Measles

Symptoms Of Measles

The first symptoms of measles develop 7 to 14 days after contact with the virus. It includes cough, runny nose, watery eyes, and fever. Measles rashe appear 3 to 5 days after the first symptoms. 

1. Initial symptoms 

The first symptoms develop after 7 to 14 days of infection. It begins with a high temperature that reaches around 104°F. The other symptoms include cough, runny nose, swollen eyelids, weakness, loss of appetite, watery eyes, and red eyes that may be sensitive to light.

2. Koplik spots 

A day or two before the rashes appear Koplik spots may appear inside the mouth (small grayish-white spots). These spots usually last for a few days and not everyone develops these spots.

3. Measles rash

A measles rash appears 2 weeks after the initial symptoms. The symptoms become severe and signals towards the host’s immune response towards the replicating virus. It usually begins as red spots. The rash is made up of small, red, brown spots that may join together into large blotchy patches. It first appears on the neck or head before spreading to the rest of the body. The rash fades slowly in the same order of progression as it appeared. Resolution of rash may be followed by desquamation (shedding of outer layer of skin), particularly in undernourished children.

As the rash of measles is a consequence of immune response, it may be absent in immunocompromised individuals.

4. Other symptoms

Other symptoms like headache, abdominal pain, vomiting, diarrhea, and myalgia may be present.

Causes Of Measles

Measles is caused by an extremely contagious virus called morbillivirus, a member of the paramyxoviridae family. It is spread by:

• Contaminated droplets that are transmitted through the air while coughing, sneezing, talking or coming in direct contact with infected nasal or throat secretions. The virus remains contagious in the air for up to two hours.

• Sharing food, drinks and utensils with someone who has measles.

• Kissing someone with measles.

• Shaking hands or hugging someone with someone who has measles.

• Pregnant women to their babies during the pregnancy, delivery or while breastfeeding.

It can take one to three weeks to show symptoms of measles after being infected. This is the incubation period. This period may be shorter in infants and longer in adults.

Note: One is contagious about four days before developing a rash to about four days after the rash appears.

Types of Measles

Measles caused by the Rubeola virus is the most common but there are different types of measles such as:

1. Atypical measles syndrome

Individuals who are vaccinated may develop  atypical measles syndrome (AMS) on exposure to measles due to incomplete immunity. The symptoms include headache, fever, cough, edema, and rashes.

2. Modified measles

It is seen in people who receive immunoglobulin as postexposure prophylaxis. It is characterized by a short-lived rash and a prolonged incubation period.

3. Hemorrhagic measles 

It is characterized by a purpuric rash and bleeding from the nose, mouth or bowel.

Risk Factors Of Measles

While measles can affect anyone, some risk factors elevate the risk of contracting the disease. Some of the risk factors are:

1. Vitamin A deficiency

Measles is a major cause of morbidity and mortality. If you have Vitamin A deficiency, there is a very high chance of measles infection. 

2. Being unvaccinated

Unvaccinated young children are prone to measles and its complications including death. Unvaccinated pregnant women and non-immune people can become infected. 

3. International traveling 

Traveling to countries where measles is common and less controlled puts you at a higher risk of developing the disease. 

4. Countries experiencing a measles outbreak 

Countries experiencing or recovering from a natural disaster. Damage to health infrastructures interrupts routine immunization and greatly increases the risk of infection. 

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Diagnosis Of Measles

It is important to detect measles as soon as possible since it is a contagious disease. Establishing a diagnosis for measles involves the following:

1. Clinical evaluation 

Healthcare providers should consider measles in patients with febrile rash symptoms and white centers in your mouth (koplik spots). Koplik spots are especially helpful because they appear early. If the child has recently traveled or is unvaccinated, measles is even more likely.  Sometimes other diseases can be complicated with measles, but measles rashes are easy to differentiate from other rashes. The rash starts on the hands and face rather than the trunk. 

2. Lab tests 

Laboratory confirmation is important after the clinical evaluation is done by the doctor. 

• IgM antibody: Detection of Measles specific IgM antibody in serum. The antibody is usually present soon after the rashes appear. The level of antibody is highest during the 14th day and is not present after the 30 days. 

• IgG antibody: A four fold or greater increase in measles virus specific IgG antibody levels is seen between acute and convalescent phase serum specimens.

