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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
     [phone]

     NIH/National Institute of Allergy and Infectious Diseases
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

     Centers for Disease Control (CDC)
     1600 Clifton Road, NE
     Atlanta, GA  30333
     [phone]

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.