$Unique_ID{BRK03980} $Pretitle{} $Title{Measles} $Subject{Measles Rubeola Morbilli Nine Day Measles } $Volume{} $Log{} Copyright (C) 1987, 1989, 1990 National Organization for Rare Disorders, Inc. 336: Measles ** IMPORTANT ** It is possible the main title of the article (Measles) is not the name you expected. Please check the SYNONYMS listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Rubeola Morbilli Nine Day Measles General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Measles is a highly contagious disease occurring primarily in children. This disease is characterized by fever, cough, acute nasal mucous membrane discharge (coryza), inflammation of the lining of the eyelids (conjunctivitis), a spreading rash, and eruption of small, irregular, bright red spots (Koplik's spots) on the inner cheeks in the mouth with a minute bluish or white speck in the center of each. Because measles can be contracted from someone whose symptoms have not yet appeared, it is often difficult to avoid exposure. Measles ceases to be contagious four days after appearance of the rash. Although concerted efforts have been made to eliminate measles in the United States, increasing numbers of cases have been reported recently in some areas. This may be due in part to a drastic rise in the cost of vaccine, shortage of supplies due to liability insurance problems, or fear by the public of possible side effects of vaccines. This is in spite of strict observance of immunization/attendance requirements by school officials. However, parents may underestimate the need for this immunization. Usually measles and the danger of its complications can be avoided by timely immunization. Symptoms Measles usually begins like a common cold after a seven to fourteen day incubation period, with sinus congestion, a runny nose, a cough, and red, irritated eyes. Two days later, although often unnoticed, Koplik's spots (small red spots with blueish-white specks in the center) form inside the mouth opposite the molars. After four days of these worsening symptoms, a telltale rash appears first on the face and neck, then on the trunk, arms and legs. Patients may have some degree of sensitivity to light. After two to four days of listlessness, the rash, cough, stuffiness and red eyes (conjunctivitis) abruptly improve. If no complications have set in, measles has run its course by the tenth day. Measles patients can have lowered resistance to infections such as bronchitis, ear infections, or other bacterial infections. Possible direct complications may include pneumonia and inner ear infections such as otitis media and mastoiditis which can possibly lead to deafness. Encephalitis, which occurs in up to one out of 1,000 measles cases, can result in mental retardation. In some extreme cases, corneal ulceration may occur. Measles virus may also be associated with Subacute Sclerosing Panencephalitis (SSPE), a slow virus infection. (Slow viruses may stay dormant in humans for extended periods of time, then for reasons yet unknown, may become reactivated.) SSPE is a chronic brain disease of children and adolescents that can occur months to years (usually years) after an attack of measles. SSPE can cause intellectual deterioration, convulsive seizures, coma and motor abnormalities. (For more information on this disorder, choose "SSPE" as your search term in the Rare Disease Database.) Causes Measles is caused by a paramyxovirus. The virus infiltrates the nose and mouth (nasopharynx), and is highly contagious. Affected Population Measles affects males and females equally, and can occur worldwide. Supposedly on the verge of extinction in the United States in 1983 when only 1,497 cases were reported, measles (rubeola) rebounded to a total of 2,813 in 1985. As of May 1986, a total of 1,976 Americans (more than in all of 1983) had been afflicted. The licensing of the first widely used measles vaccines in 1963, followed shortly by an improved version, reduced the number of reported cases from a pre-vaccine total of 525,000 annually to the record low in 1983, which reflects a ninety-nine percent decline. Related Disorders Rubella, or three-day measles, is marked by mild constitutional symptoms that may result in abortion, stillbirth, or congenital defects in infants born to mothers infected during the early months of pregnancy. Other symptoms may include a two to three week incubation period with no recognizable symptoms, mild course of short duration, low fever, rash (less extensive than other types of measles), a reddish flush simulating that of scarlet fever which may be noticed on the face, enlargement of lymph nodes, and a normal blood count. Symptoms are usually mild in children with Rubella. Adults characteristically experience fever, discomfort, headache, weakness or exhaustion, stiff joints, and mild nasal membrane inflammation (rhinitis). Encephalitis is a rare complication that has occurred during extensive outbreaks of rubella among young adults in the armed services. Transient testicular pain is also a frequent complaint in affected adult males. (For more information on rubella, choose "rubella" as your search term in the Rare