• Virus culture: Measles can also be diagnosed by isolation of the virus in cell culture from respiratory secretions, nasopharyngeal or conjunctival swabs, blood or urine.

• Giant cell test: Direct detection of giant cells in the respiratory secretions, urine or tissue obtained by biopsy provides another method of diagnosis.

• Real-time polymerase chain reaction (RT-PCR): Measles RNA by RT-PCR is a common method for confirming measles. Serum samples as well as the throat swab are used for sample collection.

• Urine sample: A urine sample can also contain the virus. Collecting urine samples can increase the chances of detecting the measles virus. 

3. Molecular analysis 

Genotyping is done to map the transmission pathway of the measles virus. Genotyping is the way to distinguish between wild-type measles virus infection and rashes induced by measles vaccination. 

Specialist To Visit

Patients exhibiting the signs and symptoms of measles should visit first to a general physician. The doctor will be able to diagnose measles from the combination of the symptoms especially with the characteristics of rashes and if the condition worsens many complications can also be seen. If needed, your doctor may recommend you to go to a specialist such as:

• Infectious disease specialist

• Pediatrician

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Prevention Of Measles

As measles is a viral disease, taking antibiotics cannot treat it. The best thing is to learn how to prevent it:

1. Measles, mumps and rubella (MMR) vaccine 

Getting vaccinated is the best way to prevent measles. You can either take the measles, mumps, rubella and varicella  (MMRV) combination vaccine and opt for MMR. From time to time, boosters of the vaccine need to be taken to prevent oneself from getting the disease.

The following people should get themselves vaccinated to safeguard themselves:

• People who never had measles

• Infants between 6 to 11 months of age

• If you are not sure if you are vaccinated in the past

• The second dose should be given at 3 years and 4 months of age

Note: Measles vaccine has been well tolerated and immunogenic in HIV-1 infected children and adults, although the antibody levels may wane. Because of the potential severity of wild type measles virus infection in HIV-1 infected children, routine measles vaccine is recommended except for those who are severely immunocompromised. 

Measles vaccine is contraindicated in individuals who are severely immunocompromised because of the possibility of progressive pulmonary or CNS infection with the vaccine virus.

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2. Human normal immunoglobulin (HNIG)

HNIG is a special concentration of antibodies that give short-term but immediate protection against measles. It is recommended for people in the following age group if they are exposed to someone with measles.

• Babies under 6 months of age

• Pregnant women who have not been fully vaccinated

• People with compromised immune systems

In immunocompetent persons, administration of immunoglobulin within 72 hours of exposure usually prevents measles virus infection and almost always prevents clinical measles. Administered upto 6 days after exposure, immunoglobulin will still prevent or modify the disease.

3. Special circumstances 

A dose of MMR vaccine can also be given to children over 6 months of age under certain circumstances. For example, in conditions like:

• If there is an outbreak of measles in your area

• Exposure to measles

• Planning to travel where measles is widespread

4. Isolation 

To prevent measles, keep a distance from the person having the infection. An infected person should be isolated for a few days to a few weeks to return to normal activities.

5. Practice hygiene and cleanliness 

To prevent measles keep yourself clean and free of infections. The steps to be taken care of:

• Avoid touching your nose, mouth as much as possible

• Use tissue paper while coughing and sneezing

• Always use a sanitizer

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Treatment Of Measles

There is no specific treatment for measles and the condition usually improves by itself within 7 to 10 days. To avoid the spreading of infection avoid contact with people who are vulnerable like pregnant women, immunocompromised people, and young children. Also try to stay away from work or school at least for 4 days when the measles rash first appears. 

The treatment includes relieving the symptoms & fighting the infection. If symptoms are causing discomfort then the symptoms need to be treated first, while you wait for your body to fight off the virus. The treatment approach includes:

1. Controlling fever and relieving pain

• Paracetamol and Ibuprofen can be taken to control fever and the pain caused by the fever. 

• Liquid infant paracetamol can be used for young children.

2. Taking Vitamin A supplements

Children with low levels of Vitamin A are more likely to show more severe symptoms of measles. Vitamin A has been found to be effective in reducing the severity of measles. The WHO recommends administration of once daily doses of 200,000 IU of Vitamin A for 2 consecutive days to all children with measles who are >12 months of age and lower doses for children 6-12 months of age.

