children, pregnant women and persons who have a weakened immune system have high risks of getting affected by Measles. Travelling to countries where measles is prevalent puts people under high risk of being caught by this disease. 

Treatment

The diagnosis of measles is usually made from serological tests. The main test that has to be performed on the patient to facilitate the diagnosis is a blood test. The classic symptoms of measles like skin rash and white spots in the mouth are enough for the doctors to confirm the presence of the disease. 

Though there is no specific treatment for measles, most of the infected persons do survive the condition. In some people, the body will fight against the infection and the virus will clear out the system with time. For others, in the event of infection, treatment is based on antipyretics for fever and antitussives for cough. No antibiotics work for viral infections. A dose of immunoglobulin can lessen the severity when taken within 6 days of infection. For the duration of the infection, it is recommended that the patient should rest and maintain good hydration. Plenty of fluid intakes are suggested to remain hydrated. Vitamin A supplements are also recommended by the doctors for those having a vitamin A deficiency. Follow up sessions with your physician are must until the symptoms reduce and the condition resolves completely.

The Measles virus shows sensitivity to light. So wearing sunglasses, resting in a darkened room, and maintaining dim lights can help.

Practicing good hygiene, not sharing personal things with infected persons, and avoiding contact with sick people can help prevent the measles. The infected persons should avoid visiting populated areas until the virus gets cleared from their system.

Some of the medical conditions like dengue, enteroviral infections, Kawasaki disease, etc. have symptoms similar to measles. So it is better to consult the doctor to rule out the other conditions and avoid the confusion.

Complications

Though the incubation period and infectious period vary, the virus can cause serious complications once it settles in the body. The most frequent complications of measles are bacterial infections, encephalitis, ear infection leading to hearing loss, bronchitis as a result of respiratory tract infections, croup, severe diarrhoea, difficulty breathing, vomiting, febrile seizures, eye infection leading to blindness and pneumonia. Pneumonia is most common as it affects the lungs and inflames it. The groups which are vulnerable to measles are

  • Children under 5 years old
  • Adults over 20 years old
  • Pregnant women
  • People with a weakened immune system
  • Young children who are poorly nourished
  • People with a vitamin A deficiency

However, this type of disease does not usually appear in well-nourished children and its incidence is very low. Encephalitis or inflammation of the brain can be life-threatening as they lead to neurological deficits. People with AIDS, leukaemia, and HIV have a compromised immune system which makes them susceptible to this unpleasant condition. In pregnant women, the complication can be miscarriage, low birth weight or preterm labour. If proper attention is not given, the infant can carry the measles infection at the time of birth.

Hepatitis, Thrombocytopenia (less platelet count), Squint (damage of eye nerve and muscle) are the less common complications from measles.

The very rare complications can be Neuritis, heart complications, transverse and ascending myelitis.

Vaccination (MMR Vaccine)

The measles vaccine is the only measure that exists to prevent the onset of the disease. Since the 1960s, the measles vaccine has been in use. MMR vaccine is usually administered to protect the people from Measles. It also offers protection against Mumps and Rubella. This three-in-one vaccination hence got its name MMR (Measles, Mumps, and Rubella). The vaccines hold a live but weakened virus that helps the immune system to produce antibodies. Children should take routine vaccinations to prevent measles. The vaccines can be had in two doses; first vaccination at 12 months and second vaccination between the ages of 4 and 6. Children who had taken both the doses are considered immune for life.  Adults who are exposed to the measles virus should take the vaccines within 72 hours to decrease the chance of infection.

The vaccines are completely safe and typically mild side effects can appear; no major side effects can be anticipated. 1 out of 6 people may experience fever after the vaccination and severe problems are almost nil. 

It is recommended that pregnant women should avoid the vaccine. And women who have plans to become pregnant should consult the doctor before getting vaccinated. The vaccines are also not advised for persons who are allergic to Gelatin or Neomycin. This increases the chances of them getting infected by the virus when they are exposed to it. How can such persons who cannot receive the vaccines be made safe? It is by developing herd immunity. Is it possible? Yes. It is to be noted that vaccination protects not only you but also the people like them who cannot be vaccinated. This kind of herd immunity can be generated only when at least 96 percentage of the population in any particular area is vaccinated against measles. 

A person can opt for revaccination or a booster shot if he had availed the vaccination before his first birthday or had been injected with a vaccine containing killed virus instead of the live one.  If anyone feels that their immunity level is low to fight against measles, there is no harm in receiving another second dose; but the third dose reaps no benefits.

Also if anyone is unsure about his/her vaccination status, he/she should consult the doctor and avail a blood test checking for antibodies presence to fight against measles. 

It is to be noted that you can get affected by measles only once in your life. This means you are immune for life simply because your body has had the virus already. Getting affected by this virus again is almost unlikely to happen. 

The World Health Organization has planned to eliminate measles by 2020 in five WHO Regions under the Global Vaccine Action Plan.

Facts about Measles in Adults

Although Measles is more common in children, it is likely to affect the adults too. Adults who are not vaccinated have high chances of getting caught by Measles. Pneumonia, blindness and encephalitis are some of the serious complications in adults who are exposed to the infection.

Adults born in or before 1957 are naturally immune to measles because of the exposure to the disease in their adolescent age. It was in 1963, the process of vaccinating for measles first began and the vaccine was improved in later years. The first dosage of the vaccine was routinely administered from 1967 while the second dose or booster dose began in 1991. Adults who had received their first dosage have 90 % chances of being prevented from measles. This percentage increases to 97 when they had received both the doses. People born between 1963 and 1991 (who received only the first dose) can receive a booster shot at any time.

Facts about Measles in Babies

New-born babies have passive immunity received from their mothers. This protects them from the virus until they receive the vaccines. When do babies receive their vaccine? They receive their first dose of the vaccine for measles only when they are 12 months old. What about the unvaccinated period of the first 12 months? This period makes them vulnerable to measles infection (because passive immunity weakens after 2.5 months in recent years). Measles is usually contracted between the age of 12 months and 4 years in children. The serious complications of Measles in babies are pneumonia, encephalitis, and hearing loss.

Measles Outbreak - What to do?

The outbreak is a condition when a disease keeps spreading across the country at highly alarming levels. Like any other disease outbreak, the measles outbreak is also dangerous. What about Measles in the UK? Is it prevalent or eradicated? The UK had experienced sizable outbreaks in its past. However, in 2016 measles has been eliminated from the UK; but not from the world. So the chances are high to face imported measles cases in the UK.

Measles outbreaks have been linked to low vaccination rates, and travelers bringing the virus from abroad. Vaccine exemptions should be avoided to prevent the outbreak of this disease. When there is an outbreak, the space for spreading the virus becomes high.  So people should limit themselves from visiting mass gatherings, public places and highly populated areas. It is recommended to avoid contact with the infected person as it is contagious. 

Upon the outbreak, taking 2 doses of the MMR vaccine is a must to save you from the infection of measles. Infected persons should be isolated to prevent others from getting affected by this disease. Infected children and adults should stay off their school and work respectively to prevent spreading. What is the prerequisite to prevent measles? Proper vaccination. This is very important to avoid further measles outbreaks. Measles clusters will keep emerging if people reject vaccinations. 

If you experience the symptoms of measles or had been in physical contact with persons affected by measles, consult your doctor right away.