Disease Database, and see the related article in the Prevalent Health Conditions/Concerns area of NORD Services.) Scarlet Fever is an infection caused by a bacteria that usually affects the mouth/throat area (pharynx), but may also affect the skin or birth canal. Patients may experience headache, abdominal pain, nausea, and a skin rash. Rarely, complications are lymphocytic meningitis and hepatitis. A reddish flush may be apparent on the face, chest and extremities, with tiny red spots in some cases. The disease is much milder now than in the past, and complications are rare when properly treated. Roseola Infantum (Exanthem Subitum or Pseudorubella) is an acute disease of infants or very young children characterized by high fever, absence of localizing symptoms or signs, and appearance of red spots (a rubelliform eruption) simultaneously with, or following, lowering of the fever (defervescence). The cause and mode of transmission are not known, but the disease is probably communicable and caused by a neurodermotropic virus. It occurs most often in the spring and fall. Minor local epidemics have been reported. Atypical Measles Syndrome (AMS) is most common in adolescents and young adults and usually associated with prior immunization using the original killed measles vaccines, which are no longer in use. However, live measles vaccine administration has also been known to precede development of AMS, perhaps as a result of inadvertent inactivation due to improper storage. Presumably, inactivated measles virus vaccines do not prevent wild virus infection and can sensitize patients so that disease expression is altered significantly. AMS may begin abruptly, with high fever, toxicity, headache, abdominal pain, and cough. The rash may appear one to two days later, often beginning on the extremities. Swelling (edema) of the hands and feet may occur, pneumonia is not uncommon, and nodular densities in the lungs may persist for three months or longer. Therapies: Standard In general, once a person is infected, there is little to do other than let measles run its course, and make the patient as comfortable as possible. The use of aspirin to treat viral diseases in children and young adults should be avoided because of the risk of Reye Syndrome, a rare but life-threatening condition. (For more information on this disorder, choose "Reye" as your search term in the Rare Disease Database.) Bed rest and a light diet seem to be of benefit. Vaccination for measles is the most effective method found to prevent outbreaks of measles. Vaccine failure occurs in just ten percent of cases. The vaccine approved in 1963 is no longer in use. Anyone who received one of these vaccines between 1962 and 1969 should be reimmunized with the current vaccine. This new live vaccine is strong enough to produce immunity to measles, but not so strong as to produce severe reactions. The age for vaccination has also changed. Currently, measles vaccination is now recommended at fifteen months - after antibodies passed on by the mother have disappeared. Some authorities advocate lowering the age to twelve or even six months, with revaccination at fifteen months, when measles is usually epidemic. Children should be vaccinated before exposure to measles, or within seventy-two hours of exposure, if the protection is to be effective. The American Academy of Pediatrics recommends that an initial immunization of measles, mumps, and rubella (MMR) be given at fifteen months of age and a second MMR immunization be given at the beginning of middle school or junior high school. The new recommendation for measles immunization consists of two doses of vaccine - one at 15 months of age and the second one at four to six years of age. Students entering college and medical personnel with direct patient contact should also have a second vaccination. (For more information concerning vaccination schedules, see "New Recommended Schedule for Active Immunization of Normal Infants & Children" in the Prevalent Health Conditions/Concerns area of NORD Services.) Pregnant women exposed to measles should have their immunity tested to avoid possible risk to their unborn babies. Rubella, more than any other type of measles, can pose a great risk to fetuses. Therapies: Investigational The number of anti-viral agents which may be useful in treating measles is still limited. Immunoglobulins and interferons, as well as a variety of immune stimulators or immune modulators, are possible therapies that are still undergoing further investigational evaluation at this time. This disease entry is based upon medical information available through May 1990. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Measles, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Institute of Allergy and Infectious Diseases 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 Centers for Disease Control (CDC) 1600 Clifton Road, NE Atlanta, GA 30333 (404) 639-3534 References MEASLES ON THE REBOUND: Stephen J. Ackerman; FDA Consumer (October 1986, issue). Pp. 18-21. IMMUNOTHERAPY IN VIRUS DISEASES: H. Schulte-Wissermann, et. al.; Monatsschr Dinderheilkd (April 1986, issue 134(4)). Pp. 172-81.