3. Drinking plenty of fluids 

If your child is having a high temperature drink a lot of fluids to eliminate the risk of dehydration. 

4. Treating sore eyes 

Cleaning your child’s eyelids and closing curtains or dimming lights can help in soothing the eyes.

5. Treating cold-like symptoms 

If your child has cold-like symptoms that make them sit in a hot bathroom, drinking warm drinks containing honey can help to relax the airway and soothe a cough. 

6. Dealing with other illnesses

Medical care is necessary to avoid serious complications because of the measles virus. Some serious problems are:

• Shortness of breath

• Convulsions 

• Sharp chest pain 

7. Ribavirin (antiviral)

Some case reports have been published in favor of intravenous ribavirin in immunocompromised patients. However, the benefits of ribavirin in measles have not been conclusively demonstrated in trials.

Home-care For Measles

There is no specific home care treatment for measles. The patient requires care and time to time medicines and few precautions since it is a contagious disease. Home care is to be taken to make the disease tolerable:

• Get plenty of rest

• A sponge bath can reduce discomfort due to fever

• Drink plenty of water 

• Pain relievers and analgesics such as acetaminophen

• To reduce itching from the rash, one can use witch hazel on the rashes or add oatmeal to a bath.

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Complications Of Measles 

Measles can cause the following complications:

1. Common complications

• The most common complications are otitis media and bacterial pneumonia.

• Other respiratory complications include laryngitis, tracheitis, bronchitis, giant cell pneumonia, bronchiectasis and flaring up of latent M. tuberculosis infection.

• Gastrointestinal complications include persistent diarrhea, appendicitis, hepatitis, and ileocolitis.

2. Severe complications in children and adults 

The severe complications include pneumonia and encephalitis. These complications can be life threatening and the patients require hospitalization for proper recovery.

3. Long-term complications

Subacute sclerosing panencephalitis (SSPE) is a rare and fatal disease of the central nervous system that develops 7 to 10 years after a person has measles at a frequency of 1 per 100,000 cases.

4. Rare complications 

In rare cases, measles can lead to heart and nervous system problems and serious eye disorders. 

Alternative Therapies For Measles

Home remedies for measles

The following home remedies can help in recovery from measles.

1. Aloe vera: It is applied on the inflamed area and helps in soothing inflamed skin. 

2. Neem leaves: Neem has antibacterial and anti-allergic properties. It is used to relieve the itching sensation caused due to skin rashes. Take neem leaves and make a thin paste of them and apply them to the affected area and let them dry.

3. Licorice herb: It is an ancient herb to cure measles. Tea can be prepared by adding licorice herb and it helps in reducing the cough caused by measles.

4. Baking soda: One cup of baking soda can be added to bathing water and this will provide quick relief from itching. 

5. Coconut water: It is rich in nutrients and cleanses the body. Drinking plenty of coconut water helps in flushing the toxins out of the body. It keeps the body hydrated.

6. Turmeric: It has both antioxidant and antiseptic properties. It is used as an ancient home remedy. Drinking hot water infused with turmeric and honey helps reduce symptoms associated with measles. 

7. Green tea: Green tea can be consumed for antioxidant, anti-inflammatory, and immune boosting effects. Try to consume caffeine-free green tea. 

8. Phyllanthus amarus: It is a medicinal plant used in the treatment of measles. However, phyllanthus can interact with lithium, diabetes and blood-thinning medications such as warfarin. Hence, should be consumed only after consultation with your doctor.

Dietary modifications

• Drink  8 glasses of filtered water daily.

• Avoid refined foods, such as white breads, pastas, and sugar.

• Use healthy oils in cooking, such as olive oil, coconut oil or ghee.

• Reduce or eliminate trans fats found in processed and packaged foods like biscuits, namkeens, and cakes etc.

• Limit caffeine containing beverages like coffee.

• Avoid alcohol and tobacco.

Nutritional supplements 

• A multivitamin containing antioxidants, vitamins A, B, C, E, and minerals such as magnesium, calcium, zinc, and selenium, should be taken daily.

• Omega-3-fatty acids such as fish oil and flaxseed oil can be taken to reduce inflammation and improve immunity.

• Probiotic supplements can be taken for maintaining gastrointestinal and immune health.